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Health education holds a key for the future
hf. 1. Nws. Stud. Vol. 2, pp. 171-175, Pergamon Press, 1965. Printed in Great Britain
Health Education Holds a &y for the Future SUSAN KING:HALL British Societyfor Intcrnaiional Health Education, London.
the last 100 years or so, mankind has discovered how to prevent most of the diseases which shortened the lives of his ancestors. Today the means are known for preventing or curing malaria, tuberculosis, enteric infections and a host of other conditions from which millions of people have suffered and died in the past. Where there has been a sustained and carefully planned effort to use advances in medical science the results have been dramatic. To quote but one example: in 1900 tuberculosis claimed 60,000 victims in Great Britain. By 1963 this figure had dropped to 3,000. But although similarly dramatic and massive savings of human suffering and lives can be cited experience is showing that these impressive gains will not be maintained merely by making further discoveries in the laboratory. The problems now facing those who care for mankind’s health are to be found in the full application of available knowledge by the people who can benefit from it. Some early workers in public health believed that to provide people with the facts would automatically lead them to change their behaviour, but as modern medical knowledge has been made available to people it has become clear that this assumption cannot be justified. People will not turn away from their traditional ways of behaviour because someone-often from a different community than their own-tells them it is “scientifically” desirable to behave differently. For example although the educated city dweller expects a clean water supply, to protect him from at least some enteric infections, village people, accustomed to using a traditional water source will not lightly abandon it because an outsider tells them it would be wise if they did. Nor must it be assumed that unwillingness to change behaviour is restricted to the less educated-most people reading this article will know cigarette smokers who are aware that they run a much heavier risk of contracting lung cancer than the non-smoker-and yet the knowledgeable smoker does not necessarily abandon his habit. Faced with these facts of human behaviour how can we nevertheless try to make available the vast new store of knowledge in a form which is acceptable and applicable by those who have need of it? To an increasing number of people the key lies in health education. This aspect, or method of approach and philosophy, of public health puts the emphasis on helping people to help themselves in promoting their own and their neighbour’s health. WITHIN
171
D
172
SUSAN KING-HALL
Some of the older notions of health education equated education with the giving of 4nformation” or with “health propaganda”. Modern ideas about health education are built up from the reverse concept: starting with the interests and understanding of those whom it is hoped to help, rather than from the standpoint that this or that particular item of information “ought” to be communicated. The nature of the health problems facing mankind today makes this approach essential if there is to be real success. All over the world the health problems to be overcome depend increasingly upon the individual behaviour of each person. For example in the developing countries a clean water supply is only of value when the people in the village are prepared to use it and to keep it clean. A malaria eradication scheme requires that every householder co-operates by allowing all of his house to be sprayed and avoids washing the spray off afterwards. In the western world the current health problems are also closely related to what individual people are personally prepared to do-for example to refrain from cigarette smoking, to eat wisely, to dress sensibly. Where individual behaviour is the key to success the essential aim of health education must be to help people to take the necessary action. To provide information will not necessarily produce that result. People need to have an interest, a motive or a desire to change their established habits-which may have seemed to serve well in the past. They must also have the means to carry out the precepts. Space will not permit a detailed discussion here of the specific educational methods to be used in a given set of circumstances, nor of the problems of ensuring that the medical services are in fact there to meet a created demand. Suffice to say these must be borne in mind as well as the fact that although a well planned programme of health education is built up around people’s interests and concerns, the purpose, or aim, to which it is directed must be firmly based on the