In preparation for a presentation to some medical officers of health, I put
together two displays which may be of interest.  The 2002 display is something I
came up with to identify the problems with top-down heart health initatives
which define the community's problems as being their "unhealthy lifestyles":
smoking, eating, and laying around.

Then I reviewed what Ron Labonte had written in 1988 in a report on heart health
inequalities.  Why isn't this message being heard?

Labonte, R. (1988). Promoting Heart Health in Canada: Focus on Heart Health
Inequalities. Ottawa: Health Canada.

1.   A fundamental premise of a Heart Health Inequalities program protocol,
then, is that communities have the power to define their own 'health problems'
These problems may or may not include physiological and behavioural risk
factors, but actions on these risk factors will follow actions on risk
conditions or pyschosocial risk factors.

2.   Community self-determination of issues and solutions is not a one-time,
static process of asking groups about their concerns. Rather, it is an honest,
respectful, critical and open dialogue between community members, groups and
professionals in which problems are discussed, defined and redefined until all
participants are satisfied that the best possible 'problem definition' has been
made.

3.   This step in the community development process is extremely important
because the definition of the problem often defines the nature of the actions
that will be taken by individuals, groups, professionals and agencies.
-------------------------------------------------------------------------------------------------------------------
Raphael, D. (2002). The New Public Health is About Listening to People: Merging
Democratic Principles with Community Health Action. Toronto: Author.

1.   The most important determinants of health in western societies such as
Canada are related to how societal and community institutions are organized and
resources distributed. This assumption is in stark contrast to current medical
and public health preoccupations with the provision of health care services and
altering 'healthy lifestyle' behaviours.

2.   The lay knowledge that community members possess about their health and its
determinants -- accumulated from their life experiences -- are as valid, if not
more so, than knowledge collected by experts through traditional scientific
procedures such as indicator analyses and health surveys.

3.   Identifying and responding to community health needs involves the
commitment to a set of principles that are guided by the best values of health
promotion: empowerment, participation, holistic emphasis, intersectoral action,
equity, sustainability, and use of multiple strategies.

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