I could not agree more with my distinguished colleague Dr. Lawrence Green!
While Dr.Raphael has reiterated what we have known for over 100 years that poverty is related to health and many other societal ills, we
cannot state unequivocally that  lifestyle planning does not have a place in our health planning models of modern society. Please note that
our upcoming  FORUM on ECONOMIC INEQUITIES AND HEART HEALTH; FROM RESEARCH TO POLICY, PLANNING AND PROGRAMMES will deal with the exact issues
raised by Dr. Lawrence Green. Check out www.yorku.ca/wellness for more information on the FORUM.
Joseph

Ron Dovell wrote:

> I brought up the Poverty/Lifestyle debate within a group of planners,
> mainly within my current health region. Dr. Lawrence Green, author of
> the Precede-Proceed model and several texts on health planning, has
> offered comments and permission to repost on this listserv ...
>
> > Dear Ron, nice commentary. I think you are right to draw the discussion of the upstream vs downstream determinants back from
> > the brink of potentially self-defeating political rhetoric to a recognition that we must address all determinants, not just the upstream
> > (distal), not just the downstream (proximal). The upstream-downstream debate, when pursued as an either-or choice is as
> > self-defeating as the prevention vs medical care debate. We are not going to gain resources for prevention (upstream) by taking
> > resources away from the sick people who need medical care.
> >
> > You also correctly note that contemporary health promotion planning and evaluation models are increasingly ecological in their
> > recognition of social circumstances and other more distal determinants that must be incorporated as targets in the focus of
> > intervention efforts. But most local health units have little authority and fewer resources to address most of the more distal social
> > determinants. They have always had and always used to great advantage their authority and resources to address the distal and
> > proximal physical environmental factors (chlorination and fluoridation of water supplies, regulation of emissions and water
> > pollutants, solid waste management, control of vectors and food safety), as you well know from your own sanitation background.
> > But to take just two of these, food safety protection upstream on the farms and meat packing plants is no substitute for restaurant
> > inspections and other downstream interventions to prevent contamination of otherwise safe food, or water coliform testing to
> >
> > Raphael does us a service by encouraging more authority and resources for local health units and for provincial and federal health
> > promotion programs to give greater attention to upstream social environmental determinants, as public health has had in
> > addressing upstream physical environmental determinants. He might unwittingly do us a disservice if his arguments are taken as
> > justification for taking resources away from our evidence-based, downstream interventions on lifestyle. Let us use the arguments
> > to expand the scope of our programs, not to disparage the sincere, scientifically grounded and people-focused lifestyle intervention
> > efforts of practitioners in local health units, medical care, school, and workplace settings.
> >
> > Much of the economic, poverty-focused argument re upstream social determinants must be taken outside the public health sector
> > to the broader political arena. Blaming public health practitioners for doing the jobs they are resourced and authorized to do is too
> > much like the victim-blaming inherent in an exclusively individual behavioural approach to lifestyle change. At least since the
> > Ottawa Charter and the Epp Report in Canada, if not sooner there and in other countries, health promotion has given increased
> > attention to the social circumstances surrounding individual behaviour, as you note with respect to adolescent risk behaviours, and
> > as we can demonstrate more broadly with the great public health success stories of the twentieth century: smallpox eradication,
> > polio nearly eradicated, a 50% reduction in smoking, and similar reductions in cardiovascular deaths, stroke deaths, and
> > automobile crash deaths in the last third of the century. If the only hope for change in health is income redistribution, t
> >
> > These are important discussions Ron and Dr Raphael. Thanks for weighing in. I like the BC preliminary Model attached to your
> > e-mail, but would give a little more prominance or explanation to the "Intersectoral Partnerships" dot point in the "community" box
> > to acknowledge the need for such partnerships to address the important determinants that Dr Raphael emphasizes. --Larry Green
> >
> text of an email received from Dr. Lawrence W. Green
> posted by
> --
> Dr. Ronald A Dovell
> Health Planning Researcher
> Interior Health
>
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