latest available technical knowledge relating to the problem itself. This partnership concept of health education involving the special skills and knowledge of the social scientist and educationist on the one hand, and those of the nurse, the midwife and the doctor and their colleagues on the other hand, has led to a need to look afresh at the training which each receives-not in order to make every nurse a social scientist or vice versa, but to ensure that each understands enough of the skills of the other to profit from them in their daily work. For example how much attention is given in nurses’ basic and post-basic training to the problems of communication-beginning not from the person who wants to convey information, but from the patient himself? Several studieso *) have shown that people’s understanding of visual symbols may be quite different from that intended by the artist. Similarly a chat with people who have just been seen by a doctor in a hospital ward often reveals in a heart-rending way that there has been no communication at all-even though the doctor has spoken freely and the patient has given the appearance of listening to what was said. As the knowledge about the human body’s functioning+r its failure to do sohas grown at such a tremendous pace recently so more and more information has had to be added to the traditional body of medical and nursing knowledge taught to those caring for the sick. Yet should this trend continue unchecked? Reflecting on the increasing need to prevent rather than cure and to influence people’s behaviour if positive health is to be promoted, would it not yield greater
HEALTH EDUCATION HOLDS A KEr FOR THE FUTURE
173
dividends in human happiness if increased emphasis were placed on the social sciences and the principles of education in the training of future health workers ? An expansion of these (cbehavioural” aspects of the curriculum taught to future health workers should also lead to an increase in the study of the factors which influence people in different cultures. There is today a great lack of both social scientists specialising in the field of health and of trained health workers with an adequate knowledge of the social scientists’ tools to enable them to act as efficient research workers. Both groups are needed to improve the health (as opposed to the care of sickness) services, which it is the avowed aim of most countries to provide. In addition there is a need for more specialists in health education trained at the post-graduate level. The specialist in health education, properly trained at postgraduate level in both the social and the health sciences is not another field worker, but a person whose task is to enable health, community and other workers concerned with promoting sound health behaviour to see and use their opportunities more fully. Such a specialist is now increasingly working at three levels : as a planner at a national level ; as a consultant to those carrying out health education programmes on a regional basis ; and as a teacher of the principles of education in the health setting to all types of health worker. British leaders in medicine, education and industry are seeking to assist this modern concept of health education by offering technical aid, based on this philosophy, to the developing countries requesting it. The medium through which this is being done is the British Society for International Health Education. Founded in 1962, as a voluntary non-governmental organisation, it is currently working on a variety of projects. These include training seminars in the developing countries for sister tutors, and midwifery tutors on the philosophy, content and methods of health education, and how it can be incorporated into local basic training for nurses, midwives and community workers. It is planned to study ways of developing the health education content of the post-graduate and post-basic training taken by overseas students studying in Britain for a wide variety of diplomas and degress and thirdly to encourage a post-graduate standard of training for specialists in health education, for whom there is a large and unsatisfied demand in many parts of the developing world. The British Society is supported by individuals and groups who believe its philosophy is sound and useful and who want to make a specific contribution to the long term well being of the newly emergent nations. Full particulars may be obtained from the General Secretary, The British Society for International Health Education, 85 Central Buildings, 24 Southwark Street, London, S.E. 1, England.
1. ALAN C. HOLMES,A Study of Understandingof Visual Symbols in Kenya, Published by O.V.A.C. (1963), 5s. 2. FORT~JNATO VlsRaa TEUTORI,An Exjmiment in Prc-testingAudio-Vincol Math& (in Mexico), ht. 3. Health EducationsVI, 189 (1963).
