Realism has lots to offer public health, but it won't be the only future.  I
know that all of our disciplines have different definitions, but provided
that the dictionary definition of realism as, "concern for fact or reality
and rejection of the impractical and visionary" (http://www.m-w.com/) at
least partially applies, then there's going to be some revolt from an overly
realist approach to promoting public health.

We have to give some recognition to the increasing, albeit slowly,
[visionary] work on health and human rights.  This work is slowly gaining
acceptance as the major human rights NGOs are beginning to recognize it, as
are some in academia (Paul Farmer's book, PATHOLOGIES OF POWER comes to
mind; from the philosophical end, Henry Shue's BASIC RIGHTS).

Certainly, the realist approach is very valuable for future public health
work; however, if there's any hope for a more globally just distribution of
disease burden, then we have to come to terms with the scale of our problems
throughout the world.  And, thus, we will have to construct the norms that
allow for change by valuing even those who have no real power in the
political processes.  Public health based in realism alone will be far too
cavalier with lives -- irreal with distance -- that do not have any power
over the decision making and political processes.

There's a brilliantly useful book from the human rights movement that, while
a little bit too "sunny," could -- and should -- be useful for promoting
public health:  Risse, Thomas, Stephen C. Ropp, and Kathryn Sikkink. Eds.
THE POWER OF HUMAN RIGHTS: INTERNATIONAL NORMS AND DOMESTIC CHANGE.
Cambridge, UK: Cambridge University Press, 1999.  The authors carefully lay
out a "spiral model" of socialization to human rights norms.  It's more
complicated than I care to explain with six levels in the spiral, a good
dose of "network and field theory," and the possibility (I think, judging
from my country's new Attorney General) of working in multiple directions.

We may need a good dose of realism in achieving our policy aims and building
political support for public health programs, but to be more fully equitable
we will need to finish constructing, maintaining, and instrumentalizing a
human rights regime that includes health and the rest of the so-called
"second generation," positive, or economic human rights.

Sorry to sound preachy, but I think there are incredibly interesting and
powerful possibilities in the linkages between health and human rights
(especially, acknowledging that these human rights have yet to be fully
envisioned or realized), and these linkages could change the boundaries of
acceptable policy.

-- Joseph Lee <[log in to unmask]>
  Instructor, Nova Seisekisakuragaoka
 http://www.josephlee.name/


> From: "Bernier Nicole F." <[log in to unmask]>
> Reply-To: Social Determinants of Health <[log in to unmask]>
> Date: Fri, 4 Feb 2005 11:08:06 -0500
> To: [log in to unmask]
> Subject: [SDOH] RE : [SDOH] Interactive task
> 
> In the 1960s and 1970s political scientists made efforts to develop theories
> of decision-making more closely approximating the actual behaviour of
> decision-makers. The debates then were between the 'incremental' and
> 'rational' models of policy-making. The mainstream position was that the
> 'rational' model was a model of how decision OUGHT to be taken, while the
> 'incremental' model best described the ACTUAL practice of decision-making in
> governments. 
> 
> The credit for developing the incremental model of public decision-making is
> attributed to Yale University political scientist Charles Lindblom. See his
> classical text 'The Science of Muddling Through' Public Administration Review
> 19 (1959) 79-88. Other classics include Simon, Herbert 'A Behavioral Model of
> Rational Choice' Quarterly Journal of Economics 69 1 (1955) 99-118.  See also
> Etzioni, Amitai, 'Mixed-Scanning: A "Third" Approach to Decision-Making",
> Public Administration Review 27 (1967) 385-92. For an updated version of the
> debate, any textbook entitled "Introduction to Policy Analysis" or so will
> address this.
> 
> It is time public health scientists and practitioners adopt a realist
> perspective on the policy-process (as opposed to normative, idealist) to
> further advance their cause.  This is where the new generation of students in
> public health is going, watch it 10-15 years from now.
> 
> 
> Nicole 
> 
> 
> 
> -----Message d'origine-----
> De : Social Determinants of Health [mailto:[log in to unmask]] De la part de Ken
> Hoffman
> Envoyé : 4 février 2005 10:55
> À : [log in to unmask]
> Objet : [SDOH] Interactive task
> 
> This is a very interesting discussion.  I believe that the policy
> development process is indeed iterative, but I think the most important
> part of the discussion as it relates to SDOH relates to the boundaries
> placed on analysis of the "problem" and "acceptable solutions", which
> are inherently political and ideological.  This is an exercise in
> bounded rationality.
> 
> One approach to the issue of hunger, for example, is to treat this as a
> temporary lack of access to food, and to look for a charitable solution
> through food banks.  A slightly more progressive response looks at the
> system of social assistance (inadequate though it is) and
> redistribution.  The more radical analysis sees the problem as a lack of
> opportunity for employment and other means of generating adequate income
> - at least partly attributable to systemic barriers - and looks to
> address those barriers.  This is the more threatening approach because
> it starts to look at the way power is distributed in society, and it
> means actually changing some systems.
> 
> I believe that the sort of "denial/indifference" that Dennis speaks of
> comes from the ideological glasses that are worn when looking at the
> data that describe a problem, or considering a solution.  And because we
> like to think of ourselves as "objective", we often don't want to
> acknowledge the ideology that frames the way we look at issues, or the
> way we even choose to study a particular problem.
> 
> 
> Ken Hoffman
> Community Health Consultant
> and Associate, The Alder Group
> ... promoting health and innovation
> 
> phone: 613.729.0308   fax: 613.729.0920
> 
> -----Original Message-----
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