Marc Lalonde, the Health Field Concept and Health Promotion

During the 20(th) century, public health evolved with increasing capacity for disease prevention as scientific breakthroughs occurred in microbiology, immunology, nutrition, and other sciences. Disease-control advanced and new epidemiologic evidence identified risk factors for the growing burden of noncommunicable diseases such as the cardiovascular diseases, cancer, and others. Medical care also improved and became more accessible through health insurance systems both in the private and governmental sector. Health systems became more combined public–private endeavors, with health insurance for medical- and hospital-care taking center stage. Epidemiology blossomed as a science following World War II, producing vital insights and evidence of contributory factors to noncommunicable diseases. In the 1960s the cumulative evidence of smoking as a direct cause of lung cancer and heart disease was identified as a major public health challenge. These relationships became clear and increasingly accepted after the US Surgeon General’s Report in 1964. In 1974, Hon. Marc Lalonde, Canada’s Minister of National Health and Welfare issued the book A New Perspective on the Health of Canadians, which identified genetic, environmental, personal lifestyle, and medical care as equally important issues in personal and population health. New Perspectives led to the “Ottawa Charter” in 1986 which defined health promotion and has become a vital issue in public health. The health promotion movement immediately found a crucial role in smoking reduction and diet change to deal with the pandemics of lung cancer and heart disease. In the 1980s health promotion found itself at the frontline dealing with the HIV pandemic when there were no biomedical means to stem the pandemic of death from AIDS. Public health had to find new and effective instruments for disease control. A renewed emphasis on social inequalities in health in the 21(st) century exemplified in the Millennium Development Goals (MDGs) addressed vulnerable populations with linked targets of reducing poverty, promoting education and gender equality, safer environment, and biomedical disease-control measures as global health policy. This more holistic approach to population health has become a leading element in modern public health largely based on the intellectual contribution of Marc Lalonde.