Health promotion pioneer named Michael Smith scholar

by Patty Pitts

Canada’s Food Guide, Participaction, B.C.’s Health Guide—governments have promoted healthy lifestyles for decades, but with mixed results. A higher demand for organic foods and bike paths is offset by increased adult and child obesity and more pressure to ‘super size’ fast foods.
The messages are out there, but does Canada’s population understand what it’s being told about health promotion?

Dr. Irving Rootman, UVic’s new Michael Smith Foundation for Health Research Distinguished Scholar, plans to spend the next five years examining the link between literacy and health by developing and implementing a national program of research focusing on this connection. Working through the university’s Community Health Promotion Coalition, he also wants to find better ways to evaluate the effectiveness of health promotion programs.

“Low levels of literacy have been associated with poor health, poor understanding of treatment, greater use of health services, low adherence to treatment regimens, and poverty and unemployment,” says Rootman. “This is a cause for concern, especially when you consider that more than 40 per cent of Canadians fell into the two lowest categories of literacy in the 1994 International Literacy Survey.”

Surveys, and their results, play a prominent role in Rootman’s career. In 1978, he helped develop the first health promotion survey conducted in Canada and the world for Health Canada. “It was the first national survey carried out by Statistics Canada by phone,” he recalls. “Many of the questions developed for that survey are still being asked today.”

Rootman’s interest in health promotion began during a 1965 summer work term in a mental hospital in Weyburn, Saskatchewan, as a Yale master’s student. “I was hired to start a study on public attitudes toward the mentally ill in the anglophone and francophone communities in rural Saskatchewan.” He became so interested in the study that he stayed to complete it.

He later examined drug use among rural students at the University of Calgary and, as a postdoctoral fellow at Bedford College at the University of London (after earning his PhD at Yale), he studied service delivery to people with drug-related problems. One of his papers caught the attention of Health and Welfare Canada, which appointed Rootman to set up a research program on the epidemiology of non-medical drug use in Canada. At the same time, then- Health Minister Marc Lalonde released a report called A New Perspective on the Health of Canadians.

“The report put forward the notion, for the first time, of a ‘health field’ concept that health care was not the sole determinant of health, that it also encompassed environmental, lifestyle and human biological factors,” says Rootman.

The idea languished among health policy-makers in Ottawa until American and Swedish health authorities jumped on the concept, leading the way to the establishment of the first national government body on health promotion. Rootman joined it as the head of a group studying health promotion issues, and during this time he developed Canada’s first health promotion survey. It supported the development of a national framework for health promotion, released in 1986.

Rootman became instrumental in developing knowledge around the issue. He organized cross-country workshops, leading to a recommendation to establish university-based health promotion research centres across Canada. The University of Toronto established the first one and appointed Rootman as its inaugural director. By 1993, UVic was a participant in a centre with UBC and SFU, funded by Health Canada and the Social Sciences and Humanities Research Council (SSHRC).

Rootman’s interest in health promotion expanded to include the effectiveness of the programs themselves. While on study leave from U of T last year, he applied for an SSHRC grant to examine the link between literacy and health. While at UVic, he’ll build on the national program “to establish B.C. as a leader in literacy and health, not just in Canada but in the world.”

The Smith Foundation award made it possible for Rootman to move to the West Coast and reunite with the coalition’s Drs. Marcia Hills and Jennifer Mullett, whom he met while chairing the Canadian Consortium for Health Promotion Research.

“Health literacy is an outcome that health promotion should be held accountable for,” says Rootman, quoting Britain’s chief medical officer Don Nutbeam. “It depends on people’s ability to read and write, to retrieve the information and critically assess it. [The coalition] is well-known for its participatory research. We hope to use our evaluation methods to support community groups in evaluating their programs.”

(Valerie Shore photo)