Chronic disease prevention and the politics of scale: lessons from Canadian health reform.

The authors examine the politics of health-promotion dissemination in health policy using provincial cases from the Canadian Heart Health Initiative (CHHI)-Dissemination Phase, a nationwide chronic disease prevention initiative that took place between 1994 and 2005. Drawing on an analysis of health policy documents and key informant interviews from three provincial CHHI projects, the authors highlight the challenges to incorporate health-promotion strategies oriented toward collective approaches to health within variably "individual" oriented policy climates during a time of health reform. In doing this, the authors uncover a "politics of scale" where researchers developed very different strategies to advance chronic disease prevention within a contested political terrain. What emerged were strategies unique to provincial context. Understanding the politics of scale within health policy development provides insight into how health-promotion strategies should be shaped to achieve maximum effect.