Why Promoting Health Equity in Canada Requires a Social Movement

BackgroundDespite a robust research literature on the importance of promoting health equity and stated commitments by public health authorities to this goal, progress in doing so has been disappointing in Canada. One reason is the failure to mobilize the public in support of this goal. Almost a decade ago, Sir Michael Marmot called for a "social movement" to promote health equity but there are reasons for why such a movement has not taken hold in Canada.PurposeWe carry out a critical narrative review and case study of Canadian health equity activities that examines the intersection of these activities with definitions of what constitutes a social movement.AnalysisEmploying Harvey's concept of critical social research as not taking for granted apparent social structure and processes, we look beneath the surface of appearances to ask why health equity activities have generally failed in Canada such that a social movement - as defined in the social movements literature - is required to move forward.FindingsSocial movements engage the public to resist problematic social conditions outside of established governance structures and processes yet for the most part, health equity advocacy in Canada has been limited to those who do so as part of their paid employment or research funding by Canadian governing authorities whose policies create these conditions. As a result of these arrangements, health equity advocacy cannot readily meet the conditions necessary for a social movement: communicating the need for such a movement; identifying those responsible for health inequities; establishing networks supporting such a goal; and cultivating a distinct health equity identity.ConclusionWe suggest reviewing the structures, processes, and successes and failures of a variety of social movements, e.g., Social Medicine, Environmental, Labour, and Anti-Globalization, among others, to identify lessons and insights that may assist in the development of a health equity social movement in Canada.