How I became a reflexive health promoter

Ever since high school I wanted to promote health and well-being. I saw myself as someone who could help people live healthy, happy lives, disease and illness free.  It seemed simple to me, you just had to eat healthy, be physically active and reduce the stress in your life. Coming from a middle class upbringing I didn’t understand it was not easy for everyone.  

I held positions promoting physical activity in various capacities, in the health and active living sectors, and then moved into research and policy. In 2004 I started teaching the course Strategies in Health Promotion Practice in the Masters of Public Health at the University of Alberta.  I knew about and advocated for the social determinants of health and the principles of equity and inclusion. I grew and changed and became disillusioned with policy and practice in Alberta. I read Wilkinson and Pickett’s book The Spirit Level and understood that inequality, the gap between rich and poor, is hurting some more than others, but affects us all.

So, on the invitation of a colleague I came to Australia, to a University known for its social democratic focus and a department lead by Fran Baum and her philosophy of health promotion and ‘the new public health’ to undertake the Doctorate in Public Health, a program not offered in Canada.  My goals  were to focus on equity, health promotion, chronic disease prevention, primary health care – areas I knew; pick a topic that was doable while I was here for 10 months: join an existing research team; and learn about the Australian health experience. I brought ideas for dissertation topics. In fact, I had been offered work on an Alberta research team that could form my dissertation. 

A faculty member approached me to work with her on obesity.  Seeking advice, my colleague said, “You’ve been there already”. I resisted but she persisted. It was a hot topic and there was an existing research team to welcome me.  My goals could be achieved, so I agreed. Hence I started my journey of the past 7 months.

Here’s what I know.   The rates of obesity started to rise in the 1980s in the US.  I lived in Britain then and people were slim but when I returned to Canada I noticed the difference. We had all gotten fatter. Ironically, despite the fact that we are all larger, the stigma of being overweight and obese in all aspects of society persists.  Adiposity is inversely related to social economic status. Telling poor people to join a gym or buy pomegranates doesn’t work. Despite what is portrayed on the TV show America’s (and Australia’s) Biggest Loser, overweight people can only sustain a weight loss of 10% or less.  And, despite our knowledge, research and evidence about inequity, poverty, and vulnerable groups, programs and policies are still enforced and focused on healthy eating and physical activity, targeted at the middle class, and big surprise, they’re not working.

I realised that I had believed in obesity reduction strategies focused on lifestyle and personal responsibility my whole career. Furthermore, I had been a strong advocate for tobacco reduction efforts that further marginalized the poor, mentally ill and others. I had blamed parents for their fat kids and had, despite knowing the addictive qualities of tobacco, felt that those who wanted to lose weight just had to put their minds to it. On a personal level I also recognized that I was sizest. 

I now know different, much different. I am appalled at photos of headless fat people in the media and on researcher’s PowerPoint presentations. I am appalled at the money that continues to be poured into researching active living and healthy eating programs that fail repeatedly, all the while stigmatizing people who, although they are fat, are often healthy and no more prone to chronic diseases than a person who is thin. Some programs purposefully stigmatize smokers and obese people to “help” them deal with their issue, in the name of public health!

So I am continuing to learn, address my biases and prejudices in areas broader than just obesity.  My research includes interviewing diabetic clients in a primary health care clinic to get their perspectives, which is rare in the literature.

My supervisor is a fan of the artist Escher whose drawings show images that cause the viewer to take a second look and see a different perspective. This is not an Escher, but it represents how I see myself.    

and recreating yourself!