I RECENTLY worked with some online interns who are studying public health at a Bangladeshi university. Many of them had taken a course on health promotion. When the topic of health promotion came up, they talked about different ways of educating people to lead healthier lives.
All very well and important, but must our efforts stop at education? One of the more frustrating books I read recently involved the efforts of a doctor to convince his patients to lead healthier lives. He admitted that his own eating habits were atrocious, as the canteen at the hospital where he worked served almost exclusively unhealthy food. He admitted that his advice to patients to walk more was of little use when there were no safe places where they could walk safely (this was in the US, mind you); he himself drove to tennis courts in order to exercise. Yet he seemed unable to understand that what would benefit his patients would be changes in their physical environment that allowed them not just to listen to, but to act on, his excellent advice.
One day, on my way to an attractive outdoor place to walk in Dhaka, I passed people walking in circles in a parking lot. I assume they have diabetes and have been told by their doctor to exercise. Why, I wondered, were they walking in an ugly parking lot rather than going to the more attractive open space across the street? Perhaps they were afraid to cross the busy street. Others may find themselves walking in tight circles on their rooftop, as the traffic is so intimidating or their neighbourhood so dense, that they have no other options for walking outdoors.
Would we not be better off with fewer shopping malls and more parks and playing fields? If that is too difficult, how about temporarily converting less busy roads into places for outdoor recreation for several hours a week, so that people of all ages can walk, cycle, and play outdoors, getting to know their neighbours and enjoying social interaction as well as becoming physically healthier?
As to diet, access to fresh fruits and vegetables should be fairly easy in Dhaka, but people may be afraid to eat them due to concern about chemicals in agriculture or unable to afford them. Here some advice on the efficacy of cleaning your vegetables to remove chemical residue would be helpful. So too would be more support for organic agriculture and the availability, at a low price, of such 鈥渃lean鈥� produce throughout the city.
And what about our institutions? Where meals are served, must they always be unhealthy food, or could we not have policies to promote the provision of healthy foods made from fresh local ingredients?
Avoiding tobacco may seem like an issue that can safely be addressed through public education, but decades of international experience have shown that the least effective measure is school programs, which merely make smoking an illicit and desirable activity to demonstrate that you are an adult. What does work are strong laws and policies to ban all forms of advertising, promotion, and sponsorship; ban smoking in public places; place strong visual warnings on all tobacco packets; and raise the price of tobacco products through taxation. More visionary countries take this a step further and add a surcharge to tobacco and alcohol products that funds a Health Promotion Foundation, which, as in the case of ThaiHealth, then has sustainable, long-term funding to effectively address major health issues.
An increasing source of ill health lately is pollution, particularly air pollution. Here, the idea of addressing the issue through education is laughable. Unless you have the money to move to a less polluted environment, there is little any individual can do to avoid pollution. This is an area where the government has a responsibility to protect public health even where industry adamantly rejects any strong policies. It should be obvious that a strong economy (or, to be more accurate, some extremely wealthy individuals and corporations) is less important than healthy people and the environment. The main use of public education here (and to some extent elsewhere) is to educate the population about the need for strong measures to reduce air and other pollution, including through measures to greatly restrict the use of the automobile.
I have been focusing on health, but imagine a city where more people are out walking and cycling; where there are farmers markets in many neighbourhoods, with people able to interact with the growers of their (mostly) chemical-free food; where there are more trees and parks, and fewer cars and trucks. Yes, we would all be healthier. We would likely be happier, too.
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Debra Efroymson is executive director of the Institute of Wellbeing, Bangladesh.