Health Education and Its Relevance to the Nigerian Society

HEALTH EDUCATION AND ITS RELEVANCE TO THE NIGERIAN SOCIETY BY JACOB YOL 08123463845 MARCH, 2014 ABSTRACT The paper examines health education and the relevance in the Nigerian society. Health education could be regarded as the process of inculcating into the youth and the general society, the value of good health and how to maintain a healthy life. Health education is very vital for socio-economic development. This is because the essence of health education is to ensure a healthy population for a strong labour in order to have productive and efficient citizens. This paper explores the phenomenon of health education, with a view of articulating its aim and objectives and implications for society. The paper begins with a clarification of concepts and then goes on to consider the approaches, levels, the importance and factors militating against health education in Nigeria. The fundamental thrust of this paper is to examine the importance of health education. The paper however concludes that health education is very important for a healthy population, since people are well enlightened about the values of good health. INTRODUCTION Before discussing about health education, it is imperative to conceptualize what health itself means. Health is a highly subjective concept. Good health means different things to different people, and its meaning varies according to individual and community expectations and context. Many people consider themselves healthy if they are free of disease or disability. However, people who have a disease or disability may also see themselves as being in good health if they are able to manage their condition so that it does not impact greatly on their quality of life. WHO defined health as “a state of complete physical, mental, and social well being and not the mere absence of disease or infirmity.” Physical health – refers to anatomical integrity and physiological functioning of the body. To say a person is physically healthy: • All the body parts should be there. • All of them are in their natural place and position. • None of them has any pathology. • All of them are doing their physiological functions properly. • And they work with each other harmoniously. Mental health - ability to learn and think clearly. A person with good mental health is able to handle day-to-day events and obstacles, work towards important goals, and function effectively in society. Social health – ability to make and maintain acceptable interactions with other people. For instance, to feel sad when somebody close to you passes away. The absence of health is denoted by such terms as disease, illness and sickness, which usually mean the same thing though social scientists give them different meaning to each. Disease is the existence of some pathology or abnormality of the body, which is capable of detection using, accepted investigation methods. Illness is the subjective state of a person who feels aware of not being well. Sickness is a state of social dysfunction: a role that an individual assumes when ill. Definition Health education has been defined in many ways by different authors and experts. Lawrence Green defined it as “a combination of learning experiences designed to facilitate voluntary actions conducive to health.” The terms “combination, designed, facilitate and voluntary action” have significant implications in this definition. Combination: emphasizes the importance of matching the multiple determinants of behavior with multiple learning experiences or educational interventions. Designed: distinguishes health education from incidental learning experiences as systematically planned activity. Facilitate means create favorable conditions for action. Voluntary action means behavioral measures are undertaken by an individual, group or community to achieve an intended health effect with out the use of force, i.e., with full understanding and acceptance of purposes. Most people use the term health education and health promotion interchangeably. However, health promotion is defined as a combination of educational and environmental supports for actions and conditions of living conducive to health. Aims and Principles of Health Education Aims • Motivating people to adopt health-promoting behaviors by providing appropriate knowledge and helping to develop positive attitude. • Helping people to make decisions about their health and acquire the necessary confidence and skills to put their decisions into practice. Basic Principles • All health education should be need based. Therefore before involving any individual, group or the community in health education with a particular purpose or for a program the need should be ascertained. It has to be also specific and relevant to the problems and available solutions. • Health education aims at change of behavior. Therefore multidisciplinary approach is necessary for understanding of human behavior as well as for effective teaching process. • It is necessary to have a free flow of communication. The two way communication is particularly of importance in health education to help in getting proper feedback and get doubt cleared. • The health educator has to adjust his talk and action to suit the group for whom he has to give health education. E.g. when the health educator has to deal with illiterates and poor people, he has to get down to their level of conversation and human relationships so as to reduce any social distance. • Health Education should provide an opportunity for the clients to go through the stages of identification of problems, planning, implementation and evaluation. This is of special importance in the health education of the community where the identification of problems and planning, implementing and evaluating are to be done with full involvement of