I tried to move in from the "silent majority" earlier but had to
resubscribe, in order to post a message, because I had changed my email
address ...

Alison wrote ...
>
>> 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.
>>
>...
>
I wonder what medical officers of health would say about the health
promoters perceiving themselves as having a leash? We all are constrained in
one way or another but I'm sure health promoters have a longer tether than
most (along with Medical Officers, who frequently stretch their authority).
Because health promotion is so broadly defined, organizational managers
would need to define the boundaries or risk spreading the resources
(including talent) too thinly. Health promoters set some of the boundaries
by trying to delineate the "profession/process" and the skills at which HP's
can excel. Many would include the skills of being able to substantiate one's
professional views and garner support both within and external to the
organization that provides the economic returns (and, of course patience,
and persistence: Health Promotion 626b).
>
>>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
>
Health promoters must be proud of some of the recent changes to our "social
environments" via attitudes/policies/laws concerning tobacco acceptability.
While laws and tobacco police are part of the strategy, the changes do go
beyond these components (I can't remember the last time somebody asked to
smoke in my house). Unfortunately there still isn't a lot of evidence of
favorable impacts on "lifestyles of the young and silly." If the lackluster
results continue, it may open doors to looking at more distal root causes or
other changes that Alison envisions.

If health promotion is "the process of enabling people to take control over
..." then how do we rationalize the need for and implementation of public
health laws, which often control people against their will? As far as I
know, advocating for public health legislation is a health promotion
activity but what models/mechanisms can we use to "scientifically" decide
that we have the right to make certain changes for the social good? W.H.O is
now officially recognizing the need to alter lifestyles and environments due
to predicted chronic diseases on a global scale (rather than AIDS, Ebola
Viruses etc.) But at what point does the evidence warrant "taking control
over another 'publics' life?" Politicians have their mechanisms for
(eventually) making such decisions but the choice must be made much earlier
by HP's. Are the traditional epidemiological measurements sufficient or do
we have new approaches?
>
>
[log in to unmask] ( **this new address is now in effect: Sept16/96)

Ron Dovell
23 Loradean Cres.
Kingston, Ont.          fax: (613)531-7840
K7K 6X7                 phone: (613) 531-9857