PubL Hlth, Lond. (1976) 90, 79-81
Points of View Health Education* Ann Raikes M.R.C.S.. L.R.C.P.
Medical Assistant (Paediatrics), Poo/e Genera/Hospital Dorset The paper discusses the need for clarification and co-ordination of the aims, content and direction of health education. The subject is considered to be of considerable importance as, if correctly planned and given, it will prevent wastage of slender resources in time of need. The provision o f a systematic course of instruction to prevent unrealistic attitudes and to improve knowledge and use existing facilities efficiently is needed because of advances in medicine and awareness of social problems. Health education is also needed to prevent misunderstanding and lack of perspective which may result from the multiplicity of articles on health topics presented to :the public by the mass media. It is necessary that all medical, paramedical and educational disciplines work together to provide a basic comprehensive programme of instruction with local variants dictated by local needs.
Introduction This vast subject suffers from meaning many different things to m a n y different p e o p l e - wherein lies its weakness as it is far too easy to divert too high a p r o p o r t i o n of resources into minute details instead offirst clarifying the basic requirements and defining (or attempting to define) the meaning of health education. Health: a state o f organic soundness-whole. Education: systematic course o f training and instruction. Therefore health education should mean a comprehensive systematic p r o g r a m m e o f instruction--a vital field if medicine is to move forward and develop further. It is a constantly changing process needing updating and varying in content and methods of presentation. It has been said elsewhere "that the aim of Health Education is to equip people to make sound decisions on matters affecting their health, safety a n d welfare; it also tries to influence the outcome o f such decisions towards the best course of a c t i o n ; i n addition it tries to encourage t h e social acceptance of such behaviour as normal". Who? What? Why? Who needs health education ? What do they need to know ? W h y is health education needed ? These aspects must be considered before the vital question o f " h o w " is explored. Only if they are given honest unbiased t h o u g h t wilt an overall co-ordinated education programme be possible and " h o w " become more o f a viable economic proposition. Health education varies very m u c h from area to area dependent on local interests often more t h a n on skills o r needs and certainly not as part o f a clear overall plan o f instruction. A host of information assaults all senses from the radio, television, magazines, books, etc. Health, so essential for us all, is an eminently saleable topic to the public. The mass media are continuously producing features o n aspects of health in response to public demand a n d public interest. Far too often the programmes give a very biased or superficial picture causing m u c h public anxiety and giving rise to unrealistic demands and expectations. *A paper presented to the Study Group on Community Paediatrics held at Bath, 9 September 1975~
80
Ann Raikes
Whom Should We Educate? (1) Unless the professions involved in providing specialized services for the mainlenance of health and education are aware of the problems, the resources, strengths and weaknesses in their own and other paramedical disciplines, and of the facilities in their own areas, they will not have realistic goals and may well not use each other's skills to advantage. The role of health education therefore needs to be accepted, clarified and given proper status with understanding that it is a skilled task and necessary at all levels of training and in all involved disciplines. (2) Separating parents and children into two categories especially in need of health education is not possible as parents need to co-operate with and complement pre-school and school programmes designed to explain health problems to their children. These must be concurrent programmes and therefore must be considered together. Basic concepts must be offered to all children in forms designed and suited to their age and development. Parents (mother and father) need to have opportunities for discussion ~and for obtaining information and counselling from the earliest m o m e n t m m u c h needed help should be given in ~he antenatal months. One must always remember however that one often preaches to the converted and on the other hand the seeds of much needed health education fall on stony ground and are not accepted, lmpr~vement of health education will not cure all problems bu~ hopefully it will lessen some of them. [3:) Tl~e community as a whole needs to be given new information to prevent out of date concep:ts becoming deep .rooted and thus hinder improvement of services and also to stop new hazards developing where problems have altered. Examples in the fields of mental illness, epilepsy, immunization, smoking and drugs spring to mind. What Do We Need to Know? The contents of health education programmes are so varied that often no clear overall concept is presented of what is being attempted, and, as a result, programmes are frequently expensive and wasteful. The subject matter needs careful consideration but should aim to achieve the following. (a) General information about natural processes of growth, maturation, development, hygiene, nutrition, etc. (b) Understanding of certain specific health problems so that unrealistic attitudes towards disease, handicap, treatment and unrealistic expectations of progress, treatment and facilities are prevented. (c) There is a need to know about the local facilities for diagnosis, treatment and support as they vary greatly in quality and content from area to area. Unless the categories in "who" are aware of local arrangements inefficiency and under utilization of services may occur with poor communication between co-workers. (a) With improvement in health services and public awareness o f some health hazards the :pattern of problems is altering and prevention is becoming more and more important and minimization of handicap more possible. So more emphasis is required on early recognition of need and early referral for expert help. Why Should There be Health Education? TJais question is especially pertinent at the present time of financial difficulties. Only by involvement and genuine communication between the various services responsible for the health and care of children (and the population as a whole) and between these workers and the public can the progressively more complex field of health education be competently
Points of View~Health education
81
covered and taught. Advice must be co-ordinated so that muddle and multiplication of misconceptions do not occur. We must also remember that world travel and immigration have complicated the task of health education in this country by giving us the additional problems of cultural and language differences. How? The final hurdle. Some basic natural (universal) facts are needed, in addition some varied local content must be included in the overall skeleton of a programme and all services must co-opera~e in seeing that the agreed content of health education programme be carried out by people interested in and convinced of the need for such information being presented to their "pupils". Wherever possible the information must be presented by informed generalists or unbiased enthusiasts rather than specialists--if such exist! otherwise the subject will not fall into proper perspective. In the opening paragraph I suggested health education needs to be a systematic course of training--this means a co-ordinated effort by all interested workers to help each other produce that course without rigid conceptions of who does what, provided all aspects are adequately covered.
