Social goals, health policy and the dynamics of development as bases for health education.

Among the most powerful social forces in this century is self determination of nations and of people. The relatively recent phenomenon of community participation in health decisions in some countries is but one aspect of the larger societal value. We can assume that self care, mutual care and collaborative involvement between providers and citizens flow from the concept of self determination. Although the pace is uneven and varies greatly among different communities and in different countries, there is a global movement towards health by the people. This is reflected in the decline of professional dominance of the health field as people in communities assume greater responsiblity for tasks previously monopolized by the health professionals. At the macro level, communities are making decisions in the allocation of resources for health and setting health priorities. At the macro level, health education is increasingly concerned in assisting consumers to develop skills in self diagnosis, self help and self care. However, if health is a human right, it must also be appropriated responsibly by those who claim it. Many healthy problems have their roots in community life. Today, major reductions in death and disability cannot be expected from curative services; instead, future progress will have to result from changes in the environment and lifestyle. Environmental changes will require in turn the cooperation of non-health sectors. Traditionally, professionals and others in these sectors have been reluctant to touch health planning and health policy due to medical dominance and a general attitude that health care belongs to the health professions. A primary task in health education is therefore to build stable linkages with other workers and the public in order that health status may be improved by finding areas of common concern and by institutionalizing joint efforts in seeking solutions through multipurpose planning. In-service training and continuing education for professionals and decision-makers are important strategies in this connection. The fostering of community capabilities for health planning and citizen responsibility in health matters is a priority in health education. This represents an investment in health resource development since the basic resources for collaboration in health improvement are people themselves, both professional and lay. Through community participation, all of us become both shapers of societal goals and governmental policies concerning health and health care, and recipients of the fruits of those goals and policies.