sorry, but I don't see the evidence of lifestyle approaches -- either upstream
or downstream -- being effective.  If you expand lifestyle to empowerment and
community participation models, then I am with you. In contrast I see how public
health's preooccupation with "lifestyle" has taken social determinants issues
right off the table, and created an atmosphere of victim blaming. We have no
idea of what  low income people make of all this.  I argue that they end up
blaming themselves for their life situations and poor health. The BC model still
has as its goals the changing of health-related behaviours.  This has a strong
component of  expert-driven paternalism and  has a strong potential to be even
more disempowering to marginalized communities.

My experience in Ontario with the heart health community has been one where the
poor are seen as "diseased" with their disease being their not wanting to listen
to upper-middle class professionals who believe -- dogmatically -- in the
healing power of exercise, fruits and vegetables, and non-smoking.  This in
spite of the limited evidence as to the efficacy of these kinds of programs..

Please read Michael's Fitzpatricks "Tyranny of Health" by Routledge.  You will
never think the same again about these issues,  Sadly, it may come down to one
of the other.  Right now we have one approach.  Its time for some of the other!

dr.

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