Report on Jubilee ,Congress of 1he Medical Association of South Africa (14-18 July 1975, Johannesburg) This Congress was an auspicious occasion. The papers and discussion, as expected, were first class; but in addition the philosophy of medicine in Southern Africa received special attention, both retrospectively and prospectively. The pioneer spirit came through clearly in the Historical Review presented by Professor J. H. Louw, entitled "The History of Medicine in South Africa Over the Past 50 Years". The present situation was defined by the Secretary of State, Dr de Beer, his talk being entitled "A Forward View of Health Services in South Africa". In his opinion, the major medical problems in South Africa were that a tuberculosis epidemic was imminent and that nutritional problems were still paramount. He described how their highly developed medical services were suffering from problems very similar to those experienced in many other countries. He itemized the organizational problems which were complicated by the proximity of developing and developed communities. In the sessions on the prevention, screening, early diagnosis, treatment :and management of cancers, Professor J. F. Holland and Dr I. H. Krakoff made a formidable team and in their presentations covered the main facets of the chemotherapy of many cancers. They indicated the recent reorientation in the concepts of chemotherapy and the management of neoplasia. They tempered optimism with realism, giving some really practical advice on the management of cancers. Screening and its use in the presymptomatic diagnosis of cancers was analysed at a sub-plenary session. The panel comprised Professor J. F. Holland (U.S.A.), Dr I. H. Krakoff (U.S.A.), Dr D. J. Rice (Canada) and Professor K. Schwarz .(New Zealand). The audience waxed enthusiastic about the potential of screening and presymptomatic diagnosis, the general conclusion reached being that, subject to the right indications, screening and presymptomatic diagnosis could be invaluable. K. Schwarz
Points of View Health Education* Ann Raikes M.R.C.S.. L.R.C.P.
Medical Assistant (Paediatrics), Poo/e Genera/Hospital Dorset The paper discusses the need for clarification and co-ordination of the aims, content and direction of health education. The subject is considered to be of considerable importance as, if correctly planned and given, it will prevent wastage of slender resources in time of need. The provision o f a systematic course of instruction to prevent unrealistic attitudes and to improve knowledge and use existing facilities efficiently is needed because of advances in medicine and awareness of social problems. Health education is also needed to prevent misunderstanding and lack of perspective which may result from the multiplicity of articles on health topics presented to :the public by the mass media. It is necessary that all medical, paramedical and educational disciplines work together to provide a basic comprehensive programme of instruction with local variants dictated by local needs.
Introduction This vast subject suffers from meaning many different things to m a n y different p e o p l e - wherein lies its weakness as it is far too easy to divert too high a p r o p o r t i o n of resources into minute details instead offirst clarifying the basic requirements and defining (or attempting to define) the meaning of health education. Health: a state o f organic soundness-whole. Education: systematic course o f training and instruction. Therefore health education should mean a comprehensive systematic p r o g r a m m e o f instruction--a vital field if medicine is to move forward and develop further. It is a constantly changing process needing updating and varying in content and methods of presentation. It has been said elsewhere "that the aim of Health Education is to equip people to make sound decisions on matters affecting their health, safety a n d welfare; it also tries to influence the outcome o f such decisions towards the best course of a c t i o n ; i n addition it tries to encourage t h e social acceptance of such behaviour as normal". Who? What? Why? Who needs health education ? What do they need to know ? W h y is health education needed ? These aspects must be considered before the vital question o f " h o w " is explored. Only if they are given honest unbiased t h o u g h t wilt an overall co-ordinated education programme be possible and " h o w " become more o f a viable economic proposition. Health education varies very m u c h from area to area dependent on local interests often more t h a n on skills o r needs and certainly not as part o f a clear overall plan o f instruction. A host of information assaults all senses from the radio, television, magazines, books, etc. Health, so essential for us all, is an eminently saleable topic to the public. The mass media are continuously producing features o n aspects of health in response to public demand a n d public interest. Far too often the programmes give a very biased or superficial picture causing m u c h public anxiety and giving rise to unrealistic demands and expectations. *A paper presented to the Study Group on Community Paediatrics held at Bath, 9 September 1975~
80
Ann Raikes
