Greetings,

Last Wednesday, June 30th, the Ontario Health Promotion Email (OHPE)
Bulletin carried a very interesting, eloquent letter to the editor,
responding to a recent feature article in the OHPE Bulletin about
competencies in public health. Brian Hyndman  wrote in response to OHPE
Bulletin (http://ohpe.ca/ebulletin/ViewFeatures.cfm?ISSUE_ID=365)
with additional thoughts on core competencies in health promotion.
You can download the original document on Core Competencies in public health
from the Ontario Public Health Association on OPHA website at
http://www.opha.on.ca/corecompetencies/index.html
This Letter to the OHPE Editor is copied below, and can also be viewed on
OHPE's website at:
http://ohpe.ca/ebulletin/ViewFeatures.cfm?ISSUE_ID=368&ROWNUMBER=1

It would be great to have more discussion on 'competencies' for health
promotion, and the potential for the marginalization of health promotion as
public health safety, and health care systems gain greater prominence in the
media.  This list is an excellent place to engage in these discussions.

Alison Stirling,
co-facilitator, CLICK4HP listserv
health promotion consultant, Ontario Prevention Clearinghouse
e: [log in to unmask] OR [log in to unmask]
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Letter to the OHPE Editor


As a long-standing proponent of a broad, comprehensive vision of public
health practice, I was particularly interested in Linda Rosenbaum's article
describing the work of the OPHA Core Competencies Task Group. The thorough,
inclusive consultation process proposed by the Group will help to ensure the
identification of the necessary building blocks for a high quality,
responsive, equitable and sustainable public health system in Ontario.

To say that the effort is a timely one is something of an understatement.
Over the past decade, public health professionals expressed increasing
concerns that the long-term under-funding and neglect of public health
infrastructure had eroded Ontario's capacity to respond to major health
threats. Events such as Walkerton and the SARS
epidemic proved that the basis for these anxieties could not be dismissed as
self-serving advocacy from professional interests.

Rosenbaum cites the numerous expert review committees and reports, some of
which were commissioned in the wake of the above-noted crises in Ontario,
laying out competing blueprints for a rejuvenated public health system.
While there is much to commend in these initiatives, I am concerned by an
undue emphasis on communicable disease control at the expense of health
promotion, chronic disease prevention and other core functions of public
health. For example, the recently released document, "The SARS Commission
Interim Report: SARS and Public Health" by the Honourable Mr. Justice Archie
Campbell, Commissioner, makes the following assertion:

"While it would be wrong to downgrade the long-term importance of health
promotion and population health, the immediate threat posed by any
infectious outbreak requires that a dominant priority must be given to
protecting the public against infectious disease. It does not disrespect the
advocates of health promotion to say that the immediate demands of public
safety require that public health, as its first priority, looks after its
core business of preventing us from infectious disease." (Campbell, 2004, p.
12).

One can readily understand the concerns underlying this viewpoint.  It
would, however, be a gross error of judgment to uphold infectious disease
control as the single, over-riding "core business" of a reformed public
health system in Ontario.

The ultimate strength of public health lies in its capacity to address the
myriad of health issues affecting the entire population. Communicable
disease prevention, while a critical priority of public health practice,
should not be given precedence over public health efforts addressing tobacco
addiction, childhood obesity, air quality and socio-economic inequalities,
to name but of a few of the key issues affecting the health and well-being
of Ontarians. And to put the relative magnitude of health risks in
perspective, Dr. Richard Schabas, the former Chief Medical Officer of Health
for Ontario, noted that smoking kills as many Canadians as SARS did, every
eight hours.

Health promotion cannot be a marginalized component of an effective public
health system. To fully meet the health needs of Ontarians, public health
practice requires a complementary, sustainable balance of communicable
disease prevention and health promotion skills and approaches. I trust that
the OPHA Core Competencies group will appreciate the need for this balance
as they proceed with their important work.

Brian Hyndman, M.H.Sc.,
Health Promotion and Evaluation Consultant,
The Health Communication Unit
Centre for Health Promotion
University of Toronto

References

Campbell, A. "The SARS Commission Interim Report - SARS and Public Health in
Ontario." Toronto: Ontario Ministry of Health and Long-Term Care, April 15,
2004.  Available on-line at
http://www.health.gov.on.ca/english/public/pub/ministry_reports/campbell04/c
ampbell04.html.

Schabas, R. "Don't cry wolf on every flu." The Globe and Mail, Monday
February 2, 2004, A11.

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