the community to make it the community’s own program. • Health Education is based on scientific findings and current knowledge. Therefore a health educator should have recent scientific knowledge to provide health education. • The health educators have to make themselves acceptable. They should realize that they are enablers and not teachers. They have to win the confidence of clients. • The health educators should not only have correct information with them on all matters that they have to discuss but also should themselves practice what they profess. Otherwise, they will not enjoy credibility. • It must be remembered that people are not absolutely without any information or ideas. The health educators are not merely passing information but also give an opportunity for the clients to analyze fresh ideas with old ideas, compare with past experience and take decisions that are found favorable and beneficial. • The grave danger with health education programs is the pumping of all bulk of information in one exposure or enthusiasm to give all possible information. Since it is essentially a learning process, the process of education should be done step-by-step and with due attention to the different principles of communication. • The health educator should use terms that can be immediately understood. Highly scientific jargon should be avoided. • Health Education should start from the existing indigenous knowledge and efforts should aim at small changes in a graded fashion and not be too ambitious. People will learn step by step and not everything together. For every change of behavior, a personal trail is required and therefore the health education should provide opportunities for trying out changed practices. Historical Development of Health Education While the history of health education as an emerging profession is only a little over one hundred years old, the concept of educating about health has been around since the dawn of humans. It does not stretch the imagination too far to begin to see how health education first took place during pre-historic era. Some one may have eaten a particular plant or herb and become ill. That person would then warn (educate) others against eating the same substance. Conversely, someone may have ingested a plant or herb that produced a desired effect. That person would then encourage (educate) others to use this substance. For health care programmes to succeed in this country, Nigerians must be educated about health care concepts. This involved a number of educational issues which are essentially dependent on systematic health education. Udoh, Fawole, Ajala, Okafor and Nwana (1987) defined health education as a process with intellectual, psychological and social dimensions relating to activities which increase the abilities of people to make informed decisions affecting their personal, family and community well being. According to them, health education is an integral part of the school curriculum at all levels, and an integral component of community based health programme. Mass health education and mobilization of individuals and the community to create health awareness is an important tool in the realization of health for all by the year 2000 and beyond. Adegoroye (1984) stated that health education should run through, and be built into all sectors of the community. There should be family health education, school health education and community health education. Health education should be carried out both at the group and individual levels in the homes, clinics, market squares, places of worship and other social gatherings. In the past, health workers were found of underrating the level of intelligence and problem - solving skills of health services consumers (community members). They were often labelled as ignorant, unhygienic or illiterate. Hence, health services providers saw little or no need to involve the consumers in the process of providing services (Folawiyo, 1990). For example, in the past, if a dispensary was to be built in a village, the government would only acquire land and start to build the dispensary, without consulting the villagers. This wrong approach has led to non-utilization or under-utilization of many government health centres or hospitals. But today, with the introduction of health education programmes in the health care delivery system, the orientation has changed tremendously. Henry (1993) asserted that in reciprocity, the community now sees the health care programmes as our programmes instead of government’s programmes. Approaches to Health Education • The persuasion approach –deliberate attempt to influence the other persons to do what we want them to do (DIRECTIVE APPROACH) • The informed decision making approach-giving people information, problem solving and decision making skills to make decisions but leaving the actual choice to the people. E.g. family planning methods Many health educators feel that instead of using persuasion it is better to work with communities to develop their problem solving skills and provide the information to help them make informed choices. However in situations where there is serious threat such as an epidemic, and the actions needed are clear cut, it might be considered justified to persuade people to adopt specific behavior changes. Targets for Health Education • Individuals such as clients of services, patients, healthy individuals • Groups E.g. groups of students in a class, youth club • Community E.g. people living in a village Health Education Settings When considering the range of health education interventions, they are usually described in relation to different settings. Settings are used because interventions need to be planned in the light of the resources and organizational structures peculiar to each. Thus, health education and promotion takes place, amongst