Thanks to Alison for bringing things back to basics here on CLICK4HP.I agree
with the person who said we need to move beyond educating people about the
link between poverty and inequality and health. For people who get educated
and see the light, I think the issue is powerlessness. Most people, from the
ordinary guy in the street to the city councillor to the business people,
don't think they have any power to do anything. And some of us are just
exhausted.

I agree with Peter Elson that fitting health promotion strategies into the
bandaids that help people survive like food banks and soup kitchens is for
sure better than social marketing. That is perhaps the best that we can do
in institutions where funding requirements limit health promoters to
developing programs that fit into packages, with a beginning and end, and
outcomes that will reassure the funder that what we did "worked". But let's
see if we can imagine a world where health promoters aren't limited by those
boxes.

It is also quite trite to say that hp is no substitute for food, literacy,
education and a good job. For people who are "forced" to do health promotion
with the poorest in our communities there is a very real issue here.I'm on
the board of a community health centre that works with the poorest parts of
our community.  We know that heart disease is rampant here and related to
poverty, our docs/NP's/nurses are faced with people coming in with heart
attacks on a not irregular basis. The question the clinical and hp staff
have is how do we do heart health work that is relevant to these folks. IS
there ANYTHING that can be done on a prevention level. Well, let's focus on
the root cause - poverty - what can we do? Well what do you know, we're
already doing what Peter Elson suggests - the hp staff are very busy with
food security initiatives exactly as Peter described - food buying clubs,
good food boxes, school breakfast programs, support at the food banks and
the soup kitchens, carrying out all those good integrated h.p. initiatives.
And they too are questioning the value of that work. Is there a way to move
beyond this kind of hp to other strategies that will have more impact -
should we be getting out of the standard food security business and dealing
with the poverty issue ina more effective way. What would be more effective?
These are the questions we are asking now.

To be fair, when I first heard the staff wanted to develop a heart health
"progran" I rolled my eyes and thought Oh God,here we go again, more focus
on lifestyle not the determinants of health. But when I heard what was
happening in the clinic and the analysis of the community demographics I
re-thought it. Yes hp is no substitute for income, but do we therefore throw
up our hands and say, oh well this is the best we can do - soup kitchens and
food banks?




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