In response to Veli Rautio's question (forwarded to Dennis, who is not on
the CLICK4HP list):

> Mr. Dennis Raphael,
> "This is surely the death knell of HP in Canada. I doubt you will hear a
peep out of your click4hp subscribers."

What exactly do you mean? Please explain your reasoning!
With respect, Veli Rautio

the following response was received from Dennis Raphael <[log in to unmask]>:


Health is determined in small part by risk behaviours.  And of course, 
environments affect health behaviours.  But these health behaviours 
contribute only a small part to health status.  Health promotion always 
recognized that the primary determinants of health involved actual living 
conditions.  Living conditions such as shelter, income, food, housing and 
others (see Ottawa Charter for Health Promotion).  Health promotion was 
about democratic control and public participation over the DETERMINANTS of

health.

Instead we see health authorities concluding that the primary health 
problem we face is that uneducated people -- usually poor, Aboriginal, 
youth, women, gay and bisexual, or recent immigrants -- are eating 
(substitute smoking, drinking, watching TV) themselves to death.  When was

the last time a health promotion agency --or health unit -- asked people 
what THEY thought were the primary determinants of health?  We did -- in a

number of community quality of life studies -- and you know what, 
vulnerable people never asked for help not being fat, or cutting out 
smoking, etc.  They wanted jobs, respect, decent housing and food, and a 
good chance for their children.

However, the Government of Canada now tells us that health promotion is 
really only about risk behaviours and helping people to change these risk 
behaviours by building supportive environments -- in other words if you 
smoke we will make life miserable for you and if you are fat, even more 
so.  And hundreds and hundreds of "health promoters" in Canada and 
elsewhere are putting out the message to the public that these issues 
related to living conditions are unimportant and trying to convince 
already marginalized people that they are the cause of their own health 
misfortunes.  At the same time these governments make everyday living more

and more difficult for those who are not in the top quintile of income 
earners. See the problem?

Of interest:

Social Determinants of Health: Canadian Perspectives
General Editor, Dennis Raphael, Foreword by Hon. Roy J. Romanow, P.C., 
O.C, Q.C.
http://www.cspi.org/books/s/socialdeter.htm

Staying Alive: Critical Perspectives on Health, Illness, and Health Care 
(coming Feb. 2006)
General Editors, Dennis Raphael, Toba Bryant, Marcia Rioux, Foreword by 
Gary Teeple
http://tinyurl.com/cojcf

Dennis Raphael, Ph.D.
Associate Professor & Undergraduate Programme Director
School of Health Policy & Management
Atkinson Faculty of Liberal & Professional Studies
York University
4700 Keele St.
Toronto ON M3J 1P3
Ph: 416-736-2100 ext. 22134
Fax: 416-736-5227
E-mail: [log in to unmask]
Website: http://www.atkinson.yorku.ca/draphael

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