What Would Real Engagement by the Canadian Public Health Community in the Politics and Structural Determinants of Health Involve? A Response to Recent Papers in the Canadian Journal of Public Health

Abstract

Two recent commentaries in the Canadian Journal of Public Health call for the public health community to address the political and economic determinants of health. Ronald Labonté urged the Canadian public health community to stop its political fence-sitting and take seriously the politics of health. Lindsay McLaren and Elizabeth McGibbon called for the public health community to engage in addressing the structural determinants of health. These sentiments are not new having been expressed in Canada since at least 1986 with little evidence of governmental response. In this commentary we identify and discuss different forms of engagement and why to date such engagement by the Canadian public health community has been limited to apolitical forms of rhetorical exhortation rather than critical analysis of the role the state plays in producing public health within neoliberal capitalist formations. As such, these exhortations will prove to be ineffective as the likelihood of public health moving towards critical analysis seems unlikely under current conditions. The primary reason for this depoliticization of health issues is that traditional public health institutions and many public health researchers are embedded within the very same governing structures whose public policies create the health threatening living and working conditions – the social determinants of health -- public health aims to address. We call for a broader social movement – that could involve the public health community – challenge existing power relations under neoliberal capitalism that make achieving Health for All almost impossible to achieve.