Within Canada, reaction to the Lalonde Report was mixed. For provincial health ministries working diligently to develop and control the curative system, the document posed a challenge. How could they balance the ever-increasing costs of care with the new emphasis on prevention and health promotion? For the emerging environmental movement, the report provided useful support but little guidance on how to create multisectoral approaches to pollution problems. And for some public health experts, the focus on personal responsibility for lifestyle choices seemed like “victim blaming” in instances where a citizen’s behaviour reflected his or her social class, employment status, educational level or ethnic origin. Within the Department of National Health and Welfare, some staff took up the challenge and pushed for the creation of the Health Promotion Directorate, which united employees in the non-medical use of drugs group with those working on anti-smoking and anti-drunk-driving initiatives. With very limited funds as a result of federal budget cuts in 1978 and 1979, the new directorate worked with its provincial and municipal counterparts and leading non-governmental organizations, such as the Canadian Public Health Association, the Non-Smokers’ Rights Association and the Heart and Stroke Foundation, to develop crosscutting health promotion initiatives that focused attention on healthy lifestyle choices. But would making healthy lifestyle choices effectively lower health care costs?