On Mon, 13 Jul 1998, David Seedhouse wrote:

> There are people who argue that it is unjust to redistribute income
> (I'm not one of them I hasten to add).

Yes, and they're not all rich! (But, they are wrong!)

And, in response to some of my comments about redistribution of income,
David wrote:

But not everyone in HP agrees with you.  Surely it is time to
> become more explicit so that everyone (not least the recipients of HP,
> many of whom are not concerned about world poverty) knows where they
> stand.

Of course, not everyone agrees with me. But, this discussion began with
queries about HP and poverty. So, I am trying to focus on that.
And, since we are discussing "politics" and HP, we do need to discuss
disagreement. I can't get anymore explicit about where I stand!!! But, I
recognize that I have a privileged position (professor with tenure); most
people working in HP do not have such protections. It is much more risky
for them to disclose..but, I repeat myself...

David then suplied us with a synopsis of his theory

> `Work for health is essentially enabling.  It is a question of
> providing the appropriate foundations to enable the achievement of
> personal and group potentials.

Now, all personal and group potentials? What about the "bad guys"..do we
want to work for their potentials? I am not being facetious although it
may seem that I am.

The work by Wilkinson and others suggest that "social cohesion"..(not well
defined by him or others) may be responsible for the health status of a
population. So, the more "socially choesive" a society is, the higher the
health status. Maybe the immediate reaction to that is "warm fuzzies"
because we are probably all decent folk and have visions of warm,
nurturant, healthy communities. But, social cohesion, while leading to
"health" of a population may do so at the expense of some more than
others. Japan is always cited as an example of a society with high health
status and social cohesion. But that cohesion is accomplished at the
expense of Japanese women, mostly.

So, *who* gets enabled and *who* gets to meet his/her potential?

Then, David wrote about the four boxes:
> 1.      The basic needs of food, drink, shelter, warmth and purpose in
> life.
> 2.      Access to the widest possible information about all factors
> which have an influence on a person's life.
> 3.      The skill and confidence to assimilate this information....
> 4.      The recognition that an individual is never totally isolated
> from other people and the external world....

Sherrie has asked about #1..keeping with the theme she started about
poverty. I would add that you can have all of #2-4 and still NOT be
"healthy." In fact you could be as mean as a junk yard dog.
(Obviously, I don't think mean is healthy...at least not for the
recipients of meanness)

>It will be immediately obvious that this notion of health does not
> have traditional medical provision as its focus.

David, most of us have been past the medical focus since the Lalonde
document..if not before...but POLITICS keep us from living out our
knowledge.

> `... work for health cannot be fully comprehensive - not all work
> should be thought to be health work.

Now this is where HP is getting into trouble.."health" has become a
totalizing concept. But, I think that is perfectly understandable, if
regrettable, given that HP is, (at least for some of us!),
part of movement for social change..it will have its contradictions.

>  What a person makes of the foundations he has is
> up to that person, as long as he possesses at least the essentials
> of the central conditions.  Given this then an individual must be
> allowed to become the architect of her own destiny. (1)  (Quotation
> slightly changed from the original.)

So, a healthy person can be a nasty person too? If so, Ontario is becoming
a healthier province!

Really, I apologize if I'm appearing a little testy here...but, this is
one of our core problems I think. If the social cohesion approach is
correct, and everyone is living out his or her potential, we better hope
it is the "good guys" who determine what cohesion is!

We all know that these issues have been discussed by philosophers,
theologians, academics, mothers, etc..for centuries. But, when we are
discussing POVERTY and HEALTH, we have to confront that some people are
realizing their health potentials and destinies at great cost to others.
WHAT are we going to DO about that?

Rhonda