Thanks Jordan - I am not familiar with the Health Inequalities Matrix but there are some existing works drawing on critical realism that offer useful perspectives for conceptualizing SoDH and how health and assocoated inequalities are generated. See: 1. Forbes A, Wainwright SP. On the methodological, theoretical and philosophical context of health inequalities research: a critique. Social Science and Medicine 2001;53:801-16. 2. Wainwright SP, Forbes A. Philosophical problems with social research on health inequalities. Health Care Analysis 2000;8:259-77. I also wrote a response to Michael Marmort in JAMA drawing on CR, here: 3. Clark A, Lissel S. Status Syndrome. JAMA 296: 395-396.2006. For a CR-driven critique of evaluation - see Pawson and Tilley (1997) Realist evaluation. Sage, London. As part of one of the government evaluations in the UK, I drew on CR to design the evaluation of the secondary prevention element of the Scottish National CHD Demonstration project: 5.Clark AM, MacIntyre PD, Cruickshank J. A critical realist approach to understanding and evaluating heart health programmes. Health 2007;11(4):513-39. Finally - I would echo your frustration with the findings of the UK Parliamant report. Many of those designing the evaluations had jobs and funding dependent on keeping Ministers and Depts. of HM Government happy. That what was produced was not useful was entirely predicted by many involved and mostly related to the constraints and that the then representative of the Government themselves imposed. Alex AM Clark PhD BA (Hons) RN Associate Professor, AHFMR Population Health Investigator, CIHR New Investigator International Institute Qualitative Methodology (IIQM) Affiliate Scholar Room CSB 4-112 Faculty of Nursing University of Alberta, Edmonton, AB. Canada T6G2G3 Tel: 001 780 492 8347 Fax: 001 780 492 2551 -----Original Message----- From: Social Determinants of Health on behalf of Jordan Panayotov Sent: Sat 3/21/2009 10:55 PM To: [log in to unmask] Subject: Re: CPHA response to WHO SDOH report Dear Maija (and everybody else), Being annoyed will not help at all for getting public (and more importantly decision-makers') attention to SDH. You are absolutely right that the analysis should be extended, since the decisions made should be analytic rather than emotional. Proper analysis requires proper theoretical platform. Otherwise there are problems with evidence and evaluation leading to waste of resources. However, with deepening global financial crisis no government in the world can afford waste of resources anymore. I'm saying this for more than four years now on different international forums, including: USA, Canada, UK and Australia, but it seems that nobody listens. www.icare.biz/resources I offer a solution - Health Inequalities Matrix, which unlike other models is based on critical realism, therefore provides universal explanations and predictions. Pointing out the importance of proper theoretical framework for correct interpretation and use of the evidence, Green (2000) notes that "the accumulation of empirical evidence about effectiveness is of limited value to the practitioner unless accompanied by general principles which might inform wider application". She concludes that "Of more relevance to the practitioner are general principles together with an understanding of context-specific factors, which will allow adaptation to suit different situations". Connelly (2001) and (2005) highlights the importance of theoretical framework based on critical realism (if A than always B) for getting successful solutions. Did you ever read these in order to appreciate Health Inequalities Matrix? Green J., The role of theory in evidence-based health promotion practice, Editorial, Health Education Research, Vol. 15, No. 2, 125-129, Oxford University Press 2000 Connelly J., Critical realism and health promotion: effective practice needs an effective theory, Editorial, Health Edu Research, Vol.16, No2, 115-120, Oxford University Press 2001 Connelly J., More public health theory please - but make it adequate, Editorial, Journal of Public Health, Vol.27, No.4, p. 315, 2005 Regrettably, so far you and your colleagues ignore Health Inequalities Matrix. Some are trying (up to their ability to comprehend it) to use it as much as they can, without giving credit to its creator, or acknowledging it in any other way. The result is confusing "normative" from economics with "normative" from legislation; distribution