Moving the needle on equitable health promotion: Reckoning with structure

Fifty years after the Lalonde Report, public health must move beyond individual-level determinants to confront the structural forces that shape health. Drawing on 27 years of research on the social and structural determinants of health, this commentary reflects on the persistent health inequities in Canada and argues for a future public health agenda rooted in intersectionality, structural analysis, and community engagement. Framing the Lalonde@50 conference contributions by Frohlich, Watson-Creed, Delormier, and Ndumbe-Eyoh, this piece highlights the urgency of upstream interventions, ontological humility, Indigenous self-determination, and anti-racist practice. By integrating concepts such as the inverse care law and fundamental causes of disease, it argues that inequalities will continue to emerge as long as resources remain unequally distributed. Thus, public health must remain structurally attuned and anticipatory in order not only to respond to inequities but to get ahead of them.