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World Health Organization (WHO) definition of health literacy: The cognitive and social skills which determine the motivation and ability of individuals to gain access to understand and use information in ways which promote and maintain good health.
As China is establishing itself as a more permanent global presence, efforts are being taken to shift how the government connects with and influences the general public on health related issues. When the People’s Republic of China was first established in 1949, the government’s concept of health education revolved mainly around increasing knowledge of the general public through heavy-handed, top down campaigns that provided little information. Recently, there has been a gradual shift toward measures that support the WHO’s definition of health literacy with campaign efforts using positive language to proactively maintain healthy habits.
The responsibility of health education in The People’s Republic of China has typically fallen to the Ministry of Health (MOH)’s Patriotic Health Campaign Committee (PHCC). This committee, established in 1950, heads the Patriotic Health Campaign, which works on a national and provincial level to inform the general public on actions to take to improve health.
In the past, the PHCC has presented health issues as enemies to be destroyed. Little information was provided and issues were oversimplified in an attempt to eradicate problems as quickly as possible, rather than educating the public to encourage healthier decisions. Dialogue about healthcare was typically one-way, with education curriculums developed at the national level and then taught throughout cities across the country regardless of local characteristics and needs.
In the 1950s and 1960s, to help control the schistosomiasis endemic, the PHCC identified snails as being responsible for the transmission of the disease. The government conducted a mass campaign to eliminate snails through poisonous drugs, an approach that had limited success eradicating the problem. This complemented Mao Zedongs’s war against “the four devils”—flies, mosquitoes, mice, and sparrows—that encouraged Chinese peasants to kill these pests to improve general health. Mao era propaganda targeted specific environmental factors as being the fastest and easiest way to “understand” and therefore eliminate a much more complex problem.
As recently as 2004, the Communist Party mobilized a campaign to remove civet cats, badgers, raccoon dogs, rats, and cockroaches in order to combat the SARS virus. Rather than informing the public of what SARS is and how it can be avoided, the government took a simplistic approach to the issue by identifying an enemy to defeat in order to solve the problem. Both SARS and schistosomiasis are influenced by a number of environmental factors. Furthermore, the mass killing of species can greatly influence the environment and cause new issues. For these reasons, such tactics oversimplified the issues and did nothing to increase the education of the general public about these diseases. http://news.bbc.co.uk/2/hi/asia-pacific/3371659.stm
Another example of the Chinese government’s heavy-handed approach to an overly-simplified problem concerns the country’s on-going anti-smoking campaign. The MOH has a history of adopting a strong anti-smoking stance and in 2003 ratified the WHO’s Framework Convention on Tobacco Control. While there has been international support for this effort through the Bill and Melinda Gates Foundation, the MOH approach has intentionally presented a limited scope of information in their marketing tactics to intensify their discouraging of specific behaviors. The campaign’s visual assets do not provide any information about why smoking is dangerous or the benefits of quitting other than associating smoking with death. Scare tactics such as these have been known to produce results, but do nothing to help increase the general public’s understanding of the underlying issues.
Despite these current examples of propaganda-supported social marketing, the MOH and Chinese government have been showing increasing acceptance of other social marketing efforts. In the case of the schistosomiasis control-program mentioned before, recently China has been exploring a more informative approach by administering “a health education program aimed at changing behaviors of people living in the epidemic area. Three preventive healthy behaviors were proposed for the residents: avoid contact with contaminated water; comply with treatment for prevention and infection; and properly dispose of excreta. Knowledge about the dangers of unhealthy behaviors is provided and disseminated.” [Wang 272 http://www.bvsde.paho.org/bvsacd/cd26/promocion/v15n3/269.pdf] This approach better informs the public of the exact means through which schistosomiasis is spread. Possessing a more complete knowledge of this danger is an important element to developing the motivation to combat it. Rather than strict control, a more well-rounded behavioral reform is the focus. Good habits are encouraged and two of the three directives are encouraging healthy behavior rather than admonishing poor behavior.
As the government decentralizes and the power of local governments increases, there should be more opportunities to explore social marketing practices that encourage healthy behaviors. While challenges remain, it will be exciting to see what strategies are adopted to reach the various audiences of such a vast population. It is encouraging that there is already a shift away from overly-negative, overly-simplified messages and tactics toward more informational, audience-focused efforts. Additionally, the involvement of such organizations as the Gates Foundation and WHO in health education efforts indicates that the government is becoming more tolerant and flexible in how it reaches the general public.