A concern with behaviour can occur on AT LEAST four levels. Let's assume that working women can benefit from having quality and affordable day care. Let's also assume that we believe that access to health care is health promoting and should be a concern of health promoters. We can argue for this along a number of lines. 1) that working women who has such access will be under less stress and will therefore smoke less, will not drink to excess, will take care to vaccinate children, will have less hectic lives and thereby be more attentive to potential threats such as child injury, etc. One immediately sees that for those health promoters under the foot of behaviourally oriented bosses, there will be a bit of a stretch to justify activities related to promoting such access. Notice the emphasis here on illness and injury prevention. 2) using a general psychological approach (such as that seen by the Mustard/population health types) having access to child care will be associated with improved coping, strenghened immune systems, increased sense of control, and "may" be associated with improved health. While Judith Rodin has demonstrated the immune system enhancing aspects of increased control among seniors, this has not been a major area of research among day care advocates. 3) One can simply follow the Ottawa Charter and argue that health promotion is the "process by which individuals are enabled to increase their control over, and thereby improve their health." Within the W.H.O. definition of health as involving physical, psychological, and social well-being there is certainly enough evidence to suggest that women's health (i.e. well-being, life satisfaction, etc.) is improved when quality daycare is available. In this scenario, we need not prevent illness or injury, but simply show increased well-being. If biomedical or epidemiological types do not like this evidence, the approach is to convert them to our rules of evidence, not be trapped into playing their game. 4) Finally, one can simply argue on grounds of principle (and beliefs and values) that adequate day care is a right and not having such works against women. And since health promoters are concerned with enhancing well-being and maximizing 'health' this is an end in itself. Personally, I feel a case can be made, if the right questions are asked, to justify access to day care along all four grounds. But obviously, relying on arguments 1 and 2 may be more problematic in that one is playing by the illness prevention rules which may not be the best rules for health promoters to play by. Not consider other health promotion issues such as social isolation, employment, crime, FRONT-YARD PARKING, public transportation, quality schools, equitable distribution of resources, availability of bicycle paths, and one can begin to see that playing by the illness prevention rules becomes more problematic. In fact one can argue that with increasing paths there will be MORE deaths due to bicycle injuries. In summary, where does "human behaviour' fit in when these health promotion issues are considered? Best wishes, Dennis Raphael, Ph.D., C.Psych. Associate Professor University of Toronto Division of Community Health Faculty of Medicine Department of Behavioural Science McMurrich Building, Room 101 Toronto, Ontario M5S 1A8 Tel: (416) 978-7567 Fax: (416) 978-2087 E-Mail: [log in to unmask]