Social Diagnosis as an Educational Process
Thus, in the planning of health promotion, the needs and resources are identified, causes assessed, priorities set, and goals pursued. To conduct an effective social diagnosis, one must apply the principle of participation and ensure the active involvement of the people who will be affected by the program being planned.
The importance of this principle, echoed over the decades in the theorities of psychology, education, and various other applied behavioral sciences, has been confirmed in community experience in three bodies of literature : the technical-assistance fields including notably public health (health education), family planning, and agricultural extension; the community development and rural economic development literature from around the world, especially India; and the concern with community involvement through concientacion, a phenomenon largely of Latin America in the 1960s and early 1970s.
A convergence of these three traditions appears to be afoot. In some of the earlier policies supporting health education, the governments and the World Health Organization itself seemed more concerned with using health education to get people involved in implementing centrally planned programs. Later the concern was with health education to increase people`s participation in the centralized planning of local programs. That tendency was reversed with WHO`s New Policies for Health Education in Primary Health Care.
During the same period, community development specialists who were addressing the plight of the rural poor were “shifting from the capital-investment growth models of the 1960s to the more people-centered basic-needs approaches...one of the most important and least understood of which is popular participation.
The traditional of technical assistance in public health through health education can be broadened under the rubric of health promotion to combine the traditions of community development and concientacion whereby individual and community activation and development of human resources become ends in themselves. They can serve personal and community social needs primarily and thereby improve health indirectly. Concientacion is the Spanish word (which could perhaps be translated as consciousness-raising) for a process whereby poor people become conscious of the political realities of their situation and take collective action to addres issues of equity and social justice. They can be encouraged to take control of the determinants of their health through an educational and community organization process within the broader context of social, economic, and health policies. For this kind of empowerment and citizen control to occur, however, professionals must be willing to relinquish some of the power inherent in their positions and traditional roles. Above all they must be willing to listen and learn themselves. This could be the process occurring in Eastern Europe today.
Lichter and his colleagues applied the PRECEDE model but started with an epidemiological and educational diagnosis (assessing interests in health topics) rather than with a social diagnosis. Their experience demonstrated the practical utility of paying attention to community perceptions of needs and priorities in planning a health promotion program, and it demonstrated the need to start with an understanding of social or quality-of-life concerns before presuming the health topics to be ranked. They administrated several brief surveys to assess needs and to help set priorities for a hospital-based community health promotion program in Dearborn, Michigan. Consumers and health professionals were independently surveyed to collect information about their perceptions of how important certain diseases were and what topics should be priorities for educational programs.
There were only slight differences between consumers and health professionals in the ranking of the importance of disease topics, but the differences in their perceptions of which health topics should be addressed in educational programs were dramatic. The health professionals, blinded by their scientific knowledge of the important relationship between health, disease, and cigarette smoking, identified smoking as the top priority; consumers ranked smoking 13th out of 15 choices. The consumer`s first need was to gain a better understanding of health care insurance, a topic ranked 7th by the professionals.
References :
E. C. Bivens, “Community Organization: An Old but Reliable Health Education Technique”, in The Handbook of Health Education, P. M. Lazes, ed., Germantown, MD: Aspen, 1979.
S.R. Arnstein, “A Ladder of Citizen Participation”, Journal of the American Institute of Planners 35, 1969.
E. de Kadt, “Community Participation for Health : The Case of Latin America”, “World Development 10, 1970.
For a review of the U.S. “maximum feasible participation” experience during the 1960s, see D.P. Moynihan, Maximum Feasible Misunderstanding: Community Action in the War on Poverty, New York : The Free Press, 1969.
World Health Assembly, New Policies for Health Education in Primary Health Care: Background Document for the Technical Discussions of the Thirty-sixth World Health Assembly, Geneva, World Health Organization, TD/HED/82.1, 1982.
J.M Cohen and N. T. Uphoff, “Participations Place in Rural Development : Seeking Clarity through Specificity”, World Development 8, 1980.
L. W. Green, Community Health, St. Louis : Times Mirroy / Mosby, 1990.
L. W. Green, M. W. Kreuter, Health Promotion Planning An Educational and Environmental Approach, Mayfield Publishing Company, Mountain View, California, 1991.
M. Lichter et al., “Oakwood Hospital Community Health Promotion Program”, Health Care Management Review 11, 1986.
