This latest exchange is the 2nd time in recent memory
that Dennis has been criticized for improper tone that
I did not feel was improper. Of course gender (and
other) issues affect everything we say and do, but
here's my 2 cents worth on what might be going on:

A lot of what gets said and done in the name of health
promotion has a moralistic quality to it. The U.S.
government in general and American culture in
particular are especially good at taking an issue and
turning it into a morality play - e.g. you smoke,
you're bad; you're a large person, you're bad, etc.
"Lifestyle behavior" makes it very easy to focus on
the individual and not deal with the big social causes
of why we do what we do, which are so much harder to
deal with. So most of health promotion focuses on
individuals and not changing social and economic
structures. This morality quality can even slip into
population health approaches.

Socioeconomic status also has a lot to with who gets
focused on and who gets protected. Generally, the
richer you are, the less anybody can tell you what to
do with your life. So most, but not all, of the
moralism gets directed at poor people, because they
are easy targets ("I'm not going to give any money to
that person on the street who is obviously drunk
because he'll just spend it on more alcohol. I'll
offer him a hamburger")

This is not to say that I like cigarette smoking or
want to be around it. This is to say that it's
important to closely examine the politics of the work
we do and see what we're really supporting.
Coincidentally, I just had a conversation with an
elementary school teacher who was saying how
distasteful she found one of her first graders
spouting political ideology, obviously taught by her
parents. Whether it's ideology you do or don't agree
with, it's still propagandizing a child.

When someone in the field (in this case -- Dennis, at
other times -- myself and others) makes a statement
that opposes the morality of health promotion, they
tend to get skewered.

Listserves like this are great because they provide us
with a forum that we can all learn from to broaden our
thinking.

Chaya Gordon, MPH
Research Manager
American Society on Aging
San Francisco, CA
(415) 974-9604

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