Health in pedagogical discourses and school practices Selected perspectives
Health in pedagogical discourses and school practices Selected perspectives Edited by Alicja Szerląg
Kraków
© Copyright by Oficyna Wydawnicza „Impuls”, Kraków © Copyright by Uniwersytet Wrocławski
Review: Robert Saciuk
Editors: Elżbieta Możdżeń
Cover design: Ewa Beniak-Haremska
Publication is financed by Department of Pedagogy Faculty of Medicine Wroclaw Medical University and Institute of Pedagogy of Wroclaw University
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Oficyna Wydawnicza „Impuls” - Kraków, ul. Turniejowa / tel. () --, fax () -- www.impulsoficyna.com.pl, e-mail: impuls@impulsoficyna.com.pl Wydanie I, Kraków
Table of Contents Introduction .................................................................................................................
Health in postmodernity Monika Wójta-Kempa, Iwona Taranowicz, Andrzej M. Fal Health as a value in postmodern society ..................................................................... Anna Sladek Subjective dimension of health ...................................................................................... Edyta Nieduziak Metaphorical presentations of health in modern culture .......................................
Educational context of health Żanetta Kaczmarek Education in the aspect of health threats. Prospective approach .......................... Dariusz Białas Education as a factor determining individual health potential in the community of knowledge. Network mind in the systemic-interactive model of health-oriented education .............................................................................. Hana Horká Environmental education as an instrument for health promotion. Environmental aspects of health education ................................................................ Danuta Wiśniewska Quality management in health promotion .................................................................
Table of Contents
Health education in practice Jaroslav Vaculík Health and hygienic conditions at schools a hundred years ago ........................ František Čapka Position and responsibilities of teachers in applying health principles in Czech schools in the past and now ....................................................................... Jan Šťáva, Stanislav Střelec Legislative conditions for health education in the Czech primary school ....... Stanislav Střelec, Jan Šťava The school as the institution promoting the development of social health in pupils ............................................................................................................................ Marek Jagusz, Paweł Fryderyk Nowak Health education – in realities of the Polish school .............................................. Paweł Fryderyk Nowak Catechesis teachers as health educators in school environment ........................ Jadwiga Kuciel-Lewandowska & Co-authors The “keep it straight” campaign and health education ......................................... Agnieszka Blok Doggies and children – learning safe behaviours towards dogs – “Dogolandia” Foundation educational programme ............................................... Renata Chrzan Influence of mode of active life on health and frame of mind ............................ Authors .........................................................................................................................
Introduction The issue of health constitutes a crucial element of reflections over both human condition and contemporary world. It significantly embraces the axiological spheres of meanings, with regard to which the individual does not only carry out the process of self identity, but also determines life priorities which accomplishment requires social engagement. In consequence, the category of health manifest itself in various spheres – subjective, social, cultural, civic, economic or last but not least – educational. Hence, the reflections tackling this topic become an interdisciplinary discourse, since exercised in the filed of medicine, sociology, psychology, pedagogy, education as well as economy, political science and even technical disciplines. It should be also emphasized that in the context of findings established within World Health Declaration and action strategies in the European Region of WHO Health for All in st century, health is perceived as individual value but also as a form of a capital crucially influencing the development dynamics of entire societies. Therefore, in this perspective reaching optimal health condition becomes one of inalienable, individual rights, with the responsibility for individual and social health as one of civic duties, embracing as well the sphere of governmental policies. Taking the above into consideration, it is impossible not to appreciate the role played by health education, directed at shaping pro-health attitudes, enabling the establishment of social capital of health. Hence, such pedagogical discourse placing health in heart of its attention shall be considered important in the context of priorities of contemporary world. Presenting the joint publication “Health in pedagogical discourses and school practices. Selected perspectives” we nurture hope that due to perspectives presented it will become a part of the reflections tackling the issue of health and particularly: – health in postmodern society, – educational contexts of health, – health education in its practical dimension. Thanks to stands taken by researchers from Poland and Czech Republic it became possible to create discursive examination of:
Introduction
– – – – –
health as a value in postmodern society and contemporary culture; threats to health in prospective approach; education and its role in health promotion; quality management in health promotion; multidisciplinary - historical, social, cultural and subjective determinants of health education in school environment; – educational innovations targeting at the health of young generation. The issue of health, within the above-mentioned range, is considered by us as extremely practical for all those that place in the centre of research interest the humanistic examination of health, health education and health promotion in various kinds of environments. Therefore, we highly recommend it particularly to pedagogists, teachers, therapists and students of such subjects as pedagogy, education, public health or medicine. Alicja Szerląg
Health in postmodernity
Monika Wójta-Kempa Iwona Taranowicz Andrzej M. Fal
Health as a value in postmodern society As S.J. Williams writes “Health is many things to many people, with a huge ‘industry’ to back it up, much of which itself appears quite ‘unhealthy’”. In this article authors want to show the diversity of health definitions and compare two of the most known perspectives in sociological debate. First perspective treats health as a special kind of an individual capital, the second – as a social value. The main goal of this paper is to show that in contemporary health education provided to postmodern societies the first perspective is the most efficient one. In the following paragraphs both perspectives will be shortly presented. In the end of the article the authors will suggest the essential changes required to improve health education and promotion. According to sociological approach health is defined as relatively persistent resources of attributes, and striving for health embraces many activities, both consuming (e.g. buying medical services, “health consumption”) and investing ones (e.g. increasing health, for instance by diet supplements). When getting old the person looses the amount (the capital) of health, but he/she can make appropriate efforts (costs) to renew, regenerate and even increase health. It is really important to teach people how to increase the capital of health, especially those who got ill.
