*** Bonjour tout le monde,
Back again on this old but never solved debate on individual
vs structural HP measures. It pops up regularly on Click4HP and
has led to many lively, and sometimes a bit nasty, debates.
Depending on the beliefs one has about how science is properly done,
you can convincingly argue that one or the other is better, as
we have very good illustrations in our recent book «Health Promotion
in Canada, Critical perspectives» (O'Neill et al. dirs.,
Toronto, CSPI, 2007).
I nevertherless tend to share Glenn's view below that BOTH
are important and that for a specific problem (as the one at
stake here: child obesity) in a specific population in a
specific environement, the intervention mix should be determined
on the basis of a careful analysis of what we know (if we do...)
seems to work, carefully adapted to the context where it occurs.
I also think it is important to recognise that for most health
promoters who work in organizations, despite the structural
and social determinants of heath discourse so prevalent especially
in Canada, the day to day job has to do with intervening properly
on individual lifestyles issues. This can be done in a variety of ways
in which the participative ones have usually shown a better chance of
success
and, as ecologists invite us to think globally and act locally, we can
always invite health promoters caught in the narrow mandates of
their organizations to think structurally when they act individually.
It can help them to figure out better interventions without totally
alienating their work environement, and be supportive in various
ways of what is done by the happy few whose day to day work is
to work structurally. The latter work being obviously more important
than
ever given the global mess in which greed has plunged the planet
and the political mess in which the dominant values system,
coupled to an archaic electoral system, has plunged Canada.
Joyeuses fêtes malgré tout !!!
Michel O'Neill. ***
Le 17 déc. 2008 à 15:38, Glenn Laverack a écrit :
> To get back to the original question 1st. 2 very good papers on
> obesity
> in children and the evidence of interventions can be found at:
> BMJ 2008; 337: a1824 and a1848. These are parts 1 and 2 and review the
> evidence to date - the conclusion is not very positive I am afraid
> largely because HP has relied too heavily on motivational and
> behaviour
> change strategies.
>
> The failure of top-down programming has not been because of the issues
> it chooses to address or the messages it chooses to communicate. It
> has
> been because of the way in which health programmes have been
> delivered.
> Top-down programming has relied heavily on strategies that have not
> engaged with those people suffering the worse inequalities, in for
> example obesity and health, the poor and marginalised. Low
> participation
> in top-down programming has hindered its progress to close the gap in
> health status between different social and economic groups in society.
> Some key authors have even suggested that it has contributed to
> inequalities in health. What this means is that the predominant
> style of
> HP programming, the style that most people reading this email will be
> involved in, has been contributing to inequality rather than
> addressing
> it!
>
> Of course, from a HP perspective we as practitioners need to address
> both lifestyle issues and structural issues within a global context.
> What this means in practice, for example, is that a national agenda on
> reducing obesity through an increase in physical activity (top-down)
> will also have to address local problems such as an unsafe environment
> in low socio-economic communities (bottom-up) through mobilisation
> leading to policy change and legislation. In turn this will contribute
> to a global agenda by a reduction in fossil fuel consumption because
> more people are walking to the local shopping centre rather than using
> their motor vehicles for personal safety.
>
> Hope this helps. Glenn Laverack. Health Promoter.
>
>
> ----Original Message Follows----
> From: Nicholson Ellen <[log in to unmask]>
> Reply-To: Health Promotion on the Internet <[log in to unmask]>
> To: [log in to unmask]
> Subject: [CLICK4HP] Obesity Interventions
> Date: Wed, 17 Dec 2008 12:29:51 -0000
>
> Hello,
>
>
>
> Just wondering if anyone knew of any research into the effectiveness
> of
> "brief intervention" work to support weight loss, particularly with
> children.
>
>
>
> Many thanks,
>
>
>
> Ellen Nicholson
>
> Public Health Policy and Performance Officer
>
> NHS Cambridgeshire
>
> Ph 01223 884805
>
> Email <mailto:[log in to unmask]>
> [log in to unmask]
>
>
>
>
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