A concern with behaviour can occur on AT LEAST four levels.

Let's assume that working women can benefit from having quality and affordable
day care.  Let's also assume that we believe that access to health care is health
promoting and should be a concern of health promoters.

We can argue for this along a number of lines.

1) that working women who has such access will be under less stress and will
therefore smoke less, will not drink to excess, will take care to vaccinate children,
will have less hectic lives and thereby be more attentive to potential threats such
as child injury, etc.  One immediately sees that for those health promoters under
the foot of behaviourally oriented bosses, there will be a bit of a stretch to justify
activities related to promoting such access. Notice the emphasis here on illness
and injury prevention.

2) using a general psychological approach (such as that seen by the
Mustard/population health types) having access to child care will be associated
with improved coping, strenghened immune systems, increased sense of control,
and "may" be associated with improved health.  While Judith Rodin has
demonstrated the immune system enhancing aspects of increased control among
seniors, this has not been a major area of research among day care advocates.

3) One can simply follow the Ottawa Charter and argue that health promotion is the
"process by which individuals are enabled to increase their control over, and
thereby improve their health."  Within the W.H.O. definition of health as involving
physical, psychological, and social well-being there is certainly enough evidence
to suggest that women's health (i.e. well-being, life satisfaction, etc.) is improved
when quality daycare is available.  In this scenario, we need not prevent illness or
injury, but simply show increased well-being.  If biomedical or epidemiological
types do not like this evidence, the approach is to convert them to our rules of
evidence, not be trapped into playing their game.

4) Finally, one can simply argue on grounds of principle (and beliefs and values)
that adequate day care is a right and not having such works against women.  And
since health promoters are concerned with enhancing well-being and maximizing
'health' this is an end in itself.

Personally, I feel a case can be made, if the right questions are asked, to justify
access to day care along all four grounds. But obviously, relying on arguments 1
and 2 may be more problematic in that one is playing by the illness prevention
rules which may not be the best rules for health promoters to play by.

Not consider other health promotion issues such as social isolation, employment,
crime, FRONT-YARD PARKING, public transportation, quality schools, equitable
distribution of resources, availability of bicycle paths, and one can begin to see
that playing by the illness prevention rules becomes more problematic.  In fact one
can argue that with increasing paths there will be MORE deaths due to bicycle
injuries.

In summary, where does "human behaviour' fit in when these health promotion
issues are considered?

Best wishes,



Dennis Raphael, Ph.D., C.Psych.
Associate Professor
University of Toronto
Division of Community Health
Faculty of Medicine
Department of Behavioural Science
McMurrich Building, Room 101
Toronto, Ontario M5S 1A8
Tel: (416) 978-7567
Fax: (416) 978-2087
E-Mail: [log in to unmask]