Emerging research points to the importance of social, economic and environmental determinants in affecting the health status of individuals and communities. For example, the Black Report on health inequalities in the United Kingdom revealed significant inequities in the health status of low-income groups, while the Alameida County study in California revealed the importance of social support and social networks as determinants of health (Berkman and Syme, 1979).

As a result of these studies and related developments, the narrowly focused “lifestyle” approach to health promotion recommended by the Lalonde Report began to fall into disrepute. Many health promotion programs were criticized for “blaming the victim” by ignoring the social and economic barriers to making healthy choices (e.g., Labonte and Penfold, 1981).