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Canadian Public Health Association

A Public Health Approach to Policy Advocacy

INTRODUCTION

Public health practice is an approach to maintaining and improving the health of populations that encompasses the principles of social justice, attention to human rights and equity, evidence-informed policy and practice, and addressing the underlying determinants of health. Central categories of its work include health promotion, health protection, population health surveillance, and the prevention of death, disease, injury and disability.

Beyond those widely-shared understandings, the Canadian Public Health Association (CPHA) embraces some additional dimensions of what we consider to be a public health approach oriented to our mission of advocating for policy and advancing practice that improves the health of populations in Canada. Although health professionals often invoke a ‘public health perspective’ or ‘public health approach’, there is no definitive understanding of what this means. CPHA lays out our own understanding of the field in the evergreen document Public Health: A Conceptual Framework.

This new document is intended to summarize the perspective informing CPHA’s policy development and advocacy activities. It represents four main dimensions of what we consider to be the conceptual underpinnings of our own current approach to policy advocacy: 

  1. Goals of a public health approach;
  2. Core values;
  3. Evidence as the foundation of action; and
  4. The political nature of public health.

GOALS OF A PUBLIC HEALTH APPROACH

In line with the 1986 Ottawa Charter for Health Promotion (World Health Organization, 2012), CPHA understands the health and well-being of populations to be shaped by a range of modifiable factors: individual behaviors, access to health care, and the entire context of conditions in which people live, learn, play, work, and age. As stated in the Geneva Charter for Well-Being (World Health Organization, 2021), health promotion in current conditions of planetary multi-crisis must rest on “a positive vision of health that integrates physical, mental, spiritual and social well-being”, understanding that these conditions are shaped by “ecological, political, commercial, digital and social determinants of health and health inequities, within and between social groups”. Accordingly, public health must advocate for “investments that integrate planetary, societal, community and individual health and well-being, as well as changes in social structures to support people to take control of their lives and health.” Dr. Theresa Tam, Canada’s former Chief Public Health Officer, notes that improving these conditions to produce better health outcomes requires concerted effort on many fronts: not only evidence-informed interventions into society, economy and the environment but also action by communities and leadership from public officials (Public Health Agency of Canada, 2023).

Because historical and contemporary patterns of resource distribution and discrimination underpin systemically differentiated patterns of health and well-being within and across populations, a public health approach must emphasize the pursuit of health equity, or conditions under which all persons can attain their full potential for health and well-being. As the Geneva Charter states, advancing health equity requires addressing “unfair, avoidable or remediable differences [in health and well-being] among groups of people, whether those groups are defined socially, economically, demographically, or geographically or by other dimensions of inequality (e.g., sex, gender, ethnicity, disability, or sexual orientation).” In addressing those differences, public health must “seek to alter institutions, policies and practices that cause inequitable distribution of power and resources” (National Collaborating Centre for Determinants of Health, 2023). 

The value commitment to health equity is reflected in CPHA’s organizational mission to “enhance the health of all people and communities in Canada, particularly those who face structural disadvantage”. Importantly, the commitment to prioritize the health of those facing structural disadvantage does not remove other more structurally advantaged or sizeable populations from public health consideration. However, the need to assess relative risks, benefits and diverse interests across differently-situated and differently-sized populations presents ongoing tensions for setting public health advocacy priorities, developing policy recommendations and navigating political structures.

CORE VALUES GUIDING OUR WORK

Social justice and human rights
Widely acknowledged core value commitments underpinning a public health approach are grounded in the concepts of social justice and human rights. Social justice, the principle that societal institutions should enable all people to live fulfilling lives and contribute to their community, is reflected in in Section 7 of the Canadian Charter of Rights and Freedoms (Government of Canada, 2025), which provides for “the right to life, liberty and security of the person and the right not to be deprived thereof except in accordance with the principles of fundamental justice.”

Many elements of Canada’s legal system as well as its ratification of various United Nations treaties (e.g., the International Convention on Civil and Political Rights as well as the International Convention on Economic, Social and Cultural Rights) suggest that the right to health in Canada “continues to evolve on a spectrum from a narrow right to health services, to a right to health protection, towards a broader right to determinants of health” (Jones, 2022). The scope of CPHA’s understanding of a public health approach that advances the right to health protection and the determinants of health continues to evolve in tandem with evolutions in legal and societal norms.

