Hi, my name is John Macdonald and I work in Sydney.
 
I think the insights of Dennis Raphael are "spot on" and, I have to say, given the wealth of other intelligent comment from Canada, suggest an environment much more open to the massive amount of evidence internationally available that the narrow focus on behavioural change is really untenable and often serves an obvious political conservative agenda resisting movements towards greater social justice.
 
In Australia we have equity (and social gradient) issues in our face, given the low life expectancy of Aboriginal people here. (Mind you, my first expereince of dramatic social gradient was as a student in First Nation "reservations" in Ontario). We have great moral and logical difficulty in Australia to ascribe the poor health status of our own First Nation to "lifestyles" - though this is still the normal practice, alas - and once we have equity on the map it should help us to challenge the behavioural change model. Some are doing this and many of us read your exchanges avidly.
 
Several other things for anyone still reading:
 
- Men's health:
Internationally and in Australia, men's poor health status has generally been ascribed to a deficit view of men - men behaving badly (violence, beer etc) with additional interest in the medical condition of the prostate also. A social determinant of health approach allows to move beyond opinion and assumption (and a reductionist medical view)and helps us move towards an examination of what environments actually promote or hinder men's health (and promote the veryhigh rates of male suicide). It has been my experience that it requires some courage to accept this perspective for many people brought up to ascribe to the  mantra that "masculinity" is the problem. The Australian Medical Association and the Australasian Men's Health Forum are working on a national Men's Health Policy based on the social determinants approach.
 
- Primary Health Care: Alma Ata 1978 and all that it led to in the Third World preceeded Ottawa (with respect!) in its insights into the need to think health as being embedded in the social fabric and many colleagues in "developing" countries feel our overlooking of this incomprehensible.In many ways the insights of Alma Ata, though dated now, were closer to those of the social determinants than Ottawa, and more "holistic".
 
Finally and not at all modestly, most of these insights, for what they are worth, are in my recent book by Earthscan, Environments for Health (2005) and the earlier one, Primary Health Care, medicine in its place, my earlier book with Earthscan (2000, 1993).
 
I am naive enough when I read this website to feel I am part of something global and rather fine
 
John Macdonald
 
 
 

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