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March 2003, Vol 93, No. 3 | American Journal of Public Health 392-396
© 2003 American Public Health Association

MODELS FOR POPULATION HEALTH

Population Health in Canada: A Brief Critique

David Coburn, PhD, Keith Denny, MA, Eric Mykhalovskiy, PhD, Peggy McDonough, PhD, Ann Robertson, DrPH and Rhonda Love, PhD, (Critical Social Science Health Group)

The authors are with the Department of Public Health Sciences, University of Toronto, Ontario, Canada.

Correspondence: Requests for reprints should be sent to David Coburn, PhD, Department of Public Health Sciences, McMurrich Building, University of Toronto, Ontario M5S 1A8, Canada (e-mail: david.coburn{at}utoronto.ca).

An internationally influential model of population health was developed in Canada in the 1990s, shifting the research agenda beyond health care to the social and economic determinants of health. While agreeing that health has important social determinants, the authors believe that this model has serious shortcomings; they critique the model by focusing on its hidden assumptions.

Assumptions about how knowledge is produced and an implicit interest group perspective exclude the sociopolitical and class contexts that shape interest group power and citizen health. Overly rationalist assumptions about change understate the role of agency.

The authors review the policy and practice implications of the Canadian population health model and point to alternative ways of viewing the determinants of health.




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