Greetings!

When I posted a message to this list on Monday September 13th about the
Ontario minister of health's announcement of healthcare reform, I noted that
health promotion had been left out of the discussion of 'health'.  Perhaps
we are becoming used to how health promotion is being ignored, or focused on
a smaller part of the field - on lifestyle and individual choice. There has
not been a debate or much dialogue on what we see as being encompassed by
health promotion, or what is ignored. I'm encouraging CLICK4HP subscribers
to take a look at recent messages on another listserv, with hopes that we
can start a similar exchange here.

For the past 3 days the Social Determinants of Health listserv (SDOH), which
Dennis Raphael moderates, has been engaged in an interesting and far-ranging
dialogue around ignored determinant(s) of health, and what is meant by
'social determinants'.
The discussion began on Monday September 13th, when Dr. Alex Clark of U of
Alberta posted the following notice about a  Disussion paper on Class and
Health in NEJM:

"Useful paper on class and health in the US from the latest addition of the
New England Journal of Medicine
Issacs, SL and Schroeder SA (2004) Class - The Ignored Determinant of the
Nation's Health. New England Journal of Medicine 351: 1137-1142.   See link:
http://content.nejm.org/cgi/content/short/351/11/1137?query=TOC "

That posting generated many more on other 'ignored' determinants of health -
policy, environment and systemic issues - culminating in a debate on the
term 'social determinants' versus 'societal determinants'. As Barbara
Starfield put it:
"The problem is in the term 'social determinants'.  Does it include or
exclude environmental determinants? Health services determinants? As is
increasingly recognized, social determinants usually assume an individual
model of influences rather than a societal one. According to dictionaries.
'social' is usually defined as something to do with interrelationships
between the individual and the group. This is the point of all of this
discussion---that 'social' does not mean 'societal' and it is the latter
which is generally neglected in this turn toward 'social determinants'... "

The discussion continued on definitions, with exchanges on the breadth of
the term, with Dr. Raphael referring to his own recently published book on
Social Determinants of Health, indicating his agreement that 'societal' was
more encompassing, but that since Marmot et.al and the World Health
Organization (WHO) have adopted the social determinants of health as the
term, it would be best to use it.  Additional comments looked at the use of
language, of bridging divides between academic and professional and
community, and encouraging the discussions of determinants in learning
environments.

The lively discussion has been an excellent lead-in for a critical response
to an article in the Toronto Star on the Premiers endorsing lifestyle
programs (see http://tinyurl.com/6qxrp).

See the archives for September for browsing through these discussions at
http://listserv.yorku.ca/archives/sdoh.html
(look for topics titled Policy & Law as Determinant, Ignored Socio-Economic
Determinants, and Social or Societal Determinants).


Your thoughts, ideas, comments and concerns are welcome!


Alison Stirling,
co-facilitator, CLICK4HP

To unsubscribe send one line: unsubscribe click4hp to: [log in to unmask] . To view archives or modify subscription see: http://listserv.yorku.ca/archives/click4hp.html