Dennis, Thanks for your reply. I greatly appreciate hearing your thoughts on this matter and certainly find myself in agreement with much of what you write. Perhaps it is wishful thinking on my part that evidence would have some bearing on policy. As you observed, the opposite seems to more often be true. Yet I do think we have some obligation to be prepared to provide the evidence (rather than to ask, "do I really have to justify this?"). As I see it, the fact that we may not sway others with power is no reason to neglect rigorous evaluation and self-critique of what we do. Moreover, from time to time (though, admittedly, not often enough), there come along policymakers who are sympathetic to our cause. We can do our part to support them by providing the arguments that "speak the language" of their colleagues (the economic arguments we'd discussed). As you wrote, this evidence alone is not sufficient to produce change, but it is necessary. And when that evidence is in the right hands, I remain (naively?) hopeful that we will do better. Thanks again for this dialogue. Warmly, Mark From: Dennis Raphael <[log in to unmask]> Reply-To: Social Determinants of Health <[log in to unmask]> To: [log in to unmask] Subject: Re: Looking for info re: expenditures on determinants of health Date: Tue, 30 Nov 2004 09:08:19 -0500 Hi Mark: You work on the assumption that "policy follows evidence". I suggest the opposite is likely more accurate: "Evidence follows policy" in that once the powers-that-be have made a decision based on ideology and values, then they seek evidence to justify the action. The evidence about the social deteminants of health has been around since 1850. Some jurisdictions act upon this; others do not. Do you think that one more study is going to convince policymakers to implement something that goes against their world view? How much evidence would be necessary to develop family-friendly policies in the USA? Or what study would convince Americans to reinstitute useful progressive tax policies? Or why are labour unions disdained in some nations despite their profound positive effect upon individual health and healthy public policy? Thanks for the debate! dennis ------------------- Problems/Questions? Send it to Listserv owner: [log in to unmask] To unsubscribe, send the following message in the text section -- NOT the subject header -- to [log in to unmask] SIGNOFF SDOH DO NOT SEND IT BY HITTING THE REPLY BUTTON. THIS SENDS THE MESSAGE TO THE ENTIRE LISTSERV AND STILL DOES NOT REMOVE YOU. To subscribe to the SDOH list, send the following message to [log in to unmask] in the text section, NOT in the subject header. SUBSCRIBE SDOH yourfirstname yourlastname To post a message to all 1000+ subscribers, send it to [log in to unmask] Include in the Subject, its content, and location and date, if relevant. For a list of SDOH members, send a request to [log in to unmask] To receive messages only once a day, send the following message to [log in to unmask] SET SDOH DIGEST To view the SDOH archives, go to: http://listserv.yorku.ca/archives/sdoh.html ------------------- Problems/Questions? Send it to Listserv owner: [log in to unmask] To unsubscribe, send the following message in the text section -- NOT the subject header -- to [log in to unmask] SIGNOFF SDOH DO NOT SEND IT BY HITTING THE REPLY BUTTON. THIS SENDS THE MESSAGE TO THE ENTIRE LISTSERV AND STILL DOES NOT REMOVE YOU. To subscribe to the SDOH list, send the following message to [log in to unmask] in the text section, NOT in the subject header. SUBSCRIBE SDOH yourfirstname yourlastname To post a message to all 1000+ subscribers, send it to [log in to unmask] Include in the Subject, its content, and location and date, if relevant. For a list of SDOH members, send a request to [log in to unmask] To receive messages only once a day, send the following message to [log in to unmask] SET SDOH DIGEST To view the SDOH archives, go to: http://listserv.yorku.ca/archives/sdoh.html