I agree with the thrust of Dennis's arguments. What disturbs and
challenges me, however, is that the same charges could also be leveled
against the field of health promotion.

Are Canadians better off than they were before the Ottawa Charter was
created in 1986? Are the levels of child poverty higher or lower?  Is
there a greater degree of homelessness? Are working conditions better or
worse? Do people feel more empowered to take charge over the conditions
affecting their health or less empowered? Is our air quality better or
worse? Has our level of social and community cohesion increased or
decreased?

Like Dennis, I am concerned about the implications of the population
health approach. But, unlike some critics of the approach, I do not hold
the advocates of population health responsible for the preponderance of
'unhealthy public policies' over the past decade. With the arguable
exception of Fraser Mustard's work on child development, our political
masters have largely ignored the blueprints for a healthier society
emanating from population health and health promotion camps.

If health promotion is to emerge as a credible alternative to population
health it needs to demonstrate real accountability to some of the
questions I note above. As a starting point, health promotion needs to
acknowledge its own limitations ( esp. the failure to walk its own
talk), and develop a credible approach to addressing the barriers to the
achievement of 'health for all'. Until this happens I don't think that
health promotion advocates are in a position to throw stones until they
get their own glass house in order.



"d.raphael" wrote:

> Discussion Piece?
>
> In Canada, population health has become official federal policy
> while health promotion has been delegated to the sidelines.
> Nonetheless, as pointed in the recent CPRN review by Legowski
> and McKay (Health beyond health care: 25 years of federal health
> policy development - http://www.cprn.org), health promotion
> continues to be the choice of approach for most nations, and in
> academia, health promotion continues to have a strong presence.
>
> The review by Legowski and McKay is fascinating and important for
> any health promoter to read as it traces the shift from health
> promotion to population health. Does population health represent
> a retreat from the welfare state and a lack of concern with
> citizen voice as argued by critics?  Or does it pose a brave new
> way to have governments improve the health of Canadians?
>
> My personal opinion?  During the ascendence of population health
> in Canada, poverty levels and homelessness have doubled. There
> has been an explosion of inequality and a weakening of democratic
> institutions. Not a great endorsement for the role of population
> health as a means of having governments address the determinants
> of health!  Will population end up being as suggested by
> Shakespare "All sound and fury signifying nothing"? or a lot more
> research money to demonstrate the obvious with no parallell
> change in government policies that weaken population health?
>
> DR
>
> References
>         Coburn, D. & Poland, B. (1996). The CIAR vision of the
> determinants of health: A critique. Canadian Journal of Public
> Health, 87, 308-310.
>         Hamilton, N. & Bhatti, T. (1996). Population Health
> Promotion: an Integrated Model of Population Health and Health
> Promotion.  Ottawa:  Health Promotion Development Division,
> Health Canada, 1996. On-line at
> http://www.hc-sc.gc.ca/main/hppb/phdd/resource.htm
>         Health Canada (1998). Taking Action on Population Health:
>  A Position Paper for Health Promotion and Programs Branch Staff.
>  Ottawa: Health Canada. On-line at
> http://www.hc-sc.gc.ca/main/hppb/phdd/resource.htm.
>         Labonte, R. (1995).  Population health and health
> promotion: What do they have to say to each other?  Canadian
> Journal of Public Health, 86, 165-168.
>         Labonte, R. (1996).  The population health/health
> promotion debate in Canada: The politics of explanation,
> economics, and action.  Critical Public Health, xx, xxx-xxx.
>         Poland. B., Coburn, D., Robertson, A., & Eakin, J.
> (1998).  Wealth, equity, and health care: a critique of a
> population health perspective on the determinants of health.
> Social Science and Medicine, 46, 785-798.
>         Raphael, D. & Bryant, T. (2000). Putting the population
> into population health. Canadian Journal of Public Health, 91,
> 9-12.
>         Raphael, D. & Bryant, T. (2000). Population Health as a
> model for a new public health: a critical analysis. Submitted for
> publication.
>         Robertson, A. (1998). Shifting discourses on health in
> Canada: From health promotion to population health.  Health
> Promotion International, 13, 155-166.
>         Robertson, A. (1999). Health promotion and the common
> good: Theoretical considerations. Critical Public Health, 9,
> 117-133.
>         Wong, D. (1997).  Paradigms Lost: Examining the Impact of
> a Shift from Health Promotion to Population Health on HIV/AIDS
> Policy and Program in Canada. Ottawa: Canadian AIDS Society.

--
Brian Hyndman
The Health Communication Unit
at the Centre for Health Promotion
University of Toronto
100 College Street, Rm 215
Toronto, ON  M5G 1L5
Tel: 416-978-0586
Fax: 416-971-2443
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