other locations, in: • Communities • Health care facilities • Work sites • Schools • Prisons • Refugee camps …etc Who is responsible for Health Education? Health education is the duty of everyone engaged in health and community development activities. Health Extension Workers are primarily responsible in working with the families and community at a grass root level to promote health and prevent disease through provision of health education. If health and other workers are not practicing health education in their daily work, they are not doing their job correctly. When treating someone with skin infection or malaria, a health worker should also educate the patient about the cause of the illness and teach preventive skills. Drugs alone will not solve the problems. Without Health Education, the patient may fall sick again from the same disease. Health workers must also realize that their own personal example serves to educate others. Role of Health Educator • Talking to the people and listening of their problems • Thinking of the behavior or action that could cause, cure and prevent these problems. • Finding reasons for people’s behaviors • Helping people to see the reasons for their actions and health problems. • Asking people to give their own ideas for solving the problems. • Helping people to look as their ideas so that they could see which were the most useful and the simplest to put into practice. • Encouraging people to choose the idea best suited to their circumstances. The Importance of Health Education Health education is an essential tool of community health. Every branch of community health has a health educational aspect and every community health worker is a health educator. But health education has been defined as a process which effects changes in the health practices of people and in the knowledge and attitudes related to suet changes. A great deal of ill-health in this country and elsewhere is due to ignorance of simple rules of hygiene or of indifference to their practical application. However, health is of the greatest importance and an indispensable factor in life. Without it a man becomes burden to others and useless to himself. In other words, health is the basis of individual and social welfare. But the concept of health and practice of health-education is almost as old as the human race. Health education has been defined as "the sum of all experiences in school and elsewhere that favor ably influence habits, attitudes and knowledge, related to individual, community and racial health.” At present in our country much attention is being paid to the education for total health. Good health is a pre condition for good education. There is a saying that sound mind lives in a sound body. So, education cannot be acquired without the proper frame of the mind and proper frame of mind cannot be possible without proper health and hygiene. Realizing the importance of health education Secondary Education Commission, 1952-53 stated: "Unless! Physical education is accepted as an integral part of education and the educational authorities recognize it, need in schools the youth of the country, which form its 'most variable asset, will never be able to pull their full weigh to national welfare. The emphasis so far has been more on the academic type of education without proper consideration being given to physical welfare and the main¬tenance ' proper standards of health of the pupils". Health education is the very foundation of every successful public health programme so one of the main functions educations should be to help every child deve¬lop a healthy body, an alert mind and sound emotional attitudes. Health education aims at bridging the gulf between the health knowledge and health practices of the children. The Various Levels of Health Education Public health activities are performed at many levels from local to national to global. The organizations and agencies devoted to public health at these different levels share many of the same functions including dis¬ease surveillance, policy development, and provision of access to health care. To better understand how all these agencies fit to¬gether to provide public health services, this chapter will look at public health organiza¬tions within the United States and organi¬zations that exist for international public health needs. Agencies of particular interest to pharmacists, such as the Food and Drug Administration, will be emphasized. To illustrate how the various agencies work, a case study based loosely on the 2002–03 SARS pandemic will be used. Public Health from Local to Global The primary site of activity for most public health interventions is within individual communities or neighborhoods. This locale is where the members of the population and the public health practitioners interact. For issues that are unique to the community or do not spread beyond the community, the local approach is effective. However, many public health problems extend beyond local borders, for example toxic waste spills, infec-tious diseases, wars, and natural disasters. Any of these problems may require involve¬ment of counties, states, the nation, or even other countries to fully understand the scope of the problem and respond to it. National and global organizations can often facilitate communication among the affected populations, provide access to expertise not available locally, and coordinate efforts to respond. The most effective responses to public health problems are those that involve local, state, national, and international partners. Many international outbreaks of infectious disease often begin as a single episode of illness or injury that quickly spread if not contained. In the case of an outbreak of a new viral disease, public health organizations at all levels need to minimize the spread of the disease and reduce