As health organizations involve themselves in coalitions around heart
health generally, they may restrict themselves to a focus on CVD
physiological and behavioural risk factors. This allows them to tackle a
fairly narrow and manageable portion of the total heart health picture, a
portion that aligns with their historic mandates.

But health organizations engaged in heart health programs may also wish to
incorporate a Heart Health Inequalities component. If they do so, the
nature of their work, and of their relationships with their "target"
communities, changes from a community-based approach to a community
development approach. In this second approach, community groups and
organizations negotiate with health organizations the extent to which the
latter support actions on socioenvironmental risk conditions and
psychosocial risk factors. This does not mean that the heart health
coalition becomes an anti-poverty or job
creation coalition. Nor does it mean that health organizations become
housing developers or welfare rights organizers.

What it does mean is that health organizations, in the name of heart
health, and in recognition of the socioenvironmental and psychosocial
"determinants" of heart health, seek ways to support community groups and
organizations in their work on these determinants. Just as a heart health
coalition of health organizations would like to see community groups become
more involved in actions on physiological and behavioural risk factors for
CVD, a heart health coalition must be open to advice from community groups
on how it can become more involved in actions on the socioenvironmental
risk conditions and psychosocial risk factors for CVD.

Openness, honesty, dialogue and a commitment to sharing power and expertise
are the hallmarks of the new health promotion. They are the very essence of
what is meant by "partnerships", and the foundation upon which a Heart
Health Inequalities program must be based.
Visit our Web Site for Free Copies of Our Community Quality of Life Reports!

http://www.utoronto.ca/qol

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   Canalising a river
   Grafting a fruit tree
   Educating a person
   Transforming a state
   These are instances of fruitful criticism
   And at the same time instances of art.
       -Bertolt Brecht
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Dennis Raphael, Ph.D.
Associate Professor and Associate Director,
Masters of Health Science Program in Health Promotion
Department of Public Health Sciences
Graduate Department of Community Health
University of Toronto
McMurrich Building, Room 101
Toronto, Ontario, CANADA M5S 1A8
voice:    (416) 978-7567
fax: (416) 978-2087
e-mail:   [log in to unmask]