I too could not resist, particularly with respect to the comments on
'choice.'
I firmly believe that with the issue of food (as well as other issues)
we need to acknowledge that 'choice' can be extremely limited, at times
leaving no real choice once all the options are considered. I think that
this is where a personal or more in-depth understanding is critical
before statements are made about an individual choosing unhealthy
options. There are so many external factors that need to be considered
that impact upon this apparent 'choice.' On a limited budget,
particularly when you know you will not have enough food to keep your
belly full, high fat foods become more attractive. French fries and
potato chips are cheaper and tend to just sit in my stomach for hours.
Perhaps the nutritionists could explain this one. Is it the oil?
Chocolate bars seem to work too?
One could argue that you can go to the grocery store and buy a bag of
potatoes for the cost of an order of fries but then we get into access
to a kitchen to make a better choice and broil your potato, let alone
the access to get to the grocery store and carry your groceries home,
including that 5lb bag of potatoes! And we can't forget about trying to
buy protein, way too expensive except for a can tuna which you can get
for 99 cents (you'll need that can opener though and tuna gets really,
really boring day after day). So we're left with carbs and fat, let
alone not much variety to get our RDA'S, leaving us no energy to even
care, let alone exercise!
The choice is sometimes really no choice at all. I also believe it is
important to acknowledge that people are their own agents but to state
that 'We are agents who act in a manner to improve our health or who
choose "unhealthy" options' implies that we purposely choose 'unhealthy'
options when really, there is sometimes not much choice at all. We need
to look in-depth at why these apparently 'unhealthy' choices are made
before making judgments about someone's 'unhealthy' choice. It may
actually be the best perceived choice at that time.
Whew!
Lynn Lavallee
-----Original Message-----
From: Health Promotion on the Internet [mailto:[log in to unmask]] On
Behalf Of Glen Brown
Sent: Wednesday, January 08, 2003 6:00 PM
To: [log in to unmask]
Subject: Re: community capcity for healthy eating
I just can't resist wading in to this one...
I think Jacquie's note that people are their own agents is a crucial
one. BUT that should prompt us to acknowledge their role (and our own)
as agents for political change. Shouldn't our programming (including our
health promotion programming) make that front and centre? Why do so many
'health promotion' materials, intended to educate the communities we
work with, not even mention that poverty (and pollution, and unhealthy
working
conditions..) are the primary determinants of health? If it's supposed
to be a secret, it's not a very well kept one.
Here's an illustration from my own recent experience. I worked on a
project a while back looking at heart health issues for multicultural
communities. We did a literature review, some key informant interviews,
and some focus groups with people from different ethnocultural
communities in Toronto.
Everything we read from the literature, and everybody we interviewed
pointed to poverty, stress, isolation, etc as the central culprit in
poor heart health.
The focus groups were fascinating: their level of knowledge about 'good'
vs 'bad' food was quite high. In fact, I was surprised at how frequently
people expressed anxiety about contaminants and additives in food. (Not
a concept the heart health literature had acknowledged).
They knew about smoking. They knew about exercise. (One woman left me
speechless when she asked why the pamphlets suggested a daily walk when
the radio was warning people to stay inside because of smog. I wished I
had the power to hire her as a health promotion educator.)
But what they really wanted to talk about was the stress in their lives.
Did I understand, they wanted to know, how little time they had for
shopping and cooking? Did I understand that after a 12 hour taxi shift
they didn't really feel like a jog? Did I understand that their kids
were in danger of dropping out of school because the new curriculum was
so daunting? That gulping a Big Mac down at lunch was really, really,
really the least of their worries?
They told us all of this with humour, patience and remarkable
generousity of spirit. I wanted to let them know that, yes, I
understood. And that the great group of health promoters and public
health folks I was working with understood. (They really did - the group
I was working with worked with disadvantaged people every day, and they
understood the determinants of health with a passion).
And then I looked at the heart health brochures. Eat your vegetables,
quit smoking and go for a walk. Or it's your fault. Not a word about the
primary causes of heart disease that everybody - the researchers, the
health promoters, the service providers, the people in our focus groups;
everybody! - knew about. I wondered if this didn't border on contempt.
The person who first started this exchange, so many emails ago, asked
about community capacity. I wonder if part of building capacity is
building awareness (or, more accurately, validating the awareness they
already have) that social conditions are the biggest keys to health and
that communities can mobilize to affect those social conditions. That
doesn't preclude messages about individual behaviour change, but I think
it should preceed them.
Glen Brown
Glen Brown & Associates Consulting
488 Parliament Street, #1
Toronto Ontario M4X 1P2
T: 416-892-2286
F: 416-966-1362
E: [log in to unmask]
-----Original Message-----
From: Health Promotion on the Internet [mailto:[log in to unmask]]On
Behalf Of Jacquie Poitras
Sent: January 8, 2003 4:36 PM
To: [log in to unmask]
Subject: Re: community capcity for healthy eating
I recognize that health and healthy eating have many social
determinants. Every choice we make is based, in part, on societal
factors, dis/advanatage, peer group, consumerism--you name it. But in
the end, it is us as individuals who make decisions about our lives. We
are agents who act in a manner to improve our health or who choose
"unhealthy" options.
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