Hello all,
I have been very interested in the thread of this discussion. The
impressions gained by the general public of the legitimacy, urgency and
relative importance of health issues - and the way in which these issues
are framed - are shaped, in large part, by two main factors - personal
experience, and the media.  Personal experience and media tend to focus on the more sensational aspects of encounters with the health and social
services system - inability to access services, services gone wrong, public
health disasters.  Compound this with the fact that "individual
responsibility" takes on almost the status of a religion in
this society (i.e. we are all responsible for our own actions - if you are
unemployed, not eating properly, or poor it's your own damn fault), then it is easy to see why the "determinants of health" rate barely a mention in
the media.  What is given short shrift in most stories is the
analysis needed to make sense or give perspective to individual incidents
- the "but why?" questions.  (e.g. Was something like Walkerton a freak
occurrance caused by an individual who was "asleep at the wheel", or was it almost inevitable, given the cutbacks to environmental monitoring?).  There also tends to be little exploration of alternatives to the status quo (How could things be done differently?).

What can one do to start to correct this imbalance?
1) I believe it is a good idea to speak to journalism students to provide
them with a different analytical framework to use when looking at health
and social issues - one that digs deeper and looks at root causes, rather
than just stopping at individual responsibility.

2) It is also important for us to let the publishers and editors of our
news media know that people want to see this kind of analysis and in depth reporting.  The media are businesses and they need to know there is a "market" for this type of reporting because for them it means committing additional time and resources.  When you see a media outlet that does a good job, it is really important to let them know.  The Ottawa Citizen (a fairly conservative Southam paper) just did a major six story feature on the issue of the funding crisis in the schools today.  It was
comprehensive, presented good analysis, and really tried to ask the right
questions (at least, from my perspective).  I am going to write to tell
them THAT is what I want to see more of!

3) Finally, how do we interest the media in stories that illustrate what we
mean by "determinants of health"?  Most popular media find long policy
discusions intolerable;  the best way to illustrate what we mean by a
determinants of health approach is to illustrate with programs that take
that approach (and preferably programs that tell interesting "people"
stories).

An example that I often use is with a program we developed a few years ago on the issue of winter sidewalk safety.  Briefly, one winter
three of the seniors who were participating in programs at our CHC had
serious falls on icy sidewalks near our Centre.  The other seniors in the
group were very concerned about them and wanted to provide them with
personal support.  But then the discussion turned to talking about the
deplorable condition of the sidewalks themselves.  The seniors, working
with our community developer, organized a health promotion initiative
around prevention of falls on winter sidewalks that had two foci:  1)
learning about safe individual practices (e.g. use of special canes and
grippers to go on bottoms of boots); and 2) a healthy public policy
campaign to work with the City to actually change the way they maintained the sidewalks.  The seniors group achieved successes in both areas.

You will, no doubt, have your own examples of programs that are based on a determinants of health approach, and which will illustrate how working at the individual level is necessary, but not sufficient, to create the sorts of action we want.  Perhaps it would be a good idea to collect some useful examples of these kinds of programs to help people make these arguments to decision-makers and the media (or perhaps this has already been collected???).

An interesting and important challenge for us all to work on...

Ken Hoffman
Director, Community Health Promotion
Sandy Hill Community Health Centre

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