3 thoughts:

1) Public health workers, for lack of a better term, are not as cohesive a group
as social workers, teachers and others who take more proactive stances against
poverty, homelessness and other health matters. All too often, the ability of
public health to speak out on social policy issues as a unified group is
hindered by turf wars between public health disciplines. Moreover, public health
professionals are not united under strong unions, such as teachers. The public
health workforce is comprised of a mixture of professions --- nurses,
dietitians, health inspectors, health promoters.....represented by different
unions (e.g., in Ontario -- ONA, CUPE, various municipal workers unions) and
associations. This makes it difficult to maintain the level of protection and
autonomy needed for public sector workers to take proactive stances on the
issues that matter.

2) Much more work (along the lines that Dennis and others have initiated) needs
to be done to educate the media and general public about the fact that public
health community is a legitimate and credible source of opinion on social policy
issues. During my stint as  President of the  Ontario Public Health Association,
I had a limited (and I emphasize the word limited) degree of success in raising
awareness of the health impacts of regressive social policies. For example, two
op-ed pieces I wrote about the health impacts of  homelessness and child poverty
were published in the Toronto Star. All too often, however, I experienced
frustration in getting the media to pay any attention whatsoever to OPHA's
stance on these and other issues. It seemed as though the only time they were
interested in speaking to us was when a communicable disease outbreak took place
somewhere.

3) I'm glad to hear that Dennis's workshop generated some interest among
participants at the CPHA conference, but I've come to the sad conclusion that
the majority of public health practitioners know little and care less about the
impact of poverty on health.

Solutions?


"Mollie E. Butler" wrote:

