Health education for social change: a strategy for public health in the US

Health education aimed mainly at changing individual behaviour and lifestyle faces growing challenges. Recent research suggests that broader economic, social and environmental forces are the determinants of many diseases and of behaviours that contribute to ill health. Furthermore, health education programmes seeking only to change behaviour have not been particularly effective in making significant improvements in morbidity or mortality. Finally, behavior change strategies locate the problem within the individual, leading to a tendency to blame the victim for the disease. This paper offers an alternative approach to health education, an approach which seeks to involve citizens in identifying and addressing social and environmental threats to health. From the practices of the women's health movement, the movement for occupational safety and health and the environmental movement in the United States in the last decade, an expanded foundation for health education is suggested. The following principles are illustrated: 1. Health education programmes must include informational, behavioural, political, legal and economic components; 2. Health education for social change recognizes the political character of health and disease; 3. Health education efforts can be rooted in popular struggles for a more just and humane society. 4. Health education activities should address people's day-to-day concerns about their lives and their health. The paper concludes with some specific recommendations on how health educators can include action for social change in their practice.