Dennis,
First, thank you for connecting me, and all of us, to this important
body of information and allowing a format for discussion.

I have three things to bring to the table today.

First, I am going to be giving a presentation to a group of
"influencers" in Fresno, California next month on SDOH.  If that goes
well we will take it around to groups throughout the city.  The first
step is to educate my own committee members about SDOH.  To that end
I would like to give them a brief (no more than 10 pages) write-up
about SDOH and refer them to several references if they want more
information.

The next thing I would like to throw open to members of this
listserve is how to reconcile SDOH with an asset model of growth and
development.  Briefly, asset development focuses on peoples' and
organizations' strengths and seeks to increase that which is desired
versus focusing on what's wrong.  For over a year now I've read
postings on this site and have felt that there is much energy of
fighting against something, rather than visualizing what we really
want for ourselves and our communities, and building the new
structures that support those dreams.  

There is a strong movement in Fresno to commit to an asset model of
development for bringing about change.  For my part, I want to look
at the SDOH and for each one ask what is it we want?  So, rather than
fighting poverty, I want to enhance economic thriving for all people.
I think there is a significant difference between those two points. 
Perhaps we would then focus more on what makes people thrive. We
could even have measures of thriving on which we would focus, instead
of measures of poverty.

I'm wondering if there is anyone else in this group that has given
this any thought OR anyone that would like to muse about this subtle
shift in consciousness.

My last request is for examples of large-scale commitment to SDOH. 
We are going to work at the city level (Fresno is about 500,000
pop.).  What's working?  How are different sectors
participating/responding?  Is the work grassroots, top-down or both?  

I am very appreciative of whatever you, my fellow change-agents, have
to offer relative to any of the above.

Terry Mitchel
Professional change-agent and inspirer



---- Original Message ----
From: [log in to unmask]
To: [log in to unmask]
Subject: RE: [SDOH] Presentation - Town Hall Meeting
Date: Fri, 16 Dec 2005 21:47:40 -0500