> Denise thank you for raising these concerns and calling for a dialogue. It
> is disconcerting that health professionals who previously would have spoke
> out regularly on issues related to poverty and health feel they have been
> silenced.  I believe that many public health professionals have been
> silenced by new governance structures.  I too am concerned when it spills
> over into one's role as a citizen.
>
> I live in Victoria, BC and am an independent consultant so I caution that I
> am not speaking from direct experience as a public health worker. However, I
> have been on the Board of the Public Health Association of BC (PHABC) for
> the past seven years and speak regularly to colleagues around the province.
> Recently the PHABC did a report called "Layers of Change: the status of
> public health in BC under current governance structures" [A pdf copy is
> available on our website www.phabc.org.]  Colleagues across Canada tell me
> that our findings reflect what is happening in their provinces as well.
>
> Perhaps the silencing has not been deliberate but a by-product of the many
> changes. In particular when one considers the dominance of the acute care
> institutions in the regional structures. My observation is there is a patchy
> understanding in our current health system of the need for political and
> collective action.  As well, the skills to act collectively within
> communities and regions are not always what we would hope they are.
> Capacity development is needed, we have not yet reoriented the system,
> although we have reshuffled the deck.
>
> The focus of the public's debate (thanks to the media's need for
> sensationalism) is dominated by acute care and home care.  The only time
> that is given to public health is when there is a crisis (i.e., Walkerton,
> Ontario).  In BC, Regional Health Boards are having to deal with the
> shortage of doctors and nurses. They are not taking enough time to address
> or move towards health promotion or issues to do with poverty and income
> impact on the population's health.  Recently in one Health Region doctors
> were given an additional $10 million and in that same region the entire
> budget for public health is less than 10 million. .  Hysteria was almost
> created in the community with the "doctors' crisis". No one questioned the
> imbalance of spending.
>
> There is concern that funding for public health has been eroded.  A recent
> report from the Okanagan Similkalmeen Health Region on children 0-5 years of
> age found that only 2% of the Health budget was going to public health.
> [Some in government may argue this point.]
>
> As we all know the media generally do not accurately reflect needs within
> the health system, particularly in relation to public health.  Pollsters
> seldom question the erosion of public health dollars in the overall health
> system. The only time public health issues are given any time is when there
> is a crisis or another vaccine to give out.
>
> In BC most public health services focus on young children and families.
> Protection and early intervention as opposed to healthy development of
> children, families and communities dominate the provincial government's
> agenda.  Public health dollars are split between the Ministry of Health and
> Ministry for Children and Families.   The Ministry for Children and Families
> direct 80% of spending which explains partly why there is such a dominance
> on children's issues.
>
> The connect to municipalities in relation to their role in public health is
> also at risk under our current governance structures.  For example, in this
> province the Associated Boards of Health use to link to the Union of BC
> Municipalities (UBCM).  To the best of my understanding there is no formal
> link between the new Regional Health Authorities and UBCM.   Who then speak
> about the public's health locally?
>
> In BC the voice for public health is far too dependent on volunteerism.  The
> PHABC (as do many other provincial public health associations) exists almost
> entirely on volunteers which severely limits the ability to provide
> leadership, support, advocacy, etc.  Public health networks that connected
> health professionals have been severed making communication across regions
> challenging and generally limited to who one knows.  Membership in our
> public health association has decreased.  We hope to regroup this year as
> there is evidence that colleagues are interested in reconnecting. We have
> already began to plan how and are taking action to strengthen our collective
> voice.
>
> The PHABC Board has recommended to the CPHA that a funding envelope should
> be developed by the federal government for public health.  Provinces and
> Territories should be required to demonstrate what they are doing with these
> dollars to promote the public's health.
>
> I sent your "CPHA Motion" email around to colleagues in hopes that public
> health colleagues will use their citizen's voice to speak out during the up
> coming political debates.  Stronger leadership and a LOUD and CLEAR advocacy
> voice is needed right across Canada for public health issues, particularly
> in relation to poverty and low income. We must speak up for social justice
> for all Canadians not just the public whose voices are represented through
> the media.
>
> Thanks again for starting this discussion.  Look forward to comments from
> others.
>
> Regards,
>
> Mollie E. Butler
> President
> Public Health Association of BC
> www.phabc.org
>
> ----- Original Message -----
> From: "d.raphael" <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Tuesday, November 07, 2000 8:48 AM
> Subject: Discussion
>
> > Should Public Health Workers be Able to Address the Public's
> > Health?
> >
> >   I recently had the opportunity to give a "How Does Poverty
> > and Low Income Affect Health" presentation to close to 100
> > health workers at the Canadian Public Health Association
> > Annual meeting in Ottawa.1 This presentation had previously
> > been given to Health Canada staff, members of the social
> > development sector, and a number of community forums in
> > Toronto. This was the first time however, that the audience
> > had been mainly public health workers. The reaction of these
> > health workers to this presentation forms the basis of this
> > commentary.
> >    After outlining the indisputable evidence concerning the
> > adverse effects of poverty and low income, I usually consider
> > the ideological, political, institutional, personal and
> > attitudinal barriers to health workers raising issues of
> > poverty and income. I recognize that it is difficult for
> > health workers to raise issues within an institution that
> > contradict the "party line" that may be emanating from
> > government officials and institutional mandarins.
> >     Public health workers were in complete agreement with my
> > thesis that poverty and low income pose direct threats to the
> > health of Canadians. Indeed, no one suggested that pursuit of
> > neo-liberal policies of increasing economic inequality,
> > weakening social infrastructure and weakening social cohesion
> > was good for population health! I was not prepared however to
> > hear the stories in the question and answer period following
> > my presentation of how health workers feel they are unable --
> > in addition to raising the issue within their organizations --
> > to raise these issues in their role as private citizens.
> >    I was repeatedly told that public health workers cannot
> > speak out on how poverty and low income affects health in
> > letters to editors, to local elected representatives, or even
> > to fellow citizens.  To do so would risk advancement in their
> > careers and even the future of their careers in public health.
> >         I was stunned to hear this.  As I stated at the next
> > day's Annual General Meeting in support of the CPHA resolution
> > concerning the effects of poverty on health, "It is
> > frightening that those who know the most about the health
> > effects of poverty -- public health workers -- feel unable to
> > raise these issues in their role of citizens." I see no such
> > reticence among teachers, social workers, and others in
> > publicly raising issues they see as affecting the well-being
> > of the public.
> >    Considering the growing literature on the health effects of
> > poverty and low income on health, and the increasing incidence
> > of poverty in Canada, thes issue of the ability of public
> > health workers to participate in societal debate as citizens
> > demands attention.  Perhaps the passing by CPHA of its strong
> > motion concerning the effects of poverty upon health will help
> > stimulate this discussion.2
> >
> > References
> > 1. Raphael, D. Addressing Health Inequalities in Canada.
> > Presentation given at the Annual Meeting of the Canadian
> > Public Health Association, October 24, 2000. On line at
> > http://www.utoronto.ca/qol/cpha2000.pdf
> > 2.   Reducing Poverty and Its Negative Effects on Health.
> > Resolution Adopted by the Canadian Public Health Association
> > at the CPHA Annual Meeting in Ottawa, October 25, 2000
> >
> > -----------------------------------------------------------
> >
> >
> > Our Web Sites have information and reports from all of our
> > Quality of Life Projects!
> > http://www.utoronto.ca/qol     http://www.utoronto.ca/seniors
> >
> > *************************************************************
> > In the early hours I read in the paper of epoch-making
> > projects
> > On the part of pope and sovereigns, bankers and oil barons.
> > With my other eye I watch
> > The pot with the water for my tea
> > The way it clouds and starts to bubble and clears again
> > And overflowing the pot quenches the fire.
> >
> >  -- Bertolt Brecht
> > **************************************************************
> >
> > Dennis Raphael, Ph.D.
> > Associate Professor
> > Department of Public Health Sciences
> > Graduate Department of Community Health
> > University of Toronto
> > McMurrich Building, Room 308
> > Toronto, Ontario, CANADA M5S 1A8
> > voice: (416) 978-7567
> > fax: (416) 978-2087
> > e-mail:   [log in to unmask]
> >
> >
> >
> >
> >
> >
> >
> >
> >
> >
> >

--
Brian Hyndman
The Health Communication Unit
at the Centre for Health Promotion
University of Toronto
100 College Street, Rm 215
Toronto, ON  M5G 1L5
Tel: 416-978-0586
Fax: 416-971-2443
[log in to unmask]
www.utoronto.ca/chp/hcu