My problem with this dialogue is that even those who "purport" to truly
espouse hearing the voices of the patients/clients really don't know what
it's like for those people. 

I would like to pass along a challenge that was issued to me when I worked
in North Central Regina  --  for two weeks, give away your credit/debit
cards, put a spare pair of jeans with a couple of shirts in a backpack, and
with 10 bucks in your pocket, live in the community for that time. Find
those places to eat and camp out........ live in the manner that so many
people do. 

This challenge was particularly driven home for me when I lived for several
years in another country as a visible minority. My notions and feelings
around racism and exclusion are so very different now, than before that
personal experience.

This brings to mind the MLA from BC who lived on the income of a single
employable male on welfare and how his health deteriorated. Over the top?
Who knows. I have also talked to a number of mothers who were on social
assistance and found the rates livable. In my work as a clinician, there is
much to be said for experience in building the connections and rapport with
clients in a much more meaningful manner. I have found through personal
practice that I listen with more skill and compassion when I have "been
there".

Also, I tend to tune-out when the tone of someone's message rings of
putdowns. I simply don't like being treated that way. With that tone, I
begin to wonder how well I would be heard. Again, in my limited personal
experience, I tend to feel extremely unheard when a conversation is colored
with contempt. My personal practice style is to be as congruent as possible
around my attitudes, values and behaviors both personally and
professionally. I know that when I attach myself to a particular attitude or
message, that impacts my better judgment and it impacts my ability to use my
skills fully.

Bev Brewer



-----Original Message-----
From: Sandi Pniauskas [mailto:[log in to unmask]] 
Sent: Monday, December 12, 2005 5:08 PM
To: [log in to unmask]
Subject: Re: HP death knell - response from Dennis Raphael on his reasons

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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