Social Theory & Health

, Volume 17, Issue 2, pp 172–191 | Cite as

The cultural hegemony of chronic disease association discourse in Canada

  • Dennis RaphaelEmail author
  • Claudia Chaufan
  • Toba Bryant
  • Morouj Bakhsh
  • Jessica Bindra
  • Allan Puran
  • Daniel Saliba
Original Article


In this paper, we explore how corporate domination of two major disease associations in Canada, Heart and Stroke Canada (HSC) and Diabetes Canada (DC), as manifested in membership of their boards of directors may be acting with biomedical complicity to create hegemonic discourse on the nature of cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM). This is problematic as the activities that derive from this discourse thwart public policy action to address the primary causes and means of managing chronic disease: Canadians’ living and working conditions. Through critical analysis of the membership of HSC and DC boards of directors, we link their corporate and biomedical backgrounds with the limiting of chronic disease association messaging to narrow discredited behavioural approaches. We also draw attention to other means by which the corporate sector is able to shape disease association discourse on the causes and means of managing chronic disease. To rectify this, we call for membership of these boards to include those knowledgeable with broader understandings of health and those most likely to suffer CVD and T2DM: the poor, excluded, and marginalised. Since we recognise these associations will not voluntarily undertake these actions, we present means to force this shift.


Cultural hegemony Corporate domination Chronic disease Neo-liberalism 


  1. Bancroft, A., S. Wiltshire, O. Parry, and A. Amos. 2003. “It’s like an addiction first thing… afterwards it’s like a habit”: daily smoking behaviour among people living in areas of deprivation. Social Science and Medicine 56 (6): 1261–1267.Google Scholar
  2. Banting, K., and J. Myles (eds.). 2013. Inequality and the fading of redistributive politics. Vancouver: UBC Press.Google Scholar
  3. Benzeval, M., A. Dilnot, K. Judge, and J. Taylor. 2001. Income and health over the lifecourse: Evidence and policy implications. In Understanding health inequalities, ed. H. Graham, 96–112. Buckingham, UK: Open University Press.Google Scholar
  4. Braedley, S., and M. Luxton. 2010. Neoliberalism and everyday life. Kingston: McGill-Queen’s Press-MQUP.Google Scholar
  5. Brennan, J. 2012. A shrinking universe: How concentrated corporate power is shaping income inequality in Canada. Ottawa: Canadian Centre for Policy Alternatives.Google Scholar
  6. Brunner, E., and M. Marmot. 2006. Social organization, stress, and health. In Social determinants of health, 2nd ed, ed. M. Marmot and R.G. Wilkinson, 6–31. Oxford: Oxford University Press.Google Scholar
  7. Bryant, T., D. Raphael, T. Schrecker, and R. Labonte. 2011. Canada: A land of missed opportunity for addressing the social determinants of health. Health Policy 101 (1): 44–58.Google Scholar
  8. Carey, G., E. Malbon, B. Crammond, M. Pescud, and P. Baker. 2016. Can the sociology of social problems help us to understand and manage ‘lifestyle drift’? Health Promotion International. Scholar
  9. Chaufan, C. 2008. What does justice have to do with it? A bioethical and sociological perspective on the diabetes epidemic. Bioethical Issues, Sociological Perspectives 9: 269–300.Google Scholar
  10. Chaufan, C., and Saliba, D. 2017. The non-profit-corporate complex and the global diabetes epidemic: Equity implications of discourses, research agendas, and policy recommendations of diabetes-non-profit organizations. Submitted for publication.Google Scholar
