> > I just found that the following message from David Seedhouse, replying
> > to Blake Poland, had not been successful in getting posted to this list.
> > In the spirit of keeping this lively discussion flowing, I am copying it
> > here.
>

David here - I'm trying again to post a message.

> I must say I am following this discussion closely and I think I am starting
> to understand a lot of my concerns with HP.
>
> Maybe if I lay them out it will help;
>
> School feeding programs as a response to poverty.
>
> They do not feed children in the summer and on week-ends, it does not make
> sense to me if people truly believe that people do not have enough food to
> feed their children that they also think that children can go with out
> steady food.

That is a very strange policy, and contrary to what the Foundations
theory advocates.  Food is - obviously - a foundational
necessity (whether it prevents disease or not).  If you are hungry
your human potentials are impeded - and the hungrier you are the
less you can flourish.  Just to focus on hunger as a conventional
'health issue' (ie to focus on it because it causes clinical
morbidities) is a habit, nothing more.  If being diseased matters
because it prevents people developing well then being hungry without
disease matters equally.

>
> Then when I read some of the programs I learn that some of the objectives
> are to "get mothers in the habit of feeding their children breakfast"
>
> So, these programs are not really meant to address a lack of money but a
> lack of skills among parents.  And I wonder if there is any proof that
> women who live in poverty have low skills in terms of nutrition or
> remembering to feed their children.

Right.  Rich people are generally healthier on my understanding of
health because they can afford good food (and perhaps even a nanny to
feed their children), they are educated, they usually have meaningful
jobs, hope for the future and so on.  If everyone was this well off
there would, I suggest, be no need whatsoever to teach 'feeding
skills'.  The problem isn't lack of knowledge and to implement
programmes that say that it is is insulting and demeaning.

>
> Thus for me, David's stuff makes sense, these programs reflect a certain
> set of values among the people who support them.  And they are not my
> values and beliefs.

That is correct too.  The implication is that people who happen to be
poor are incompetent, and so need to 'improve themselves'.  This
neatly sidesteps feelings of guilt about living in wealth while
people next door are in poverty (it is really their fault and - look
- we are helping them to help themselves), and allows the system to
look like it is caring.  To say that it is the system itself that is
the problem is a value judgment - a political stand - that supporters
of the system cannot possibly make, because it is the system they
want and is one which serves _them_ well.
>
> Now we have a whole bunch of funded CAPC and Prenatal nutrition programs in
> Ontario, really only the Metro Toronto ones have done any work around the
> pregnancy supplement in social assistance rates with their local
> municipalities.
>
> Why?  Is it that they agree with the government that women waste the money
> given them?

Presumably.  But the notion of 'waste' is itself clearly a social
judgment.  If the poor women were rich then whatever they 'waste'
their money on now would not seem to be a waste - they would
have the luxury of pressure-free choice.

> Isn't healthy public policy part of the work they do?

A good question - why not ask them?  If you did they would have to
supply a statement (a theory even) about what healthy public
policy _is_.   And this is where you would encounter the vagueness -
a vagueness which supports the prevailing system and its values
because it 'sounds OK' on first hearing.  It is only by showing the
major flaws in conventional understandings of health - and showing
how they are set in political values - that they can be challenged.

But just criticising isn't enough - there has to be a clear and
practical alternative (and in the end I hope there will be several
alternatives, as I said to Blake).  My recommendation is the
Foundations theory of health - which is theoretically transparent and
practically oriented.  My anxiety about declarations is that they
merely place one set of vague political aspirations against equally
vague establishment ones - and the establishment will always win this
way (and of course there are many in the establishment who are
quite happy to encourage such declarations - some of them even write
them).

If a foundational health promoter (sorry about the mouthful) were
well-funded and in a position to help people with children in poverty
then he or she could select and justify clear practical priorities.
She would do this by imagining a stage or a platform (the
foundations) on which individuals and families live.  This platform
can be thought of as having four central components - basic needs,
information, education, and a sense of community - and a fifth
additional segment - crisis support, special needs, medical and
nursing assistance.  If any of the four foundational components are
lacking or damaged then the health promoter - by inspecting both the
stage and the family simultaneously - must work to replace or repair
them, concentrating first on the segment which if repaired will be
most enabling. There need be no medical problem or involvement in
this task - though there can and should be if it seems the family
could benefit from a strong fifth box (in order to help provide them
with the firmest possible foundations).

From what you say Sherrie the foundational health promoter would
work first on basic needs - and that means doing something about the
poverty.  If nothing is done about the poverty then having a proper
theory allows a very clear challenge - "why are you doing that rather
than this?  How do you justify your choice?"

Are
> they not funded by a totally different level of government and thus secure?
>
> Anyway, please continue the discussion as I am learning a lot, I have
> managed to get my hands on a copy of David's book:
>
> Health Promotion - Philosophy, Prejudice and Practice
> published by John Wiley and Sons
>
> It makes great reading!
>

Thank you for that.


David.

Please continue the discussion!