Dear All:

Sherry Tingley sent us a post asking how we could get health issues driven
by evidence and not politics. She sent us a post from David Seedhouse, who
has written numerous books on values, ethics and health promotion. I want
to make a few comments about these issues.

First, I accept the belief that health and medicine ARE political, through
and through. From the moment you "choose" to be interested in health
questions, you make political choices. These choices, ranging from what
you're interested in to what you do and don't do with your choices are
political.


So, David wrote:

> It is impossible to have health, economic and social policy driven by
> evidence.  It is always - all of it - driven by values.
............
> Show your evidence to someone who disagrees with your beliefs and all
> they need do is show you some other evidence that coheres with
> theirs - how, then , do you arbitrate between the two?

The arbitration over different points of view is what the lay person sees
played out in the media everyday and the scientist professes to engage in.
How does one theory PROVE itself to be more explanatory than another; how
is one set of evidence more powerful than another is the stuff of what is
called "science." (Forgive me for being simplistic or obvious.)

> This need not be a negative conclusion.  It seems to me that health
> promoters should ditch the myth that 'we are obviously right because
> this is a _health_ matter' (as if health were an objective notion)
> and recognise that the health promotion task is to work out a
> comprehensive justification (based on values) for the health
> promotion endeavour, and then try to implement this, bearing in mind
> that to do so is inevitably a political action.

I think it is unfair to cast people interested in health promotion as
believing they are "obviously right because this is a _health_ matter" but
David and I probably have different experiences with health promotion. My
experience has almost always been that, by and large, people working in
health promotion have had to fight an uphill battle to get _health_ on the
agenda. By this of course I mean that prevention is almost never
poitically palatable because it requires a redistribution of resources
from the haves to the have-nots. I can't think of anything much more
political than that.

>
> Health promotion plays into the hands of the new right because they
> have a political outlook (albeit a brutal and simplistic one)...

The health promotion that I know doesn't play into the hands of
the new right..it gets grabbed by the neck and beaten into submission by
the blunt hammer called deficit-reduction and all the ideological baggage
that goes with that concept and political actions. What we do about this
is the test of our savvy and mettle, to say the least, isn't it?


        ... and
> health promotion has nothing more than a collection of woolly
> declarations about what is wrong with the world.


DAVID, with friends like this......! Declarations of what is wrong with
the world are not woolly in my view. They are acts of faith and bravery in
the face of real threats to jobs and even life, in some instances. So, I
choose to woollyily declare that abuse, unemployment, poverty, etc. are
among the things that are "wrong with the world" and ought to be changed,
period. Acting on these beliefs in the _health_ arena is a choice
also..and maybe not a good choice...we all know that there are arguments
that we should just get out of the health area and get to the
"basics" of housing, income, etc..

  Health promotion
> needs to get theoretically tough - until it does it will remain a
> pawn of both the political and medical establishments (just as it
> always has been).


There is health promotion and there is health promotion. The health
promotion I choose to support is actually well-grounded theoretically in
the disciplines of psychology, sociology, political science, economics,
liberation theology, etc. Unforutnately (in my view) too many front line
practitioners are not aware of the strong base from which the ideas
and practices of what- I- choose- as- health- promotion grew. Also
unfortunately, all the knowledge of both the theory and the data, don't
always give the help you need in the political times in which we live. The
worm WILL turn.

Thnnks for reading!

Regards,
Rhonda