In the current context of state supported global capitalism, perhaps you
should substitute 'wind' with 'hurricane'?

David King
Health Promotion Service
Barnet Primary Care Trust
Hyde House
The Hyde
London NW9 6QQ

email:  [log in to unmask]
tel:    (020) 8201 4860 (w)
tel:    07973 739 158 (m)


-----Original Message-----
From: Dennis Raphael [mailto:[log in to unmask]]
Sent: 14 September 2001 11:48
To: [log in to unmask]
Subject: Re: Cause & Effect - Control of Destiny


All of this must occur within a societal context that provides people with
food,
shelter, adequate incme, and other prerequisites for health.  Without these,
lifestyle messages are pissing in the wind.


dr









Jillian Snell <[log in to unmask]>@YorkU.CA> on 09/14/2001 12:18:49 AM

Please respond to Health Promotion on the Internet <[log in to unmask]>

  Sent         Health Promotion on the Internet
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  cc:          (bcc: Dennis Raphael/Atkinson)



  Subject      Cause & Effect - Control of Destiny
  :







Dennis Raphael in his article 'Cause & Effect' tells us that poor health
practices are not just associated with low socioeconomic status but that
other factors come into play such as coping skills and a sense of control
over life circumstances.

Marmot, with his dissertation on the social gradient, did try to explain
this gradient by reference to risk factors such as diet, smoking, obesity
etc. These factors explain about 25 - 35% of the gradient but the rest is
unexplained. However Len Syme, Professor of Epidemiology, University of
California, Berkeley, put forward a hypothesis to explain the remainder of
the gradient, ie. the ability of individuals to have mastery over their
lives. Therefore the less opportunity and training you have, the less
ability you have to influence the events that affect your life and the
psycho-social factors of being less connected, having less social support
and being less resilient consequently impinge on your life and your health.

Furthermore if you want people to change their behaviour and develop good
health habits, you cannot make proclamations from the top down. People need
to be empowered to participate in the events that affect their life. For
example Albert Bandura's Social Cognitive Theory, uses the concepts of 'role
modeling' to set a high standard  and 'self-efficacy' by which he means 'the
exercise of control'. If, however, self-efficacy is not a deep personal
trait, or if it is only associated with high income groups, perhaps this
attitude of self-reliance and autonomy needs to be encouraged, possibly even
taught as a means for achieving control over one's life.

According to Len Syme, if an important dimension in the social class
gradient is this idea of 'control', then it should be taught early in life.
Thus if you empower an individual with this knowledge then they should be
able to adjust their circumstances, reduce disease risk factors and improve
their health.