174
SUSAN KING-HALL R&mm-CDurant les 100 dernieres annea, les hommes ont decouvert la fason de se pr&mmir contre un grand nombre de maladies. Ceux qui, les premiers, s’occuptrent de la sand publique, crurent qu’il sufllsait de mettre quelqu’un en prbcnce des faits pour qu’il change automatiquementde conduite. Cette hypothbe ne s’est pas realisee. Pour un nombre croissant de personnes, la cl& de l’utilisation de connaissances nouvelles se trouve dam l’tducation sanitaire, car, dans le monde entier, les problemes sanitaires d’aujourd’hui dependent de la conduite de chaque individu. Le but essentiel de l’kducation sanitaire doit &tre d’aider les gens A pendre les mesures ntcessaires pour changer leur comportement et contribuer ainsi au maintien de leur same. Leur apporter des informations n’aboutira pas nCccssairement B ce resultat. On doit leur fournir les moyens de mettre B execution les prkceptes qu’on leur enseigne ainsi qu’tlaborer un programme soigneusement ttabli autour de leurs inter&s et de leurs soucis. L’klucation sanitaire demande qu’on associe la competence et les connaissances speciales du sociologue et du l’kducateur, A celles de l’infirmitre, de la sage-femme, du mkkcin et de leurs collaborateun. 11 faut considtrer d’un oeil nouveau l’enseignement A dormer A chacun. Quelle attention prttet-on, dans l’enseignement de base et l’enseignement sp&Alis& don& aux infirmi&res, aux probltmes de communication-commencant non pas par la personne qui desire transmettre des connaissances, mais par le malade lui-m&me? Maintenant que la prevention des maladies est chose possible et depend de l’influence que l’on a sur le comportement humain, est-ce que le fait de mettre l’accent sur les sciences so&ales et les principes d’education dans l’enseignement des futures assistantes sociales donnera une plus grande part de bonheur a l’homme? Pour en arriver la, il faut des sociologues sptcialis&s dam le domaine de la santt, des assistantes sociales avec des connaissances adequates en sciences sociales et des special&s en education sanitaire ayant recu un enseignement universitaire. Ces demien auron a travailler sur trois plans: organisation nationale; consultations rtgionales; enseignement des principes d’tducation B tous ceux qui s’occupent de la santt publique. Par l’entremise de la Socittt Britannique pour 1’Education Sanitaire Intemationale, les responsables de la mkdecine, de l’tducation et de l’industrie p&tent leur contours A l’application de ces conceptions modemes sur l’education sanitaire en offrant une aide technique aux contrees en voie de dtveloppement qui la leur demande. Rosamen-Durante 10s ultimos 100 aiios el hombre ha descubierto la forma de prevenci6n de muchas enfermedades. Los primeros sanitarios creian que la poblaci6n cambiaba automiticamente de costumbres al hacerle patente demostraciones concretas. Esta presunci6n no se ha justiflcado. Si bien para un creciente nlimero de personas la clave para el use de 10s nuevos descubrimientos radica en la educaci6n sanitaria, para la humanidad en general 10s problemas sanitarios dependen de la conducta de cada persona. El objetivo principal de la educaci6n sanitaria debe ser ayudar a la humanidad para que verifique en sus costumbres los cambios necesarios para mejorar su estado de salud. La simple informacidn no lo 1ograrA en todos 10s cases. Los recursos para llevar a cabo esta labor deben de ser asequibles, y un buen programa de cducaci6n sanitaria debe ser confeccionado segun 10s intereses y necesidades de la poblaci6n. La educaci6n sanitariaexige una asociaci6n de conocimientos de1 soci6logo y educador por una parte, y 10s de la enfermera, comadroma y medico, y sus ayudantes, de la otra. Se precisa una reconsideraci6n de la formaci6n recibida por cada tmo de ellos. ~Qut atenci6n se presta a 10s problemas de relacidn en la formaci6n bhica y postescolar de las enfermeras, y en especial bajo el punto de vista de1 enfermo, y no de la persona encargada de dar dicha formaci6n? En 10s momentos actual= en 10s que es posible la medicina preventiva, y bta depende de1 ingujo sobre las costumbres, 1 aportarla mayor felicidad al hombre una revalorizaci6n de las ciencias sociales y de la pedagogia, en la ensefianza de los futures especialistas sanitarios?
HEALTH EDUCATION
HOLDS A KEYFOR
173
THE FUTURE
Para llevar esto a cabo se precisan soci~lorros especializados en sanidad; sanitarios con buen conocimiento de la sociologia; especialhas en educacih sanitaria con formach posterior a su graduacih. Estos tiltimos pueden trabajar en tres niveles diferentea: planificacih a escala national; consultas de tipo regional; ensfianza de principios de educacidn a 10s sanitarios. Dirigentes ingleses de la medicina, educacih e industria apoyan este modern0 concept0 de educacih sanitaria ofreciendo ayuda tkcnica a 10s pa&s en desarrollo que la solicitan, a travks de la Sociedad Britinica para la Educacih Sanitaria Intemacional. A~cT~~uT-
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Health Education Holds a &y for the Future SUSAN KING:HALL British Societyfor Intcrnaiional Health Education, London.
