We know the best approaches to improve Canadian health are those that address the root causes — preventing, instead of treating — but we still get caught up focusing on behaviour, and 'magical thinking'. Let's break out of the trinity trap.
As one of 200 students sitting in the first class of a Social Determinants of Health course a year ago I wondered why I had barely heard of the role of social determinants of health. I grew up with sports and was pursuing a kinesiology degree - I was told that exercise, healthy eating, and quitting smoking were magical, one-step solutions that would cure the chronic diseases plaguing Canadians (if only people would adhere to a healthy lifestyle). From Participaction to the Got Milk campaign, much of the media I was exposed to focused on the importance of lifestyle choices for better health.
As I came to learn about the upstream factors like income inequality and employment, that impact our health much more than lifestyle choices, I could only think about how much more sense it made to look at the bigger picture and target the root of the problem.
Canada has a rich history of policy documents and research in the area clearly demonstrating the importance of social context when examining health issues. From the 1974 Lalonde report, A new perspective on the health of Canadians, and the 1986 Canadian Epp Report, Achieving health for all: a framework for health promotion, to the Ottawa Charter for Health Promotion and the work of bodies such as Health Canada, a health framework including structural factors such as food, income, and shelter has existed for quite some time. Yet we tend to ignore these facts and instead accept the idea that breaking individuals of their “irresponsible” health behaviours can solve our biggest health problems. The focus on health behaviourism continues to lead to public policy failure to improve the overall health of Canadians.
The Canadian Men’s Health Foundation (CMHF) operates within this world of health behaviourism. Founded by Chairman Dr. Larry Goldenberg and President Wayne Hartrick in 2014, the CMHF takes a behaviour-centric approach to health, emphasizing biomedical markers and lifestyle choices. Their Don’t Change Much campaign aims to promote men’s health by encouraging the adoption of simple, easy to implement changes to everyday health behaviours.
With a focus on sleek and engaging social media like “listicles” and videos with hyperbolic headlines, the campaign aims to inspire and motivate men by selling the idea that they don’t have to change much about their lives in order to reap the benefits of better health. This is in spite of the fact that income inequality contributes to over 40,000 premature deaths that occur annually in Canada, of which more than half occur in men.
"Instead of blaming individuals and deeming them deserving of their health misfortune, we should invest resources into deeper causes."
But, looks can be deceiving, and this behaviour-focused approach ignores the wealth of evidence we have on the impacts of social factors on health. This world where health problems are the fault of individuals and their lifestyle choices is a fantasy scenario that ignores the context of health problems – the social, economic, or political factors that help produce these behaviours.
This approach emphasizes individual willpower as the key to maintaining a health lifestyle. Men are encouraged to “know their numbers” and are told they are responsible for controlling and tracking facts such as their cholesterol levels, BMI, and the number of servings of vegetables they eat in a week. This “pull-yourself-up-by-the-bootstraps” approach inherently ignores social and economic factors like income and education that in turn affect everyday living conditions such as stress level and spare time that affects the ability of the individual to meet these requirements. A single, immigrant father working two or three jobs is not on even footing with a highly educated, upper-middle class white man with a pension and health benefits. Instead of blaming individuals and deeming them deserving of their health misfortune, we should invest resources into deeper causes.
The fantasy scenario extends to the CMHF’s one-dimensional view of the typical “Canadian Man”. The Don’t Change Much campaign is filled with stereotypical representations of a caucasian, bearded, muscular, outdoorsman enjoying winter, hockey, hiking, and beer. Images both on the campaign website and throughout CMHF’s social media presence centre on stereotypically masculine activities such as driving and mountain climbing with minimal representations of non-stereotypical activities such as yoga, reading, and cooking.
"The health behaviourism dialogue creates a barrier that blocks discussion from moving more upstream."
Phrases invoking traditional masculinity like the “the man of the house”, are used throughout the campaign, and stereotyped family units are emphasized with virtually zero representation of LGBTQ+ and alternative parenting arrangements. They emphasize conspicuous consumption, with many images of expensive cars, luxurious vacation locations, and suited men in expensive-looking houses.
It’s time to change the conversation. Encouraging men to engage with their health is one thing – but there is more to becoming healthy than simply eating better and exercising more, and Canadian men are more than just hyper-masculine, caucasian mountain men interested in cars and drinking beer. We are one of the most diverse countries in the world with access to immense amounts of research demonstrating the need for large-scale policy change to address upstream determinants of health.
The health behaviourism dialogue creates a barrier that blocks discussion from moving more upstream, and is only as strong as it is because it's supported by strong political and media forces. We need to demand an approach to men’s health aimed at all Canadian men, not just the privileged few, and engage in the advocating and development of policies that address widening income inequality and thus worsening health in our country. If we “don’t change much”, not much will change – as health inequality in Canada worsens, is the status quo something we can still afford?
Rachel Kirkland (B.Sc. Kinesiology, MPH Candidate 2019) works in the area of health policy and promotion through the intersectional lens of the social and ecological determinants of health and planetary health.A four-time national medalist and international competitor in figure skating, Rachel is now completing her Masters of Public Health in Social and Behavioural Health Sciences, specializing in global health and public health policy, at the Dalla Lana School of Public Health (University of Toronto).