Dear Theresa, I guess you raised some important issues here. *Healthism* is certainly a great hazard for public health. As Lowell S. Levin once wrote in a WHO-EURO paper: *Health - the ultimate disease*. It is difficult indeed to discuss public health issues from a critical point of view because the instant reaction quite often will be: are you against health? Or: are you for disease? Or, in case of tobacco, are you an agent of the tobacco industry? In other words: you may run the risk of stigmatization or, even worse, *exclusion from professional discourse* if you raise critical questions regarding our own concepts, policies, and practice. I always felt uncomfortable with *Public Health Ayatollahs* because I do not believe we're living in a one-dimensional world. Despite lip-service paid to *holistic concepts* or *comprehensive health promotion action*, the practice of many approaches is rather narrow and refers to one topic only. As regards tobacco, for example, a cross-cultural study on smoking would probably reveal that there is not one culture on this planet, which is 100% smoke-free (if this assumption is wrong, please fill me in). A few years ago, I was stunned when watching a TV feature on tribal communities in Africa - and what did I see? Well, they were smoking. Not for ritual purpose, no, just for the fun of it. Drug consumption seems to be human - whether we like it or not. Tobacco control policies are necessary - no doubt about this. The question, however, is whether these policies should consume such an amount of energy of PUBLIC health practicioners. It seems to me that this topic has been picked because it's an easy one: there's a clearly defined *enemy* (tobacco industry) and there's crusaders (or Ayatollahs) for good health. One side is evil, the other is good. That's a nice little world, unfortunately, it's an unreal one as well. When it comes to more complex issues like housing, urban development & planning or, even worse, international health, we do not seem to put as much energy on the table as with tobacco. On the contrary, regarding international health, I have seen really bad things happening in the context of foreign aid projects. Health promotors became agents of engineering companies when it came to selling, for example, badly devised water & sanitation projects (recently, I came across an Australian project in the Philippines in which health promotors acted like sales agents and they were not aware of the type of their activities because they believed they would *help* the people; the people, on the other side, claimed that they did not want the services and the facilities this project was installing in the province). I believe we should look at our projects and check their adverse effects regularly. Of course, health has always been value-loaden. Take for example the way dictatorial systems exploit public health issues for their purposes (the Nazi's *population health* - this is the literal translation of *Volksgesundheit* - aimed at building a uniform society aiming at total control of body, mind & soul; however, everything was covered with the banner of *population health*). I sometimes do see similarities with current *health* policies. There is a dilemma we have to deal with: we certainly cannot stop formulating, implementing and evaluating public health policies; but we also have to be aware of their restrictive implications as far as individuals and collectives are concerned. In many cases, our policies have a very weak research basis, and in many cases the research basis is discussed controversially among *experts*. Take *drug prevention policies* as an example. Some believe that it should be *war against drugs*, others favor non-militaristic approaches, but both sides claim that *research shows ...* Or take a current Australian debate: the Federal Government intends to put higher insurance premiums on people who smoke, drink alcohol, and/or take illicit drugs. At the same time it will put higher insurance premiums in old-age people because health care costs for old people are sky-rocketing. Now that's a real dilemma, isn't it? If you want to contribute to reducing health care costs for old people by smoking yourself to premature death, you get punished. If you stop smoking and you may get old, you get punished, too. What does this policy communicate? It communicates that politicians do not seem to care of health but of budgets. The electorate gets cynical, that's probably the most health-hazardous effect of this type of public health policy. Public health has not yet become an integral element of policy development in general. It's more or less seen as an appendix of policies rather than a principle of policy formation. Plus, in most of the cases I know of, it's not public HEALTH but public DISEASE PREVENTION being addressed which, for me, is a completely different topic. I apologize for the long posting, but I guess the issues you raised need even more thoughts than I was able to sketch here. Thanks for your attention & keep on rocking. Eberhard Wenzel MA PhD Griffith University Faculty of Environmental Sciences Nathan, Qld. 4111 Australia Tel.: 61-7-3875 7103 Fax: 61-7-3875 7459 e-mail: [log in to unmask] http://www.ens.gu.edu.au/eberhard/welcome.htm