REASERCHES ON HEALTH

EDUCATION
 Overview of Health Education

 One of the greatest human accomplishments has been the spectacular

improvement in health since 1950. With death rates falling steadily, more
progress was made in the health of populations, particularly in developing
countries, in the past half century than in many millennia of earlier human
history.
 Average life expectancy – the age to which a newborn baby survives –
was approximately 40 years in developing countries in 1950; 50 years later,
life expectancy in these same countries has risen more than 60 percent to
about 65 years today (McNicoll, 2003).
 Each year, nearly four months are added to average life expectancy
globally (WHO, 2000).
 Criteria’s for success in Research
 Scale: Interventions or programs that were implemented on a national, regional or
global scale. Programs were characterized as “national” if they represented a
national level commitment, even if they were targeted at a problem that affected
only a limited geographic area. Programs that were implemented on a pilot basis,
or within only a few districts, were excluded.
 Importance: Interventions or programs that addressed a problem of public health
significance. In this case, a measure of burden of disease -- disability-adjusted life
years (DALYs) – was used as an indicator of importance.
 Impact: Interventions or programs that demonstrated a clear and measurable
impact on the health of a population. Demonstration of impact on process
indicators – such as immunization rates – was not taken as a proxy for health
outcomes. Rather, genuine changes in morbidity and mortality constituted the
criterion.
 Duration: Interventions or programs that were functioning “at scale” for at least five
consecutive years. Sustainability, including financial self-sufficiency, was not used
as a selection criterion.
 Cost-effectiveness: Interventions or programs that used a cost-effective approach,
INFORMATION IS POWER
 One facet of each and every research in
Health Education is the use of information,
particularly in three ways:

raises awareness
 First, information about a health
problem, focusing political and technical attention. In China, for example,
research showing that iodine deficiency posed a threat to children’s
mental capacity prompted government action. In Honduras, a rapid
method to estimate maternal mortality highlighted regional differentials,
which led to a public sector response. Research in Poland that linked
smoking with the heavy disease burden there, and particularly to the
exploding cancer problem, helped raise awareness among policy makers
and the general public, and provided the foundation of calls for tobacco
control legislation.
 INFORMATION SHAPES DESIGN

 Second, information in the early stages of a program shapes

design. Through careful monitoring, researchers measure the
effectiveness of various 14 ways to address a health problem and discern
which approach merits additional resources. In Egypt, for example,
information from community trials and “rehearsals” and from market
research revealed consumer preferences – essential for the design of a
national oral rehydration program that depended in large measure on
effective communication with mothers. In South Africa, research on the
impact of tobacco excise taxes shaped the stringent taxes implemented in
the late 1990s.
 INFORMATION MOTIVATES

 Third, information motivates. In the guinea worm eradication

campaign, information was disseminated in monthly publications that
highlighted the progress national programs. The information sharing helped
keep countries motivated and focused, and pressured those lagging
behind. The campaign even used information to spark positive
competition between countries.
Research on Improving the Health of the Poor in
Mexico
 Geographic area: Mexico
 Health condition: among the rural poor in mexico, the incidence of
preventable childhood and adult ill-nesses, poor reproductive outcomes
(including low birth weight), and infant mortality are high—the result of
unhygienic living conditions, poor nutrition, and social deprivation.
 Intervention or program: the programa de educación, Salud y
alimentación (progresa) & Catastrophic Health Expenditure Fund.
 Research on Improving the Health of the
Poor in
Mexico
 Cost and cost-effectiveness: expenditures on progresa totaled about $770
million per year by 1999 and $1 billion in 2000, translating into fully 0.2 percent of
the country’s gDp and about 20 percent of the federal budget. of that,
administrative costs are estimated to absorb about 9 percent of total program
costs.
 Impact: a well-designed evaluation revealed that progresa significantly
improved both child and adult health, which accompanied increased use of
health services. children under 5 years of age in progresa, who were required to
seek well-child care and received nutritional support, had a 12 percent lower
incidence of illness than children not included in the program. adult
beneficiaries of progresa between 18 and 50 years had 19 percent fewer days
of difficulty with daily activities due to illness than their non-progresa
counterparts. for beneficiaries over 50 years, those in progresa had 19 percent
fewer days of difficulty with daily activities, 17 percent fewer days
incapacitated, and 22 percent fewer days in bed, compared with similar
individuals who did not receive program benefits.
 Summary of the intervention

