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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