
In public health there are examples of education campaigns that are run in the absence of corresponding substantial, multi-level interventions. Why do we do this? Education is an approach that can be implemented relatively easily and in a cost-effective way. Much of the system change we need, on the other hand, requires difficult decisions to be made or major allocation of funding in lieu of funding something else.
What is the problem with this approach? Firstly, it comes from the perspective that if an individual understands a problem, then they can do something about it. Social, commercial, economic, political and cultural factors are structural factors that have a strong influence on the health and wellbeing of individuals and populations. These factors work through complex ways in an individual to support health behaviour change or hinder it. That is, for some people the health messaging will lead to improvement in a risk or protective factor and for some people it will not. This focus on an individual making changes because of health messaging, when the effect of education campaigns can be differential, is unfair.
By extension, making changes to the environment such that it is supportive of reduced risk, in combination with health messaging, is much more effective and can be fairer. There are several examples of this in injury control. For example, while health messaging warns parents about the dangers of drowning for children unattended in swimming pools, this is supported directly by pool fences which make it more difficult for children to use the pool without adult supervision. In this example, the majority of the effect to reduce risk of drowning is from the pool fence, which does not rely on individual behaviour change, and so is safer for everyone. Another example are interventions to reduce speeding in order to reduce the risk of road traffic accidents and death. Education campaigns are combined with legislation, enforcement of legislation and physical barriers such as speed humps which contribute to reducing speed. In this approach, interventions to create a supportive environment for change is the scaffolding required for the education approach.
Education is an important and necessary intervention factor, but made more effective and possibly fairer, through being part of a coherent multi-level intervention supporting a health promoting environment.
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