Health Education As A Paradigm To An Environmental Health Officer
Converging themes from the fields of environmental health, ecology and health, and human ecology highlight opportunities for innovation and advancement in environmental health theory and practice. In this study we assess health education as a paradigm to an environmental health officer. This was done by examining the role of research and applied programs that integrate biophysical and social sciences with environmental health practice in order to address deficiencies in each field when taken on its own. New opportunities for environmental health protection and promotion are outlined based on the three converging themes: integrated approaches to research and policy, methodological acknowledgment of the synergies between the social and biophysical environments, and incorporation of core ecosystem principles into research and practice. These converging themes are discussed in relation to their implications for new types of intervention to achieve health gains across different spatial and temporal scales at the interface between biophysical and social environments.
1.1 Background To Study
Given the importance of social and environmental issues at stake, there is clearly a need to develop research and practice in the distinctive, still-emergent field of “environmental health education”. Significant environmental health action agendas, guidelines, and projects are being reported often in the context of government programs or of nongovernmental-organization initiatives (for example, Nicholson et al., 2002; Canadian Urban Institute, 2003; Mason, 2003). However, the implicit or potential educational dimension of these proposals is not yet fully laid out. Except in works by a small number of authors (such as Gregory, 1991 and Jensen et al., 2001), theoretical foundations for environmental health education are rarely made explicit and seldom discussed, and there are very few published reports of formal empirical or applied research in this specific area.
This study provides a broad presentation of the key elements of a theoretical framework for environmental health education that stems from our effort to weave together complementary components of an integrated model as a basis for discussion and further improvement. A first version of this theoretical proposal has been constructed through a process of anasynthesis1 (Legendre, 1983, pp 206-212) of already existing elements found in environmental education, health education, and risk education literature, including reflections emerging from our own previous educational experience. We also undertook a collaborative research-development process to design and experiment appropriate educational strategies for the particular context of Lac Saint-Pierre (Québec) on the issue of water and fish contamination. This intervention process has, in turn, helped validate and enrich the initial theoretical proposal. Our project thus combines research and practice as two closely interrelated dimensions that illuminate and enrich each other through continuous feedback (Van der Maren, 1999).
Lac Saint-Pierre is one of the case studies within the interdisciplinary COMERN research project2 on the risk to human health associated with mercury contamination of aquatic ecosystems. Our specific environmental education work seeks to stimulate communities participation in the investigation and education interrelated processes so as to collectively clarify the socio-cultural components of the global issue, to search for appropriate solutions, and raise motivation and skills for involvement in health-related environmental projects. It also responds to one of the main objectives of COMERN: provide assistance to political and community-level decision makers in addressing the problem of mercury contamination. Lac Saint-Pierre is a fluvial lake in the Saint Lawrence River, presenting interesting ecological features for the study of the mercury cycle and a strong “culture” of hunting and fishing as part of the social regional “landscape”. Associating our fieldwork experience in this context with our ongoing theoretical construction process brought us to reflect on epistemological, ethical, strategic, and pedagogical issues related to environmental health education3.
1.2 Statement Of Problem
Over the past century, a range of disciplines have provided diverse resources and a rich heritage of knowledge relevant to environmental health theory and practice. In this commentary we briefly review the core themes and generic concepts emerging from environmental heath, ecology and health, and human ecology. Through these fields, we can trace various approaches to identifying health differences and strategies for health promotion and protection that can generate health “benefits”— generally measured as decreased morbidity and/or mortality. Environmental health, ecology and health, and human ecology each pro- vides constructs applicable to public health interventions at different scales of temporal, spatial, and conceptual complexity. These constructs are not mutually exclusive, because approaches attuned to deal with complex issues can also provide useful new insights to address more basic problems. The three fields should be seen as complementary approaches to addressing overlapping problem fields in health, environment, and development.
1.3 Research Objectives
The main aim of this study is to assess health education as a paradigm to an environmental health officer. The specific objectives are as follows;
- How can health education affect the environmental health practitioner and practice?
- What are the implications of health education to environmental health models and frameworks?
- What are the challenges associated with the utilization of health education to revolutionalize environmental health?
- What is the way forward for the environmental health practitioner and the sector?
1.4 Research Hypothesis
- HO1: There is no significant association between health education environmental health practice
- HA: There is a significant association between health education environmental health practice
1.5 Significance Of The Study
Our study highlights the increasingly complementary and converging work of the last two decades and argues for a further conceptual and methodological integration of knowledge and action to ensure comprehensive and sustainable environmental health gains. Our contention is that research and applied programs that integrate biophysical and social sciences with public health practice can go some way toward addressing the deficiencies in each approach when taken on its own. We also propose that reconsideration of more integrated conceptual frameworks as well as methodological choices can enable more comprehensive understandings of the complex ecosystem and social dimensions of multi-scaled health problems and potential interventions.
5.0 Conclusion And Recommendations
Given a lack of clear definition, it is not surprising that environmental health has been “recreated” at various times and in various ways by scholars and professionals who do not see it as a whole. “Medical geography” and more recently “medical geology” (perhaps better called “public health and geosciences”)6,7 grounded their views of health determinants on spatial analysis, somewhat oblivious to time-and-space analysis integral to epidemi- ology. Twenty years ago, there was a movement to define “ecosystem health” as a single concept of planetary well- being; this petered out over time. “One Health,” the enormously useful and demonstrably true concept that the health of human beings and at least animals is as one,2 is trying as a movement to decide whether to stop there or to embrace the entire ecosystem (reminiscent of the “Gaia hypothesis” of a healthy planet). The quandary for One Health is to avoid becoming a “theory of every- thing” that is so all-embracing that it cannot deliver practical solutions.
Different points of view are good when they challenge the existing assumptions but not so good when they fragment effort or when the new paradigm is actually less complete or compelling than the old one. We saw this play out 30 years ago when the new field of health promotion (in its American version) transformed health education and behavioral science but had nothing mean- ingful to say about environmental health protection. That is because the American version of health promo- tion, as articulated by the US Surgeon-General’s office and consistent with the small-l liberal underpinnings of the society, became all about individual behavior and personal lifestyle choices. In the rest of the world, the concept of health promotion embraced healthy public policy and collective behavior to achieve health protec- tion on a community basis, supporting clean water and air and community safety initiatives. This is the inherent risk of a “theory of everything”: subsuming established and technically dense fields such as environmental health into a bigger, looser framework erases important distinc- tions and they lose effectiveness in practical application.
There are two responses to this tendency to subsume environmental health in the bigger picture. One is to push back and defend the boundaries of the field, which is the traditional academic response. This is both futile and short-sighted, because environmental health does need to change and to become more inclusive. The second, and the one I espouse, is to preserve the core of the field intact but to contextualize it so that its strengths can be appreciated and better leveraged. The second edi- torial in this series will address the latter approach.
Theory, research, and practice in environ- mental health have always evolved in relation to topical challenges across the overlapping problem fields of health, environment, and development. Recent trends in environmental health, ecology and health, and human ecology all suggest that the interface between sustainability, ecosystems, social systems, and health is fertile ground for optimizing environmental health interventions and maximizing public health gain. Only with an integration of theory and a complementary methodology that incorporates scientific, institutional, and community players will interventions be devised to permit substantial gains in environmental health.
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