Department of Medical Social Science, Faculty of Public Health, Wroclaw Medical University, Manager of Department: Dominik Krzyżanowski Ph. D. Department of Medical Social Science, Faculty of Public Health, Wroclaw Medical University, Manager of Department: Dominik Krzyżanowski Ph. D. Manager of Faculty of Public Health, Wroclaw Medical University. S.J. Williams, Medicine and the body, SAGE, London, , p. .
Health in postmodernity
The concept of health treated as capital came out in the . and . in the last century. The most known model treating health as capital is known as model of the demand for health treated as the commodity named “good health”. In this context health can be viewed as a durable capital stock that produces an output of healthy time. It is assumed that individuals inherit an initial stock of health that decreases with age but can be increased by investments. Some individuals are better at “producing” health than other people. This is one of the factors, which generate and reflect the differences in social positions. Health is the kind of capital which has no “excess” and is being lost in time. The very important thing is that health might be easily converted to another kinds of capital: economic, cultural and social. The stock of health may even determine the social position of individuals. But health is not so concrete aim as – for example – richness. Even professional definitions do not catch the point. According to medical professionals health is defined as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (WHO). Professionals, however, do not know how people comprehend health as an aim which must be reached. Is it a social value achieved under normative pressure or just an unidentified object, a state which allows to work, raise children, meet friends and do any kind of social activity? In this paper we try to show, that effective health education should pay more attention to non-professional, formed in everyday life definitions of health. In present, we have to call special attention to sociological perspective focused on cultural changes, relaying on spreading out of a new and adequate definition of health. The most important issue underlies in incompatibility of professional and common definitions of health in postmodern societies. This might be the main problem in successful health promotion. There is also no easy way to define health as a value. The empirical sense of “value” was set by Krzysztof Puchalski, who differentiates between ) the health as a value and ) the value of health. When we try to understand common definitions of health then we must consider two types of a human activity. The first kind relies on professing socially accepted views such as Health is the most important thing in entire life. This is called normative value of health, which reflects the normative pressure to achieve goals socially defined as important. On the other hand, health is here a kind of unspecified and idealized state, which is unachievable (unattainable) for some individuals (for disabled people for example). The normative value of health is manifested by doing proper things (recommended by
M. Grossman, On the concept of Health Capital and the Demand for Health, “Journal of Political Economy” , , , March/April, p. . K. Puchalski, Zdrowie w świadomości społecznej (Health in social consciousness), Krajowe Centrum Promocji Zdrowia w Miejscu Pracy, Łódź , pp. –.
