We definitely need people like Dennis Raphel and others advocating for lower
income individuals and communities with respect to health and educate health
promoters and other professions about 'victim blaming'. The 'behaviour risk
factors' do place the onus on the individual and does negate the bottom-line
that $$$ are also needed in other areas, such as providing quality food,
appropriate housing, job training, educational ... etc (the list is
endless).

In addition, the stigma of being 'poor' compounds the challenges and adds to
the stressors. I would argue that this stigma contributes to the
marginalization and resulting 'demotivation' for programs aimed at
'behavioural risk factors', such as smoking, diet, & exercise and even for
other programs such as job training and education - so it's not wonder that
many programs are ineffective. Please understand when I say 'demotivation'
it does not point the finger at the individual, but rather society. If you
can find a better word that is less accusatory please tell me...

I would also argue that to completely do away with programs aimed at
behaviour, particularly exercise programs, is not the answer. What is needed
is a multitude of strategies that somehow address the marginalization and
demotivation that society has caused in addressing poverty and health. I
would hate to see any $ or policy taken away from lower income communities.
We've already seen this done in Toronto with the implementation of user fees
at our community and recreation centres, albeit some centres in lower income
communities waive the user fee.

Imagine what could be done if these health promotion programs recognized the
other pieces to the puzzle and collaborated with individuals like Dennis to
develop comprehensive programs for communities.

Lynn Lavallee
Doctoral Student
University of Toronto
Faculty of Social Work

-----Original Message-----
From: Health Promotion on the Internet [mailto:[log in to unmask]]On Behalf
Of Dennis Raphael
Sent: March 13, 2002 6:59 PM
To: [log in to unmask]
Subject: Re: paper on Public Health Units and Poverty

Lets look at the evidence.  Lifestyle programs are ineffective, and when
delivered by middle class professionals to people who are marginalized are
patronizing and demeaning.  This is nothing new.  Penfold stated this in
1979
and it has repeatedly been noted in the health promotion, sociology, and
critical public health literature.

Low income people -- when asked what they need to improve their health -- do
not
say help with changing their diet, exercise regimens, and cutting out
tobacco.
The want decent income and neighbourhood resources to support their and
their
families health.  These reuqests go unheeded.  What is given instead is the
message that you are responsible for your own poor health -- Tough luck!  Is
it
any wonder that neo-loberal and neo-conservative governments are so keen to
push
out lifestyle messages.  Do we as health promoters need to be complicit to
these
activities?

The bottom line is that if low income and other people exercised and ate
fruits
and vegetables until they became marathon athletes they would still die
younger
from a range of diseases since numerous studies indicated that these
behaviours
do not negate the effects of stress, deprived, and isloated environments.

Health promotion is about listening to communities and enabling people to
gain
control over the determinants of health.  Putting fruits and veggies into
people's faces or getting them to run around the block is NOT health
promotion!
It is a means of gaining government support for 'health promotion' programs.

dr

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