Recent exchanges on this listserve highlight a major issue in future action
on social determinants of health - the balance
between the "theologians" and the "deal-makers" in promoting action on
social determinants.

Most systems have, within them, people who are the "theologians" of the
system - people who speak out (often bravely) for the integrity and purity
of the system. They are often the system's most profound thinkers, often
involved not in preserving its status quo but in "thinking it through" to
its finest conclusions.

Every system needs theologians. Without them the moral compass of the system
goes awry or disappears altogether. Any system is well advised to cherish
its theologians, even when they make us uncomfortable. Much as we enrich our
dialogue around social determinants with evidence-based insights, at its
core the "movement" is rightly an ethical and moral one. Every system also
has deal-makers - folks skilled at negotiating the system's way into other
systems, who translate good ideas into good action.  Their deal-making is
driven at is best by a principled sense of the ideals served by the
deal-making.

But theologian and deal-maker can have damaging sides. The theologian can
stand for such rigid ideological purity that there is no chance that their
ideas would be put into practice. They also run the risk of acting as grand
inquisitors, finding and punishing heretics rather than cherishing
diversity.  Deal-makers, on the other hand, can be dangerous if "clinching
the deal" is all that matters. They can lose sight of why deals ought to be
made in the first place, and they can forget that sometimes, compromise to
get a deal isn't worth it, because core principles would be obliterated.

A healthy system needs both theologians and its deal-makers - and a group in
between who understand theology and deal-making.  The dialogue between
theologians and deal-makers is essential, but uncomfortable and fractious at
times. And that is what I see happening through this listserve. There are
some people on it who are deal-makers - they want to know what tools others
have used to clinch a deal - to embed an idea in the real, messy world.
Hersh Sehdev put it well in a recent post when he said, "Sure a national
strategy on social determinants would have been useful however meanwhile we
continue to work bottom up and see where we reach".

There are also people on the listserve with a theological bent. Dennis
Raphael, for instance, highlights what is a theological issue when he cites
Ontario's Heart Health programs, and the danger they pose when they stifle
action on the underlying determinants of heart health.

I am delighted that the Krimgolds, Sehdevs, Raphaels and Plasketts are part
of this listserve. I am one little guy in one little town, but my own
thinking - and my own actions - have already been changed by both the
deal-makers and the theologians on this listserve. When the listserve ceases
to be a rich dialogue between the messy pragmatists and the neat idealists,
it will
be time for me to leave (or to write another too-long missive).

John Butler
Markham Ontario

Send one line: unsubscribe click4hp to: [log in to unmask] to unsubscribe
See: http://listserv.yorku.ca/archives/click4hp.html to alter your subscription