Moving the needle on equitable health promotion: Reckoning with structure

Area of Science:

• Public Health
• Health Equity Research
• Social Determinants of Health

Background:

• The Lalonde Report, published 50 years ago, focused on health determinants.
• Persistent health inequities in Canada necessitate a shift beyond individual-level factors.
• Current public health approaches often overlook structural forces shaping health outcomes.

Purpose of the Study:

• To reflect on 27 years of research on social and structural determinants of health.
• To advocate for a future public health agenda incorporating intersectionality and structural analysis.
• To highlight the need for upstream interventions and community engagement in addressing health inequities.

Main Methods:

• Commentary synthesizing research on social and structural determinants of health.
• Analysis of contributions from the Lalonde@50 conference.
• Integration of concepts like the inverse care law and fundamental causes of disease.

Main Results:

• Health inequities persist due to unequally distributed resources.
• Upstream interventions, ontological humility, Indigenous self-determination, and anti-racist practices are crucial.
• A structurally attuned and anticipatory public health approach is needed to prevent inequities.

Conclusions:

• Public health must move beyond individual-level determinants to address structural forces.
• An intersectional, structural, and community-engaged approach is essential for future public health.
• Proactive strategies are required to effectively combat and prevent health disparities.