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