the mortality and morbidity rates because of interdependence and the global nature of our world today. More than at any other time in history, trade, travel, and communication span the globe and connect populations in ways never imagined 100 years ago. It has been said that an infectious disease outbreak in any part of the world can be in a person’s backyard half a world away within 24 hours. Luckily, information about an approaching virus can be transmitted even faster via web and telecommunications, so a population can prepare if it is warned. That is where the SARS-inspired case begins—a single patient who has an unknown respiratory illness. The case is designed to show how this disease impacts patients and practitioners in other continents. What starts as a local outbreak quickly becomes a global health issue. Factors Militating Against Health Education in Nigeria Studies by Eke (1989) and Idehen (2004) reveal that in many parts of Nigeria, health education in secondary schools was poorly carried out. The non implementation of the instructional components of the health education curriculum, lack of infrastructure and instructional materials where mainly the problems identified by the researchers as responsible for the poor status of health education in Nigerian. It is significant to mention that in whatever function one finds oneself, the most important factor is good health. If health is lacking, productivity will be seriously undermined. Thus every health education teacher in Nigeria has the potential for positively affecting the health status of students. Furthermore, many students contend with health problems that influence their ability to learn. For instance, some students are not adequately fed; others lack relevant vaccination and are vulnerable to various infections and diseases such as tuberculosis, measles, meningitis, malaria and infective hepatitis. Studies by Iverson (2000) reveal that many students are brought up in families in which domestic violence and drug or chemical dependencies are the rule rather than the exception. These observations compel and make necessary the provision and adequate implementation of health education curriculum in schools. Health education instructional objectives are expected to provide health knowledge, enhance wellness behaviors, promote health situations, facilitate healthful relationships and enable students make responsible decisions. An earlier report (Bernard,1992) on the objectives of health education include that it can help learners to develop resistance skills when appropriate, promote protective factors, ensure resilience in terms of the ability to prevent or to recover from sickness and to promote health literacy. Studies by Dawson (1997), Frank ham (1998) and Gold (1999) reveal the significance of health education and they concluded that health education is effective in reducing many high-risk behaviors, teenage pregnancies, smoking rates among young people. But its over all effectiveness depends on many factors such as the quality of the teachers providing health instruction, the available educational, awareness, instructional materials in terms of textbooks, pamphlets, posters and other available infrastructural facilities such as play fields, toilets, comprehensiveness of the health education programme, time available for instruction, family involvement and community participation in matters related to health education. Health education, in its various nomenclatures has been a part of the school curriculum in Nigeria since the early twenties. Health education curriculum development in Nigeria actually started with hygiene and sanitation as school subjects. An earlier report by Ejifugha (1999) reveal that serious efforts were made by the British Social Hygiene Council to teach hygiene in Nigerian schools. Initially, the efforts towards the resolution of the confusion as to what should be taught in hygiene class led to a series of conferences and memoranda. The introduction of the new terminology, health education, which shifted emphasis to the principles of healthful living was based on the fact that the contents of hygiene were inadequate for the promotion of healthful living. In 1984, the term health education was introduced as one of the school subjects in Nigeria. The health education curriculum has become a reality today in Nigeria because of government’s concern for the health status of school children. The present national health education curriculum was developed by the Federal Ministry of Education between 1980 and 1984 and finally approved for implementation in the nation’s secondary schools in August 1985 (Federal Ministry of Education, 1985) Studies by Owie (1992) had earlier revealed that the implementation of the approved health education curriculum in Nigerian secondary schools was done under the nomenclature of health science. This approach was adopted because it was alleged that the term “education” in health curriculum should not be for the secondary school level, hence health science. The present health education curriculum has ten instructional units, which are to be implemented by secondary schools in Nigeria. The ten units include: Unit 1: Growth and development Unit 2: Food and nutrition Unit 3: Physical health Unit 4: Safety and accident prevention Unit 5: Prevention and control of communicable diseases Unit 6: Community and environmental health Unit 7: Family life and sex education Unit 8: Emotional and social health Unit 9: Chemicals which alter behavior Unit10:Consumer health, (Federal Ministry of Education, 1985) These ten units of the health education curriculum are theoretically and practically planned to address the physical, mental, emotional and social dimensions of the health of school children. If the ten units are adequately implemented, they could motivate and