By

Dr. Yahya Y. Khader

B. Sc., MBBS, DHE

PHC physician, MOH, Irbid\Jordan.

Health promotion encompasses a variety of activities aiming at improving the health status of individual and community. And if successful will affect the lives of people, therefore, health promoters should be equipped with practical skills, and should understand the values and ethics implicit in their work.

In Jordan health education (HE) is an important pillar of MOH works. Recently the HE division was promoted to a full directorate, where qualified experts set their HE plans, based on priorities, community needs and information collected from different reports, surveys and studies, their work also include training of health workers and preparation of different HE media. Each health directorate in the country sets its own HE program separately according to their needs and available resources, in addition to the integrated HE activities in the primary health centers.

Specialists in the field of health promotion identify five approaches that can be used individually or in combination to achieve the desired goal:

1. The Medical approach involves medical intervention to prevent ill health using a persuasive method and expects patients to comply with the recommended intervention.
2. The Educational approach provides information and helps people to explore their values and make their own decisions.
3. The behavior change approach involves changing people’s attitudes to adopt healthy lifestyles as defined by the health promoters.
4. The individual-centered approach considers the individual to have a right to control his own health, therefore he should be helped to identify his concerns, and gain the knowledge he needs to make changes happen.
5. The society change approach aims at changing the society rather than the individual by putting health at the political agenda at all levels, and by shaping the environment so that it becomes conducive to health.

Unfortunately traditional health education approach used in Jordan, and many other countries, aimed solely at changing the people to fit the environment, and did little to make the environment a healthier place to live in.

Supporters of this traditional approach argue that medical and health experts have the knowledge, and therefore know what is in the best interests of their patients and the public in general. Also people have entrusted them with their health care and they often seek their advice in health matters.

But, many disagree, and they feel there are more than one point in their favor:

0. Experience of lay people tells them that experts are constantly changing their minds over different issues, and many a time they are proved wrong.
1. Socio-cultural differences make it unethical to impose one’s own values and standards on others, and after all, who is to say which set of values is right? And whose life is it anyway?
2. A negative and counterproductive outcome of anger and rebelliousness especially among the young and underprivileged is often encountered because of failing to comply or at being told what to do.
3. Individual behavior is not the only cause of ill health. Socioeconomic conditions of conflicts, poverty and unemployment are far more significant and politically sensitive determinants of health.
4. Freedom of choice is often limited, and it is multi-factorial and therefore blaming people for their ill health is illogical when they are actually the victims of circumstances.
5. Health promotion reaches the better off, who have the time, money, and education and desire to use the health information and take health action.

Therefore health promotion should include not only traditional health education competencies in communicating and educating, but also in managing, researching, planning, evaluating, marketing, facilitating, networking and influencing policies and practices. And more attention should be paid to the users and receivers of the health promotion, and to the concept of working in partnership with the public.