Excellent example of the need to work on both "lifestyle" and
"structural" change. Yes, I would be very interested in hearing of other
"best practices" examples of the need for both lifestyle and structural
strategies.
Joe

Ken Hoffman wrote:

>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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