of the benefit with distribution of the population, etc. Let's hope that now, when it comes from UK Parliament (see POHG post below), you'll start: a) acknowledging the problem with evidence and evaluation; and b) looking for proper solutions based on critical realism. Then, one day you'll come to Health Inequalities Matrix, and the tax payers might ask: "Why it took so long and so much of our - tax payers' - money for you to get there?!?" Indeed, Why? May be with the first day of spring (for Northern hemisphere) some positive changes might start taking place. Best wishes, Jordan =================================================================== ---------- Forwarded message ---------- From: alex scott-samuel <[log in to unmask]> Date: Mon, Mar 16, 2009 at 12:21 AM Subject: [POHG] Health Select Committee report on health inequalities To: [log in to unmask] House of Commons Health Committee Health Inequalities Third Report of Session 2008-09 Volume 1 15 March 2009 http://www.publications.parliament.uk/pa/cm/cmhealth.htm . . . The Chairman of the Health Committee, Kevin Barron MP, said: "There is no easy or quick solution to the challenge of tackling health inequalities. But, while our Committee commends the Government on its commitment to reducing the health gap, we were shocked by the lack of meaningful evidence and evaluation available on this subject." "The taxpayer must be reassured that money invested in policy initiatives is making a difference. At the moment, in relation to health inequalities, we cannot say with certainty that this is the case." The report can be downloaded in pdf or HTML at: http://www.publications.parliament.uk/pa/cm/cmhealth.htm ******************************* Politics of Health Group Mail List Message ******************************* Visit the PoHG website for lots of interesting links and publications: http://www.pohg.org.uk/ =================================================================== ----- Original Message ----- From: Maija Kagis To: [log in to unmask] Sent: Saturday, March 21, 2009 12:42 AM Subject: Re: [SDOH] CPHA response to WHO SDOH report And Dennis, you were right to be annoyed: I think we should all be very annoyed, and perhaps ask that the analysis be expanded. This is so much the same old same old. m ------------------------------------------------------------------------------ From: Social Determinants of Health [mailto:[log in to unmask]] On Behalf Of Dennis Raphael Sent: 20 March 2009 09:27 To: [log in to unmask] Subject: Re: [SDOH] CPHA response to WHO SDOH report You are exactly right. It implies that SDOH is primarily about abject poverty and/or very marginalized groups such as Aboriginal Canadians. It gives no impression that SDOH involve a much wider spectrum of disadvantaged people in particular and actually the wide range of the population in general. Its plays to misguided perceptions and prejudices as to what the SDOH problems are. It does not move our analysis any further. Contrast this with the images provides in Social Determinants of Health: The Solid Facts and you can see why I was annoyed! dennis Dennis Raphael, PhD Professor of Health Policy and Management York University 4700 Keele Street Room 418, HNES Building Toronto, Ontario M3J 1P3 416-736-2100, ext. 22134 email: [log in to unmask] http://www.atkinson.yorku.ca/draphael Of interest: *NEW* Social Determinants of Health: Canadian Perspectives, 2nd edition, edited by Dennis Raphael Forewords by Carolyn Bennett and Roy Romanow http://tinyurl.com/5l6yh9 Poverty and Policy in Canada: Implications for Health and Quality of Life by Dennis Raphael Foreword by Jack Layton http://tinyurl.com/2hg2df Staying Alive: Critical Perspectives on Health, Illness, and Health Care, edited by Dennis Raphael, Toba Bryant, and Marcia Rioux Foreword by Gary Teeple http://tinyurl.com/2zqrox See a lecture! The Politics of Population Health http://msl.stream.yorku.ca/mediasite/viewer/?peid=ac604170-9ccc-4268-a1af-9a9e04b28e1d Also, presentation on Politics and Health at the Centre for Health Disparities in Cleveland Ohio http://video.google.com/videoplay?docid=-4129139685624192201&hl=en To leave, manage or join list: https://listserv.yorku.ca/cgi-bin/wa?SUBED1=sdoh&A=1 To leave, manage or join list: https://listserv.yorku.ca/cgi-bin/wa?SUBED1=sdoh&A=1 To leave, manage or join list: https://listserv.yorku.ca/cgi-bin/wa?SUBED1=sdoh&A=1 To leave, manage or join list: https://listserv.yorku.ca/cgi-bin/wa?SUBED1=sdoh&A=1