I concur completely -- when are people going to recognize that lifestyle alone is not the only determinant of health -- poverty, education and all the others have just as great an impact -- we are all talking about eating healthier but has anyone looked at the price of food these days -- some people cannot afford to change how they eat literally.  

Kim Cheeks, Health Promotion Communication Consultant
Central Regional Integrated Health Authority
3 Bell Place, Gander,  NL  A1V 2T4
Tel: (709)651-6239  *  Fax: (709)651-3341
email: [log in to unmask]


>>> [log in to unmask] 12/12/05 07:38PM >>>
Dennis Raphael's dialogue below, expresses my sentiments exactly. 
Consider that the 'real' patients voices are not being heard and  
because of this, more often than not, the message is not getting through 
to policy makers. There are many who purport to speak on behalf of their 
constituents, but actually have no actual insight into the daily 
challenges that many face.  To add further, while healthy 
lifestyles/behaviours affect many, it is not the panacea for all. As a 
matter of fact, the healthy lifestyle message has moved beyond the 
intended message and has become a burden to many.
A prime example is that of our cancer populations and I encourage 
everyone to consider that, no, the patient did not receive a cancer 
diagnosis due to weight issues, smoking or any of the current concepts 
that add to the existing burden of trying to survive. This is less than 
compassionate not to speak of a lack of understanding.
A broader recognition of all aspects of living/surviving is required in 
order to understand the issues of the communities in which we live and work.
Sandi

>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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>
>  
>

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