Thanks to all for an excellent discussion.

Scott, you wrote, "There is, unfortunately, this tendency to forego a  
nuanced, proportional response to public health threats."

The PEOPLE are the owners of governmental public health efforts.  If  
governmental public health isn't responding sensitively to the  
emotions of the people, then the people will stop supporting  
governmental public health.

Governmental public health officials bring valuable science, and  
important ethical values, into the public discussion.  However, the  
public health official must START by acknowledging others' emotions as  
legitimate.  Without signs of empathy, it's hard to convey a  
scientific public health message about H1N1, or SDOH, or anything else.

I hope this helps.  Best wishes!

Dave Cundiff, MD, MPH
Olympia, WA, USA

***

Quoting Scott A Wolfe <[log in to unmask]>:

> If I can weigh in here, I believe that, as in so many aspects of life, the
> truth lies somewhere in the middle. I concur that Public Health officials
> (caps intentional) are highly committed and many/most get the SDOH picture.
> There is, unfortunately, this tendency to forego a nuanced, proportional
> response to public health threats. At the same time, I can't help but agree
> that Public Health Units far too often fall far short of meaningful action
> on issues of health equity and that, in the mix, plans and efforts are
> watered down such that they disproportionately benefit the middle to upper
> end of the health status gradient. Often this is the result of political
> influence, or an in-bred unwillingness to confront the concentration of
> social and political power among middle and upper-income segments of the
> population.of course, those at the lower end also often being racialized,
> and affected by other forms of social exclusion.
>
>
>
> I would suggest that the reasons for this are largely systemic and
> structural, rather than just a product of disinterest or willful inaction.
>
>
>
> Unfortunately, at least in Canada, Public Health as a 'function' and layer
> of health care has become largely divorced from the broader goals of public
> health, as a vision and concerted effort. Now, I don't want to suggest
> definitively that Public Health Units need to be absorbed into provincial
> health systems or regional health units (although, this is a concept that
> merits discussion). However, I feel strongly that it is critical for Public
> Health Units to become better integrated, particularly with primary health
> care services, and for this tandem to be better informed by a more complete
> vision of health, inclusive of the SDOH and a role in shaping public policy.
>
>
>
>
> Quite honestly, I don't think that we can ever expect Public Health Units to
> ever satisfy our expectations here until they are structurally and
> systemically integrated into the health system, as a whole. At community
> level, for the sake of analogy, we see that it is far too easy for primary
> (health) care services to be un-attuned to the systemic needs of clients
> unless structures and protocol are entrenched (eg, community governance
> boards, community advisory panels, etc) which continuously feed input
> regarding the nature and impact of social/environmental influences on
> health. Now, I recognize that PHUs do a lot of outreach and many staff are
> deeply, deeply connected to the community. However, at a planning and
> decision-making level, and at the edges of PHU jurisdiction versus
> jurisdiction of primary health care organizations, providers and other parts
> of the health system, PHUs are not empowered, mandated or equipped to play
> the role we are asking of them here.
>
>
>
> Yes, some PHUs are doing a better job. However, my sense is that much of
> this is driven by strong personalities, individual leaders, and a curious
> alignment of opportunities. Our goal should be to cascade this sort of work
> by entrenching it systemically. And this won't happen until we re-examine
> the nitty gritty of PHU jurisdiction, funding, mandate, etc. I know this is
> not going to be popular with a number of folks, and I know of some
> colleagues who have received some heavy backlash from raising this issue.it
> gets us into discussions of turf, control and power. Alas, this is my
> opinion, and one that I'm very willing to revisit if I can be shown another
> reasonable possibility.
>
>
>
> Oh, and again, I want to re-interate that my views here are an expression of
> experience dealing with systemic and structural delivery of services,
> programs and program planning. I feel strongly that PHUs, as for other parts
> of the system in Canada are chalk-full of the most committed, concerned and
> dedicated providers and staff.I'm talking here about structures and
> institutions, not people!
>
>
>
> I look forward to feedback!
>
>
>
> Scott
>
> ****************
>
> Scott A. Wolfe
>
> Health and Social Policy Analyst
>
> Principal, One World Partners
>
> Tel: 416.839.0531
>
>  <mailto:[log in to unmask]> [log in to unmask]
>
>
>
> "Our deepest fear is not that we are inadequate. Our deepest fear is that we
> are powerful beyond measure. It is our light, not our darkness that most
> frightens us. We ask ourselves: Who am I to be brilliant, gorgeous,
> talented, fabulous? Actually, who are you not to be?"
>
>   _____
>
> From: Social Determinants of Health [mailto:[log in to unmask]] On Behalf Of
> Dennis Raphael
> Sent: Friday, November 20, 2009 9:15 AM
> To: [log in to unmask]
> Subject: Re: [SDOH] SDOH vs Public Health?
>
>
>
>
> I love Peter but the reality is that outside of a few health units across
> Canada -- and they know who they are and the GREAT work they are doing --
> public health has been a profound barrier in my work trying to educate the
> public about the SDOH.
>
> It is not only the ignoring of the SDOH, but the taking of millions of
> dollars to communicate lifestyling messages that frequiently does little
> more than blame the victim.
>
> It is one thing for a single mom living in social houssing to lament "There
> is nothing I can do".  It is quite another for a highly visible community
> with influence and power to act this way!
>
> see attached.
>
> dr
>
>
>
>
> To leave, manage or join list:   
> https://listserv.yorku.ca/cgi-bin/wa?SUBED1=sdoh&A=1
>
>

To leave, manage or join list: https://listserv.yorku.ca/cgi-bin/wa?SUBED1=sdoh&A=1