Astrid von Kotze comments on “How adult education can safe your life”
Astrid von Kotze, Popular Education Programme and UWC, South Africa
This article is an important reminder that health literacy is crucially important as it enables individuals and communities to make informed, healthy decisions. Most health systems and institutions fail to deliver reliable and quality services to all, and the resources allocated are generally inadequate. This places more responsibility on people to manage their own health. Lopes points out how health is closely related to lifestyle, and how risky behaviour may jeopardise not just the wellbeing of individuals but impact entire population groups. Therefore, the call for adult education as a ‘core healthcare tool’ is important as a broader more holistic education could contribute substantively to a shift from predominantly reactive, responsive health care to preventive health care in which all people are supported when they take responsibility for health and wellbeing.
Framing health education as adult education, Lopes suggests that ‘management of knowledge’ has to happen at the right time. Useful, here, is the allusion to relevance. However, taking his example and speaking from the South, many children are tasked with looking after older people and geriatric care is very much part of their daily lives. Furthermore, child to child, and mother to child programmes have shown how intergenerational and family literacy is extremely successful because people are learning together, with and from each other. One evidence often cited is the child that advises her mother how to deal with the baby sibling who suffers from diarrhoea, by making up an oral-rehydration drink.
Further, I am concerned that the focus of this article is primarily on individuals. Acting for health usually involves more than one person – and similarly, educating and learning for health should target collectives (family, household or communities).An encouraging example of integrated, holistic health education comes from the South in the form of Community Health Clubs (CHCs) – pioneered in Zimbabwe, Sierra Leone and elsewhere. CHCs are formed bottom-up by members who share social, economic and physical conditions; they also have common experiences of gangs and drugs, unemployment and violence, sickness and disease. Yet, if these experiences are common, they are not shared. Across and even within households there is often distrust and suspicion as people compete for scarce resources. The first task, therefore, is to build a basis of trust and respect, and weekly meetings attended by young and old, women and men interested in health and wellbeing offer opportunities to meet, to learn, to construct useful knowledge together, and collectively make decisions about how to address particular issues, identified together.Sessions also offer welcome intellectual stimulation and boost confidence, as all participants realise they are knowing subjects with contributions to make in the process of exploring, analyzing, understanding and applying new lessons. In the process, CHC members enter into a socialcontract and establish a system of mutuality, accountability and transparency through dialogue and common projects.
From my experience of working in health education, I would suggest that 3 factors must come together so that education can, indeed, contribute to saving lived:
Firstly, health education must be holistic, considering the conditions of time / place of not just the individual but him/her within the context of their daily lives within communities.
Secondly, any education (adult, child or community) must build on existing knowledge, habits, livelihood strategies, and be radically participatory, bottom-up – that is, ensure strong participation in horizontal relationships through dialogue. medical hierarchies block ordinary peoples’ access to health practitioners through top-down attitudes and one-way communications that intimidate patients by treating them as victims and objects. Giving ‘lifestyle’ directives that are grossly out of touch with social, economic, political, environmental and cultural factors of patients is not helpful. For example, the poor nutritional status of many women in Bangladesh is directly tied to patriarchal relations: if she is not in a decision-making position to choose what to grow or what to eat, and how much of each nutrient each household member is allocated, how can we make the assumption she needs information about nutrition and then blame for her underweight baby?
Thirdly, In the final instance, education will always just contributeto saving lives as it cannot replace changes to the structural material conditions that must be in place so that people can act on their informed decisions. Addressing the root causes of poverty and inequality must be a first priority. Community-based education can contribute substantially towards this by modelling relations and processes.
Links to the AED 85/2018 publication in three languages: English, French, Spanish
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