I think that, until we can convince people that health is something they
can participate in, and not something imposed upon them, meaningful
change cannot occur. We (western society) are simply too entrenched in
our worldview in many ways, and granting people the dignity to
participate in ways they can understand can lend a lot in terms of
confidence and dignity. This cannot happen without help.
As a person with a background in Sociology, I view the Determinants of
Health as inherently social, and that includes those Determinants that
are not obviously so, like Biology and Genetic Endowment. The first step
in meaningful change is to convince those who make decisions that, yes,
the Department of the Environment, the Department of Labour, and the
Department of Justice, as well as the rest, are just as responsible for
social and physical health as the Department of Health. Recognizing the
nigh-invisible web of interactions between Determinants and behaviours
is difficult, and will not happen without clear examples to the
respective government departments and the public we wish to help.
Good science, social and medical, demands that we examine all the facts
without preconceptions. We need to make our society (in the abstract as
well as the concrete) healthier. That is our goal, and we, as
professionals, need to work together with the less-educated and
priveleged, as well as functionaries,  to give them the tools to take
over once we are gone. The hardest things to change are customs,
traditions and rituals, because we perform them without thinking. With
respect, let's hit the streets and kick-start a few cortexes.
Happy Holidays to all.


David F. Mercer
Researcher/Analyst
Nova Scotia Provincial Health Council
1888 Brunswick Street, Suite 301
Halifax, NS B3J 3P7
Phone: (902) 424-0183

>>> [log in to unmask] 12/21/03 11:32PM >>>
I think we are all stuck in the same quandary on this list - whether
we
believe in and practice behavioural related health promotion, or
whether was
ascribe to (and speak passionately about) the social determinants of
health.

The quandary is not about the "science", although that has provoked a
good
deal of "my approach can beat up yours" over the last year. I am no
scientist, but based on the micro/meso/macro model put forward by Joe
Levy,
I the non-scientist believe that good work does - or can - achieve
results
at all levels.

The quandary, though, has to do with how the powers-that-be see either
behavioural or more systemic approaches to improving health. Our
political
leaders by and large still don't get it. They still believe in blaming
people (no matter how gently they phrase it) for their health status.
After
all, the poor often don't vote, don't make large contributions to
political
parties and don't go to too many $200 a plate dinners.

It seems the challenge to the behavioural health promoters is to avoid
being
pressured by politicians and managers into acting as if the blame game
was,
indeed, true (with all due respect to the behavioural health promoters,
you
do run the risk of becoming preachy, as I and my family have found
out).

The danger for the supporters of social determinants of health is that
the
approach threatens profound political and sometimes social values held
by
the more powerful people in our society, who have a stake in supporting
the
blame game ("I'm OK, you're not OK"). Faced with this opposition,
supporters
of social determinants of health  run the risk of becoming self-exiled
if
they assume mere imperfect mortals will never "get on board", when in
fact
some will and some won't (and the ones who will may eventually
constitute
the critical mass needed for paradigm change). So by all means preach,
but
in the language your audience can understand and - just possibly -
accept.

So if I had my druthers, I'd druther see more dialogue on how the
respective
techniques can work together to deal with the blame game - to convince
our
fellow citizens (the poor and marginalized as well as the rich and
comfortable) that health promotion is not about blame, and that
addressing
the social determinants of health is necessary as a morally, socially
and
politically more acceptable route than reinventing the Victorian poor
laws.

Unless we support the political tools and actions we already have (and
I
applaud Dennis R. for the often effective politics of letter writing
and
speaking in public) and unless we develop new ones as well, we yield
the
field to all those who use politics more effectively - particularly
the
neocons and the big institutional curative players.

A whopping good fight between the two perspectives helps sometimes -
but not
if we don't use the debates to find common or complementary ground for
action

John Butler
The Agora Group


----- Original Message -----
From: "Dorothyanne Last" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Sunday, December 21, 2003 8:32 PM
Subject: Re: discussions about poverty, trans fats, and more


> Hello and happy holidays to everyone -
> I have recently resubscribed to this listserv after a period of
absence
and
> I am discouraged to see that the discussion seems to have narrowed to
one
> between Dr. Raphael and one or two others.  There seem to be very
few
people
> on the list and I wonder if it is because, although most of us would
agree
> with the vital importance of addressing the determinants of health,
we
would
> also like to see some other discussions about different areas of
health
> promotion?  Dr. Raphael would perhaps argue all the rest of health
promotion
> activity is meaningless, but I would differ.  I have worked in
physical
> activity promotion, in healthy family promotion, and am now working
in
> injury prevention and tobacco addiction prevention.  I have seen that
we
can
> actually make a difference in the health of people with health
promotion
> measures - maybe we are not reaching everyone - but we are reaching
many.
> Without assigning blame.
>
> Is this listserv a free and open one?  Are others welcome to voice
an
> opinion without being flattened by rhetoric?  When I first subscribed
to
the
> listserv, some years ago, it was a wonderful place to hear about
ideas and
> new research and to share our challenges.  Right now, I find it
intimidating
> and barren.  I remain hopeful it will return to its former broad and
> welcoming focus.
>
> Wishing everyone a more egalitarian new year, in discussion as well
as in
> wealth.

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