The person who serves as the health advisory to the Canadian International
Development Agency (CIDA), Canada's Official Development Assistance Agency
has said in public that the positive health impact of Canada's aid program
to Latin America is more than off set by Canada's Tobacco exports to the
region. It is also formal CIDA policy that one of the major factors
determining the health of children in developing countries is the status
of women. That there is a link between the health status of a population
and such "lifestyle" activities as smoking or a balanced diet is beyond
question. That the status of women in society is a socially determined
condition is beyond question.

One is then left to question why a definition of Health Promotion would
discount tobacco demand reduction strategies as "lifestyle strategies" and
different from health promotion - and by logical extension I suspect also
argue that the status of women is not a worthy target of Health Promotion.

One suspects (or at least I suspect) that there are two things at work
here. One is the clever strategy of reducing tobacco consumption to an
individual "lifestyle" choice in order to keep it outside the limits of
health policy. If food companies doctored anchovies the way tobacco is
doctored (no pun intended!), and we ate pizza with the anchovies on fire
the food and drug authorities would have a fit. I can equally say that
tobacco is a dietary supplement and ....  Right and wrong here are a
political issue not a medical one. The same goes for the status of women.
These are issues of power, not of science nor of logic. There are issues
of ethics here but that for another day.

There is another factor at work here, and it has to do with domains and
turf protection. One posting has lamented the idea that there has been a
growth of health promotion "experts" where they claim expertise within the
domain, the right to define the domain, and -usually- some exclusive right
to work within the domain. (Nice trick when it works!)

I suspect that there are two forces at work distroying the idea of the
'professional' in this area and in other areas. The first is that the idea
of domain-as-box is an "industrial" (fordest) construct, more fitting of
an age in which the factory was a metaphor for everything from the human
body to health promotion.

More and more a domain is defined in terms of an objective (say:
population health) and not by its boundries. Second, more and more we
realize that expertise is really a context relevant set of skills which
may be based on information, on analytical skills, or -less frequently-
simple skill of wisdom. Third, there is growing appreciation of the fact
that the "community" and the "patient" have their own knowledge and -in
fact- may bring considerable context relevant wisdom to the task at hand.

This last point is a double pronged attack on the the idea that the expert
knows best. The internet and information and communication technology in
general are  creating knowledgable patients and communities. They are
making it easier for communnities to work through to their collective
wisdom on issues at hand.

Even traditional research models are under attack when -using electronic
spaces- it is possible for a community to monitor the evidence flows
around certain health processes in continuous time - not once a year or
two when an institute holds a public dog-and-pony show- and not only when
it appears in a journal or on a panel. There is the possibility for
feedback in real time - and of individual and community responses in real
time - frequently not waiting for the 'expert' to hand down opinion.

In no uncertain terms it is clear that a struggle is brewing here. (In
fact there are a number of struggles as a result of competing agendas).
The challenge for "expert knowledge" will be to repatriate itself back
into social processes where it once held a 'gatekeeper" role. I have
argued that this brings forth the model of the participant researcher,
rather than a model of participatory research. That is a model where the
researcher has to gain/earn entry into the social process. This is very
different from the participatory research model where the community has a
limited entitlement for entry into the research process.

As these struggles take place I will continue to view childhood
consumption of second hand smoke, and eating lead off of plastic blinds as
health problems, not as the lifestlye choices of the young and silly.

Sam Lanfranco , York Centre for Health Studies <[log in to unmask]>