Date:         Thu, 15 Dec 2005 08:05:53 +1100
Reply-To:     Health Promotion on the Internet <[log in to unmask]>
Sender:       Health Promotion on the Internet <[log in to unmask]>
From:         John Macdonald <[log in to unmask]>
Subject:      Comment on social determinants of health from Australia
Content-Type: text/plain; charset="iso-8859-1"

Hi, my name is John Macdonald and I work in Sydney.

I think the insights of Dennis Raphael are "spot on" and, I have to say,
given the wealth of other intelligent comment from Canada, suggest an
environment much more open to the massive amount of evidence
internationally available that the narrow focus on behavioural change is
really untenable and often serves an obvious political conservative agenda
resisting movements towards greater social justice.

In Australia we have equity (and social gradient) issues in our face, given
the low life expectancy of Aboriginal people here. (Mind you, my first
expereince of dramatic social gradient was as a student in First Nation
"reservations" in Ontario). We have great moral and logical difficulty in
Australia to ascribe the poor health status of our own First Nation to
"lifestyles" - though this is still the normal practice, alas - and once we
have equity on the map it should help us to challenge the behavioural
change model. Some are doing this and many of us read your exchanges
avidly.

Several other things for anyone still reading:

- Men's health:
Internationally and in Australia, men's poor health status has generally
been ascribed to a deficit view of men - men behaving badly (violence, beer
etc) with additional interest in the medical condition of the prostate
also. A social determinant of health approach allows to move beyond opinion
and assumption (and a reductionist medical view)and helps us move towards
an examination of what environments actually promote or hinder men's health
(and promote the veryhigh rates of male suicide). It has been my experience
that it requires some courage to accept this perspective for many people
brought up to ascribe to the  mantra that "masculinity" is the problem. The
Australian Medical Association and the Australasian Men's Health Forum are
working on a national Men's Health Policy based on the social determinants
approach.

- Primary Health Care: Alma Ata 1978 and all that it led to in the Third
World preceeded Ottawa (with respect!) in its insights into the need to
think health as being embedded in the social fabric and many colleagues in
"developing" countries feel our overlooking of this incomprehensible.In
many ways the insights of Alma Ata, though dated now, were closer to those
of the social determinants than Ottawa, and more "holistic".

Finally and not at all modestly, most of these insights, for what they are
worth, are in my recent book by Earthscan, Environments for Health (2005)
and the earlier one, Primary Health Care, medicine in its place, my earlier
book with Earthscan (2000, 1993).

I am naive enough when I read this website to feel I am part of something
global and rather fine

John Macdonald

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