Health Education in the 21st Century Will Not Come From More Government Regulation
Everybody agrees on the need for health education, but there is not yet a common understanding of what that means and how far-reaching health education should be.
From the standpoint of civil society in a global perspective, the first agent of health is every person in his or her first person, independent of State control.
This is less obvious than it seems, and the reason is simple: Health-damaging activities have a high probability of creating costs for a somewhat generalized health system. As a consequence, legislation tries to gain control over such forms of behavior. Look at the ban on smoking in public buildings not only in the U.S., but also in many European countries. The point here is paradoxical: The enforcement of such laws needs health education but in the end, the effect is a matter of state control and not of reasonable insight.
Health education therefore comes to a limit when it becomes the expression of patronizing ideas that find their way into legislation. This may not be the case for the obviously damaging effects of smoking — even if I have been impressed by one smoker’s confession: “This is part of my personal freedom; and if I live ten years less, the system benefits by paying me less years of retirement!” I told him that he could smoke at home; nonetheless his argument is not to be neglected.
Not all of health education, however, will be in the hands of regulators and lawmakers. The first lesson should be: Beware of too much health activity-related legislation — it could be highly patronizing.
On the other hand, the idea of a healthy lifestyle is so basic that civil society must have an interest in health education starting from the family and not stopping in schools. The basic ideas are simple: wash your hands; use clean water; eat balanced food; and exercise.
Recently, I visited Lebanon and saw some Palestinian quarters in Tyre (Sour), divided from the city by entrance and exit controls. Considering the important role of religious and political issues in this community, health education needs to have support from local religious and political leaders. This is real life, and it is different in every part of the world. This leads to a second lesson: Consider the social and political context of every community, otherwise health education will not have an impact.
In the end, we come back to a matter of priorities, and health really should be a top priority. The next limit, however, is the access to health education and to health care. I do not only refer to poor countries or poor regions or to a lack of health insurance and such things. The point here is that you need trained and qualified people to perform health education, be it in schools, at doctor’s offices, or in hospitals. Look at the millions of children in so-called highly developed countries that go to school without breakfast. And though it is not news that the blood glucose level is important for learning processes — nobody pays much attention.
This leads to a need of a health education policy: If you don’t have it, forget about the ideal world. The third lesson hence is the following: If you wish to implement health education, implement a program for training the trainers.
Sure, this comes back to political priorities in the sense of “who pays what.” And here, civil society matters. First of all, extreme disparity is a matter of public failure. Not everything can be done at the same time but every state, region, and city needs to have a health priority plan that includes both access to health services and access to health education. And unfortunately, people are not always aware of the financial benefits of health education: It is beneficial to invest in health starting with health education, and even more so if you start with the poorer parts of society. So from the standpoint of civil society, one conclusion is of foremost importance: Health education must be an investment and activity priority of public policy on local, regional, national, and international levels.
The contents of health education obviously vary according to circumstances. Look at some regions in Germany where the transition to an aging society is already more advanced. Health education here becomes linked with the concept of life quality, and this means a favorable degree of social contacts, the chance of living at home even at old age, and the access to assistance services that match with the deterioration of physical abilities in old age. Health education will not only be in words but also in the form of a bundled package of activities offered which will be in need of public and individual support at the same time.
Strangely enough, this observation once more comes back to matters of justice. First of all, from the standpoint of civil society, the access to health care, health education, and assistance should not be a matter of national borders. Still, health care systems are one of the strongholds of national regulation. This is understandable due to the public nature of all health-related activities. On the other hand, it transforms health care and health education into a matter of rights of residence, political, and social borders — and this is not the idea of generalized human rights.
Second, health care professionals do not always respect national borders. Millions of Filipinas do health-related family work in foreign countries in order to support their families at home. Thousands of Eastern European nurses assist elderly, wealthy Germans. There’s a stream of doctors emigrating from Germany to Sweden, the UK, or Switzerland where they are better paid for fewer working hours.
The final conclusion for a policy on health education, therefore, comes close to the basic idea of a globalized civil society with equal standards for all human beings: If you really want efficient health education, promote and support a public discussion on matters of justice.
A lot of people have an instinct for what is right or wrong. Even if the discussion will be controversial, it will eventually lead to tangible results. All of this comes with a very positive, health-related side effect: The participation in a democratic discussion in itself is a contribution to health — as long as people feel that their contribution matters, they will feel the healthy effects on their self esteem.
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