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Imagine 2048: A reflection on the future of health promotion practice

Imagine 2048: A reflection on the future of health promotion practice

By Sume Ndumbe-Eyoh Sume Ndumbe-Eyoh on June 29, 2018

This blog is a presentation I made as part of a session I contributed to on the future of health promotion during the Public Health 2018 conference. The gathering took place in Kanien’keha:ka, on traditional Mohawk land. I live and work in Toronto, which is One Dish One Spoon Indigenous territory, referring to a treaty between the Anishinaabek and Haudenosaunee Nations. I moved to Toronto from Cameroon 17 years ago as an international student.


Imagine the world in 2048. What do you see? I imagine a world in which a greater proportion of humanity gets to partake in the beauty and bounty the world has to offer while being buffered from more of its downsides. It brings to mind what Arundhati Roy imagines as “another world.” [1]

In this “another world” described by Roy, three things will be central to health promotion practice.

  1. We will have fully embraced the broader conception of health to which all of our foundational documents have aspired, one that includes social, economic, spiritual, planetary and political dimensions of well-being. This approach thinks of well-being and a good life in a more fulsome manner — in a way that reflects how must of us experience life in community and as individuals. It values the contribution of social well-being and moves health promotion to the point of building communities in which we thrive and not just survive. For example, instead of focusing on poverty reduction, we will turn our action to having adequate incomes that allow us to all to participate in the full spectrum of social, cultural and political life.

    The Wellesley Institute recently calculated that a single person in the city of Toronto needed to earn at least $45,000 after tax in order to thrive. [2] This amount accounts for housing, transportation, debt, savings, professional development and social participation such as restaurants, sports and other cultural activities. At $14/hour, the current minimum wage in Ontario offers about half of that (around $24,000), with the living wage ($19/hour, or $39,000/year) [3] also falling short.
  2. We will lead with social justice and equity as core values. This will require a stronger emphasis on action that influences power and resource distribution on both a material and symbolic basis; it will also complicate our analysis and interventions. In “another world,” for example, the solution for eliminating racialized inequities in health will be to create more opportunities for Indigenous and racialized peoples in Canada — and, indeed, globally — to engage in society as full-fledged humans.

    According to the World Economic Forum, [4] Canada has achieved gender parity in education and health but has a long way to go in the economy and politically. This assessment masks the fact that health outcomes for low-income and racialized women remain a concern and inequities are deeper in the economic and political spheres. Consider that, as result of colonial practice and policies, including persistent systemic racism, Indigenous women generally experience worse health outcomes than White women. Similarly, the gender wage gap is 47 cents on the dollar for racialized women when compared to White men. [5]
  3. We will grow the “we,” the community of people who care about creating “another world.” To transform our world in a sustained way, we need to profoundly shift social norms and demand for government and corporate action that lets more of us thrive.

    According to the Broadbent Institute, [6] more than four out of five Canadians believe income inequality is a concern. Canadians want our governments to invest in national childcare and Pharmacare to improve incomes and to change tax policies. In Ontario’s 2018 provincial election, housing was a primary concern for young people. In order to act on these issues in an institutional and sustained way, by 2048 we will need to have developed a strong narrative to support change movements that include health promotion and are not solely driven by health concerns. This narrative counters growing inequalities, myths of scarcity and the rise in ethnic nationalism, seen in North America in a resurgence of explicit White nationalism. This narrative will also account for the reality that the majority of our decisions are developed in the unconscious mind and that well-being is a concern across political spectrums. [7] Our new narrative, one of a bigger we, will be grounded in fairness and opportunity for all. This bridging narrative requires listening (even when we don’t like what we hear), engaging, organizing and leading with love. [8]

In our quest for a more just and sustainable world, there are no shortcuts; a commitment to health promotion requires a commitment to real transformation.

In the words of Arundhati Roy,

Our strategy should be not only to confront empire, but to lay siege to it. To deprive it of oxygen. To shame it. To mock it. With our art, our music, our literature, our stubbornness, our joy, our brilliance, our sheer relentlessness – and our ability to tell our own stories. Stories that are different from the ones we’re being brainwashed to believe. … Another world is not only possible, she is on her way. On a quiet day, I can hear her breathing. [1]


Photo credit: Robert Collins



[1] Roy A. (2003). War Talk. New York, NY: South End Press.

[2] Kumar, N. McKenzie, K. and Seong-gee U. (2017). Thriving in the City: what does it cost to live a healthy life? Toronto, ON: Wellesley Institute.

[3] Tiessen, K. (2015). Making Ends Meet: Toronto’s Living Wage. Ottawa, ON: Canadian Centre for Policy Alternatives.

[4] World Economic Forum. (2017). The Global Gender Gap Report 2017. Geneva: World Economic Forum.

[5] Block, S. (2010). Ontario’s growing gap: the role of race and gender. Ottawa, ON: Canadian Centre for Policy Alternatives.

[6] Penner, B., Smith, M., Hoffman, D. and Cousineau, A. (2017). Progress in the age of Trump: Polling Presentation for the Broadbent Institute. Ottawa, ON: Broadbent Institute.

[7] Haidt, J. (2012). The righteous mind: Why good people are divided by politics and religion. New York: Pantheon Books.

[8] Powell, J. (2018, May). Special Round-Table Conversation with john powell. Toronto:ON, Colour of Poverty - Colour of Change and Laidlaw Foundation.


Racism/racializationSocioeconomic status