Another facet of the problem is that middle class white fellas like me want people to be rational in their decision-making.
For a variety of reasons -
it makes life and work seem more manageable;
it gives us a reasuring sense of competive advantage;
somewhere along the line we have picked up a moral perspective that people should be rational in their decision-making.
But as I pick up from Carlos, we are deluding ourselves that there is a lot of certainty here.
In our enthusiasm for promoting evidence based decision-making we may have failed to critically examine the assumptions supporting the claim that decisions are based on evidence in general; and in particular, that the debate about SDOH is going to be decided solely on the basis of the quality of available evidence. A superficial reading of Thomas Kuhn should disabuse us of that article of faith.
To use a biblical metaphor, the walls of Jericho are not going to fall down on the basis of the volume of our trumpets. There is something else behind the resistance to the SDOH case other than an absense of enlightenment.
But I am sure that I can detect some cracks.
Pete Whitecross
Manager Community & Consumer Participation
Northern Sydney Central Coast Health
The Lodge
Macquarie Hospital
Locked mail bag 2220
North Ryde
NSW 1670
tel 8877 5307
mobile 0422 003 129
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email [log in to unmask]
>>> Carlos Quinonez <[log in to unmask]> 08-Jan-09 6:51 am >>>
I'm not familiar with that literature, but I would think that public
opinion is more complex, i.e., people can be impressed and fooled by
statistics, and that is one way to get them to buy. Whether an
anecdote trumps that at the point of making a decision, like I said,
don't know the literature.
Yet I have another point.
I'm not sure people necessarily need knowledge on the SDOH.
I think people fundamentally know what we are doing here, sort of a
Plato inherent knowledge kind of thing.
Poverty, whether it 'will always be with us' or not, by definition,
is an outrage, we're just numb, or choose to be.
And then there's the idea that if people knew more about the SDOH,
they'd somehow change, I'm a bit of a pessimist on this issue.
What is needed now is FUNDAMENTAL change in who we are, and
unfortunately, by definition as well, it appears that this
presupposes individual change, the hardest of them all.
Think about it, what have you done today?
I was lucky, I live in the downtown of a large city, so I was able to
walk to work. I will take a subway home.
Were you as lucky?
Did you buy all local grocery last time you visited your grocer?
Man oh man, I love bananas.
Did you vote?
Did any of you or your children get a i-phone, or some i-something or
other, to be tossed in a landfill in 1 to 3 years time, so we can get
some new ones?
I have a fancy i-pod.
Did you use, like Leonard Cohen said: the bags that time cannot decay?
And don't get me wrong, public opinion is a powerful agent of change,
but I think we're beyond that.
It's fundamental now.
CQ
On 7-Jan-09, at 1:22 PM, Steve Pedersen wrote:
> I am currently reading a book by Ellen Langer, a Harvard
> psychologist, on mindfulness. She states "much research in
> psychology has shown that people often ignore population-based
> information in favor of anecdotal, idiosyncratic information. If,
> when car shopping, we are shown statistics underlining the high
> quality of a Volvo but we know someone who has had trouble with a
> Volvo, we are not likely to give much weight to the group-based
> information."
>
> I am not familiar with this literature from the field of
> psychology, but if it is correct, then at least when it comes to
> working with the public and wondering how we can communicate better
> and bring the public back into public health, that our evidence
> hierarchy (least effective - anecdotes > case control studies >
> randomized trials - most effective) needs to be flipped on its head
> as the public's prefered language of anecdotes is different - and
> perhaps until we can communicate better in that language, we
> continue to be like two trains passing in the night...
> Steve
> Andrew Taylor wrote:
>>
>> The CNA / CMA has a great and quite well-known, well-funded, and
>> well-attended event celebrating outstanding journalism in helping
>> the public better understand health, the health system and health
>> professions http://www.mediaawards.ca/EN/index.htm
>>
>> AT
>>
>>
>> On Tue, Jan 6, 2009 at 4:25 PM, Dennis Raphael <[log in to unmask]>
>> wrote:
>>
>> IPPH-CIHR and CPHI are spending a fortune on knowledge
>> disseminatrion, knowledge translation, knowledge exchange,
>> knowledge...???
>>
>> They would seem the likely award givers...
>>
>> dr
>>
>>
>>
>>
>>
>> Of related interest:
>>
>> *NEW* Social Determinants of Health: Canadian Perspectives, 2nd
>> edition, edited by Dennis Raphael
>> Forewords by Carolyn Bennett and Roy Romanow
>> http://tinyurl.com/5l6yh9
>>
>> Poverty and Policy in Canada: Implications for Health and Quality
>> of Life by Dennis Raphael
>> Foreword by Jack Layton
>> http://tinyurl.com/2hg2df
>>
>> Staying Alive: Critical Perspectives on Health, Illness, and
>> Health Care, edited by Dennis Raphael, Toba Bryant, and Marcia Rioux
>> Foreword by Gary Teeple
>> http://tinyurl.com/2zqrox
>>
>> See a lecture! The Politics of Population Health
>> http://msl.stream.yorku.ca/mediasite/viewer/?
>> peid=ac604170-9ccc-4268-a1af-9a9e04b28e1d
>>
>> Also, presentation on Politics and Health at the Centre for Health
>> Disparities in Cleveland Ohio
>> http://video.google.com/videoplay?docid=-4129139685624192201&hl=en
>>
>> Dennis Raphael, PhD
>> Professor, School of Health Policy and Management
>> York University
>> 4700 Keele Street
>> Toronto ON M3J 1P3
>> 416-736-2100, ext. 22134
>> email: [log in to unmask]
>> http://www.atkinson.yorku.ca/draphael ------------------- Problems/
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>> --
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>> and good intentions may do as much
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