Thank you Peter Sarsfield, you articulate points which I so keenly agree with!
Jane

Jane Moseley, RN, BScN, MAdEd
Assistant Professor
School of Nursing, St. Francis Xavier University
PO Box 5000, Antigonish, 
Nova Scotia, B2G 2W5
Tel: (902) 867-3582



-----Original Message-----
From: Social Determinants of Health on behalf of Pete Sarsfield
Sent: Wed 11/18/2009 4:09 PM
To: [log in to unmask]
Subject: [SDOH] SDOH vs Public Health?
 
Fellow SDOH folk:

I suggest that we don't fall into the anti-Public Health/immunization queue, as the results spill over from H1N1 to other potentially preventable diseases, including ones (ie H1N1) that disproportionally affect those people who suffer the most from social inequities.  The anti-Public Health and anti-immunization zealots have dug themselves a destructive trap by too often dismissing the efforts of Public Health in the hope that "the real threat" of social inequities may then be addressed.  Public Health tasks and SDOH work are not opponents, or should not be.

Points arising:
- There is no one "real threat",  there is only proportionality. 
Think relative risk, please, and not real   vs  unreal;

- Of course the nonsensical hysteria re H1N1 is harmful, not only because of the undue anxiety created, but more significantly due to the diversion of resources (funds;  workforce efforts) into a relatively tiny venue of risk;

- Any Public Health worker with a flicker of social awareness and responsibility (ie most of them/us - this is old news) recognize that the major threats to the health of the public are those imbedded in SDOH, but governments (at least those elected by Canadians) will not adequately resource Public Health to do more than focus primarily on acute risk prevention and individualistic health promotion.  Public Health is usually restricted to episodic and semi-muzzled lip-service to social justice and SDOH work.  Many government funded Public Health workers are not even allowed to use the words "advocacy" or "inequity",  let alone direct significant resources to SDOH work; 

- Public Health receives about 2% of Canada's health care spending.  Look for a tiny and short-lived upward spike in Public Health funding post-H1N1, with a fall back to 2 or 3% of health-care funding within two years, until the next communicable disease threat; 

- Many Public Health workers of my acquaintance are aware of the imposed narrowness of their mandate, and try to expand that mandate without abandoning the necessary work that is being done;

- If we want to help others work in a productive way on SDOH, we should consider limiting the mean-spirited snipping at Public Health and instead work to increase population health funding to ~ 10% of the health-care dollar and for the increase to be directed to SDOH work.  Public Health in Canada has been almost shut down in order to sooth Canada's fears of H1N1. Instead of railing against Public Health officials, perhaps we could try helping them do their jobs in a broader and more realistic way;

- Immunization has saved many millions of lives, mostly children.  Any immunization is of less risk to the individual recipient than the disease being addressed.  However, the cost to society of diverting funds from SDOH work into immunization is a huge and mostly-unmeasured risk;  let's together find ways to make SDOH work and Public Health services be both/and   and not  either/or  options;

- Public Health is not the enemy.

Pete Sarsfield, MD, FRCP(C) - retired
Winnipeg, Manitoba


  From: GRETA DOUCET 
  To: [log in to unmask] 
  Sent: Wednesday, November 18, 2009 10:58 AM
  Subject: Re: [SDOH] letter


        I totally agree Dennis, 
        And the CBC did do a reasonable report of the situation last night.  I have personally asked Mark Kelley to address this amongst other issues on his Connect program.  Somehow, he seems to have a more humanitarian approach than most. I am told that Victor Mallerik recently has written something quite interesting on the subject. Maybe just maybe, eventually interventions and questionning will reach "critical mass" proportions. I keep hoping.  We must continue our efforts.  I hope that it will eventually bear fruit.   Greta 



        From: Dennis Raphael <[log in to unmask]>
        Subject: [SDOH] letter
        To: [log in to unmask]
        Date: Wednesday, November 18, 2009, 1:11 PM

        My heart is warmed by the Globe and Mail's  editorial board's ongoing concern about children not being designated a priority group for receiving the H1N1 vaccine (Patchwork of policies for children, Nov. 18). My heart would be warmed even more if the board showed similar concern about the hundreds of thousands of Canadian children who by virtue of their living in poverty experience ongoing material and social deprivation exemplified through their use of food banks and living in inadequate housing.  This is the real threat to children's health, and as the evidence from numerous research shows, excellent precursors of cardiovascular disease and type II diabetes in adulthood. 


        Dennis Raphael, PhD
        Professor of Health Policy and Management
        York University
        4700 Keele Street
        Room 418, HNES Building
        Toronto, Ontario M3J 1P3
        416-736-2100, ext. 22134
        email: [log in to unmask]
        http://www.atkinson.yorku.ca/draphael 



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