Ok, time for my considered reply.
First of all, in Canada there is either an absolute "mental block"
(certainly among public health officials) or out-in-out "denial or
indifference" concerning the SDOH. I will not tell you how many times I
have heard Medical Officers of Health say to me: "Let's be practical" or
"We know about all of this, but there is nothing we can do." Making the
situation worse is the obsessive drumbeat of diet, exercise, and tobacco
use. Look at the Healthy Living Strategy or the Chronic Disease Prevention
Alliance. [I know this is not Health Canada staff's fault!]. It is as if
the Whitehall Studies of 30 years ago --and counting -- never happened. If
this is not a "mental block" or "indifference/denial", then I do not know
what is. And don't start me on the media. [Quebec is another situation --
let's lump them in with Europe!]
This is in contrast in the UK, where there was an active decision to run an
election campaign of 1997 around inequalities in health. Once elected, the
government has acted to carry out any number of initatives -- and I am no
fan of Tony Blair -- that are light years beyond ANYTHING happening in
Canada (or the USA) in the name of population health.
And when you add Sweden to the mix, the Whitehead taxonomy speaks to me.
Now the same data are available to Canadians, Americans, Britons, and
Swedes, yet the decision to address or not address these issues widely
differ. There are profound differences in the willingness of ruling
governments to respond to their implications. And I am of the belief that
such responses are determined by political ideology. Nevertheless, the
Whitehead typology does capture the range of responses to these ideas. Of
course it is a rational model, and political ideology determines
willingness to consider these concepts. But the terms "mental block"
"denial/indifference" resonate with me very strongly when I think of the
Canadian scene.
So, I have given away the game.
USA: Measurement, virtually no awarness-raising
Canada: Mental block and/or denial/indifference.
UK: More structured developments
Sweden: Comprehensive coordinated policy
dr
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