assist students to maintain and improve their health, prevent disease and reduce health related risk behavior. Ideally, secondary schools in Nigeria are expected to implement the curriculum to the fullest and Udoh (1996) had earlier reported that it seems that Nigerian secondary schools have not lived up to the expectation in terms of implementing some aspects of the health education curriculum. The inability of Nigerian secondary schools to implement the health education curriculum may have been due to certain constraints. A preliminary analysis of the status of health education in Nigerian secondary schools provided some baseline information on the range of constraints that might have affected the implementation of the curriculum. Prominent among the constraints include lack of health education textbooks, poor quality of instruction, poor execution of curriculum contents, inadequate funding, insufficient standard facilities and lack of coordinated programme implementation. In spite of the several researches that have being carried out to examine the issues and problems pertaining to health instruction in Nigerian schools, non have attempted to address the role of school administrators. Although Shuck Smith and Wood (1998) had earlier reported that administrative factors have little or no influence over health education in schools. This study is intended to bridge the gap in knowledge about what factors impinges on health instruction in Nigerian schools and to evaluate the factors that influences the teaching of health education in Nigerian secondary schools. Health Education Planning, Implementation and Evaluation: Examples of Effective Strategies and Barriers to Success Given the numerous health education initiatives that have occurred over the past 30 to 40 years, the multiple target groups and issues that have been addressed, and the differing evaluation methods that have been used, one is left with the question: what are the core ingredients of success? What methods have stood the test of time and appear to be essential components of health education programmes and services aimed at enhancing an individual’s and a community’s health? Evidence-based health education interventions are those that are most likely to be based on theory and have been shown through empirical study to be effective. The use of theory-based interventions, evaluated through appropriate designs, contributes to the understanding of why interventions do or do not “work” under particular conditions. (43) Using the definitions of evidence-based medicine (44) and evidence-based public health (45) and the work of Rimer and her colleagues, (43) evidence-based health education practice is the “process of systematically finding, appraising and using … qualitative and quantitative research findings as the basis for decisions in the practice of health education”. (46) Increasingly, health education professionals are using a concept born out of the continuous quality improvement discipline called “best practices”. For the purposes of this document, this notion has been slightly altered and renamed “leading practices”. Our intent is to identify solid practices that can be of assistance to decision-makers and service providers. The logic behind leading practices is that by sharing non-proprietary ideas/applications/processes in an organized fashion, the diffusion of successful practices will be hastened, and thus the need to learn by trial and error (with a high price for failure) is minimized. Components that appear to be essential to effective community-based health education and prevention strategies include the following. (47) • Participant involvement Community members should be involved in all phases of a programme’s development: identifying community needs, enlisting the aid of community organizations, planning and implementing programme activities and evaluating results. Wide and comprehensive representation of community members on programme planning bodies provides for a sense of ownership and empowerment that will enhance the programme’s impact. • Planning Many programmes take two or three years to move from original conceptualization to the point at which services are delivered. Planning involves identifying the health problems in the community that are preventable through community intervention, formulating goals, identifying target behaviour and environmental characteristics that will be the focus of the intervention efforts, deciding how stakeholders will be involved and building a cohesive planning group. • Needs and resources assessment Prior to implementing a health education initiative, attention needs to be given to identifying the health needs and capacities of the community and the resources that are available. • A comprehensive programme The programmes with the greatest promise are comprehensive, in that they deal with multiple risk factors, use several different channels of programme delivery, target several different levels (individuals, families, social networks, organizations, the community as a whole) and are designed to change not only risk behaviour but also the factors and conditions that sustain this behaviour (e.g. motivation, social environment). • An integrated programme The programme should be integrated; each component of the programme should reinforce the other components. Programmes should also be physically integrated into the settings where people live their lives (e.g. worksites) rather than solely in clinics. • Long-term change Health education programmes should be designed to produce stable and lasting changes in health behaviour. This requires longer-term funding of the programme and the development of a permanent health education infrastructure within the community. • Altering community norms In order to have a significant impact on an entire organization