| Health education as such, is not an end | | | | cure” for cancer, domestic violence or |
| in itself: it is a strategy for the | | | | tobacco smoking. There are at least two |
| achievement of a much more important, | | | | possible reasons for this narrowness: |
| over-all objective; the maintenance or, | | | | Lack of breadth in the opinions sought |
| where possible, the improvement in the | | | | in the exploratory stages. Health |
| community's welfare. | | | | educators need to get out more often and |
| Health education is intended to motivate | | | | build a more diverse network of |
| a change in behaviour among a certain | | | | collaborators. If we take a complex |
| target audience which will result in an | | | | problem to a surgeon, the surgeon is |
| improvement in the community's welfare. | | | | likely to find a surgical solution and |
| “Welfare” is a flexible term. It can | | | | if we take the same problem to a |
| mean something as broad as “quality of | | | | physician, a psychologist and a |
| life” or some quite specific aspect of | | | | sociologist, each is likely to find a |
| this quality of life. | | | | different solution. While each solution |
| Health education strategies might be | | | | may be effective, the most efficient |
| intended to bring about a reduction in | | | | solution might draw on elements from all |
| morbidity and mortality due to some | | | | of these disciplines. |
| specific harmful behaviour, tobacco | | | | While health educators are aware of the |
| smoking for example, or a reduction in | | | | other aspects of the problem, these |
| violence against women or the use of | | | | other aspects are too far outside health |
| condoms to prevent the spread of | | | | education's sphere of influence for it |
| disease. | | | | to have a role. For example, in many |
| The current target | | | | countries, the prevalence of tobacco |
| Unfortunately, an objective as broad as | | | | smoking increases with socio-economic |
| “to improve the community's welfare” | | | | depravation. Most anti-smoking activists |
| is too general, too imprecise and too | | | | regard the level of socio-economic |
| complex to be really useful in strategy | | | | depravation to be so far beyond their |
| generation. The first step is to reduce | | | | influence as to be regarded as a |
| the general objective to more specific | | | | macro-environmental factor that is not |
| sub-objectives or targets that are more | | | | specifically addressed in strategy |
| readily identifiable and measurable. | | | | development. |
| These targets are both more specific in | | | | At very least, do not cause harm |
| scope, and more immediate in timescale | | | | It is no longer acceptable for a |
| than the overall objective. In an ideal | | | | commercial organization to ruin the |
| world, the targets are integrated and | | | | health of its workers in the pursuit of |
| aligned in such a way that a strategy | | | | profit or for health educators to solve |
| towards the achievement of one such | | | | one problem while exacerbating another. |
| objective does not hinder and may even | | | | In Australia, health educators have |
| help efforts towards any of the other | | | | consistently attacked the spread of |
| objectives and achievement of all the | | | | melanoma among the population by |
| sub-objectives will lead to the | | | | encouraging people to stay out of the |
| achievement of the overall objective in | | | | sun and when exposure to the sun is |
| the most efficient way. | | | | unavoidable, to cover their skin with |
| Very often there is a lack of consistent | | | | clothing, hats, lotions etc. Since these |
| direction and coordination in health | | | | campaigns have been running, the |
| education's targets. There have been | | | | incidence of sun-related melanoma has |
| many fads or “hot topics” in health. | | | | fallen. Unfortunately, sunshine is the |
| Take the treatment of tobacco products | | | | best source of vitamin D which promotes |
| for example. A long time ago, it was | | | | calcium absorption, the principal |
| frowned upon. Then more recently, it was | | | | defence against osteoporosis. As |
| encouraged. By the time of the Second | | | | melanomas have decreased, osteoporosis |
| World War, cigarettes were included in | | | | has increased. |
| ration packs to help morale and to help | | | | In a similar vein, a reduction in salt |
| cope with wartime stress. Then it was | | | | consumption was part of an attack on |
| linked to cancer and in 1964, the US | | | | coronary and circulatory diseases. The |
| Surgeon General declared it the single | | | | predominant form of table salt |
| greatest cause of avoidable mortality | | | | previously available in Australia and |
| and morbidity in the USA. Since then, | | | | New Zealand was iodized, it had iodine |
| tobacco smoking has been a consistent | | | | added. The move away from salt and the |
| target for health educators around the | | | | switch to “pure” sea and rock salt |
| world. | | | | may well be accompanied by an increase |
| "It is no longer acceptable for a | | | | in iodine deficiency with its attendant |
| commercial organization to ruin the | | | | impairment of cognition and psychomotor |
| health of its workers in the pursuit of | | | | development in young people. |
| profit or for health educators to solve | | | | Make the strategies fit the task |
| one problem while exacerbating another." | | | | Another issue with many health education |
| Other campaigns over the last 50 years | | | | strategies is a tendency to generate |
| have been less consistent. Older readers | | | | “one size fits all” solutions to |
| may remember campaigns against aluminium | | | | complex problems. This may be related to |
| in cooking utensils and antiperspirant | | | | the over-simplification urge. For |
| deodorants as it was erroneously | | | | example, in many countries, the same |
| believed to be implicated in the | | | | health-consequences campaign message is |
| development of Alzheimer's disease. The | | | | directed at addicted adult smokers |
| regular updates to the list of “known | | | | trying to quit and young people at risk |
| carcinogens” may well be undermining | | | | of taking up the habit. Many analyses |
| public confidence in this branch of | | | | indicate that reactions to these |
| medical research. Often, it is a | | | | campaigns differ across genders and |
| question of balance, avoiding | | | | smoking status. The efficient health |
| over-reacting to a particular piece of | | | | educator will tailor the strategy to fit |
| research which might suggest a new | | | | the problem and the audience. |
| “target.” | | | | Health education will make the most |
| Health educators need to get out more | | | | efficient contribution to a genuine, |
| often | | | | long-term improvement in communities' |
| Sometimes it is a question of | | | | welfare when it attacks the right |
| recognizing the interconnectedness of | | | | targets. Selection of the right targets |
| many health issues. Failure to recognize | | | | will involve broader consultation and |
| this interconnectedness might be due to | | | | collaboration with other disciplines and |
| an oversimplification when selecting a | | | | recognition of the big picture. The |
| target to attack. Many, if not most, of | | | | strategies used to attack these targets |
| the threats to a community’s welfare | | | | will be based on the best research |
| are complex, multi-faceted phenomena but | | | | available and take advantage of |
| there is a tendency to attack one aspect | | | | contemporary understanding of behaviour |
| of the problem to discover “the | | | | change. |