This exchange between Barbara Krimgold and Dennis
Raphael on the spirit of 1848 email group carries important
messages for the UK - where our understanding of the
implications of the CIAR line on social determinants of
health is poorly developed. The targeting of our UK and US
colleagues by Sally Satel (author of 'PC, MD') - who
herself represents the new political correctness in the USA
- is equally worrying. The UK equivalent, as currently
represented by Michael Fitzpatrick's 'Tyranny of Health',
may seem pretty marginal in the present political climate -
but a week is a long time in politics...
--- Begin Forwarded Message ---
Date: Thu, 15 Feb 2001 13:29:23 -0500
From: Dennis Raphael <[log in to unmask]>
Subject: Re: [spiritof1848] Politicization of Public
Health? Sender: Dennis Raphael <[log in to unmask]>
To: Barbara Krimgold <[log in to unmask]> Cc:
[log in to unmask] Reply-To: Dennis Raphael
<[log in to unmask]> Message-ID:
<[log in to unmask]>
In Canada, the importance of the social determinants is
enshrined in Canadian federal and many provincial policy
documents.
An active debate is underway concerning the 'hijacking" of
the social determinants of health by the CIAR and how the
endorsement of the CIAR position by governments --
downplaying WHO concepts of health -- had led to a
downgrading of action to improve health to one of throwing
money at epidemiologically oriented researchers to carry
out more research and in many ways turn a blind eye to
government actions that weaken health determinants.
See the following references:
Coburn, D. & Poland, B. (1996). The CIAR vision of
the determinants of health: A critique. Canadian Journal of
Public Health, 87, 308-310.
Labonte, R. (1995). Population health and health
promotion: What do they have to say to each other?
Canadian Journal of Public Health, 86,
165-168.
Labonte, R. (1997). The population health/health
promotion debate in Canada: The politics of explanation,
economics, and action. Critical
Public Health,
Legowski & McKay (2000) Health Beyond Health Care:
Twenty-five Years of Federal Health Policy Development.
Ottawa: Canadian Policy Research
Network Discussion Paper No. H04. On-line at
http://www.cprn.ca/cprn.html.
Poland. B., Coburn, D., Robertson, A., & Eakin, J.
(1998). Wealth, equity, and health care: a critique of a
population health perspective on
the determinants of health. Social Science and Medicine,
46, 785-798.
Raphael, D. & Bryant, T. (2000). Putting the
population into population health. Canadian Journal of
Public Health, 91, 9-12.
Raphael, D. & Bryant, T. (2001). The Limitations of
population health as a model for a new public health.
Toronto: Authors.
Robertson, A. (1998). Shifting discourses on health
in Canada: From health promotion to population health.
Health Promotion International,
13, 155-166.
Wong, D. (1997). Paradigms Lost: Examining the
Impact of a Shift from Health Promotion to Population
Health on HIV/AIDS Policy and Program in
Canada. Ottawa: Canadian AIDS Society.
At 01:00 PM 2/15/2001 -0500, Barbara Krimgold wrote:
>I was a discussant
this morning at the American Enterprise Institute
on a panel on "The Politicization of Public Health" with
lead panelist
Sally Satel, author of "The Indoctrinologists" in the
Atlantic Monthly
and of "PC MD: How Political Correctness is corrupting
Medicine.
Other panelists Chris Foreman and Eberstadt (Harvard SPH,
an HSPH critic in your very midst!)enthusiastically
supported Satel and NCI's Jon Kerner & I had the role of
critics.
Satel's primary attack was on research on
1. showing stress of living in this society, eg
discrimination, is linked to health;
2. demonstrating that the health care system is biased v.
women & minorities;
3. social and cultural determinants of health.
She had special hostility to the Harvard & Berkeley Schools
of Public Health, and to efforts to show links from wealth
to health or power to health.
She threw special barbs at Barbara Israel, Sara Rosenbaum,
Richard Wilkinson, Nancy Krieger, John Sweeney, and Jessie
Jackson, while praising Len Syme and Michael Marmot (that
doesnt mean they agree with her; just they dont have the
honor of being on her enemies list). I would be willing to
share my remarks.
My book, "Income, SES & Health" and monograph, "Improving
Health: It Doesn't Take a Revolution" coauthored by Jim
Auerbach & Bonnie Lefkowitz & me were mentioned.
"Income, SES & Health" has chapters by Len Syme, Ichiro
Kawachi/Bruce Kennedy, Richard Wilkinson, Clyde Hertzman,
Nancy Adler, David Williams, James Lardner, Nicole Lurie,
Bill Roders, Katherine Newman, Len Nichols, and George
Kaplan. It has lots of charts and data to refute Satel's
simplistic attacks. Auerbach & I edited the book.
This book is available online on
<<http://www.npa1.org>www.npa1.org ($20, I think). I have
a few more comp copies left of "Revolution," and it can
also be ordered online at
<<http://www.npa1.org>www.npa1.org.
I'd love to hear from anyone else after a similar forum on
public health & social determinants of
Best,
Barbara
Barbara Krimgold
Center for the Advancement of Health
2000 Florida Ave. NW, Suite 210
Washington, DC 20009
Tel: 202-387-2829 ext. 109
Fax: 202-387-2857
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********************************************************************
Dennis Raphael, Ph.D.
Associate Professor
Department of Public Health Sciences
Graduate Department of Community Health
University of Toronto
McMurrich Building, Room 101
Toronto, Ontario, CANADA M5S 1A8
voice: (416) 978-7567
fax: (416) 978-2087
e-mail: [log in to unmask]
--- End Forwarded Message ---
******************************************************************
Alex Scott-Samuel
EQUAL (Equity in Health Research and Development Unit)
Department of Public Health
University of Liverpool
Whelan Building
Quadrangle
Liverpool
L69 3GB
Tel (+44)151-794-5569
Fax (+44)151-794-5588
e-mail [log in to unmask]
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--- End Forwarded Message ---
******************************************************************
Alex Scott-Samuel
EQUAL (Equity in Health Research and Development Unit)
Department of Public Health
University of Liverpool
Whelan Building
Quadrangle
Liverpool
L69 3GB
Tel (+44)151-794-5569
Fax (+44)151-794-5588
e-mail [log in to unmask]
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