>This is a statement by Kathy Hardill, a street nurse in Toronto,
>Ontario.
>------------------------------------------------------------
>Raise the Rates Town Hall - December 15, 2005
>
>Good evening everyone.  So good to be here tonight.  I would like to
>take a
>moment to acknowledge the participation of my professional
>organization,
>the Registered Nurses' Association of Ontario.  Joan, thank you so
>much for
>being with us tonight, but more importantly, I want to express how
>much it
>has meant to us to have RNAO's support throughout this campaign, from
>the
>moment we asked for it.  I applaud you for standing up against
>poverty and
>I thank you.
>
>I think a convincing argument has been made tonight that the link
>between
>low income and illness is strong.  It is, of course, not a new
>argument.
>19th century German doctor and pathology professor Rudolf Virchow
>said this
>more than a hundred years ago:  "All diseases have two causes:  one
>pathological, the other political."  And of course he was correct.
>
>Under the Mike Harris Conservative government, social assistance
>rates were
>deeply slashed by 21.6%.  Ten years later, factoring in inflation,
>this cut
>has become roughly 40%.  In addition, the Conservatives created
>legislation
>which made it easier to evict people and removed rent controls,
>making
>housing more expensive - and frankly, out of the reach of many
>people.
>During the same time period, federal income support programs such as
>CPP,
>WSIB and EI became significantly more difficult to qualify for.
>
>The result, over the last ten years, is an exponential increase in
>homelessness, poverty, hunger and illness.  There are many complex
>things
>in the world.  This is not one of them.  If people don't have enough
>money,
>they will be unable to afford food or housing.
>
>When the Liberals won the last Ontario election, many people believed
>that
>such regressive policies would be mitigated in some way.  But this
>turned
>out to be false hope.  The Liberals raised social assistance rates by
>a
>miserly three percent last year, which is just barely enough to be
>able to
>say they actually did it.  But it is not a meaningful increase - it's
>merely an insulting political gesture.
>Early this year, the Ontario Coalition Against Poverty began the
>special
>diet campaign.  I want to take this opportunity to say, on behalf of
>Health
>Providers Against Poverty, just what a privilege it has been to work
>with
>OCAP this past year.  OCAP ran dozens of clinics all across the city.
> They
>did so with a high degree of enthusiasm, including a massive,
>meticulously
>well organized clinic with over forty health providers on the front
>lawn of
>Queen's Park.  They took responsibility for all the work.  They
>treated
>recipients unfailingly with dignity and compassion, and they have
>advocated
>and continue to advocate doggedly on behalf of people being
>stonewalled by
>welfare bureaucracies.  So thank you, OCAP, you've been energizing
>and
>inspiring.
>
>Social assistance recipients were astonished that they could actually
>receive this additional money.  It made an unbelievable difference to
>people.  I began hearing from people who would leave voice messages
>saying
>not only "thank you for helping my family," but also "thank you for
>standing up, thank you for standing with us" in this struggle.
>
>And then, in November - the special diet benefit was cut by the
>Liberals,
>eliminating virtually all preventive, healthy diets and leaving only
>nominal benefits for those who already have serious health problems. 
>If
>you have HIV infection, you will only qualify for additional monies
>once
>you've begun wasting away and have lost a percentage of your body
>weight.
>Clearly there is no desire on the part of the government to assist
>people
>with HIV to protect their immune systems and avoid becoming ill.
>
>Further, under the new changes, what has traditionally been held in
>confidence between a person and her health provider must now be
>disclosed
>to one's welfare worker in order to receive the benefit.  If your
>food
>money depends on it, how can consent to release your medical
>information be
>truly voluntary?   Health Providers Against Poverty has launched a
>complaint with the privacy commissioner to this effect.
>
>Essentially, it comes down to this.  People on social assistance in
>Ontario
>do not receive enough money to pay rent and buy groceries.  But when
>we
>began this campaign, we never expected to prescribe the special diet
>benefit to everyone on assistance in the province.  What we want is
>for low
>income people to have enough money to survive without hunger and
>homelessness and preventable illnesses.
>
>Some people have blamed the campaign for the loss of the special diet
>benefit.  I say to those people:  how are we responsible for a
>government
>whose base rate of social assistance for a family of four is more
>than
>$20,000 below the low income cutoff?  How are we responsible for a
>government's decision to give food money to people with HIV only
>after
>they've begun wasting away?  Or to give people with heart disease - a
>condition whose treatment is heavily linked to diet - ten extra
>dollars a
>month?
>
>We are NOT responsible for those decisions.  Dalton McGuinty and
>Sandra
>Pupatello are responsible for those decisions.  A month ago, Sandra
>Pupatello admitted in The Medical Post that "Not one of us could
>probably
>safely live on welfare."  She and Mr. McGuinty can choose to increase
>social assistance rates by a meaningful amount.  If they don't, they
>are
>basically choosing who gets to be healthy and who does not.  That was
>true
>before the campaign started and it remains true.  Here in Toronto,
>for
>example, 1 in 3 children lives in poverty.  That is exactly like
>saying 1
>in 3 Toronto kids do not deserve to be healthy.  Does the Ontario
>government have the right to make that choice?  I don't think they
>do, not
>ethically.  But lest we get mired in pointless debate about the
>ethical
>obligations of governments, the more salient question is this:  do
>we, as
>people of conscience, have an obligation to challenge such criminal
>neglect
>on a massive scale?  I think we do.
>
>There is a story, sometimes called a parable, that many of the health
>providers here will have heard before.  In it, a health worker, let's
>call
>her a nurse, is sitting by a river, trying to relax, by fishing.  And
>as
>she's sitting on the riverbank, with her fishing line in the water,
>she
>notices something floating down the river.  She realizes that it is a
>person, a person in trouble, and so she jumps up and goes to rescue
>the
>person.  Then, just as she sits back down to resume fishing, she sees
>another body in the river.  She goes to rescue this person as well.
>Unbelievably, all afternoon, the bodies keep coming and she is so
>overwhelmed with rescuing people that she has no chance to go
>upstream to
>find out why everyone is ending up in the river.
>
>Me, I have been situated most of my nursing life way, way downstream
>-
>pulling bodies out of the river.  I could do that 24/7 if I wanted
>to. But
>what I have learned after almost twenty years of nursing is that the
>most
>important work I can do is to extract myself from that place,
>downstream,
>and to go upstream to fight for changes which prevent people from
>ending up
>in the river in the first place.
>
>Rudolf Virchow also said this:  "If medicine is to fulfill her great
>task,
>then she must enter the political and social life.  Do we not always
>find
>the diseases of the populace traceable to the defects in society?"
>Of course we do.
>
>And so I call on you to work with us upstream.
>
>"     Spread the word to your friends and people you know across the
>province about this crucial campaign.  Invite us to come and speak to
>your
>unions and churches and organizations.
>
>"     Write to Sandra Pupatello and Dalton McGuinty.  Tell them that
>social
>assistance rates must be raised by 40%, or the special diet benefit
>must be
>reinstated.  Do the same with your Liberal MPP if you have one.
>
>"     If you are a health provider, join Health Providers Against
>Poverty
>as we use our positions of social privilege to speak out about this
>issue.
>
>"     Give money to the driving force behind this campaign:  the
>Ontario
>Coalition Against Poverty, which does a phenomenal amount of work,
>most of
>which you never hear about, day in, day out, with virtually no
>ongoing
>sources of funding.  OCAP doesn't even have a photocopier, for
>heaven's
>sake, and yet I cannot think of any other organization that does so
>much
>critical work with so little money.
>
>"     Join us on the streets when we demonstrate our objections to
>legislated poverty - as we turn up the pressure on the Liberals to
>raise
>the rates, not by a miniscule three percent, but by a meaningful
>amount
>that will make a difference in people's lives.
>
>We have an unprecedented opportunity right now.  The last thing we
>should
>do is to give up pressuring.  We need thousands and thousands of
>people
>standing together on this issue, all across the province.  We have a
>chance
>to push this further than we ever have.  We have a chance to win a
>significant increase.  We must stand up and fight.  Please join us.
>
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