My problem with this dialogue is that even those who "purport" to truly espouse hearing the voices of the patients/clients really don't know what it's like for those people. I would like to pass along a challenge that was issued to me when I worked in North Central Regina -- for two weeks, give away your credit/debit cards, put a spare pair of jeans with a couple of shirts in a backpack, and with 10 bucks in your pocket, live in the community for that time. Find those places to eat and camp out........ live in the manner that so many people do. This challenge was particularly driven home for me when I lived for several years in another country as a visible minority. My notions and feelings around racism and exclusion are so very different now, than before that personal experience. This brings to mind the MLA from BC who lived on the income of a single employable male on welfare and how his health deteriorated. Over the top? Who knows. I have also talked to a number of mothers who were on social assistance and found the rates livable. In my work as a clinician, there is much to be said for experience in building the connections and rapport with clients in a much more meaningful manner. I have found through personal practice that I listen with more skill and compassion when I have "been there". Also, I tend to tune-out when the tone of someone's message rings of putdowns. I simply don't like being treated that way. With that tone, I begin to wonder how well I would be heard. Again, in my limited personal experience, I tend to feel extremely unheard when a conversation is colored with contempt. My personal practice style is to be as congruent as possible around my attitudes, values and behaviors both personally and professionally. I know that when I attach myself to a particular attitude or message, that impacts my better judgment and it impacts my ability to use my skills fully. Bev Brewer -----Original Message----- From: Sandi Pniauskas [mailto:[log in to unmask]] Sent: Monday, December 12, 2005 5:08 PM To: [log in to unmask] Subject: Re: HP death knell - response from Dennis Raphael on his reasons Dennis Raphael's dialogue below, expresses my sentiments exactly. Consider that the 'real' patients voices are not being heard and because of this, more often than not, the message is not getting through to policy makers. There are many who purport to speak on behalf of their constituents, but actually have no actual insight into the daily challenges that many face. To add further, while healthy lifestyles/behaviours affect many, it is not the panacea for all. As a matter of fact, the healthy lifestyle message has moved beyond the intended message and has become a burden to many. A prime example is that of our cancer populations and I encourage everyone to consider that, no, the patient did not receive a cancer diagnosis due to weight issues, smoking or any of the current concepts that add to the existing burden of trying to survive. This is less than compassionate not to speak of a lack of understanding. A broader recognition of all aspects of living/surviving is required in order to understand the issues of the communities in which we live and work. Sandi >the following response was received from Dennis Raphael <[log in to unmask]>: > > >Health is determined in small part by risk behaviours. And of course, >environments affect health behaviours. But these health behaviours >contribute only a small part to health status. Health promotion always >recognized that the primary determinants of health involved actual living >conditions. Living conditions such as shelter, income, food, housing and >others (see Ottawa Charter for Health Promotion). Health promotion was >about democratic control and public participation over the DETERMINANTS of > >health. > >Instead we see health authorities concluding that the primary health >problem we face is that uneducated people -- usually poor, Aboriginal, >youth, women, gay and bisexual, or recent immigrants -- are eating >(substitute smoking, drinking, watching TV) themselves to death. When was > >the last time a health promotion agency --or health unit -- asked people >what THEY thought were the primary determinants of health? We did -- in a > >number of community quality of life studies -- and you know what, >vulnerable people never asked for help not being fat, or cutting out >smoking, etc. They wanted jobs, respect, decent housing and food, and a >good chance for their children. > >However, the Government of Canada now tells us that health promotion is >really only about risk behaviours and helping people to change these risk >behaviours by building supportive environments -- in other words if you >smoke we will make life miserable for you and if you are fat, even more >so. And hundreds and hundreds of "health promoters" in Canada and >elsewhere are putting out the message to the public that these issues >related to living conditions are unimportant and trying to convince >already marginalized people that they are the cause of their own health >misfortunes. At the same time these governments make everyday living more > >and more difficult for those who are not in the top quintile of income >earners. See the problem? > >Of interest: > >Social Determinants of Health: Canadian Perspectives >General Editor, Dennis Raphael, Foreword by Hon. Roy J. Romanow, P.C., >O.C, Q.C. >http://www.cspi.org/books/s/socialdeter.htm > >Staying Alive: Critical Perspectives on Health, Illness, and Health Care >(coming Feb. 2006) >General Editors, Dennis Raphael, Toba Bryant, Marcia Rioux, Foreword by >Gary Teeple >http://tinyurl.com/cojcf > >Dennis Raphael, Ph.D. >Associate Professor & Undergraduate Programme Director >School of Health Policy & Management >Atkinson Faculty of Liberal & Professional Studies >York University >4700 Keele St. >Toronto ON M3J 1P3 >Ph: 416-736-2100 ext. 22134 >Fax: 416-736-5227 >E-mail: [log in to unmask] >Website: http://www.atkinson.yorku.ca/draphael > >Send the following text: unsubscribe click4hp to: [log in to unmask] if you wish to unsubscribe. Go to http://listserv.yorku.ca/archives/click4hp.html to view CLICK4HP archives or manage your subscription (you will have to create a password). > > > > Send the following text: unsubscribe click4hp to: [log in to unmask] if you wish to unsubscribe. Go to http://listserv.yorku.ca/archives/click4hp.html to view CLICK4HP archives or manage your subscription (you will have to create a password). Send the following text: unsubscribe click4hp to: [log in to unmask] if you wish to unsubscribe. Go to http://listserv.yorku.ca/archives/click4hp.html to view CLICK4HP archives or manage your subscription (you will have to create a password).