Health promotion begins to face a number of challenges, including setbacks in the progress against tobacco use as a result of tax reductions and threats to the well-being of communities resulting from a severe economic recession and the erosion of the social safety net. The resulting fiscal restraint placed increased demands on health promotion to demonstrate its accountability and prove the ‘effectiveness’ of its initiatives.

At the same time, the federal government’s shift from health promotion to a population health approach forced health promoters to integrate their concepts and values into new frameworks for thinking about health.