the last 100 years or so, mankind has discovered how to prevent most of the diseases which shortened the lives of his ancestors. Today the means are known for preventing or curing malaria, tuberculosis, enteric infections and a host of other conditions from which millions of people have suffered and died in the past. Where there has been a sustained and carefully planned effort to use advances in medical science the results have been dramatic. To quote but one example: in 1900 tuberculosis claimed 60,000 victims in Great Britain. By 1963 this figure had dropped to 3,000. But although similarly dramatic and massive savings of human suffering and lives can be cited experience is showing that these impressive gains will not be maintained merely by making further discoveries in the laboratory. The problems now facing those who care for mankind’s health are to be found in the full application of available knowledge by the people who can benefit from it. Some early workers in public health believed that to provide people with the facts would automatically lead them to change their behaviour, but as modern medical knowledge has been made available to people it has become clear that this assumption cannot be justified. People will not turn away from their traditional ways of behaviour because someone-often from a different community than their own-tells them it is “scientifically” desirable to behave differently. For example although the educated city dweller expects a clean water supply, to protect him from at least some enteric infections, village people, accustomed to using a traditional water source will not lightly abandon it because an outsider tells them it would be wise if they did. Nor must it be assumed that unwillingness to change behaviour is restricted to the less educated-most people reading this article will know cigarette smokers who are aware that they run a much heavier risk of contracting lung cancer than the non-smoker-and yet the knowledgeable smoker does not necessarily abandon his habit. Faced with these facts of human behaviour how can we nevertheless try to make available the vast new store of knowledge in a form which is acceptable and applicable by those who have need of it? To an increasing number of people the key lies in health education. This aspect, or method of approach and philosophy, of public health puts the emphasis on helping people to help themselves in promoting their own and their neighbour’s health. WITHIN
171
D
172
SUSAN KING-HALL
Some of the older notions of health education equated education with the giving of 4nformation” or with “health propaganda”. Modern ideas about health education are built up from the reverse concept: starting with the interests and understanding of those whom it is hoped to help, rather than from the standpoint that this or that particular item of information “ought” to be communicated. The nature of the health problems facing mankind today makes this approach essential if there is to be real success. All over the world the health problems to be overcome depend increasingly upon the individual behaviour of each person. For example in the developing countries a clean water supply is only of value when the people in the village are prepared to use it and to keep it clean. A malaria eradication scheme requires that every householder co-operates by allowing all of his house to be sprayed and avoids washing the spray off afterwards. In the western world the current health problems are also closely related to what individual people are personally prepared to do-for example to refrain from cigarette smoking, to eat wisely, to dress sensibly. Where individual behaviour is the key to success the essential aim of health education must be to help people to take the necessary action. To provide information will not necessarily produce that result. People need to have an interest, a motive or a desire to change their established habits-which may have seemed to serve well in the past. They must also have the means to carry out the precepts. Space will not permit a detailed discussion here of the specific educational methods to be used in a given set of circumstances, nor of the problems of ensuring that the medical services are in fact there to meet a created demand. Suffice to say these must be borne in mind as well as the fact that although a well planned programme of health education is built up around people’s interests and concerns, the purpose, or aim, to which it is directed must be firmly based on the latest available technical knowledge relating to the problem itself. This partnership concept of health education involving the special skills and