M. Wójta-Kempa, I. Taranowicz, A.M. Fal. Health as a value in postmodern society
medical staff or based on social wisdom), but it is only for ‘expression of the value’ but not for changing the existing stock of health. It is made by showing socially accepted opinions (like in surveys) and spectacular but single and occasionally taken health events. Shortly, when we say that health is important we do so to stay in collectivity of values, but it not means systematical caring about health. Exploring normative value of health was close to sociomedical approach of health. The conservative researchers (like M. Sokolowska) claim that achieving health is natural priority in individuals’ activity and the main value which all other values depend on. In this context individual should be focused on health treated as the border condition of all other values and life-time goals. But many professional and non-professional observations notice that for most people health is important despite other life priorities, but it may be important “silently”, when it is personally inwardly experienced. Health is very often unnoticed until the person falls ill. Health as an individual experience means a good, natural thing as such, even though a person does not use this “feeling healthy” for any other purposes. (Donuhe-White and Cuddeback ). Next we must consider the second kind of conceptual understanding of health which is called real-life or genuine value of health. In this context the essential assumption is why “the real” value of health does not refer to “the normative” one. The most interesting question is: why people declare that health is the most important thing in their life and simultaneously take almost none activity to protect or decrease it. On the conceptual and empirical level the answer refers to the strength of desire of that value, particularly in relation to other values. The most known Polish researcher who conducted such uneasy empirical study was K. Puchalski. He was trying to find the validation of emotional attitudes in relation to health, which competes with other life-time values. According to the author “it is naive to expect that relatively healthy man or woman could be focused on health more than on another values”. The sociologist explore the area of social values, but they rarely conduct empirical challenge which could allow to show the relationships between health and another values. Which of them compete with health and which of them – however – might potentially strengthen individual striving for health? Which of them are the real threat for human health? Such research might give the light to solve – even partially – the problem of unhealthy behaviors. The main result of Puchalski’s studies is the statement that many people asked if they would choose health or any other value, they would say ‘I don’t know’.
P. Donuhe-White, K.F. Cuddeback, The Good of Health: An Argument for an Objectivist Understanding [in:] P. Taboada, K.F. Cuddeback, P. Donuhe-White (eds.), Person, Society and Value. Towards a Personalist Concept of Health, MPG Books, Bodmin, Cornwall . K. Puchalski, Zdrowie w świadomości..., op. cit., p. .
Health in postmodernity
That is why identifying cooperative and competitive to health social values is the first step to successful teaching people how to live healthier and cope with difficulties in making daily decisions. It is important when we want to teach them how to care about their health. The point is to teach them how to choose from ‘the social offer’ of values and to decide to fulfill those which are really precious. This choice should not be based on tradition or social pressure, but on individually defined benefits. One way or another, treating health as a value focuses on many kinds of opinions and beliefs referring to societal but unreal goals and activity emerging from the duty but not from self-esteemed need. The individual recognizes social value but he or she does not feel it. Health can be also an instrumental value which enable individuals to achieve another socially defined goals. As long as people would think that health is instrumental value and health educators will teach them that health is absolute or autotelic one (it happens when educators do not know how to understand sociological surveys precisely), the health promotion and education will not have any spectacular results. The truth is that we must learn what people really think about their health and face the new challenges emerging from the facts. It is necessary to innovate teacher training and rise teacher readiness to help the young generation to deal with the choices and current social problems, especially this connected with health. Firstly, we must understand what is the social and cultural meaning of health in our culture. We assume that Polish society will be becoming more and more a postmodern one. Postmodern thinkers believe that societal values and norms exist only as a wide framework for human thinking and activities. In a world of “diversity of truths” people reject science-based expert opinions and causal thinking. They do not look for scientific views or explanations and they do not seek for absolute values. Socially defined values are relative, contextual and separated from collectivity of meanings based on integrated system of values. The permissiveness in achieving social values implicates convictions of an arbitral decision-making possibility and free-form behavior. Also health seems to be less and less valuable despite of many health information and promotion. Moreover, providers of health information are defined as unreliable. People who lost their health are educated how to cope with medical problems, but are not asked how they are going to care about health personally. When lost, health is not a value any more. The return to physical and social efficiency become more important, but practically unsolved problem. We can see that in many developed countries the authority of professional expertise, political argument, science and technology are in advantages stages of deconstruction. In medical section diminution of faith in health professionals and medical science arises from at least two common sources. First is the failure of those authorities to provide an adequate solution to several health problems
M. Wójta-Kempa, I. Taranowicz, A.M. Fal. Health as a value in postmodern society
