Saturday, August 14, 2010

I Act on Truths

My classes do not officially begin until August 23 but my first assignment has been made available to me and I have begun. In reviewing the professor's plan for our semester, aka the syllabus, I thought I must be in heaven. He expects us to read articles, take notes, look up unfamiliar words, ponder the ideas and then talk and write about our perceptions and opinions. Hello! I do that every day :)

So the first reading has to do with how we as health educators should go about the business of encouraging people to adopt the behaviors that science tells us are necessary to avoid disease and disability. The author, David Buchanan, a DrPH , describes the medical model and the health education model and in so doing, seems to encourage us to choose neither.

I have my thoughts and expect that I am going to become "famous" for choosing NOT to engage in the dialogue that he suggests, but I will get to that later. First I wanted to summarize a few of Dr. Buchanan's references. He mentioned praxis, theoria, Aristotle and Plato. Theoria is basically an explanation of our beliefs. For example, I believe "this" to be true because in my universe I see it every day, science routinely recreates it, and nothing disrupts it. These are facts. Praxis is the reasoning behind our actions. We act according to and in spite of ever changing things in our world. We want to force an outcome or maybe stop one. For example, I know that too many calories consumed leads to weight gain (I believe it because I see it repeated over and over again). This is a scientific fact. Now I will make choices and take action, on any given day, about how much of what I will eat based on a multitude of changing situations and perceptions.

In his writing, Buchanan moves towards the concept that health educators should not persuade people to do something because of the facts but that health educators should share a dialogue with people so that they choose a course of action that will allow them to live the life they consider fulfilling. He notes, without apology, that the person may not wish to address obesity (or any health issues) because they have deemed other things important - taking precedent.

The irony is that I agree with Buchanan. Many times the people that we are trying to reach are too consumed with other "life" issues to exercise five times a week thirty minutes a day or to even THINK about doing such a thing. I use his argument, however, to support the persuasion and policy perspective not to discount it. I believe in making the environment as conducive to healthful living as possible and doing so withOUT engaging the community in dialogue. The people most at risk for adverse health outcomes need immediate help.

Where I do see hope for this "illuminating" and autonomy that he discusses is in reaching our youth in the school system. He is right. When people understand that certain behaviors will promote their individual life goals they are more likely to commit to that type of lifestyle. He doesn't say anything new however. Our alcohol, tobacco and other drug programs have often used that same approach to keep kids off harmful substances and sometimes they even work!

The part about Plato had to do with his belief that a person learns what makes a good and bad life and can become discerning or critical in that regard. The ultimate goal being to choose the path to make the good life, both physically and spiritually. This was described as the purpose of higher education. I do not disagree. I read that passage thinking oh YES, I have spent so many years cultivating MYSELF and learning what it is that makes me happy and brings me peace and at the same time can better some parts of the lives of others - or at least not harm them! But for Buchanan to expect that public health educators can take on the role of informing self actualization and encouraging social justice does not make sense to me. There are other disciplines for that. We (PHE) are REALLY in the business of promoting health - not through a dialogue but through well, I am going to say it, manipulation!

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