  11. Choiniere, J.A. 2011. Accounting for care: Exploring tensions and contradictions. Advances in Nursing Science 34 (4): 330–344.Google Scholar
  12. Clark, A.M., M. DesMeules, W. Luo, A.S. Duncan, and A. Wielgolz. 2009. Socioeconomic status and coronary heart disease: Risks and care implications. Nature: Reviews Cardiology 6 (11): 712–722.Google Scholar
  13. Coburn, D. 2004. Beyond the income inequality hypothesis: Globalization, neo-liberalism, and health inequalities. Social Science and Medicine 58: 41–56.Google Scholar
  14. Cockerham, W.C., B.W. Hamby, and G.R. Oates. 2017. The social determinants of chronic disease. American Journal of Preventive Medicine 52 (1): S5–S12.Google Scholar
  15. Cole, N. 2017. Definition of cultural hegemony. Retrieved from ThoughtCo. website.
  16. Coleman, W.D. 2013. Business, labour and redistributive politics. In Inequality and the fading of redistributive politics, ed. K. Banting and J. Myles, 93–115. Vancouver: UBC Press.Google Scholar
  17. Commission on Social Determinants of Health. 2008. Closing the gap in a generation: Health equity through action on the social determinants of health. Geneva: World Health Organization.Google Scholar
  18. Coulter, K. 2009. Women, poverty policy, and the production of neoliberal politics in Ontario, Canada. Journal of Women, Politics & Policy 30 (1): 23–45.Google Scholar
  19. Crawford, R. 1977. You are dangerous to your health: the ideology and politics of victim blaming. International Journal of Health Services 7 (4): 663–680.Google Scholar
  20. Davey Smith, G. (ed.). 2003. Inequalities in health: Life course perspectives. Bristol, UK: Policy Press.Google Scholar
  21. Davey Smith, G., Y. Ben-Shlomo, and J. Lynch. 2002. Life course approaches to inequalities in coronary heart disease risk. In Stress and the heart: Psychosocial pathways to coronary heart disease, ed. S.A. Stansfeld and M. Marmot, 20–49. London, UK: BMJ Books.Google Scholar
  22. Davey Smith, G., D. Grunnell, and Y. Ben-Shlomo. 2001. Life-course approaches to socioeconomic differentials in cause-specific adult mortality. In Poverty, inequality and health: An international perspective, ed. D. Leon and G. Walt, 88–124. New York: Oxford Universtiy Press.Google Scholar
  23. Diabetes Canada. 2015. Making an impact together. Retrieved from Toronto.
  24. Diabetes Canada. 2016. Financial statement: Canadian Diabetes Association.
  25. Diabetes Canada. 2017. Board of directors. Toronto: Author. Retrieved from
  26. Dinca-Panaitescua, S., M. Dinca-Panaitescu, T. Bryant, I. Daiski, B. Pilkington, and D. Raphael. 2011. Diabetes prevalence and income: Results of the Canadian Community Health Survey. Health Policy 99: 116–123.Google Scholar
  27. Dinca-Panaitescua, S., M. Dinca-Panaitescu, D. Raphael, T. Bryant, I. Daiski, and B. Pilkington. 2012. The dynamics of the relationship between the experience of low income and type 2 diabetes: Longitudinal results. Maturitas 72 (3): 229–235.Google Scholar
  28. Esping-Andersen, G. 1990. The three worlds of welfare capitalism. Princeton: Princeton University Press.Google Scholar
  29. Geneau, R., D. Stuckler, S. Stachenko, M. McKee, S. Ebrahim, S. Basu, and A. Alwan. 2010. Raising the priority of preventing chronic diseases: A political process. The Lancet 376 (9753): 1689–1698.Google Scholar
  30. Grabb, E.G. 2007. Theories of social inequality, 5th ed. Toronto: Harcourt Canada.Google Scholar
  31. Gramsci, A. 2000. The Gramsci reader: Selected writings, 1916–1935. New York: NYU Press.Google Scholar
  32. Gürcan, E.C. 2015. The nonprofit-corporate complex: An integral component and driving force of imperialism in the phase of monopoly-finance capitalism. Monthly Review 66 (11): 37.Google Scholar
