In the early 1970s, a central government think tank, the Long Range Health Planning Branch, identified the effects of lifestyle and environment on public health and began to consider policy solutions to improve public health (Laframboise 1973; McKay 2000). That activity culminated in a report that identified objectives for the health-care system and for the prevention of health problems and promotion of good health (Lalonde 1974). A combination of research and advocacy was introduced to support and validate the notion that public policies affect determinants of health (Milio 1981; WHO 1986, 1988).
Healthy Public Policy
Health and environment are under provincial jurisdiction in Canada. Two provinces, British Columbia and Québec, have formalized HIA as a component of policy-making, and they offer different experiences (Banken 2001, 2004; Kwiatkowski 2004; Gagnon et al. 2008). In British Columbia, attention to the health of the population was advanced by a group of government officials who had an interest in health promotion. From 1989 to 1995, structures and policies for HIA were starting to be included in British Columbia’s health-care policy, and it was proposed that HIA of all government projects, programs, and laws be conducted. Guidelines were produced, and a series of workshops were held to raise awareness of and develop capacity for HIA1 (Banken 2004). By 1999, the values underpinning the reform of health care had changed, and resources for HIA were redeployed. The guidelines that required the use of HIA in government decisions were not changed, but they were no longer seen as mandatory. Banken (2004) concluded that the rise of HIA in that short time had been accelerated by key persons in the British Columbia Ministry of Health, that it did not benefit from wide ownership, and that it had become closely identified with a particular policy orientation. Banken contended that if other institutions had been more involved in examining the value of and establishing structures for HIA, support for HIA would not have withered as quickly after the policy direction changed and after key persons left the ministry.
Québec had a different experience in using HIA as part of healthy public policy. Banken (2001) traced the linking of environment and health to robust public-health input during hearings on the use of pesticides (BAPE 1983). That input led to a memorandum of understanding (MOU) between Québec’s Ministries of Health and Environment. A framework was developed to support the memorandum and led to the systematic practice of integrating health and the environment into projects and policies (Banken 2001, 2004). In the 1990s, pol-
1The committee is not aware of any examples of HIA from this period. Therefore, although it is documented that HIA was a part of the policy discussion, it is not possible to evaluate how HIA was conducted in British Columbia.