Introduction

Canada is commonly seen as a progressive country with its multicultural model, its tolerance for diversity and its sensitised human rights legislation (Elliot and Bonauto, 2005). Although Canada can be commended for the progress it has made in each of these areas, one need only scratch the surface to expose the inequalities and inequities that lie beneath.

Lesbian, gay, bisexual and trans (LGBT) populations are a clear example of a people who were once unrecognised culturally, neither tolerated nor accepted socially, and completely devoid of inclusion in human rights legislation and its ensuing protections in Canada. The last 45 years have seen momentous shifts in each of these areas, so much so that it has produced a near utopian veneer that serves to mask continuing forms of oppression and micro-aggressions that simmer from below. Despite the elevation of Canada's LGBT communities as a recognised population that makes up part of the multicultural fabric of the land, with near full recognition of human rights protection in legislation, LGBT people fall woefully behind the general population with regard to health and wellbeing. HIV/AIDS continues to be the illness-based focus that the Canadian state gives varying degrees of support to, barely recognising the broader health and wellness issues, needs and concerns that affect LGBT Canadians.

Two models have informed health policy in Canada (with international influence), which have progressively focused on diversity, given the multicultural make-up of the country, with varying success:

• • the world-renowned ‘Health Promotion’ model (Government of Canada, 1974), which focused on achieving a healthy lifestyle;

• • the internationally regarded Population Health model (Health Canada, 1998, 2001), which more explicitly identifies diverse populations and attempts to address the social determinants of health (SDoH) (Public Health Agency of Canada, no date).

Neither have completely addressed LGBT people as a population that experiences health inequalities: the former was critiqued for its lack of attention to structural differences; and the latter fell short, due to its over-emphasis on determinants of health at the expense of ‘social’ aspects – becoming mired in unsatisfactory notions of ‘health cause and effects’ (Orsini, 2007).