Whom Should We Educate? (1) Unless the professions involved in providing specialized services for the mainlenance of health and education are aware of the problems, the resources, strengths and weaknesses in their own and other paramedical disciplines, and of the facilities in their own areas, they will not have realistic goals and may well not use each other's skills to advantage. The role of health education therefore needs to be accepted, clarified and given proper status with understanding that it is a skilled task and necessary at all levels of training and in all involved disciplines. (2) Separating parents and children into two categories especially in need of health education is not possible as parents need to co-operate with and complement pre-school and school programmes designed to explain health problems to their children. These must be concurrent programmes and therefore must be considered together. Basic concepts must be offered to all children in forms designed and suited to their age and development. Parents (mother and father) need to have opportunities for discussion ~and for obtaining information and counselling from the earliest m o m e n t m m u c h needed help should be given in ~he antenatal months. One must always remember however that one often preaches to the converted and on the other hand the seeds of much needed health education fall on stony ground and are not accepted, lmpr~vement of health education will not cure all problems bu~ hopefully it will lessen some of them. [3:) Tl~e community as a whole needs to be given new information to prevent out of date concep:ts becoming deep .rooted and thus hinder improvement of services and also to stop new hazards developing where problems have altered. Examples in the fields of mental illness, epilepsy, immunization, smoking and drugs spring to mind. What Do We Need to Know? The contents of health education programmes are so varied that often no clear overall concept is presented of what is being attempted, and, as a result, programmes are frequently expensive and wasteful. The subject matter needs careful consideration but should aim to achieve the following. (a) General information about natural processes of growth, maturation, development, hygiene, nutrition, etc. (b) Understanding of certain specific health problems so that unrealistic attitudes towards disease, handicap, treatment and unrealistic expectations of progress, treatment and facilities are prevented. (c) There is a need to know about the local facilities for diagnosis, treatment and support as they vary greatly in quality and content from area to area. Unless the categories in "who" are aware of local arrangements inefficiency and under utilization of services may occur with poor communication between co-workers. (a) With improvement in health services and public awareness o f some health hazards the :pattern of problems is altering and prevention is becoming more and more important and minimization of handicap more possible. So more emphasis is required on early recognition of need and early referral for expert help. Why Should There be Health Education? TJais question is especially pertinent at the present time of financial difficulties. Only by involvement and genuine communication between the various services responsible for the health and care of children (and the population as a whole) and between these workers and the public can the progressively more complex field of health education be competently
Points of View~Health education
81
covered and taught. Advice must be co-ordinated so that muddle and multiplication of misconceptions do not occur. We must also remember that world travel and immigration have complicated the task of health education in this country by giving us the additional problems of cultural and language differences. How? The final hurdle. Some basic natural (universal) facts are needed, in addition some varied local content must be included in the overall skeleton of a programme and all services must co-opera~e in seeing that the agreed content of health education programme be carried out by people interested in and convinced of the need for such information being presented to their "pupils". Wherever possible the information must be presented by informed generalists or unbiased enthusiasts rather than specialists--if such exist! otherwise the subject will not fall into proper perspective. In the opening paragraph I suggested health education needs to be a systematic course of training--this means a co-ordinated effort by all interested workers to help each other produce that course without rigid conceptions of who does what, provided all aspects are adequately covered.
Report on Jubilee ,Congress of 1he Medical Association of South Africa (14-18 July 1975, Johannesburg) This Congress was an auspicious occasion. The papers and discussion, as expected, were first class; but in addition the philosophy of medicine in Southern Africa received special attention, both retrospectively and prospectively. The pioneer spirit came through clearly in the Historical Review presented by Professor J. H. Louw, entitled "The History of Medicine in South Africa Over the Past 50 Years". The present situation was defined by the Secretary of State, Dr de Beer, his talk being entitled "A Forward View of Health Services in South Africa". In his opinion, the major medical problems in South Africa were that a tuberculosis epidemic was imminent and that nutritional problems were still paramount. He described how their highly developed medical services were suffering from problems very similar to those experienced in many other countries. He itemized the organizational problems which were complicated by the proximity of developing and developed communities. In the sessions on the prevention, screening, early diagnosis, treatment :and management of cancers, Professor J. F. Holland and Dr I. H. Krakoff made a formidable team and in their presentations covered the main facets of the chemotherapy of many cancers. They indicated the recent reorientation in the concepts of chemotherapy and the management of neoplasia. They tempered optimism with realism, giving some really practical advice on the management of cancers. Screening and its use in the presymptomatic diagnosis of cancers was analysed at a sub-plenary session. The panel comprised Professor J. F. Holland (U.S.A.), Dr I. H. Krakoff (U.S.A.), Dr D. J. Rice (Canada) and Professor K. Schwarz .(New Zealand). The audience waxed enthusiastic about the potential of screening and presymptomatic diagnosis, the general conclusion reached being that, subject to the right indications, screening and presymptomatic diagnosis could be invaluable. K. Schwarz