  33. Hall, P.A., and M. Lamont. 2013. Social resilience in the neoliberal era. Cambridge: Cambridge University Press.Google Scholar
  34. Harvey, D. 2007. A brief history of neo-liberalism. Oxford: Oxford University Press.Google Scholar
  35. Heart and Stroke Canada. 2015a. How caring hearts are changing the future: 2015 report to donors.
  36. Heart and Stroke Canada. 2015b. Making it happen together. Retrieved from Ottawa:
  37. Heart and Stroke Canada. 2017. Our board of directors. Toronto: Author. Retrieved from
  38. Hofrichter, R. 2003. The politics of health inequities: Contested terrain. In Health and Social Justice: A reader on ideology, and inequity in the distribution of disease, 1–56. San Francisco: Jossey Bass.Google Scholar
  39. Irwin, K.G., A. Siddiqui, and C. Hertzman. 2007. Early child development: A powerful equalizer. Geneva: World Health Organization.Google Scholar
  40. Jarvis, P. 2013. Universities and corporate universities: The higher learning industry in global society. London: Routledge.Google Scholar
  41. Kelly, S.J., and M. Ismail. 2015. Stress and type 2 diabetes: A review of how stress contributes to the development of type 2 diabetes. Annual Review of Public Health 36: 441–462.Google Scholar
  42. Kreatsoulas, C., and S.S. Anand. 2010. The impact of social determinants on cardiovascular disease. Canadian Journal of Cardiology 26: 8C–13C.Google Scholar
  43. Kuh, D., and Y.B. Shlomo. 2004. A life course approach to chronic disease epidemiology. Oxford: Oxford University Press.Google Scholar
  44. Labonte, R., and A. Ruckert. 2015. Social determinants of health under Canada’s neo-liberal capture After’08: Social policy and the global financial crisis, 272. Vancouver: UBC Press.Google Scholar
  45. Langille, D. 2016. Follow the money: How business and politics define our health. In Social determinants of health: Canadian perspectives, 3rd ed, ed. D. Raphael, 470–490. Toronto: Canadian Scholars’ Press.Google Scholar
  46. Leys, C. 2001. Market-driven politics. London, UK: Verso.Google Scholar
  47. Liburd, L.C., L. Jack, S. Williams, and P. Tucker. 2005. Intervening on the social determinants of cardiovascular disease and diabetes. American Journal of Preventive Medicine 29 (5): 18–24.Google Scholar
  48. Lynch, J., and G. Davey Smith. 2005. A life course approach to chronic disease epidemiology. Annual Review of Public Health 26: 1–35.Google Scholar
  49. Macarov, D. 2003. What the market does to people: Privatization, globalization, and poverty. Atlanta, GA: Clarity Press.Google Scholar
  50. Mayes, C. 2014. Governing through choice: Food labels and the confluence of food industry and public health discourse to create ‘healthy consumers’. Social Theory & Health 12 (4): 376–395.Google Scholar
  51. Navarro, V. 2009. What we mean by social determinants of health. Global Health Promotion 16 (1): 5–16.Google Scholar
  52. Nettleton, S. 1997. Surveillance, health promotion and the formation of a risk identity. In Debates and dilemmas in promoting health, ed. M. Sidell, L. Jones, J. Katz, and A. Peberdy, 314–324. London, UK: Open University Press.Google Scholar
  53. Panitch, L. 2000. The new imperial state. New Left Review 2: 5–20.Google Scholar
  54. Panitch, L., and C. Leys. 2009. Socialist Register 2010. Morbid symptoms: Health under capitalism. Halifax: Fernwood Press.Google Scholar
  55. Pilkington, F.B., I. Daiski, T. Bryant, M. Dinca-Panaitescu, S. Dinca-Panaitescu, and D. Raphael. 2010. The experience of living with diabetes for low income Canadians. Canadian Journal of Diabetes 34 (2): 119–126.Google Scholar