The intervention aimed at eliminating a source of inequity in the health system. The
Fund was created in line with the Mexican Government’s commitment to assure access to health services for
populations with no social security. Thus, services became available for this previously disadvantaged group
for any health condition approved by the National Health Council. The Fund also aimed to support states to
finance the treatment of illnesses that represent a risk of catastrophic expense from the institutional point of
view. Thus, funds will cover and guarantee access for the affiliated population to costly, specialized
treatment
. In summary, the Fund was designed to support not only the universalization strategy called
vertical coverage, but also the so-called horizontal population coverage, which broadens the health coverage
of population groups through affiliation to the Social Health Protection System.
Ten years after the launch of the Catastrophic Health Expenditure Fund, the results are encouraging. Each
year, the lives of more than 150 000 Mexicans of all ages are saved or improved because of assured access to
treatment they would not otherwise have been able to afford. Of course, this is far from meeting the needs
of such a densely populated country, and there is yet a long way to go. But it does give cause for optimism.
 Curbing Tobacco Use in Poland

 Geographic area: Poland

 Health condition : in the 1980s, Poland had the highest rate of smoking in
the world. nearly three quarters of Polish men aged 20 to 60 smoked every
day. in 1990, the probability that a 15-year-old boy born in Poland would
reach his 60th birthday was lower than in most countries, and middle-aged
Polish men had one of the highest rates of lung cancer in the world.
 Global importance of the health condition today: Tobacco is the second
deadliest threat to adult health in the world and causes 1 in every 10 adult
deaths. it is estimated that 500 million people alive today will die
prematurely because of tobacco consumption. More than three quarters
of the world’s 1.2 billion smokers live in low- and middle-income countries,
where smoking is on the rise. by 2030, it is estimated that smoking-related
deaths will have doubled, accounting for the deaths of 6 in 10 people.
 Curbing Tobacco Use in Poland

 Intervention or program: in1995, the Polish parliament passed

groundbreaking tobacco-control legislation, which included the
requirement of the largest health warnings on cigarette packs in the world,
a ban on smoking in health centers and enclosed workspaces, a ban on
electronic media advertising, and a ban on tobacco sales to minors.
Health education campaigns and the “great Polish smoke-out” have also
raised awareness about the dangers of smoking and have encouraged
Poles to quit.
 Impact: Cigarette consumption dropped 10 percent between 1990 and
1998, and the number of smokers declined from 14 million in the 1980s to
under 10 million at the end of the 1990s. The reduction in smoking led to
10,000 fewer deaths each year, a 30 percent decline in lung cancer
among men aged 20 to 44, a nearly 7 percent decline in cardiovascular
disease, and a reduction in low birth weight
 Summary of the intervention

In November 1995, the Polish parliament passed the “Law for the Protection of
Public Health Against the Effects of Tobacco Use” with a huge majority of 90
percent of the votes. The groundbreaking legislation included:
 A ban on smoking and the sale of cigarettes in health care centers, schools,
and enclosed workspaces
 A ban on the sale of tobacco products to minors under 18 years of age
 A ban on the production and marketing of smoke less tobacco
 A ban on electronic media advertising (including radio and television) and
restrictions on other media
 The printing of health warnings on all cigarette packs to occupy 30 percent of
at least two of the largest sides of the packs—the largest health warnings on
cigarette packs in the world at that time
 Free provision of treatment for smoking dependence
 Summary of the intervention

