Dr. Raphael,

You ask: "Do you have to demonstrate costs effectiveness to justify
providing women with opportunities for gainful employment, for children to
have healthy and happy early childhoods, and for citizens to be free from
violent and sudden death in their streets due to crime?"

With all due respect, I would answer "yes."  We in the public health sector
can't simply write off those who will only be moved by such justifications
(perhaps not only cost effectiveness, but certainly cost-benefit analyses).
I agree that these efforts (ensuring opportunities of employment, health,
and safety) are worthwhile in their own right.  But to ridicule (that seems
to be the sprit of your question: "I could go on!") those who may disagree
with us will likely ensure that public health continues to receive only the
scraps.  We must be prepared to justify what we do to all parties--from
those moved primarily by social justice arguments to those who will only
hear the economic case.

Best regards,

Mark Hansen
Boston, MA




From: Dennis Raphael <[log in to unmask]>
Reply-To: Social Determinants of Health <[log in to unmask]>
To: [log in to unmask]
Subject: Re: Looking for info re: expenditures on determinants of health
Date: Mon, 29 Nov 2004 17:37:00 -0500

The problem with the question about "spending expenditures" on
determinants
of health assumes that these determinants of health can be strengthened
through "program" spending which targets a determinant isolated
from the
context within the determinant -- and related determinants -- exist.

Having said that, an economic case can be made for spending on childcare,
education, and reducing poverty through increased minimum wage, and
increased social assistance rates.  Contact Martha Friendly, U of T, re:
childcare and the Canadian Council on Social Development re all the other
stuff!
------------------------------------------------------------
However, a more fruitful -- but more problematic from a "public
health"
perspective -- is to consider how broad patterns of government spending and
approasches to public policy impact upon health and well-being or in the
jargon, population health.

Consider "government spending" in the US, UK, Canada and the
Nordic
countries (Sweden, Norway, Finland, Denmark) in terms of early childhood
education and care (daycare).  Then consider the educational achievement
scores typical of each nation, its crime rate and spending on police and
jails, the participation of women in the work force, the percentage of
single parents living in poverty, or its general level of health care
spending and disease incidence. What is the relationship?  There is little
doubt that life is better for the average person in social democratic
political economies and a lot worse for people in the "Anglo-Saxon
liberal
economies".  See references 4 and 5 below.

Sherry Phipps has spent a lot of energy contrasting health status among
women between Norway and Canada and relating these to public policy
approaches to families.

I guess the bottom line is:  Do you have to demonstrate costs effectiveness
to justify providing women with opportunities for gainful employment, for
children to have healthy and happy early childhoods, and for citizens to be
free from violent and sudden death in their streets due to crime? I could
go on!

CPHA and many other health researchers need to broaden their thinking to
include these broader concepts of societal well-being, social justice, and
social welfare!

see

1. Why We Need a New Welfare State
by Gosta Esping-Andersen, et al (Paperback - October 1, 2002)
(Rate this item)
Other Editions: Hardcover | Paperback

2.   Social Foundations of Postindustrial Economies
by Gosta Esping-Andersen (Paperback - March 1, 1999)
Avg. Customer Rating:
(Rate this item)
Other Editions: Hardcover | Paperback

3.   Welfare States in Transition : National Adaptations in Global
Economies
by Gosta Esping-Andersen (Editor) (Paperback - July 31, 1996)
Avg. Customer Rating:
(Rate this item)
Other Editions: Hardcover | Paperback

4. The Political Economy of Social Inequalities: Consequences for Health
and Quality of Life (Policy, Politics, Health, and Medicine Series)
by Vicente Navarro (Hardcover - September 1, 2000)

5. Political and Economic Determinants of Population Health and Well-Being:
Controversies and Developments (Policy, Politics, Health, and Medicine
Series)
by Vicente Navarro, Carles Muntaner

6. Pay the Rent or Feed the Kids by Mel Hurtig.  Do we need a cost analysis
on this?  :-)

dr

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