David Gourlay wrote:
>
> Dennis Raphael, Ph.D. wrote:
>
> As we in Ontario and Canada continue to observe the effects
> of increasing inequality on our society, I have to
> wonder about the deafening silence among many health
> promoters.
>
> - I agree with Professor Raphael that health promoters are generally
> silent and if they are not in particular circumstances, it is limited to
> their own constituencies, which is fine, but leadership is needed to
> enhance the message beyond a certain jurisdiction.
>
> A few thoughts:
>
> Health promotion requires organized infrastructure in order to be
> successful. This may employ information technology, ie:interent or
> non-profit groups. There are a variety of approaches one may use, but we
> seem to lack the forum for discussion and the platform to utilize
> knowledge or resources. I realize there are examples of this already
> such as this list-serv and university programs, but more is required if
> health promotion is to become a significant component of our health
> system.
>
> As a policy researcher in health I see new visions in health promotion
> evolving all the time. This is a relatively new field for me as I had
> been focussing on the federal role in health. If you ask anyone in
> Health Canada what that role is today, they will shuffle some papers,
> look away and whistle "It's a Long Way to Tripperary". And let me tell
> you, they are a long way from there. The fact of the matter is that
> health is a file that is "whole" and not a sum of its' parts.
>
> Another fact is that health policy solutions are never fixed. The
> population health approach is based on this theory in which solutions
> are never meant to last for a long period of time as social factors
> change and solutions must be flexible to meet these changing demands.
> I wonder if a bureaucracy, any administrative system whether it is based
> in a hospital or government is able to respond in an effective manner to
> these solutions with its' tendency to act so slowly.
>
> I think I am off topic here. One could look at the inequities in the
> health system as a researcher and devote a lifetime to it. It is an
> interesting topic. I am presently preparing research on pharmacare and
> home-care for the National Anti-Poverty Organization in Ottawa. They
> wish to design advocacy positions for their membership as both these
> files are in the policy development stage. They wish to ensure that the
> federal positions are sensitive to the working poor. My position is
> simple: that these innovative files possess the potential to assist the
> working poor and other economic classes in society, but as a health
> file, the funding and delivery must be orientated to the relevant
> constituency and ensure that resources are not wasted.
>
> The role of the health promoter at any level is to participate and
> advocate through the means available to us.
>
> If we feel we are missing that, we must then take the leadership role to
> create them using energy and passion.
>
> David Gourlay
>
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David, I agree that it is worth challenging the federal government to
define its role in health promotion -- and in other areas of provincial
jurisdiction in the social services.  In fact, I would suggest that this
is one of the most important roles of social advocates in all fields in
this post-CHST era.  The questions you raise affect the whole field, and
encompass the federal government's place in the funding (both direct to
service providers and through transfer payments) and quality-control and
coordination of services.  Most central at the moment appears to be the
role of jurisdication and the Constitution, and the willingness of the
federal government to play a role in federalism.

I think that it is very important to focus on the politicians who make
policy, though, and not on the workers in the federal government.  The
public service has been incredibly dispirited through years of frozen
contract negotiations and direct attacks through downsizing.  The
government of Canada was in fact condemned by the United Nations
International Labour Organization for human rights abuses for the way it
has treated its public service workers.

The treatment of public service workers and the treatment of social
policy (including health in general and health promotion in particular)
are very closely linked.  The lack of respect of human values is
inherant in both.  The years of this treatment of public service workers
is bound to affect their morale, increasing the turnover of the staff
with whom you work, affecting in turn the quality and expertise in your
contacts with the federal government.  A government committed to good
public services should reflect its respect for Canadians in the way it
treats those Canadians it employs, which would mean re-opening
legitimate collective bargaining with its workers (which health
promoters must recognize as one effective tool of community organizing
and lobbying as well), and settle its outstanding pay equity dispute
with its clerks, secretaries, hospital and library workers (health
promoters also recognize the signifance of gender equity and
stratification on population health).

So, though your frustration with the bureaucracy of Health Canada is
understandable, it is hardly fair to single out public service workers
for paper shuffling and whistling.  Talk to Cabinet and the provincial
politicians.