The Global Health Education Divide

Written by Angelina Wilson and Gabriel Oguda

Edited by Emily Fisher

Introduction

Health education is a planned process designed to achieve health and illness-related learning (Tones & Green, 2004). Advocates of health education underscore the importance of developing personal skills throughout the process of education. Similar to the goals of health education, developing personal skills in the process of empowerment is also a key aim of health promotion (WHO, 1986) and many health promoters agree that health education forms an integral part of health promotion (Nutbeam& Kickbusch, 2000). Established aims of health education include aiding individuals to make informed decisions for health-related behavior change, for empowerment, and for social and political change related to public health (Tones & Green, 2004).

Historically, a key public health strategy has been the use of health education and it is still quite influential in modern day health promotion practice and public health (Nutbeam, 2000). During the 1960s and 1970s, the transmission of information and health campaigning formed an integral part of health education in the developing countries (Nutbeam, 2000). This was because it was believed that health-related behavior change cannot be achieved without informing individuals about the necessary change and how they can take steps to achieve this change. Health education techniques include the use of pamphlets, advertising, lectures, group or panel discussions, symposia, poster or exhibit presentation (Saha, Poddar, & Mankad, 2005): recent research has also outlined the importance of distributing health-related products for free to aid in health education related change, such as condoms in HIV/AIDS prevention (Community Guide News, 2012). Due to advancements in technology and a significant amount of research in health education, there has been immense improvement in health education, but this improvement is more profound in some parts of the world to the neglect of others. The positive and multiplier effect of education on population health, especially for women, has been well demonstrated in both developed and developing countries: however, there still exists a lack of health education for many health issues in developing nations, which can be just as deadly as the lack of access to vaccines (Kickbusch, 2001), (Nutbeam & Kickbusch 2000).

Despite the recognized importance of health education there is still a great disparity in global health education with a concentration in the industrialized world. The aim of this article is to discuss why disparities in this realm exist and how they can be minimized.

Disparities in Health Education

“Although disease patterns vary geographically, the conditions that foster disease onset such as poverty, limited access to health care, the status of women, environmental degradation, political instability, war, and genetic susceptibility are often the same worldwide. The rise of chronic conditions of the industrialized world in rapidly developing countries, such as cardiovascular disease, lung disease due to smoking, and diabetes mellitus, highlights our sameness again” (Houpt, Pearson, & Hall, 2007).

This obvious similitude in health issues globally is not reflected in the amount of information available concerning health in the developing world. It is only recently that we have a massive campaign for health education in Africa. Research has shown that 90 percent of global health resources go to the developed countries resulting in a global health divide (WHO, 1988) (‘WHO | Adelaide Recommendations on Healthy Public Policy’, n.d.). Eighty percent of Latin American women were said to be literate as compared to a 10% literacy rate among poor African countries such as Niger and Burkina Faso (Save the Children 2000).  Low-level of literacy transforms into poor quality of life and also widens the global health education divide because our techniques for health education often utilize methods that require a literate audience.

During a review of the literature, very little information was found on the prevalence and reason for the disparity in health education across different vulnerable groups including women, people with low socio-economic status, the elderly, and children. Some of the effects of the global health education divide include poorer health regardless of the illness in question (DeWalt, Berkman, Sheridan, Lohr, & Pignone, 2004). In addition this divide leads to the inability for self-management, higher medical cost, more frequent hospitalizations, longer hospital stays, and lack of necessary skills to obtain needed services.

Solutions from Health Promotion

How best can we reduce this inequity? One key solution is to find ways to make health information more accessible. Medical practitioners need to ensure that the information provided corresponds with patients’ levels of health literacy (Egbert & Nanna 2009). Examples of easy to understand materials include videos, picture-based messages, or text-based material that is written at a lower reading level (Egbert & Nanna 2009). Accessibility does not only involve providing information, but also making sure that the channel and source of communication is adapted to local needs. Haque et al. (2012) found in their study of the lack of uptake of free government antimalarial medications that villagers were instead going to unauthorized drug dispensaries: understanding why this is the case is extremely important when governments are spending monies for certain efforts and not effectively reaching the people they set out to reach and people are choosing to utilize ineffective treatments.

