In health education we rightly focus on the personal. We emphasize ways to enhance individual health and well-being.
In a world that is learning first-hand the limits of individualism, maybe it’s time to adjust our curriculum to recognize that personal health is directly tied to public health. And public health is all about our environmental, economic, political and social realities.
I have been teaching an elective called Advanced Health/Public Health Policy for the last four years at Community High School in Ann Arbor, Michigan. Most students come to the class directly from their required Health/Wellness class where they have been intrigued enough by what they got there to want to delve deeper.
Three public health concepts we learn in the Advanced class could be included in any health curriculum.
First, the Social Determinants of Health (SDOH), usually thought to include – at least – Economic Stability, Social/Community context, Environment/Neighborhood, Health Care, and Education. All of these impact personal health in ways we don’t often study in our Health Education classes, even if we are addressing national standards.
All the skills and knowledge in the world will not improve the health of an individual student who doesn’t have access to clean water. Individual students can practice stress management through yoga and meditation, but that will do little to stem the systemic racism that is at the root of that stress. Taking care of one’s own mental health is difficult at best when the nearest therapist is a day’s drive and a 6-month wait away. When a student’s zip code is the biggest determinant of their overall health and life span, it is hard to talk about individual behaviors and behavior change as the keys to a person’s health.
Second, Upstream Causes: That is, getting to the root of a particular health problem. A public health official, considering why someone who has kidney disease doesn’t take their medication, might examine things like do they have enough money for it? Can they get to the pharmacy to get it? Do they trust the doctors and hospital system? Are the pills too big to swallow? Can they open the bottle?
In a health class, we might look at upstream causes to consider mental health. Depression and Anxiety continue to rise among our students, and it is right for them to recognize symptoms, understand treatments and practice healthy ways to nurture their mental health. But looking at the upstream causes for these disorders may be just as important: social atomization, climate dread, soul-crushing economic competition and inequality, the purposeless many of them feel about their futures. Going upstream has been profoundly meaningful to my students.
Last, Social Justice/Ethics: Looking at health through an equity lens ensures that personal health is less about purely personal decisions and more about social justice.
In a health class, for instance, a study of alcohol and other drugs should include a look at society’s failed war on drugs and mass incarceration to broaden the discussion beyond just their own individual use. Students also need the opportunity to examine how their own use might have ethical implications: throwing up in a public venue (that someone else has to clean up); the environmental impact of red plastic cups all over town after a big game (again, I live in a college town); even lying routinely if that’s what it takes to maintain one’s use.
We may go back to the primacy-of-the-individual culture after this pandemic is over. I hope not. Because I think we all know instinctively that we’re all in this together. There is no such thing as purely personal health. That’s why as health teachers, bringing the public into our curriculum is really just teaching health itself.
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