Dr. Raphael, You ask: "Do you have to demonstrate costs effectiveness to justify providing women with opportunities for gainful employment, for children to have healthy and happy early childhoods, and for citizens to be free from violent and sudden death in their streets due to crime?" With all due respect, I would answer "yes." We in the public health sector can't simply write off those who will only be moved by such justifications (perhaps not only cost effectiveness, but certainly cost-benefit analyses). I agree that these efforts (ensuring opportunities of employment, health, and safety) are worthwhile in their own right. But to ridicule (that seems to be the sprit of your question: "I could go on!") those who may disagree with us will likely ensure that public health continues to receive only the scraps. We must be prepared to justify what we do to all parties--from those moved primarily by social justice arguments to those who will only hear the economic case. Best regards, Mark Hansen Boston, MA 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: Mon, 29 Nov 2004 17:37:00 -0500 The problem with the question about "spending expenditures" on determinants of health assumes that these determinants of health can be strengthened through "program" spending which targets a determinant isolated from the context within the determinant -- and related determinants -- exist. Having said that, an economic case can be made for spending on childcare, education, and reducing poverty through increased minimum wage, and increased social assistance rates. Contact Martha Friendly, U of T, re: childcare and the Canadian Council on Social Development re all the other stuff! ------------------------------------------------------------ However, a more fruitful -- but more problematic from a "public health" perspective -- is to consider how broad patterns of government spending and approasches to public policy impact upon health and well-being or in the jargon, population health. Consider "government spending" in the US, UK, Canada and the Nordic countries (Sweden, Norway, Finland, Denmark) in terms of early childhood education and care (daycare). Then consider the educational achievement scores typical of each nation, its crime rate and spending on police and jails, the participation of women in the work force, the percentage of single parents living in poverty, or its general level of health care spending and disease incidence. What is the relationship? There is little doubt that life is better for the average person in social democratic political economies and a lot worse for people in the "Anglo-Saxon liberal economies". See references 4 and 5 below. Sherry Phipps has spent a lot of energy contrasting health status among women between Norway and Canada and relating these to public policy approaches to families. I guess the bottom line is: Do you have to demonstrate costs effectiveness to justify providing women with opportunities for gainful employment, for children to have healthy and happy early childhoods, and for citizens to be free from violent and sudden death in their streets due to crime? I could go on! CPHA and many other health researchers need to broaden their thinking to include these broader concepts of societal well-being, social justice, and social welfare! see 1. Why We Need a New Welfare State by Gosta Esping-Andersen, et al (Paperback - October 1, 2002) (Rate this item) Other Editions: Hardcover | Paperback 2. Social Foundations of Postindustrial Economies by Gosta Esping-Andersen (Paperback - March 1, 1999) Avg. Customer Rating: (Rate this item) Other Editions: Hardcover | Paperback 3. Welfare States in Transition : National Adaptations in Global Economies by Gosta Esping-Andersen (Editor) (Paperback - July 31, 1996) Avg. Customer Rating: (Rate this item) Other Editions: Hardcover | Paperback 4. The Political Economy of Social Inequalities: Consequences for Health and Quality of Life (Policy, Politics, Health, and Medicine Series) by Vicente Navarro (Hardcover - September 1, 2000) 5. Political and Economic Determinants of Population Health and Well-Being: Controversies and Developments (Policy, Politics, Health, and Medicine Series) by Vicente Navarro, Carles Muntaner 6. Pay the Rent or Feed the Kids by Mel Hurtig. Do we need a cost analysis on this? :-) dr ------------------- Problems/Questions? 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