Well, Shannon, in response, with no disrespect to you, because I am sure 
you are providing a valuable service.

The simple reality is that decision-makers are informed and in the event 
that they are not, then it is their responsibility to become just that - 
informed. There is another issue though and that is which 
decision-makers?  We continue to have changes in government and in 
healthcare and then the games begin again. Your letter says nothing 
which has not been said for decades, sorry but that's reality. I applaud 
you for your efforts, but do you not understand that it will not make an 
effective impact?

With respect to the SDH in cancer care, this also is not new news. Ask 
the patients, we do ask the patients, right? With the rare exception, in 
Canada, there is no patients' voice. I am not talking about the 'fluff' 
campaigns of which there are many. Please know that this is not simply 
my own opinion. It is the opinion of many, both in the patient 
populations and also an acknowledged within healthcare providers 
themselves. So we continue to have entities which purport to speak for 
the patients, but if you read the literature, the literature will tell 
you that they do not understand what patients needs are. An oxymoron, 
really is quite simply amazing. There are huge dichotomies in 
understandings which are acknowledged by health care professionals 
themselves. The research says; this is what we think patients need; the 
patients say, no; so then the research says - well, it can't be because....

While the philosophy of the Canadian Strategy for Cancer Control is 
obviously one that needs to be put in place, I would like in public the 
budget which calls for $260 million. That of course is a technical 
detail which is quite elusive. Further, the Federal Health Care 
Minister, last year, indicated that while he was not fully funding the 
allotted $260 million dollars that the CSCC requested, he would indeed 
not be reducing the funding which the organizations already receive. If 
in fact the CSCC is fully supported by its members, then it would be a 
rather large step in the right direction for those organizations to pool 
their time/resources so we are not taking public funds to dilute public 
funds.

How long does 'Hope' take? Courage? I evidence as a non healthcare 
individual first hand suffering - physical and emotional suffering.  
What I do find amazing is that we do not accept suffering in other 
countries, but in fact are quite complacent and polite enough to 
continue to allow it to happen here. I have to tell you that I don't 
care about 'your sphere' of influence because I find that rather 
paternalistic.

Today, in the U.S., and in the 'underground' network, a small group of 
women cancer patients effectively changed the content of a portion of 
the statistical analysis which the American Cancer Society had published 
a few weeks ago. They tried polite, it didn't work.

Before I sent this reply, I was chatting with a pharmacist who has 
recently been diagnosed with CUP (cancer of the unknown primary). I 
asked her if this response was too inflammatory. Her response was: "It's 
the truth".

"Hope" is an illusion often times.
Sandi

Lavell, Shannon wrote:

