Brian,
I always appreciate the reminder that social determinants of health did not
begin with population health. Many nurses can identify with the
invisibility you experienced as a health promoter because the contribution
of the founders of modern public health nursing in health promotion is
likewise typically ignored.

I would like to add to the discussion a reminder that modern nursing, from
the time of Nightingale's health nurses (1870s) to Lillian Wald's public
health nurses (early 1900s) in the US dealt with broad determinants of
health, primarily focused on addressing poverty, housing, and public policy
to address child labour and welfare. Wald was a social activist at the turn
of the century who was a strong champion of intersectoral collaboration
long before the term was coined.

It's also interesting that 7 decades before Thomas McKeown  discovered that
"health care" contributed little to health, Nightingale wrote that "money
would be better spent in maintaining health in infancy and childhood than
in building hospitals to cure disease".

I also am the first to admit that public health nursing did get somewhat
derailed as it moved from autonomous practice and came under the
jurisdiction of the powerful disease model that came to dominate health
care, public health included. The health promotion movement is a welcome
support for nurses who wish to return their practice to a socioecological
approach.

Adeline

At 04:34 PM 6/16/99 -0400, you wrote:
>Glen,
>
>I liked your analogy very much, but feel the need to propose a revision:
>
>The model of health promotion practice I support would also focus on advocacy
>efforts "to stop the dumping of toxic chemicals into the stream in the first
>place." One of my quibbles about the population health paradigm -- the one
that
>has gained some recognition in Canada, at least -- is the tendency of its
>proponents to appropriate key principles and concepts that are rooted in
health
>promotion without giving proper credit to their source of origin. Health
>promoters recognized the importance of addressing the social, economic and
>environmental causes of illness long before the determinants of health were
>suddenly "rediscovered" by Fraser Mustard and Co.
>
>Brian Hyndman.
>
>
>>
>> In the Health Promotion Model, we work with each of the communities to
>> reduce their need to drink out of the stream. With some communities, that
>> might require a well. With others, education about the dangers of stream
>> drinking. With others, bottled water.
>>
>> In the Population Health Model, we figure out how to stop the dumping of
>> toxic chemicals into the stream in the first place.
>>
>> Oh, yeah, and then there's government policy: close the hospital, cut back
>> on health promotion, reduce environmental protections and call it health
>> reform.
>>
>> Glen Brown
>
>--
>Brian Hyndman
>The Health Communication Unit
>at the Centre for Health Promotion
>University of Toronto
>The Banting Institute
>100 College Street, Rm 215
>Toronto, ON  M5G 1L5
>Tel: 416-978-0586
>Fax: 416-971-2443
>[log in to unmask]
>www.utoronto.ca/chp/hcu
>
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