Dennis Raphael, Ph.D. wrote: As we in Ontario and Canada continue to observe the effects of increasing inequality on our society, I have to wonder about the deafening silence among many health promoters. - I agree with Professor Raphael that health promoters are generally silent and if they are not in particular circumstances, it is limited to their own constituencies, which is fine, but leadership is needed to enhance the message beyond a certain jurisdiction. A few thoughts: Health promotion requires organized infrastructure in order to be successful. This may employ information technology, ie:interent or non-profit groups. There are a variety of approaches one may use, but we seem to lack the forum for discussion and the platform to utilize knowledge or resources. I realize there are examples of this already such as this list-serv and university programs, but more is required if health promotion is to become a significant component of our health system. As a policy researcher in health I see new visions in health promotion evolving all the time. This is a relatively new field for me as I had been focussing on the federal role in health. If you ask anyone in Health Canada what that role is today, they will shuffle some papers, look away and whistle "It's a Long Way to Tripperary". And let me tell you, they are a long way from there. The fact of the matter is that health is a file that is "whole" and not a sum of its' parts. Another fact is that health policy solutions are never fixed. The population health approach is based on this theory in which solutions are never meant to last for a long period of time as social factors change and solutions must be flexible to meet these changing demands. I wonder if a bureaucracy, any administrative system whether it is based in a hospital or government is able to respond in an effective manner to these solutions with its' tendency to act so slowly. I think I am off topic here. One could look at the inequities in the health system as a researcher and devote a lifetime to it. It is an interesting topic. I am presently preparing research on pharmacare and home-care for the National Anti-Poverty Organization in Ottawa. They wish to design advocacy positions for their membership as both these files are in the policy development stage. They wish to ensure that the federal positions are sensitive to the working poor. My position is simple: that these innovative files possess the potential to assist the working poor and other economic classes in society, but as a health file, the funding and delivery must be orientated to the relevant constituency and ensure that resources are not wasted. The role of the health promoter at any level is to participate and advocate through the means available to us. If we feel we are missing that, we must then take the leadership role to create them using energy and passion. David Gourlay ______________________________________________________ Get Your Private, Free Email at http://www.hotmail.com