>I have just spent a weekend in Aylmer Quebec with many hardworking
>leaders in the cancer community and made an impassioned case for
>supporting the SDH in our Canadian Strategy for Cancer Control. I also
>had Dennis's coaching on a letter I hand delivered to the secretary to
>the Minister of Health (MP Steven Fletcher) and hand delivered a copy of
>that letter to the Minister of Health, Tony Clement. (see below for the
>text from that letter). 
>
>I sincerely believe that although big money is an issue,  we need to
>become peaceful, respectful activists that go forth and create
>relationships with leaders who are working hard but may be misinformed,
>distressed or of another mind set, and go about the difficult task of
>finding common ground respectfully but courageously. Kind of a Martin
>Luther King jr non-violent movement with clear, good thinking, good
>intention and suggestions for policy change. 
>
>And as my sphere of influence unfolds, and the relationships I am
>creating unfold, it is looking hopeful that some key leadership folks
>are listening, and with collective will, I am hopeful the cancer
>community will take the lead in addressing the SDH aspects of the
>chronic diseases. ie: by addressing poverty etc. Here is my lettter:
>
>
>22 February, 2006
>
>Mr. Steven Fletcher
>Member of Parliament
>Parliamentary Secretary to the Minister of Health and
>to the Minister for the Federal Economic Development Initiative for
>Northern Ontario
>3111 Portage
>Avenue Unit A
>Winnipeg, MB R3K 0W4
>
>Dear Mr. Fletcher
>
>I warmly applaud you and thank you for championing the Canadian Strategy
>for Cancer Control (CSCC). 
>
>Every day I work with cancer care medical colleagues who work hard for
>an extra 5-10% improvement for outcomes for patients who are downstream
>with the disease of cancer. I am a counsellor, in a social work &
>nutrition department within a cancer clinic, who listens to, and
>advocates for, families facing emotional and financial struggles,
>sometimes at the end of life. As a direct result of my counseling
>experience I have become an advocate for prevention, working upstream
>with cancer care. This also means I have become an advocate for strong
>leadership regarding our social and physical environment. 
>
>There are some big ways we could improve levels of disease in our
>country by about 30%, according to Dennis Raphael, professor at the
>School of Health Policy and Management, York University. In fact, the
>kind of changes I'm referring to will not only decrease disease rates,
>but will also reduce the incidence of crime and economic
>un-productivity. This is a tremendous three-for-one cost savings.
>
>The single best predictor of where people will sit on an illness -
>health continuum is their socioeconomic status. In other words, the
>single best predictor of health is a person's or family's living
>conditions. Living conditions are about meeting basic needs by having
>enough money (a "living" wage), a decent place to live and being able to
>take care of each other when they need to (ie: throughout childhood,
>elder care, during times of crisis, change or illness). We need to
>support families so that they can do their job well. It may seem
>"expensive" to support families with adequate resources, but if we
>don't, the costs of running the country on skimpy social budgets is
>staggering.
>
>International statistics indicate that Canada has a larger proportion of
>families living under unhealthy living conditions compared to many other
>developed countries. Our child poverty rates are 15-17% (with the US at
>21% and  Mexico at 27 %, as compared to Scandinavian countries with 2 to
>4 %)*. Four years ago I was working in a family support agency affected
>by Gordon Campbell's cutbacks to social programs. The writing was on the
>wall. My colleagues and I looked at each other and said "The crap is
>going to hit the fan in this province". We were working hard everyday
>with largely low income families helping them to cope with challenges.
>Now we are wondering what to do about homeless youth and it is
>absolutely no surprise to me that the BC Ministry of Children and Family
>Development is under scrutiny for the death of 19 month old Sherry
>Charlie, who died in 2002 after being placed in the custody of an uncle
>with a history of violence and spousal assault. Why should a ministry of
>over worked social workers be hung out to dry for a leadership decision
>to cut service? Paying for another government commission is not the
>answer. Funding the programs is the answer. Remember the three for one.
>We simply have to get everyone educated fast on how to lead this kind of
>social and economic change effort.
>
>In fact, that is one of the primary reasons I am enthused about the
>National Cancer Leadership Forum. Visionary leadership by Dr. Simon
>Sutcliffe, a symphony of 45 different agencies working together, and
>fearless training and recruitment of grassroots leaders (thanks to Pat
>Kelly), to support a solid plan with a prevention focus. Dr. Sutcliffe
>once said to me, as I prepared a presentation on this topic for my
>colleagues: "The biggest improvements in health are a result of social
>change."
>  
>Chronic diseases are linked at the social determinants of health, the
>root system that feeds a tree of ailments. Cancer is one of those
>ailments. The Population Health Template provides direction for tracking
>key elements and actions
>(http://www.phac-aspc.gc.ca/ph-sp/phdd/pdf/discussion_paper.pdf). 
>
>I am hopeful that through your influence and leadership we will see the
>immediate and long range benefits of supporting the "social determinants
>of health" through policy change including environmental (ie: ensuring
>knowledge of toxic products gets to employees and employers, pesticide
>use) and social programs (ie: adequate food, housing, shelter and
>education). 
>
>In my experience people are more apt to make healthy lifestyle choices
>if they have the resources to do so. And it is much easier to help
>people make healthy choices if they have enough in the way of financial
>resources. Throw in universal access to education and our hopefulness
>and prosperity just might go through the roof. I find people to be
>enormously resilient, creative and hard working if given the right
>environment.
>
>In my view of the world, leaders have an obligation to be stewards for
>our social and physical environments while facing the bluster of
>economic globalization that tends to let market forces create unstable
>job situations, less pay and benefits, and poorer working and
>environmental conditions. I see our leaders as stewards for a human
>petri dish called Canada, a place where people can grow in optimum
>conditions. Improvement in individual lifestyle choices will follow.
>
>I hope your government will take up the social and environmental issues
>that will create a Canada that is an optimum environment for growth,
>resiliency and creativity. Economic prosperity will follow. Isn't it
>nice to know that something so intuitive is backed by research, although
>this research needs champions like you. I would be glad to forward you a
>copy of Dennis Raphael's "Social Determinants of Health -  Canadian
>Perspectives" that has tremendous lists of resources both nationally and
>internationally. 
>
>Your courage to be a voice for the CSCC has inspired my hopefulness.
>Thank you.
>
>Sincerely,
>
>
>Shannon Lavell, RN BSN MA
>705 Sutherland Avenue
>Kelowna, BC, V1Y 5X4		Ph: (250) 860-4994		Email:
>[log in to unmask] 
>
>* Child Poverty in Rich Countries 2005:
>http://www.unicef.org/brazil/repcard6e.pdf 
>
>cc: The Honourable Tony Clement, Minister of Health and the Minister for
>the Federal Economic Development Initiative for Northern Ontario
>
>-----Original Message-----
>From: Social Determinants of Health [mailto:[log in to unmask]] On Behalf Of
>Dennis Raphael
>Sent: Sunday, March 05, 2006 5:49 AM
>To: [log in to unmask]
>Subject: Re: [SDOH] my letter to the Globe and Mail this morning
>
>
>I recall reading "Living Downstream" a number of years ago and having
>the
>same response:  I think the Cancer Society follows the money:  the money
>available is to blame people for their illness, absolving regulators and
>governments of any responsibility...
>
>http://www.amazon.ca/exec/obidos/ASIN/0375700994/701-2438581-6191547
>
>Living Downstream: a Scientist's Personal Investigation of Cancer and
>the
>Environment
>by Sandra Steingraber (Author)
>
>
> http://www.steingraber.com/
>
>http://www.oriononline.org/pages/om/06-1om/Steingraber.html
>
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