ontreal, the poverty capital of Canada! For decades, Montreal has held this sad distinction, as year in year out, one third of its population falls below the Statistics Canada low-income cutoff. Moreover, many problems related to social inequalities are concentrated in the densely populated neighbourhoods in the city centre and the north-south corridor, thus forming a geographic “T” of poverty which successive censuses confirm with discouraging consistency. Unemployment, social assistance and a low percentage of higher education round out the picture of economic poverty. That was the situation in the city when the Direction de sante publique (DSP) de Montreal was created in 1992. Through its programs and interventions on public policies, can public health help reduce poverty in a population? Can poverty’s impact on the poor be reduced or can poverty even be prevented? This was the challenge the DSP set for itself from the outset and which has appeared one way or another in its policies and programs ever since. The DSP’s concerns are not new. Considering the history of public health in Montreal, 1 one sees that around 1850 there were already concerns for women and young children in underprivileged environments. Young women there were dying of postpartum fever and children were dying of various infections, especially respiratory. Over time, the causes of death change but the disparities in the face of disease and death remain. In fact, the DSP has no choice but to intervene regarding poverty and social inequality if it truly intends to improve the population’s state of health. With the great physicians of the 19 th century (Chadwick, Virchow) having shown the way, modern scientific literature – of which the Black report 2 is a fine example – confirms the significance of the problem in terms of higher rates of incidence, prevalence and severity of disease and mortality. Whether cancer or any other chronic disease, trauma, infections or mental health, the disadvantaged almost systematically experience poorer health, and in the rare circumstances for which their health indicators appear better – as for instance with breast cancer incidence in Montreal – these do not translate into lower mortality rates. In addition, the Whitehall studies 3 also showed that health inequities were graded across the various social classes categories. Social inequalities were not only determinants of poverty but also determinants of the health of populations.