Harm reduction
CPHA’s understanding of a public health approach is also grounded in a principled ethical commitment to harm reduction, which pragmatically prioritizes compassion, dignity and respect for autonomy in ‘meeting people where they are’, including when their situation and choices increase risk to their health. (AHS Harm Reduction Team, 2019). The perspective of public health ethics holds that since we live in an imperfect world in which risks of harm cannot and should not be wholly eliminated, “reducing harm is a powerful means of advancing health justice and reducing stigma” (Goldberg, 2023). In 2024, CPHA presented its vision of a public health approach to harm reduction in its Framework for a Public Health Approach to Substance Use (Canadian Public Health Association, 2024). While that framework focuses specifically on substance use, the principles of harm reduction extend far beyond this context, applying across a wide range of situations where individuals’ choices entail risk to themselves. Its core value commitment is that “individuals have the right to make decisions about their own health and well-being,” and “are best positioned to understand their own needs and preferences”. The role and preferred approach of public health is “to empower individuals by respecting their autonomy, supporting them in making informed choices, and ensuring that their voices are centered in decisions about their care.”

Truth and Reconciliation with Indigenous Peoples
Public health in Canada has a distinctive obligation to address inequities affecting the health and well-being of Indigenous (First Nations, Inuit, and Métis) Peoples, and to do so in ways that respect evolving priorities and best practices as articulated by Indigenous Peoples. The starting point of public health response is to acknowledge that current inequities in Indigenous Peoples’ health and well-being are rooted in historical and present-day impacts of racism, colonialization, cultural genocide, and structural violence, as well as dislocation from land, culture, spirituality, languages, and traditional economies and governance systems. The Reports of the Truth and Reconciliation Commission and the associated Calls to Action document and provide recommendations for addressing these impacts. Further essential principles are laid out by the 2019 Final Report of the National Inquiry into Missing and Murdered Indigenous Women and Girls, which calls for governments and health service providers to recognize and support the expertise of Indigenous Peoples in caring for and healing themselves, through services designed and delivered by themselves and grounded in community practices, world views, cultures, languages, and values (National Inquiry into Missing and Murdered Indigenous Women and Girls, 2019). These Canadian reports are grounded in the United Nations Declaration on the Rights of Indigenous Peoples (United Nations, 2007), which asserts rights to individual and collective life, integrity, liberty and security; and the right to traditional medicines and health practices; and equal access to the conditions of highest attainable physical and mental health.

Both Indigenous and non-Indigenous public health practitioners are continually developing and evolving the application of these rights- and justice-based calls for systemic change across the various domains of public health practice (Hendry et al, 2025). CPHA understands best practice within a public health approach to include:

  • Allyship in actively cultivating relationships with Indigenous public health professionals and organizations, in supporting their priorities and initiatives;
  • Using a distinctions-based approach to identify and address health inequities among First Nations, Inuit and Métis peoples, and to support their capacity for public health governance, service delivery, and research;
  • Supporting capacity-building for an Indigenous workforce to provide health and wellness services to their peoples within adequately-resourced health systems, both within and outside their own communities;
  • Supporting Indigenous sovereignty over health-related data, understood as the right of First Nations, Inuit, and Métis peoples to own, control, access, and possess information related to their communities (Schnarch, 2004);
  • Recognizing the centrality of traditional knowledge and healing in health services for Indigenous people, and the need to draw on Indigenous knowledge alongside Western science in decision-making that advances Indigenous priorities; and
  • Identifying, challenging, and dismantling anti-Indigenous racism embedded in health systems, institutions, and policies.

Anti-racism and anti-discrimination
In order to advance social justice, human rights and health equity, a public health approach must understand the structural workings and inequitable health impacts of racism and other forms of stigma and discrimination, and aim to undo these structures through comprehensive multi-domain policy approaches (Clark et al, 2022). This requires recognizing intersectional identities and experiences among racialized groups and other equity-denied populations. It must also focus on identifying and undoing racism within public health systems, including through the responsible collection, governance, and use of disaggregated data as well as changes to organizational/institutional structures, policies, and practices (NCCDH & CIHR-IPPH, 2023). CPHA’s orientation to advocacy in these areas is grounded in the Values section of our organizational Mission and Vision statements.

Navigating public health values and principles
CPHA’s public health approach recognizes that internal tensions of values and principles exists within this field of practice. Internal to public health, for instance, a utilitarian administrative orientation toward using resources most effectively to improve population-level health can be in tension with a person-centred harm reduction orientation that prioritizes individual autonomy, holistic well-being, and health equity. Navigating such tensions requires understanding that a public health approach aims at producing population health outcomes in ways congruent with important social values (Bellefleur & Keeling, 2016).

EVIDENCE AS THE FOUNDATION OF ACTION

CPHA understands a public health approach to draw on multiple kinds of evidence as well as guiding principles of analysis and decision-making. It relies on a robust, accurate and valid evidence base composed of scientific research, population characteristics, needs, values, and preferences (Brownson et al, 2009). That evidence takes the form of public health research, surveillance and epidemiology, and community-based knowledge, as well as the expertise of professionals and persons with lived and living experience. Indigenous knowledge is another part of the evidence base relevant to the health and well-being of First Nations, Inuit, and Métis Peoples as well as that of non-Indigenous peoples. Public health analysis, interventions and decision-making must also be informed by insights from the wider sphere of scientific research and policy fields shedding light on the determinants of health.

