Minkler M, Cox K
Int J Health Serv. 1980;10(2):311-22. doi: 10.2190/023K-58E7-6TM8-3RRM.
Paulo Freire's philosophy of "education for critical consciousness" takes on special relevance within the context of the health care system. This dialogical approach to change, stressing action based on critical reflection by the people is seen here as importantly supplementing current efforts to deal with the "health care crisis" in the United States and many developing countries. Applications of the Freir approach in a health context of necessity involve the perception of health and medical care within the total oppressive structure of society. Viewed thusly, health "reform" cannot justifiably be envisioned except within the context of broader structural transformations. Two case studies are presented to illustrate the application of the Freire approach within a health context. Successful utilization of the methodology among peasants in rural Honduras and a relatively unsuccessful application among impoverished elderly residents of an urban United States ghetto are described and analyzed. Modifications of the approach to increase its usefulness in a variety of situational contexts are suggested. The potentials and limitations of this approach to radical change in the health field finally are described, along with lessons learned from initial work in the applications of conscientización to the health field.
保罗·弗莱雷的“批判性意识教育”理念在医疗保健系统背景下具有特殊的相关性。这种强调基于民众批判性反思采取行动的对话式变革方法，在此被视为对美国和许多发展中国家当前应对“医疗保健危机”努力的重要补充。弗莱雷方法在健康领域的应用必然涉及在社会总体压迫结构中对健康和医疗保健的认知。如此看来，除非在更广泛的结构转型背景下，否则无法合理设想健康“改革”。本文呈现了两个案例研究，以说明弗莱雷方法在健康领域的应用。文中描述并分析了该方法在洪都拉斯农村农民中的成功运用，以及在美国城市贫民区贫困老年居民中的相对不成功应用。文中还提出了对该方法进行修改以提高其在各种情境下实用性的建议。最后阐述了这种激进变革方法在健康领域的潜力和局限性，以及从将“意识觉醒”应用于健康领域的初步工作中吸取的经验教训。
