Ron,
Thank you for sharing Larry Green's perspective and for raising this
discussion to another plane.

I believe that we have a need to address determinants of health such as
poverty, but as Larry suggests, it takes more than just the public health
system to accomplish what needs to be done.  His comment about blaming the
victim rings true and supports the perspective I shared a couple of weeks
ago about needing to undertake constructive collaboration in the discussion
toward the goal I believe we share - improved opportunities and access to
health for all.
Joyce Fox

----- Original Message -----
From: "Ron Dovell" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Monday, March 04, 2002 3:35 PM
Subject: Public Health Practice and Poverty


> 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
>
> Send one line: unsubscribe click4hp to: [log in to unmask] to unsubscribe
> See: http://listserv.yorku.ca/archives/click4hp.html to alter your
subscription

Send one line: unsubscribe click4hp to: [log in to unmask] to unsubscribe
See: http://listserv.yorku.ca/archives/click4hp.html to alter your subscription