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