This was meant for the list and is very interesting, so I thought I would send it there,

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From:   [log in to unmask][SMTP:[log in to unmask]]
Sent:   Saturday, June 27, 1998 1:55 PM

> Hello all,
>
> More on the Ontario pregnancy benefit.  I am sorry for the Ontario focus,
> maybe we can look at the issue of politics driving health policy and people
> could share what is happening else where.  It seems in Ontario we are
> seeing a radical shift away from public policy for public good and instead
> public policy for political gain.  I think the recent proposal for the
> removal of the nicotine patch and gum from consumer's hands in Ontario is a
> hard one to understand as well.  How do we get health, economic and social
> policy to be driven by evidence?
>
> Anyone have any thoughts?

Dear Sherrie

It is impossible to have health, economic and social policy driven by
evidence.  It is always - all of it - driven by values.  Your problem
at the moment is that the values used to select the 'policy evidence'
are not ones you agree with - but any alternative you prefer would be
driven by _your_ values (which are presumably for planning and
intervention rather than laissez faire).

No doubt you will want to say that this or that example of injustice
or unnecessary disease speaks for itself, but it can't do.  For you
to be angry or distressed about a particular situation requires a)
that you have certain beliefs that certain social arrangements are
wrong, b) that you have reasons for focusing on this injustice rather
than the millions of others you could choose from and c) that it
bothers you enough to want to try to do something about it.

Show your evidence to someone who disagrees with your beliefs and all
they need do is show you some other evidence that coheres with
theirs - how, then , do you arbitrate between the two?

This need not be a negative conclusion.  It seems to me that health
promoters should ditch the myth that 'we are obviously right because
this is a _health_ matter' (as if health were an objective notion)
and recognise that the health promotion task is to work out a
comprehensive justification (based on values) for the health
promotion endeavour, and then try to implement this, bearing in mind
that to do so is inevitably a political action.

Health promotion plays into the hands of the new right because they
have a political outlook (albeit a brutal and simplistic one) and
health promotion has nothing more than a collection of woolly
declarations about what is wrong with the world.  Health promotion
needs to get theoretically tough - until it does it will remain a
pawn of both the political and medical establishments (just as it
always has been).

Best wishes



David Seedhouse