(diseases like swine flu, salmonella in eggs, different options for vaccinating kids etc.). The second major cause of loss the faith in authoritativeness of science arises from the increasing levels of education, networking and personal development of patients/clients of the present generation. In such conditions, the present and most important challenge for health educators is to show that the healthy way of living is better and worthwhile without any lengthy, reasoned debates. The relationship between health educator and patient must emerge from mutual action and difficult decisions made in the past. Doctors, nurses and other health educators are not any more a “authority figures” or even “client educators” but “client facilitators” offering the client timely experiences in self-awareness, self-discovery, self-education, self-empowerment and self-discipline. Such co-operation must rely on shared or re-negotiated definition of health perceived as a shared goal. Becoming a patient and going through the sick role must be seen and supported by the medical staff. The postmodern societies face the situation that values are replaced by individual or group interests. These interest are named, articulated and communicated. There are several symptoms that seem to confirm the rightness of that assumption in our country. First, the model of patient behaving like a client is spreading out and the patient’s characters like rationality, activity, independence and skepticism are more and more stronger. People take their health in their hands and become more active and aware consumers of medical and quasi-medical services. It has been commented that aware consumers on the health market are becoming more equal partners with doctors and negotiate their treatment, making choices the experts used to make for them (e.g. Bury ). Another way of building the objective value of health is emerging of public health as an academic discipline and hot political debate. Some common observations suggest that those pragmatic interests are the only social goals which are understood and accepted. Nowadays, individuals who want to achieve traditionally defined values are treated like socially unfitted deviants. For example, the person who would like to live according to the highest normative standards will be soon ‘fi xed’ by other participants of the group. For example, people excessively focused on their health are called hypochondriac. The latest The Social Diagnosis has shown that health is the most important value in the system of values of the Polish society. Many other studies
J. Czapiński, T. Panek (eds.), Diagnoza społeczna . Warunki i jakość życia Polaków (The Social Diagnosis , Objective and Subjective Quality of Life in Poland), Rada Monitoringu Społecznego, Warszawa. J. Gabe, M. Bury, M.A. Elston (eds.), Key Concepts in Medical Sociology, SAGE, London . J. Czapiński, T. Panek (eds.), Diagnoza społeczna ..., op. cit.
Health in postmodernity
conducted for instance by CBOS (Centrum Badania Opinii Społecznej – Public Opinion Research Centre) also illustrate the dominant position of health among other values. It has to be pointed out that health – however - is not an overriding one. About of respondents claim that striving for good health is one of the priorities in entire life, but we do not know, how many of them choose it as the first one. Such hierarchy of values reflects the normative system of values and does not give us any possibility to reach the real (genuine) value of health, which is never reached by simply asking individuals about their life goals. Subjective values declared during the survey cannot illustrate general health activity or another aspects of health consciousness. Table 1. The most important conditions of happy life total
men
health
67,8
64,4
70,9
good marriage
56,6
56,2
57,0
kids
48,8
40,5
56,2
work
31,8
37,5
26,7
money
30,3
36,9
24,1
providence, god
15,4
11,4
19,0
honesty
11,0
11,2
10,9
cheerfulness, optimism
10,7
10,0
11,4
The most important conditions of happy life (up to 3 values)
women
%
kindness and social respect
8,4
7,5
9,2
education
6,3
6,8
5,8
strong personality
5,8
7,5
4,2
freedom, liberty
4,7
6,1
3,5
10,4
11,0
9,8
other values Source: www.diagnoza.com.
This simple quantitative study does not show any both professional and common definitions of health. In the last study of Iwona Taranowicz we can find examples of empirically caught every-day definitions of health. Only of respondents treat health as the state without any health troubles or lack of illness. Most of them claim that health means physical and mental fitness, self-sufficiency and independence. In short, health is a state of the whole body, which I. Taranowicz, Zdrowie i sposoby radzenia sobie z jego zagrożeniami (Health and the ways of managing its threats. The sociological analysis), Arboretum, Wrocław .
M. Wójta-Kempa, I. Taranowicz, A.M. Fal. Health as a value in postmodern society
enables spending life in a chosen – active and enjoyable – way. It allows to play every social role, which individual wants to play without any limitations and pressure. Health is defined in terms of social activity and efficiency, independently of an illness. Table 2. Common definitions of health by Iwona Taranowicz What is your definition of health?
frequency
%
physical and mental fitness
179
46,6
no health troubles
58
14,8
well being
52
13,5
activity
46
12,0
self-sufficient, independence
29
7,6
state defined by the doctor
20
5,2
total
N = 384
100,0
Source: I. Taranowicz, Zdrowie..., op. cit., p. 160.
The genuine value of health might be clearly shown when we do not ask about it directly. For example, the participants of the Public Opinion Research Centre survey were asked what has a stronger influence on reaching the success: good look (haircut, make-up and clothing) or slim figure and muscular body. About of respondents claim that the good look is more efficient than the health of the body ( of them think that body-look is more important). It is significant that respondents choose factors based on non-healthy activities, which do not force to constraints and many self-denials. Those findings lead us to the statement that modern society and its representatives – paradoxically – do not reward individuals who take care of their health. In this context we could say that other life values and roles are more important than health. If an individual would live in a more balanced manner (live healthier, work less, sleep more etc.) he or she would be professionally and socially pushed to ‘normal’ life and ‘normal’ social roles.