or community, the health education programme must be able to alter community or organizational norms and standards of behaviour. This requires that a substantial proportion of the community’s or organization’s members be exposed to programme messages, or preferably, be involved in programme activities in some way. • Research and evaluation A comprehensive evaluation and research process is necessary, not only to document programme outcomes and effects, but to describe its formation and process, and its cost-effectiveness and benefits. Examples of Effective Health Education Initiatives and Strategies—Systematic Reviews Systematic reviews summarize the overwhelming amount of health-related research initiatives that exist and also provide health providers and decision-makers with information on evidence based practice. (48) A number of systematic reviews have been done on the effects of health, health care, education and social justice-related interventions. (49,50) One of the most comprehensive tools available to identify effective health education, health promotion and public health strategies is the Guide to community preventive services: systematic reviews and evidence based recommendations, prepared by the Task Force on Community Preventive Services for the US Department of Health and Human Services in 1996. The purpose of the Guide is to provide public health practitioners and decision-makers with recommendations regarding population based interventions for promoting health and preventing disease, injury, disability and premature death in communities. Its aim is to promote evidence-based public health practice by providing best advice on which community-based health promotion and disease prevention interventions work and which do not work, based on available scientific evidence. Although the primary focus for the Guide is on interventions that have been evaluated in industrialized nations, health educators in developing nations might well find the information relevant to their situations. More than 200 interventions in the following topical areas have been reviewed, and the Task Force on Community Preventive Services has issued recommendations for their use in the following areas, among others: • Adolescent health • Alcohol • Asthma • Birth defects • Cancer • Diabetes • Violence • HIV/AIDS, STIs and pregnancy • Mental health • Motor vehicle • Nutrition • Obesity • Worksite • Oral health • Physical activity • Social environment • Tobacco • Vaccines. Three topic areas in which a great deal of health education activity is occurring are physical activity, obesity and tobacco use. For illustrative purposes, the Guide provides the following examples of health education strategies that have sufficient evidence to be designated as recommended actions. Behavioural and Social Approaches to Increase Physical Activity: Individually Adapted Health Behaviour Change Programmes Individually-adapted health behaviour change programmes for increasing physical activity teach behavioural skills that help participants incorporate physical activity into their daily routines. The programmes are tailored to each individual’s specific interests, preferences and readiness for change. These programmes teach behavioural skills such as: • Goal-setting and self-monitoring of progress toward those goals • Building social support for new behaviour • Behavioural reinforcement through self-reward and positive self-talk • Structured problem-solving to maintain the behaviour change • Prevention of relapse into sedentary behaviour. Challenges to Implementing Health Education and Prevention Programmes Prevention through evidence-based health education intuitively makes sense. Much evidence accumulated over many years of research clearly demonstrates the context in which and the groups for whom behaviour can most effectively be modified. Why, then, does so much evidence generate so little action when it comes to opportunities for prevention strategies to improve the health of our communities? Why do initiatives with proven efficacy in one area fail to be adopted in communities experiencing similar health problems in other locations? The purpose of this section is to explore the barriers and challenges that communities experience in adopting and embracing new prevention strategies. The section concludes with a description of how these obstacles can be addressed and in some cases can be viewed as opportunities. Example 3. Reducing tobacco use initiation: mass media education campaigns combined with other interventions Prevention through health education, while naturally attractive, is conceptually complex. Practised for many years in a multitude of contexts and venues, prevention has evolved today into being an integral part of the continuum of services provided within the health and other sectors. There is much to acknowledge and be proud of in the currently ongoing health education activities and those that have been tried in the past. The tradition and culture of prevention incorporates, among other virtues, a growing scientific base, a sound philosophy built on great compassion and dedication, and recognition that through concerted, planned action, improved health can be achieved and maintained. Yet, prevention continues to be a “hard sell”. Why? • Dramatic results Prevention’s results are often “invisible”. It may involve the heart attack that doesn’t occur, the lung cancer that doesn’t form or the injury that does not disable. The story of individuals averting heart disease through diet and physical activity is not as sensational or dramatic as the weekly statistics on heart bypass operations. Prevention tends to be non sensational, subtle and therefore easily ignored. • We tend to focus on the crisis Within the medical care sector, patients are often “triaged”, with priority given to those in