A historical account of government health policy describes the beginnings of the public health movement, which gave us pure water, improved sewage and public sanitation. It moves on to the events leading to the establishment of universal health care in Canada, and the growth of health promotion after the Lalonde Report. It emerges that none of these major advances follow a neat and logical course. They all take a long time and progress towards eventual implementation occurs in fits and starts in a non-linear way. Unforeseen obstacles like wars and depressions slow things down.
Ideological differences make continuous development difficult.
Once adopted, there is dispute about their outcomes, so that the debate about whether it is health-related initiatives or general prosperity that is responsible for the increased longevity of Canadians is far from being resolved. This research has so far explained quite a lot about the nature and source of these inequalities, but it has not yet defined policy consequences of the research. There are strong ideological disagreements about what to do about inequalities in health and about the place of social determinants of health like social class and income. The report recognizes that debates of this kind have occurred at every stage of the development of health policy, going back to public health in the 19th century. Aristotle s Ethics and Politics locate the concept of health in the broader field of living well, both morally and socially, and help us to understand some of the results of the research into inequalities in health.