Health Education and Promotion – Connecting the Dots for a Layman
Several decades after the independence of Pakistan, the health situation of the country still looks grim. It will not be a difficult task to imagine the only earning member of a family expiring away with malaria, dengue, tuberculosis, mental illness or leprosy. Pakistan is organized and structured. It is a country with proper planned health care system with regulatory bodies assigned for monitoring various aspects of health care.
The poor in Pakistan are a major chunk of the population. A poor Pakistani is not only deprived of financial resources but also lacks access to secondary and tertiary health care services. According to WHO international standards the ratio of doctors to nurses should be 1:3. However this is reversed in the case of Pakistan as the ratio of doctors to nurses is 3:1.
At this time only the elite class has access to good medical services while the poor only get some form of medical care through government agencies. Lack of awareness, poverty and illiteracy has surrounded us. Government and the ministry of health need to arrange and conduct health awareness programs in order to increase number of doctors so that middle class man and a poor patient can visit a doctor easily. Modern healthcare providers are committed to improve the nation’s healthcare system by reducing health inequalities with an unprecedented approach to redefine and reshape new means and capabilities that will best achieve an appropriate health care system.
Whilst the provision of health care is in a state of constant change, it is important to remember that the key objective is to maintain and improve the health of the population; which means that we should focus more on the prevention and wider determinants of health. In order to prevent diseases, it is essential that we understand why diseases arise. And conversely why, in many cases, they do not. I hope the readers will find this article as a basic structure to understand public health and that it will encourage them to delve deeper into this subject.
When we talk about health care of a population, it depends both on the provision of health care for the sick and on public health services to promote health and prevent the spread of a disease. The first attempts to improve public health aims to remove sewage and offal from the streets. Wretchedly, Pakistan is still struggling to take this step. Earlier generations tended to accept ill health and premature death as unavoidable vulnerabilities of human existence; but today, we find ourselves at the dawn of renewed thinking about our plan to overcome the inertia and restructure and transpose ourselves—to mutate in ways that will improve our own health care system.
Many people confuse health promotion with health education; there is a wide difference between the two. Health promotion involves educating an entire community about ways to improve its social, physical and economic environment. However health education involves empowerment of individuals through which we can reach a state of complete physical, mental and social well-being.
Therefore, we understand the concept of health promotion is beyond healthy life styles. Briefly, I am highlighting the target areas that require health promotion:
1. Smoking cessation: Pakistan has a long history of providing information about the dangers of smoking through government funded campaigns, health campaigns in schools and advice from general practitioners. Banning the sale of cigarettes to children under the age of 18 years and prohibition of smoking in certain public places are a perfect example of legislative policies. Another example of how health services can aim to move from providing a curative approach to one where prevention and education is the goal where smokers can be identified and influenced for supportive treatment such as nicotine replacement therapy.
2. Alcohol: Alcoholism is rising in alarming proportions in Pakistan. Many rehabilitation facilities here in Pakistan are just fancy and lavish clinics with comfortable beds for patients who are kept there for a month and then discharged after which they probably relapse. Paradoxically the problem lies in the economic status of an alcoholic. Advice on dealing with alcohol abuse, identify and counselling problem drinkers is necessary.
3. Nutrition: The most recent estimates suggest that 24 percent of the Pakistani population is suffering from malnutrition,whereas the United Nations Food and Agriculture Organization (FAO) states that 37.5 million people in Pakistan are not receiving proper nourishment. The prime cause is poverty and secondary to that is consumption of foods with low nutritional values. Public policy in the field of nutrition has been scant and poorly coordinated. As an example, preconception advice for women concerning folate intake will reduce the risk of having a baby with neural tube defects.
It is important to educate the population through media, relaxation of taxes on healthier food items, providing scientific advice to policy makers and introduction of healthy nutrition to school curriculum.
4. Sexually transmitted diseases and unwanted pregnancy: Last but not least! Improving health through changes in sexual behavior will help reduce the number of unwanted pregnancies and sexually transmitted diseases. There are no powerful laws designed to prevent underage sexual intercourse which will help in the long run to prevent the incidence of teenage pregnancies. This is best encouraged through health education and by providing supportive environments. The contraception pill has been very influencing in reorienting the doctors towards providing preventive rather than curative health care.
Lastly, I would briefly discuss the ethics of health promotion where a key conflict lies between the goals of health promotion and the rights of individuals to personal autonomy. The funds should only be spent when there is a good prospect of benefit to health of the public. All promotional health campaigns shall at least be submitted to an ethical review before implementation, in order to avoid ethical disasters.
The irony is not a declining health care system in Pakistan but the fact that in the past three decades we have improved the health of our population to a great extent but the pace of progress has been unsatisfactory. Even though some initiatives like family planning were remarkable, they did not flourish as planned. It all boils down to poverty.
In Pakistan a woman who is poor and pregnant has herself in a troublesome loop of life. Because it is the poor man who suffers the most and surrenders himself and his family to preventable private care. He is obliged to visit public hospitals and most likely not be treated to match his needs or receive any awareness, due to the huge load public sector hospitals cater to.
About the Author: Dr. Rakshinda Mujeeb earned a Doctorate in Pharmacy from Baqai Medical University, Pakistan. She is currently working as a research associate in the department of Emergency Medicine at the Aga Khan University Hospital. A part time writer for different e-news blogs, Rakshinda wishes to pursue Masters in public health in the near future. She can be reached at [email protected]
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