greatest need or distress. Because of the moral obligation to reach out to those in greatest need, vast resources continue to be expended on rescuing people in crisis. What remains is limited time and resources to spend on ways to prevent crisis and the need for rescue. Lobby groups form if treatment services are not available on demand, while few people would demonstrate in demand of timely and accessible health education services. • Time While some of the results from a preventive act may be immediate (e.g. a life saved because of wearing a seat belt), other results may take months if not years for the benefits to become apparent. This time-lag makes it difficult for the public to relate a preventive action to a positive outcome. As well, many health education initiatives are either one-time events or lack sufficient funds to develop longer-term strategies for addressing the known risk factors that are barriers to building community capacity. • Complex issues To be effective, prevention needs to target multiple causes of a disease, such as dietary and physical activity patterns, peer influences and supports, and the stress of one’s social circumstances. This demands that preventive services include not only those services found within the traditional health area but also those in other areas such as housing, transportation and agriculture. • Practitioners’ knowledge Persons engaged in providing health education services are not aware of the accumulated knowledge that has been learned across many fields. Health education programmes often reinvent the wheel rather than build on advances. • Low tech “We seem to take on faith that the more dazzling the technological features of an intervention–whether diagnostic or therapeutic–the greater its value to society”. Health education usually requires little technology. • Vested interests One of health education’s greatest challenges relates to the strong commercial forces that flex their economic muscle to stifle often meager prevention budgets and efforts. For example, annual sales of tobacco and high-fat foods are in the millions of dollars, and advertisements are slick and targeted. Most children can easily recite jingles from advertising by fast food outlets and soft drinks companies. Extensive research is conducted by industries on ways in which to influence segments of the population to eat, drink and engage in behaviour that compromises people’s health. Preventive efforts are overwhelmed by these well resourced, carefully planned and strategically marketed products. Given these obstacles and challenges to providing prevention activities, what strategies might exist to address this imbalance and possibly take advantage of opportunities that might exist? Does this provide us with clues as to ingredients that should be included in a health education strategy? First and foremost, the strongest ally of any health education effort is the people it serves. Raising public awareness of the issues that affect health and of how the public can influence these issues needs to be the centre piece of any health education strategy. A noted community health worker once said that while professionals learn through data, communities learn through stories. “Stories can bring both the potential and the consequences to a personal level.” Health education initiatives should be based on the needs and capacities of the local community and on an open and participative process. Next, attention must be focused on the most cost-effective techniques and strategies that exist. While research in this area is ongoing, with many questions still unanswered, sufficient evidence already exists on the magnitude of the health gains that could be gained across populations if certain preventive strategies were put in place. Finally, the old saying “healthy choices should be easy choices” has never been so true. People’s behaviour, for many reasons, tends to gravitate towards the avenue of least resistance. A product that is less expensive, easier to obtain or displayed in a more attractive way is the one that will be chosen. Getting active by going for a walk may be fraught with obstacles such as unsafe neighbourhoods, child support issues or simply lack of motivation. How these issues are addressed through health education and the broader area of health promotion requires creativity and often also an examination of the context in which people regularly make decisions. There are many ways to make healthy choices the easy ones. Examples include: • Priority placed by employers on opportunities for physical activity • The information provided at the point of purchase on the nutrition content of food • The prominence of physical activity in school programmes • Elevating the price of tobacco products to discourage potential young smokers. CONCLUSION This paper discussed the values of health education. The paper analytically discuss the levels, approaches, importance, aim and objectives, also, the paper examines the planning, implementation and evaluation of health education in the society as well as the factors militating against the success of health education; attention was also drawn to the target of health education and who is responsible for health education. In a nutshell, the paper explains the fact that health education is very important but, there are challenges affecting the smooth functioning of health education in the society. REFERENCES Adegoroye, C. (1984), The Value of Health Education in the Society. Oxfor Unversity Press. Ejifugha, A. U (1999), Development of Health Education in Nigeria. Owerri; Canon Publishers Nigeria Ltd. Folawiyo, D. (1990), The Challenges of Health Education in Nigeria. Aboki Publishers. Henry, F. (1993), The Function of Health Educator. Heinemann Publishers. Owie, I. 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