health promotion policy toolkit

Things are getting worse, not better. Chronic disease rates continue to rise, services are overwhelmed, and we are further than ever from achieving meaningful, lasting health outcomes for Canadians. We’ve known for decades that health cannot be achieved only by accessing care, but our ‘healthcare' systems were never built to address this fact. They were built to deliver medical services to passive recipients, not to enable people to live healthy lives. And while our understanding of health has evolved toward its social determinants, toward resilience, toward health as a resource for everyday living, our governance, our incentives, and our delivery models have not. Because it's hard, we avoid it. Or we try in vain through scattered programs and well-meaning policies that never quite deliver. In the end, we stay downstream—throwing money at treating what happens after the damage is done, instead of preventing it in the first place.

But here’s the truth: governments alone can’t do this. Nor should they. Health is co-produced by individuals, families, schools, workplaces, civil society, our medical system and its professionals, Indigenous partners, media, and the private sector. What we’ve lacked isn’t ideas or intentions. It’s alignment of strategies and of effort. The kind of alignment that connects sectors without collapsing them, that respects jurisdiction while refusing fragmentation, and that moves us from vision to action. That’s why this work matters.

In the 1970s, we redefined health. Not merely as the absence of physical disease, but as a state of physical, mental, emotional, and social well-being that enables individuals to identify and realize aspirations, satisfy needs, and change or cope with the environment. In short, to define what health means for themselves.

From that moment forward, it became clear that achieving health depended not only on access to medical care to treat illness, but on the social, economic, environmental, and political conditions in which people live, play, learn, grow, work and age. The true determinants of health lie in sectors not traditionally regarded as health-related: safety, shelter, education, income, social justice, equity, and sustainable resources.
 

Yet while we expanded our understanding of health conceptually, ‘healthcare’ systems remained structurally tied to the delivery of medical services. Built to treat ‘downstream’ physical illness and disability, they continued to grow—serving individuals as passive recipients of care, rather than enabling the broader conditions for health. And while medical service delivery remains an urgent and essential priority, we’ve struggled to act upstream.

“Let’s not forget that the ultimate goal of Medicare must be to keep people well rather than just patch them up when they’re sick. The second stage of Medicare is to reorganize our health services and redirect our emphasis to prevention and health promotion. That’s the part we haven’t done yet. We’ve only dealt with half the problem.”
  — Tommy Douglas, Father of Canadian Medicare

Simply put, if we want a strong and healthy Canada, we have to stop waiting for Canadians to get sick. But working across sectors and jurisdictions on the many determinants of health is highly complex and governments and civil society have struggled to do so. The result has been decades of fragmented programs, well-meaning pilots, and episodic funding. We simply lacked the tools. 

Until now.

The Health Promotion Alignment Framework is the Rosetta Stone we’ve been looking for.

All related materials are offered without conditions for non-commercial use and may be shared, adapted, or reproduced, whether in whole or in part, for internal government, policy, or planning purposes, with attribution. For any other use, including educational or commercial purposes, reproduction or distribution, please contact the author. All content remains the intellectual property of the author. 

Marc Dupont, Founder & Principal of Lac Meech Strategies is a senior health policy expert with over three decades of  experience in government, public administration, and consulting. He has played  key roles in shaping major federal health initiatives, including Canada’s response  to the United Nations Framework Convention on Tobacco Control, the Integrated  Pan-Canadian Healthy Living Strategy, and federal-provincial-territorial  consultations for the Public Health Goals for Canada. He has appeared as an  expert witness before the Parliamentary Standing Committee on Health (HESA)  and contributed to the National Consensus Conference for the Mental Health Commission of Canada as a symposium moderator. His career includes executive roles at the Public Health Agency of Canada (PHAC), serving as CEO of a health policy consulting firm, and teaching as faculty at the Canada School of Public Service.