Canadian Journal of Public Health

, Volume 104, Issue 1, pp e52–e54 | Cite as

Getting to the Root of the Problem: Health Promotion Strategies to Address the Social Determinants of Health

  • Dana M. Gore
  • Anita R. KothariEmail author


Although extensive research shows that the social determinants of health influence the distribution and course of chronic diseases, there is little programming in public health that addresses the social determinants as a disease prevention strategy. This paper discusses different types of health promotion initiatives and differentiates them based on whether they attempt to impact intermediate (environmental) determinants of health or structural determinants of health. We argue for the importance of programming targeted at the structural determinants as opposed to programming targeted solely at the immediate environment. Specifically, the former has more potential to create significant improvements in health, contribute to long-term social change and increase health equity. We urge public health leaders to take this distinction into consideration during public health program planning, and to build capacity in the public health workforce to tackle structural mechanisms that lead to poor health and health inequities.

Key words

Chronic disease health promotion public health practice social conditions social change social environment 


De nombreuses études montrent que les déterminants sociaux de la santé influencent la distribution et l’évolution des maladies chroniques, mais peu de programmes de santé publique abordent les déterminants sociaux comme stratégie de prévention des maladies. Nous expliquons les différents types d’initiatives de promotion de la santé et nous les différencions selon qu’elles tentent d’avoir des effets sur les déterminants intermédiaires (environnementaux) ou structurels de la santé. Nous plaidons en faveur de l’importance des programmes qui ciblent les déterminants structurels plutôt que ceux qui ciblent uniquement l’environnement immédiat. Les premiers sont en effet plus susceptibles d’apporter des améliorations significatives à la santé, de contribuer à un changement social durable et d’accroître l’équité en santé. Nous exhortons les responsables de la santé publique à tenir compte de cette distinction dans la planification des programmes de santé publique et à renforcer la capacité des effectifs de la santé publique de s’attaquer aux mécanismes structurels qui mènent aux problèmes de santé et aux iniquités en santé.

Mots clés

maladie chronique; promotion de la santé pratique en santé publique situation sociale changement social environnement social 


  1. 1.
    Senate Subcommittee on Population Health: A Healthy, Productive Canada: A Determinant of Health Approach. Ottawa, ON: Standing Senate Committee on Social Affairs, Science and Technology, 2009.Google Scholar
  2. 2.
    United Nations: Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases. A/66/L.1. Geneva, Switzerland: United Nations, 2011.Google Scholar
  3. 3.
    Gore D, Kothari A. Social determinants of health in Canada: Are healthy living initiatives there yet? A policy analysis. Int J Equity Health 2012;11:41.CrossRefGoogle Scholar
  4. 4.
    Solar O, Irwin A. A Conceptual Framework for Action on the Social Determinants of Health. Social Determinants of Health Discussion Paper 2 (Policy and Practice). Geneva: WHO, 2010.Google Scholar
  5. 5.
    Graham H. Social determinants and their unequal distribution: Clarifying policy understandings. Milbank Q 2006;82(1):101–24.CrossRefGoogle Scholar
  6. 6.
    Lorenc T, Pettigrew M, Welch V, Tugwell P. What types of interventions generate inequalities? Evidence from systematic reviews. J Epidemiol Community Health 2013;67(2):190–93.CrossRefGoogle Scholar
  7. 7.
    Alvaro C, Jackson LA, Kirk S, McHugh TL, Hughes J, Chircop A, Lyons RF. Moving Canadian governmental policies beyond a focus on individual lifestyle: Some insights from complexity and critical theories. Health Promot Int 2010;26(1):91–99.CrossRefGoogle Scholar
  8. 8.
    Poland BD, Green LW, Rootman I. Reflections on settings for health promotion. In: Poland BD, Green LW, Rootman I (Eds.), Settings for Health Promotion: Linking Theory and Practice. Thousand Oaks, CA: Sage Publications, 2000.Google Scholar
  9. 9.
    Stewart-Brown S. What is the evidence on school health promotion in improving health or preventing disease and, specifically, what is the effectiveness of the health promoting schools approach? Health Evidence Network Report. Copenhagen, Denmark: WHO Regional Office for Europe, 2006.Google Scholar
  10. 10.
    Ministry of Health, Population Health and Wellness. Evidence Review: Healthy Communities (prepared by the Public Health Association of BC). Victoria, BC: Ministry of Health, 2006.Google Scholar
  11. 11.
    Commission on Social Determinants of Health. Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health. Final Report of the Commission on Social Determinants of Health. Geneva: WHO, 2008.Google Scholar
  12. 12.
    Frolich KL, Potvin L. The inequality paradox: The population approach and vulnerable populations (Transcending the known in public health practice). Am J Public Health 2008;98(2):216–21.CrossRefGoogle Scholar
  13. 13.
    Public Health Association of BC. A Fresh Crunch in School Lunch: The BC Farm to School Salad Bar Guide. Victoria, BC: PHABC, 2010.Google Scholar
  14. 14.
    Haydon E, Roerecke M, Giesbrecht N, Rehm J, Kobus-Matthews M. Chronic Disease in Ontario and Canada: Determinants, Risk Factors and Prevention Priorities. Toronto, ON: Ontario Chronic Disease Prevention Alliance, 2006.Google Scholar
  15. 15.
    Dandona P, Aljada A, Chaudhuri A, Mohanty P, Garg R. Metabolic syndrome: A comprehensive perspective based on interactions between obesity, diabetes, and inflammation. Circulation 2005;111:1488–54.CrossRefGoogle Scholar
  16. 16.
    Foodnet Ontario. Mission. Available at: (Accessed October 31, 2012).
  17. 17.
    ProMOTION Plus. Gender Equity Audits, 2002. Available at: (Accessed July 11, 2012).
  18. 18.
    ProMOTION Plus. Toward Balance Award Program, 2002. Available at: (Accessed July 11, 2012).

Copyright information

© The Canadian Public Health Association 2012

Authors and Affiliations

  1. 1.School of Health Sciences, Faculty of Health SciencesUniversity of Western OntarioLondonCanada

Personalised recommendations