The sweeping legislation has served as a model for other countries. The
European Union followed the Polish precedent in 2003 and required similar
health warnings on all cigarette packs. In 1999 and 2000, the tax on cigarettes
increased 30 percent each year, and a total ban on advertising was passed in
1999.In just a few years, Poland had transformed from one of the least
favorable climates in Europe for tobacco controls to one of the most
favorable.
 Eliminating Measles in Southern Africa

 Geographic area: seven countries in southern Africa: Botswana, Lesotho,

Malawi, Namibia, south Africa, Swaziland, and Zimbabwe
 Health condition: in 1996, the seven countries of southern Africa reported a
total of 60,000 measles cases and 66 measles deaths.
 Global importance of the health condition today: measles, one of the most
contagious infections known in humans, ranks among the top four
childhood killers worldwide. Despite the existence of a safe and effective
vaccine, an estimated 30 million to 40 million cases of the disease and
some 454,000 deaths occurred in 2004. Just under half of these deaths were
in sub-Saharan Africa, where measles kills more children than HIV/AIDs.
 Eliminating Measles in Southern Africa

 Intervention or program: in 1996, the seven southern African countries agreed on a plan to
eliminate measles. the strategy consisted of routine immunization for babies at 9 months,
a nationwide catch-up campaign to provide a second opportunity for immunization to all
children aged 9 months to 14 years, and follow-up campaigns in young children every
three to four years. in addition, the countries organized surveillance for cases of measles
and improved laboratory facilities so that suspect cases could be confirmed.
 Cost and cost-effectiveness: the majority of the funding for the measles initiative came
from national bud-gets. an estimate of the total cost of the program is $26.4 million, with
the average cost per immunized child at $1.10. the cost of increasing routine coverage
from 50 percent to 80 percent has been estimated at about $2.50 per year of healthy life
gained, making measles immunization an extremely cost-effective intervention.
 Eliminating Measles in Southern Africa

 Impact: Between 1996 and 2000, the number of measles cases across
southern Africa fell from 60,000 to 117. the number of reported measles
deaths fell from 166 to zero
 Preventing HIV/AIDS and Sexually
Transmitted Infections in Thailand
 Geographic area: Thailand
 Health condition: Between 1989 and 1990, the proportion of direct sex workers in
Thailand infected with HIV tripled, from 3.5 percent to 9.3 percent and a year
later reached 21.6 percent. over the same period, the proportion of male
conscripts already infected with HIV when tested on entry to the army at age 21
rose six fold, from 0.5 percent in 1989 to 3 percent in 1991.
 Global importance of the health condition today: HIV/AIDS is one of the greatest
threats to human health worldwide, with an estimated 38.6 million people
infected with the virus in 2005. the vast majority of people with HIV are in sub-
Saharan Africa, where life expectancy today is just 47 years; without AIDS, it is
estimated that life expectancy would be 5 years longer. the number of children
who have lost a parent to AIDS is now estimated at 20 million.
 Preventing HIV/AIDS and Sexually
Transmitted Infections in Thailand
 Intervention or program: in 1991, the national Aids committee led by
Thailand's prime minister implemented the “100 percent condom program,”
in which all sex workers in sex establishments were required to use condoms
with clients. Health officials provided boxes of condoms free of charge, and
local police held meetings with sex establishment owners and sex workers,
despite the illegality of prostitution. men seeking treatment for sexually
transmitted infections were asked to name the sex establishment they had
used, and health officials would then visit the establishment to provide
more information.
 Cost and cost-effectiveness: total government expenditure on the national
AIDS program remained steady at approximately $375 million from 1998 to
2001, with the majority spent on treatment and care (65 per-cent); this
investment represents 1.9 percent of the nation’s overall health budget.
 Preventing HIV/AIDS and Sexually
Transmitted Infections in Thailand
 Impact: condom use in sex work nationwide increased from 14 percent in
early 1989 to more than 90 percent by June 1992. An estimated 200,000
new infections were averted between 1993 and 2000. the number of new
STI cases fell from 200,000 in 1989 to 15,000 in 200; the rate of new HIV
infections fell fivefold between 199 and 1995.