National Academy of Medicine

“Well-Being in All Policies”: Promoting Cross-Sectoral Collaboration to Improve People’s Lives

By Thomas E. Kottke, Matt Stiefel, and Nicolaas P. Pronk
April 14, 2016 | Discussion Paper

In “A New Perspective on the Health of Canadians,” Marc Lalonde, the Canadian Minister of National Health and Welfare, concluded that health care does not have the power to fully mitigate the threats posed by unhealthful environments and behaviors. This 1974 report broke new ground by creating a comprehensive framework for the determinants of health based on 4 health fields — human biology, environment, lifestyle, and health care organization.

In 1990, perceiving that health care policy continued to dominate the formulation of health policy despite the Lalonde report, Robert G. Evans and Gregory L. Stoddart wrote “Producing Health, Consuming Health Care.” This landmark essay presented a series of progressively richer models that described the relationships among health, health care, the determinants of health, and well-being. They started with a model that they considered dominant at the time — a simple feedback loop between health care and disease as defined by the medical care system.

In the 19th century, linguists introduced the concept that language determines thinking. We believe that linguistic reasons explain why the broader determinants of health might not be taken into consideration when social policy is formulated in the United States.

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Disclaimer: The views expressed in this paper are those of the authors and not necessarily of the authors’ organizations, the National Academy of Medicine (NAM), or the National Academies of Sciences, Engineering, and Medicine (the National Academies). The paper is intended to help inform and stimulate discussion. It is not a report of the NAM or the National Academies. Copyright by the National Academy of Sciences. All rights reserved.