Public versus Clinical Health
Public health practice differs from clinical or hospital based practice in three fundamental ways. One is that public health practice focuses on groups or populations of people healthy or ill while clinical practice focuses only on the ill individual. Also clinical practice is constituted of a series of short-term repeated practitioner-client contacts while public health practice is a long term continuous practitioner-client interaction. Lastly public health practice is practitioner driven while clinical practice is client driven or put another way, public health practitioners go out looking for clients while clinical health practitioners sit in their offices, clinics or in hospital and wait for clients to come to them.
Now, if you set out every day to interact with diverse groups of people or whole communities to create awareness about any issue as public health practitioners do, you soon meet challenges which you would not if the interaction was with individuals and was only occasional. Let us talk about some of the unique challenges of creating and sustaining health awareness and how practitioners, institutions and governments can innovate ways to overcome them.
There are two broad levels of public health practice each with its attendant challenges. First the operational level where the peculiar challenge is sustenance of interest in and consumption of the public health goods and services by the population, and the strategic or policy making level where there is often a higher prioritization of the clinical health agenda over the public health one especially in countries like Kenya where infectious disease outbreaks occur all year round. These challenges however need not delay or derail the course if investment is made in some simple and pragmatic innovations to use on this mission of creating health awareness, preventing diseases, promoting healthy lifestyles and prolonging life for all, that is public health. This article will talk about some of the innovative strategies useful for the operational level of public health practice.
Multi-Prong Approach
First, health awareness creation is best done using multi-prong approach to both the message and the messenger. The great success Kenya has so far achieved in HIV and Tobacco awareness creation was through a multi-lateral approach and should be replicated in all other public health issues. All public health messages should be varied and adopted to suit different social and economic classes of our society and they should be passed on regularly and routinely using all types of media by all public and private institutions in this country. This means, like for HIV, public health messaging should be the mandate of all agencies of government and the private sector but not only the Ministry of Health as is often the case. Short and simple public health messages, for example “ Regular Exercise is Good for your Health”, can be displayed in public access areas of all institutions and can or be inscribed on all institution’s correspondence or as addendums to their logos and mottos. Today it is common to see every letter from a company with a header or footnote proudly declaring “ABCDE Company is ISO 9001:2008 Certified.” How about also adding “ABCDE Company Encourages Regular Hand Washing” or “ABCDE Company Supports Responsible Use of Alcohol”? The Ministry of Health can lead in encouraging all other institutions along this way.
The targeting of public health messages also requires some innovativeness. People in the upper socio-economic class may not relate closely to a message like “Boil Your Water Before Drinking” because they most likely drink bottled water which they consider safe. So how about a message like “Ensure Your Water is Safe Before Drinking”? This can apply across all classes. Better still would be a public health messaging system that is not based on a policy of one-message-fits all so that different wording is used to pass a similar message to different social classes. And lastly on this, the medium used for disseminating messages need to be varied according to the targeted audience. Recent surveys show that more youth than adults connect to social media and listen to social commentaries and on vernacular radio. A message about preventing teenage pregnancies or drug abuse for example, would best be aired on social media and on vernacular radio at the peak hour of social commentating.
Little Known Role-Models
Concerning the messenger, think of this, People are more likely to discuss their lifestyles and social habits, which are important components of public health, with their social peers than they would with strangers even if the strangers are of higher knowledge and experience in the matter at hand like their doctor. So a woman visiting a hair salon on a Saturday afternoon is more likely to listen to the opinions of her mates and her hair dresser concerning her dieting, family planning, weight control or annual health checks than she would listen to the opinions passed over the radio, TV or a billboard by a strange specialist called Dr Amulundu. Still even if she listened to the radio or TV messages she would not act on them until she has received endorsement from her mates and hair dresser at her salon. This is the point about role of the little known role-models and opinion gate-keepers in public health awareness. To effectively and widely reach out to people about their health let us also think about which influential but less famous people we can use to reach target audiences. The Ministry of Health can for example reach women better with a message about breast cancer screening if they recruited salon workers and trained them for even one day in a workshop on the importance of breast cancer screening so that they pass the message to their clients.
National Assimilation and Acculturation
In addition to choosing the right message and messenger it is also important to create the right forums that enable national assimilation and acculturation in good public health practices from a young age. Examples of these forums would be to create annual public health education days in schools and religious gatherings just like there are sports days and national prayer days. During such days school children can receive public health messages to educate them about health and they can engage in activities like environment cleaning in their schools and neighbouring communities. In time these events can expand to involve whole communities and will in time create a national culture of maintaining good personal, public and environmental sanitation and health. Countries like Rwanda are already doing this and results are showing with reports of cleaner cities.
Support Tools and Facilities
Lastly let us compliment our health messages with tools, facilities and services to support good health practices. For example let government and private institutions avail free water and ample waste disposal points in all publicly accessed places. It is a negligible cost for such an enormously beneficial service. Public toilets and waste disposal facilities are just as important as recreation facilities and relevant public health policies should exist for example to have refuse bins even inside commuters transport. In my travels around the country I have seen some county governments like Machakos and Kakamega are doing well by providing free sanitary facilities and services. This is important because those most likely to harm public health by engaging in undesired practices are often those who cannot afford or access paid up services.
The writer is an infectious diseases and public health specialist and acting Dean of the School of Health Sciences South Eastern Kenya University. This article was first published on the author’s blog www.health247.co .ke
