Academic journal article Canadian Journal of Public Health

A Surgical Intervention for the Body Politic: Generation Squeeze Applies the Advocacy Coalition Framework to Social Determinants of Health Knowledge Translation

Academic journal article Canadian Journal of Public Health

A Surgical Intervention for the Body Politic: Generation Squeeze Applies the Advocacy Coalition Framework to Social Determinants of Health Knowledge Translation

Article excerpt

Research illuminates unique opportunities for policy to support the optimization of lifelong health outcomes by investing in the generations raising young children because human beings are especially sensitive to the social determinants of health (SDoH) in their earliest years.1 However, there is a major gap between this evidence and Canadian government budgets. Whereas Global AgeWatch ranks Canada among the top countries for aging because of public spending on medical care and SDoH policies like Old Age Security,2 UNICEF ranks Canada among the least generous OECD (Organisation for Economic Co-operation and Development) countries for investments in the generation raising young children because our parental leave and child care services fall below international standards.3 Canada also ranks poorly for preventing child poverty by comparison with seniors' poverty.4

The gap between SDoH evidence about younger generations and Canadian government budget decisions invites questions about building political will to act on the science. The WHO Commission on the SDoH concluded that "building political will ... is central to all [its] recommendations",5 because the path from research to policy is mediated by politics. The National Collaborating Centre on the Determinants of Health concurs, observing that "participating in policy development and advocacy is a key role for public health".6

Younger Canadians are less effective at building political will. Not only are children ineligible to vote, adults under age 45 are one third less likely to vote than are older Canadians, and younger citizens are less likely to organize in between elections. While the Canadian Association of Retired Persons (CARP) has lobbied for decades on behalf of citizens age 50+, no corresponding group has organized for younger generations. This void creates imbalance in the world of politics by generating fewer incentives for governments to prioritize investments in early life course stages by comparison with later stages. The result is a larger gap between SDoH research and government budget priorities for younger Canadians than there is for older cohorts, as reflected in the diverging rankings from Global AgeWatch and UNICEF.


In response, we designed a transformative population health intervention called Generation Squeeze, which we are evaluating each year, beginning with our pilot in 2015. Whereas medical care routinely practices surgery on a human body, Generation Squeeze metaphorically performs a surgical intervention for the body politic - one that aims to narrow the gap between what scholars know about the SDoH for younger generations and what governments prioritize in their budgets. Guided by the "health political science" literature,7-9 the intervention performs evidence-based, non-partisan political activity with the goal of creating new incentives for policy-makers to translate SDoH research about Canadians in their 20s, 30s and 40s and their children into government budget investments. All activities of the intervention adhere to Canada Revenue Agency, lobbyist and election advertising legislation.

Our intervention responds to research by Clavier and de Leeuw who assert that "engaging in the policy game with rules by which health promotion currently plays is ineffective. The health promotion realm has been very good at talking the talk of the policy world, with lofty statements on healthy public policy, the SDoH, and the like, but it has failed to walk the walk of the complex, iterative, and quintessentially power-driven policy process".8 Raphael concurs, urging health promotion scholars to engage in the "raw politics"9 that shape investment in the SDoH.

Generation Squeeze is a theory-driven intervention to engage in raw politics. We hypothesize that by remedying the age imbalance in citizenry organizing, the intervention can incentivize paradigm changes in SDoH investments. These changes will result in Canada advancing its international ranking for SDoH policies (e. …

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