  56. Raphael, D. 2000. Health inequalities in Canada: Current discourses and implications for public health action. Critical Public Health 10 (2): 193–216.Google Scholar
  57. Raphael, D. 2001. Inequality is bad for our hearts: Why low income and social exclusion are major causes of heart disease in Canada.
  58. Raphael, D. 2002. Social justice is good for our hearts: Why societal factors—not lifestyles—are major causes of heart disease in Canada and elsewhere.
  59. Raphael, D. 2011. A discourse analysis of the social determinants of health. Critical Public Health 21 (2): 221–236.Google Scholar
  60. Raphael, D. 2015. Beyond policy analysis: The raw politics behind opposition to healthy public policy. Health Promotion International 30 (2): 380–396.Google Scholar
  61. Raphael, D., S. Anstice, K. Raine, K. McGannon, S. Rizvi, and V. Yu. 2003. The social determinants of the incidence and management of type 2 diabetes mellitus: Are we prepared to rethink our questions and redirect our research activities? Leadership in Health Services 16: 10–20.Google Scholar
  62. Raphael, D., I. Daiski, B. Pilkington, T. Bryant, M. Dinca-Panaitescu, and S. Dinca-Panaitescu. 2012. A toxic combination of poor social policies and programmes, unfair economic arrangements and bad politics: The experiences of poor Canadians with Type 2 diabetes. Critical Public Health 22 (2): 127–145.Google Scholar
  63. Raphael, D., and E.S. Farrell. 2002. Beyond medicine and lifestyle: Addressing the societal determinants of cardiovascular disease in North America. Leadership in Health Services 15: 1–5.Google Scholar
  64. Schrecker, T. 2016. ‘Neoliberal epidemics’ and public health: Sometimes the world is less complicated than it appears. Critical Public Health 26 (5): 477–480.Google Scholar
  65. Scott-Samuel, A., and K.E. Smith. 2015. Fantasy paradigms of health inequalities: Utopian thinking? Social Theory & Health 13 (3–4): 418–436.Google Scholar
  66. Shaw, M., D. Dorling, D. Gordon, and G.D. Smith. 1999. The widening gap: Health inequalities and policy in Britain. Bristol, UK: The Policy Press.Google Scholar
  67. Smith, M. 2005. A civil society?: collective actors in Canadian political life. Toronto: University of Toronto Press.Google Scholar
  68. St. Paul’s Foundation. (2017). Heart and Stroke Foundation commits $500,000 to support First Nations Health Authority Chair in Heart Health and Wellness at St. Paul’s [Press release].
  69. Stansfeld, S.A., and M. Marmot (eds.). 2002. Stress and the heart: Psychosocial pathways to coronary heart disease. London: BMJ Books.Google Scholar
  70. Steptoe, A., and M. Kivimäki. 2013. Stress and cardiovascular disease: an update on current knowledge. Annual Review of Public Health 34: 337–354.Google Scholar
  71. World Health Organization. (2008). Closing the gap in a generation: Health equity through action on the social determinants of health. Geneva: World Health Organization.Google Scholar
  72. World Health Organization. 2015. Early child development.
  73. World Health Organization. 2017. Four noncommunicable diseases, four shared risk factors.

Copyright information

© Macmillan Publishers Ltd., part of Springer Nature 2018

Authors and Affiliations

  • Dennis Raphael
    • 1
    Email author
  • Claudia Chaufan
    • 1
  • Toba Bryant
    • 2
  • Morouj Bakhsh
    • 1
  • Jessica Bindra
    • 1
  • Allan Puran
    • 3
  • Daniel Saliba
    • 4
  1. 1.School of Health Policy and ManagementYork UniversityTorontoCanada
  2. 2.Faculty of Health SciencesUniversity of Ontario Institute of TechnologyOshawaCanada
  3. 3.Faculty of Applied Health SciencesUniversity of WaterlooWaterlooCanada
  4. 4.Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoCanada

Personalised recommendations