Regarding H. Platt's recent posting about the discussion on "what is *real*
health promotion" I agree that it is too early for this discussion to
'fizzle out'.
Fortunately we are seeing some lively debate continuing on the focus *and*
limits of health promotion.

I am particularly delighted to see Jane Springett's comments on this area:
>"It is interesting how the status quo uses the lifestyle model to contain
the issues... "

As a health promotion consultant who is asked on a daily basis to assist HP
practitioners in finding resources, strategizing, planning, evaluating
health promotion activities and programs, the day-to-day reality is that
'lifestyle' oriented health promotion, particularly disease and injury
prevention is what is funded and supported.  Yes, the status quo is to focus
on the lifestyle model, or risk losing any funding and political support for
health promotion.
Many of the health promoters who are asking for "evidence based strategic
interventions for behaviour change" are graduates like myself of the Health
Promotion program at University of Toronto (of which Dennis Raphael has
frequently written).  While we are personally committed to 'the tenets of
the Ottawa Charter of Health Promotion', and have years of experience in
community development, social advocacy, as environmental activists and
change agents -  what is asked of us in our work is to develop and implement
 individual behaviour change approaches that have been 'evaluated and proven
cost-effective and efficacious'.  Indeed, the comments that Jane made are
frequently echoed in daily conversations with other health promoters.  I
just got off the phone discussing with two health promoters working in
public health units who are deeply concerned about the four alternatives:
> 1) keep quiet and keep your job
>2) facilitate change through various "subversive" ways...  so you are not
perceived as a health promoter.
>3) do something else and still view yourself as a health promoter.
>4) Quit.

Rather than bickering about what is "real" health promotion we need to apply
a broad perspective on health promotion and set some realistic priorities.
We need to use all the opportunities and approaches that are available, to
continually engage in self reflection and debate and to work with the
disempowered.

The recent "Action Statement for Health Promotion in Canada" produced after
a two year consultation process across the country offers strategic
directions for action,  useful in our current situation.  To quote from the
preamble of this Action Statement:
"In the light of these realities, promoting health requires that we focus
our efforts and prioritize our actions by:
* affirming and sharing the vision and values of health promotion;
* emphasizing the creation of alliances across and between sectors;
* honing our knowledge, skills and capacity to improve health;
* emphasizing political commitment and the development of healthy public
policies;
* strengthening our communities; and
* ensuring that health systems reform promotes health both inside and
outside the health care system.

"....To  improve action the focus of practice needs to be sharpened and some
infrastructures need to be strengthened or developed"

In my opinion we have a long way to go to change the infrastructures to
enable health promotion practitioners to go beyond being 'tobacco police'
for the 'lifestyles of the young and silly'.
There is still much work to be done in developing appropriate evaluation
methods for community-based health promotion work and policies that create
healthy living conditions.

Let's keep up the debate.

Alison Stirling
<[log in to unmask]>
Ontario Prevention Clearinghouse
Toronto, Ontario, Canada M5B 2E7
http://www.opc.on.ca


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