The discrepancy in the availability of health education is further augmented by the techniques adopted.  The extreme importance of cultural factors is sometimes underplayed during health education (Resnicow, Baranowski, Ahluwalia, & Braithwaite, 1999). An appropriate communication channel, which is tailored to different cultures, is necessary for health education to be achieved. This is very important because the health information provider needs to gain the trust of those receiving the message. After information is made available, ensuring correct understanding and application of the information is also important. This involves the feedback process where the patients are allowed to respond to the services, thus helping to tighten up the approach hence increasing uptake. Armstrong et al. (2001) in their study of the usage insecticides treated nets (ITNs) in Tanzania noted that local knowledge enhanced social marketing and increased patronage of the ITNs. They explained that knowledge of local conceptions of malaria aided in health campaign and education, which enhanced ownership of ITNs.

Another challenge that health promotion professionals need to address is cost. The health education divide results partly from costs. Measures should be put in place make information available at the least cost without interfering with the quality of content. For example, necessary health information should be incorporated into consultation visits of patients especially in the rural areas.

To conclude, we can say that health education is an indispensible asset in promoting health: reducing the health education divide is an instrumental step in reducing health inequity. Health education has many facets and extends beyond the transmission of health information in the form of advertising, pamphlets, and bill boards. The level of health literacy of those receiving the information, using culturally appropriate methods of transmission, and the ability of the receiver to process the intended information are all critical in the health education process. For health education to actually reach disadvantaged and vulnerable groups these factors must be taken into account.

References
Armstrong, J.R.M., Abdulla, S., Nathan, R., Mukasa, O., Marchant, T.J., Kikumnbih, N., Mushi, A.K., Mponda, H., Minja, H., Mshinda, H., Tanner, M., Lengeler, C. (2004). Effect of large-scale social marketing of insecticide-treated nets on child survival in rural Tanzania. The Lancet, 357, 1241.
Community Guide News (2012). Effectiveness of health communication campaigns that include mass media and health-related product distribution. Retrieved on November 30, 2012 from http://www.thecommunityguide.org/news/2012/HealthCommunicationCampaigns.html.
Egbert, N. & Nanna, K.M. (2009). Health literacy: challenges and strategies. The Online Journal of Issues in Nursing, 14(3).
Haque, U., Scott, L.M., Hasizume, M., Fisher, E., Haque, R., Yamamoto, T., Glass, G.E. (2012). Modelling malaria treatment practices in Bangladesh using spatial statistics. Malaria Journal, 11, 63.
DeWalt, D. A., Berkman, N. D., Sheridan, S., Lohr, K. N., & Pignone, M. P. (2004). Literacy and Health Outcomes. Journal of General Internal Medicine, 19(12), 1228–1239. doi:10.1111/j.1525-1497.2004.40153.x
Houpt, E. R., Pearson, R. D., & Hall, T. L. (2007). Three Domains of Competency in Global Health Education: Recommendations for All Medical Students. Academic Medicine, 82(3), 222–225. doi:10.1097/ACM.0b013e3180305c10
Nutbeam, D. (2000). Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health Promotion International, 15(3), 259–267. doi:10.1093/heapro/15.3.259
Resnicow, K., Baranowski, T., Ahluwalia, J. S., & Braithwaite, R. L. (1999). Cultural sensitivity in public health: defined and demystified. Ethnicity & Disease, 9(1), 10–21.
Saha, A., Poddar, E., & Mankad, M. (2005). Effectiveness of different methods of health education: A comparative assessment in a scientific conference. BMC Public Health, 5(1), 88. doi:10.1186/1471-2458-5-88
Tones, K., & Green, J. (2004). Health promotion. Planning and Strategies. London: Sage Publications.
WHO | Adelaide Recommendations on Healthy Public Policy. (n.d.). Retrieved May 23, 2011, from http://www.who.int/healthpromotion/conferences/previous/adelaide/en/index.html

Published: November 2012, Health Promotion Connection

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