knowledge of the social scientist and educationist on the one hand, and those of the nurse, the midwife and the doctor and their colleagues on the other hand, has led to a need to look afresh at the training which each receives-not in order to make every nurse a social scientist or vice versa, but to ensure that each understands enough of the skills of the other to profit from them in their daily work. For example how much attention is given in nurses’ basic and post-basic training to the problems of communication-beginning not from the person who wants to convey information, but from the patient himself? Several studieso *) have shown that people’s understanding of visual symbols may be quite different from that intended by the artist. Similarly a chat with people who have just been seen by a doctor in a hospital ward often reveals in a heart-rending way that there has been no communication at all-even though the doctor has spoken freely and the patient has given the appearance of listening to what was said. As the knowledge about the human body’s functioning+r its failure to do sohas grown at such a tremendous pace recently so more and more information has had to be added to the traditional body of medical and nursing knowledge taught to those caring for the sick. Yet should this trend continue unchecked? Reflecting on the increasing need to prevent rather than cure and to influence people’s behaviour if positive health is to be promoted, would it not yield greater
HEALTH EDUCATION HOLDS A KEr FOR THE FUTURE
173
dividends in human happiness if increased emphasis were placed on the social sciences and the principles of education in the training of future health workers ? An expansion of these (cbehavioural” aspects of the curriculum taught to future health workers should also lead to an increase in the study of the factors which influence people in different cultures. There is today a great lack of both social scientists specialising in the field of health and of trained health workers with an adequate knowledge of the social scientists’ tools to enable them to act as efficient research workers. Both groups are needed to improve the health (as opposed to the care of sickness) services, which it is the avowed aim of most countries to provide. In addition there is a need for more specialists in health education trained at the post-graduate level. The specialist in health education, properly trained at postgraduate level in both the social and the health sciences is not another field worker, but a person whose task is to enable health, community and other workers concerned with promoting sound health behaviour to see and use their opportunities more fully. Such a specialist is now increasingly working at three levels : as a planner at a national level ; as a consultant to those carrying out health education programmes on a regional basis ; and as a teacher of the principles of education in the health setting to all types of health worker. British leaders in medicine, education and industry are seeking to assist this modern concept of health education by offering technical aid, based on this philosophy, to the developing countries requesting it. The medium through which this is being done is the British Society for International Health Education. Founded in 1962, as a voluntary non-governmental organisation, it is currently working on a variety of projects. These include training seminars in the developing countries for sister tutors, and midwifery tutors on the philosophy, content and methods of health education, and how it can be incorporated into local basic training for nurses, midwives and community workers. It is planned to study ways of developing the health education content of the post-graduate and post-basic training taken by overseas students studying in Britain for a wide variety of diplomas and degress and thirdly to encourage a post-graduate standard of training for specialists in health education, for whom there is a large and unsatisfied demand in many parts of the developing world. The British Society is supported by individuals and groups who believe its philosophy is sound and useful and who want to make a specific contribution to the long term well being of the newly emergent nations. Full particulars may be obtained from the General Secretary, The British Society for International Health Education, 85 Central Buildings, 24 Southwark Street, London, S.E. 1, England.
1. ALAN C. HOLMES,A Study of Understandingof Visual Symbols in Kenya, Published by O.V.A.C. (1963), 5s. 2. FORT~JNATO VlsRaa TEUTORI,An Exjmiment in Prc-testingAudio-Vincol Math& (in Mexico), ht. 3. Health EducationsVI, 189 (1963).