An important part of CPHA’s public health approach is awareness that the relevant evidence base is constantly expanding as new paradigms of evidence and evidence-gathering emerge, and as evolving conceptual approaches open up new perspectives on the determinants of health and well-being. Over the past decade, for example, public health analysis, research and advocacy has evolved significantly within the conceptual frameworks of planetary health (Planetary Health Alliance, 2025), digital public health (Iyamu et al, 2024), commercial determinants of health (World Health Organization, 2025), and information environments and trust (Palmer & Gorman, 2025).

A public health approach must deploy evidence to consider how to analyze risk and identify priority courses of action in contexts of multi-dimensional risks and limited resources. Risk assessment identifies the nature and likelihood of negative health outcomes related to specific upstream causes. Decisions about intervention may draw on the ‘precautionary principle’, an approach to managing risk in circumstances of scientific uncertainty when known risks are judged to call for prudent intervention even before scientific knowledge is definitive (Ducas, 2016; Pinto-Bazurco, 2020). For this reason, public health decision-making rests not solely on demonstrated evidence of what works, but also on evidence showing what holds promise of working. A further dimension that a public health approach must incorporate is relative risk, enabling priorities for intervention to be identified in contexts where multiple health risks to diverse populations are in play (and where non-health-specific social priorities and values are often also at stake).

CPHA’s public health approach realizes that these varied types of evidence and decision-making principles do not always point toward a single obviously correct course of action. This is true for several reasons: 

  • distinct kinds and sources of evidence might conflict or seem incommensurable
  • research and engagement of stakeholders or communities takes place under imperfect conditions
  • assessments of kinds of risks and impacts to distinct population groups may vary across different perspectives; and 
  • individuals and communities do not prioritize health-centric risks or benefits uniformly in comparison with other important societal goods and values. 

Responsible policy analysis and advocacy requires acknowledging these complex considerations while explaining the evidentiary and value commitments informing a recommended approach.

THE POLITICAL NATURE OF PUBLIC HEALTH

Many public health practitioners envision their activity as apolitical. Framing public health as a health science might seem to place it above partisan politics, in a place of authority that can give authoritative evidence-based prevention advice to the public as well as a distanced perspective from which to direct and criticize the actions of elected leaders. 

Contrary to these perspectives, however, CPHA understands public health to be an intrinsically political enterprise in the sense that it operates within a larger societal context of diverse values, interests, beliefs, and policy priorities. Like other public enterprises under the umbrella of government, public health is subject to challenge about authority and responsibility for decision-making, means of decision-making and priority principles for resource allocation, as well as the legitimate stakeholders and kinds of evidence having a role in decision-making (Cairney 2025a; Cairney 2025b). Given this political context in which public health operates, its decision-making cannot be, and should not aim to be, based on evidence alone. Rather, it is informed by the best available evidence at a given point in time as well as the larger context of the public arena in which its decision-makers have authority alongside those in other policy and political spheres (Kothari & Smith, 2022).

In order to have impact, a public health approach must recognize this context and shape its policy strategies accordingly. One necessary strategy is advocating for public health systems to have the necessary administrative structure and powers, fiscal and human resources, and evidence base required to carry out its mandate (CPHA, 2022). Another is deploying a pragmatic understanding of political processes and constraints in allying with stakeholders in other policy sectors to advocate on the whole range of determinants of health.

Recognizing that public health is politically situated also means recognizing that its core values and aims do not have automatic priority in larger decision-making arenas of public policy and politics. It is part of public health’s mission to convince allies and the larger public that their values and interests are aligned with public health aims. However, such efforts must begin by understanding that a pluralistic Canadian society (along with the political orders that govern it) holds a great diversity of values, goals, preferences, and risk priorities beyond health-centric ones. 

This politically-sensitive orientation entails a degree of pragmatism going beyond formally defined public health advocacy competencies (National Collaborating Centres for Public Health, 2025). It entails that CPHA’s public health approach takes a dual lens toward advocacy, aiming both at long-term progress toward population health and health equity as well as more pragmatic gains within the shorter-term art of the possible. We describe how CPHA defines advocacy priorities and strategies in a separate brief on our policy development process.

CONCLUSION

Taken together, these elements outline how CPHA conceives of a public health approach to policy advocacy in 2025: one that pursues clear goals for population health and equity, is rooted in enduring commitments to justice, reconciliation, and harm reduction, is guided by diverse forms of evidence, and is attentive to the political contexts in which decisions are made. This working paper is not intended to prescribe a single, fixed definition of a public health approach, but rather to articulate the principles and perspectives that currently guide CPHA’s advocacy. As both public health challenges and societal conditions evolve, so too will our understanding and practice. By making our conceptual foundations explicit, CPHA aims to strengthen the integrity of its policy work, invite dialogue across the public health community, and contribute to collective efforts to create the conditions for health and well-being for all people in Canada.

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