174
SUSAN KING-HALL R&mm-CDurant les 100 dernieres annea, les hommes ont decouvert la fason de se pr&mmir contre un grand nombre de maladies. Ceux qui, les premiers, s’occuptrent de la sand publique, crurent qu’il sufllsait de mettre quelqu’un en prbcnce des faits pour qu’il change automatiquementde conduite. Cette hypothbe ne s’est pas realisee. Pour un nombre croissant de personnes, la cl& de l’utilisation de connaissances nouvelles se trouve dam l’tducation sanitaire, car, dans le monde entier, les problemes sanitaires d’aujourd’hui dependent de la conduite de chaque individu. Le but essentiel de l’kducation sanitaire doit &tre d’aider les gens A pendre les mesures ntcessaires pour changer leur comportement et contribuer ainsi au maintien de leur same. Leur apporter des informations n’aboutira pas nCccssairement B ce resultat. On doit leur fournir les moyens de mettre B execution les prkceptes qu’on leur enseigne ainsi qu’tlaborer un programme soigneusement ttabli autour de leurs inter&s et de leurs soucis. L’klucation sanitaire demande qu’on associe la competence et les connaissances speciales du sociologue et du l’kducateur, A celles de l’infirmitre, de la sage-femme, du mkkcin et de leurs collaborateun. 11 faut considtrer d’un oeil nouveau l’enseignement A dormer A chacun. Quelle attention prttet-on, dans l’enseignement de base et l’enseignement sp&Alis& don& aux infirmi&res, aux probltmes de communication-commencant non pas par la personne qui desire transmettre des connaissances, mais par le malade lui-m&me? Maintenant que la prevention des maladies est chose possible et depend de l’influence que l’on a sur le comportement humain, est-ce que le fait de mettre l’accent sur les sciences so&ales et les principes d’education dans l’enseignement des futures assistantes sociales donnera une plus grande part de bonheur a l’homme? Pour en arriver la, il faut des sociologues sptcialis&s dam le domaine de la santt, des assistantes sociales avec des connaissances adequates en sciences sociales et des special&s en education sanitaire ayant recu un enseignement universitaire. Ces demien auron a travailler sur trois plans: organisation nationale; consultations rtgionales; enseignement des principes d’tducation B tous ceux qui s’occupent de la santt publique. Par l’entremise de la Socittt Britannique pour 1’Education Sanitaire Intemationale, les responsables de la mkdecine, de l’tducation et de l’industrie p&tent leur contours A l’application de ces conceptions modemes sur l’education sanitaire en offrant une aide technique aux contrees en voie de dtveloppement qui la leur demande. Rosamen-Durante 10s ultimos 100 aiios el hombre ha descubierto la forma de prevenci6n de muchas enfermedades. Los primeros sanitarios creian que la poblaci6n cambiaba automiticamente de costumbres al hacerle patente demostraciones concretas. Esta presunci6n no se ha justiflcado. Si bien para un creciente nlimero de personas la clave para el use de 10s nuevos descubrimientos radica en la educaci6n sanitaria, para la humanidad en general 10s problemas sanitarios dependen de la conducta de cada persona. El objetivo principal de la educaci6n sanitaria debe ser ayudar a la humanidad para que verifique en sus costumbres los cambios necesarios para mejorar su estado de salud. La simple informacidn no lo 1ograrA en todos 10s cases. Los recursos para llevar a cabo esta labor deben de ser asequibles, y un buen programa de cducaci6n sanitaria debe ser confeccionado segun 10s intereses y necesidades de la poblaci6n. La educaci6n sanitariaexige una asociaci6n de conocimientos de1 soci6logo y educador por una parte, y 10s de la enfermera, comadroma y medico, y sus ayudantes, de la otra. Se precisa una reconsideraci6n de la formaci6n recibida por cada tmo de ellos. ~Qut atenci6n se presta a 10s problemas de relacidn en la formaci6n bhica y postescolar de las enfermeras, y en especial bajo el punto de vista de1 enfermo, y no de la persona encargada de dar dicha formaci6n? En 10s momentos actual= en 10s que es posible la medicina preventiva, y bta depende de1 ingujo sobre las costumbres, 1 aportarla mayor felicidad al hombre una revalorizaci6n de las ciencias sociales y de la pedagogia, en la ensefianza de los futures especialistas sanitarios?
HEALTH EDUCATION
HOLDS A KEYFOR
173
THE FUTURE
Para llevar esto a cabo se precisan soci~lorros especializados en sanidad; sanitarios con buen conocimiento de la sociologia; especialhas en educacih sanitaria con formach posterior a su graduacih. Estos tiltimos pueden trabajar en tres niveles diferentea: planificacih a escala national; consultas de tipo regional; ensfianza de principios de educacidn a 10s sanitarios. Dirigentes ingleses de la medicina, educacih e industria apoyan este modern0 concept0 de educacih sanitaria ofreciendo ayuda tkcnica a 10s pa&s en desarrollo que la solicitan, a travks de la Sociedad Britinica para la Educacih Sanitaria Intemacional. A~cT~~uT-
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