Critical thinking among environmental health undergraduates and implications for the profession

During a study conducted in 2000-2002, the critical-thinking dispositions of undergraduate environmental health students at Illinois State University were found to have significant shortcomings. The critical-thinking-disposition scores were comparable to those of other undergraduates throughout the United States and Canada; nevertheless, these findings have significant implications for environmental health academic programs and the profession. Environmental health professionals commonly confront "ill-structured" problems, for which critical thiking is an essential skill. In addition, the challenges faced by the profession in terms of recognition, funding, and public support require a high level of critical thinking. This paper provides a number of recommendations for academic programs and professionals.     

News From Health Research: Toward a Better Understanding

News about health research findings, especially regarding controversial topics, can seem confusing and conflicting to students and the general public. Many people eventually develop a "turned-off" attitude toward all health news. Yet medical information is one of the key factors involved in health decision-making, because it influences a person's judgment about the potential health impact of a behavior choice. As part of their health education, youngsters need to learn skills to better understand and evaluate reports of research news, so the information available for health decision-making will be more complete and accurate. Such news is already abundant in television, radio, newspaper and magazine reports and will continue to increase as research advances, knowledge expands and health "facts" are revised. This article outlines concepts and skills to help teachers and students understand the changes and controversies in health news. To most effectively use new information generated by medical research, students need to: 1) understand basic concepts about the nature of research and the research process; 2) apply critical thinking approaches to health news; and 3) locate additional health information resources. Generating ways to address these needs is a high priority of the school health education work at the National Heart, Lung and Blood Institute. Comments are invited on this approach.     

Environmental surveillance in health in Brazil's Unified Health System

The incorporation of environmental surveillance in the field of public health policies is a relatively recent demand in Brazil. One of the major challenges in environmental health surveillance is defining its object and the specificity of its practice. The expanded concept of exposure, treated as a set of complex relations between a society and the environment, and not as a personal attribute, is central to the definition of indicators and should guide the practice of environmental surveillance in the health sector. Among the difficulties encountered in applying this concept within the Brazilian Health System, is the need to restructure health surveillance activities and to form multidisciplinary teams capable of dialoguing with other sectors. Furthermore, information systems capable of aiding in health situation analysis and decision making must be constructed. Taking this into consideration, a review of the object and concepts of environmental health surveillance was undertaken and the challenges with respect to its implementation in the Brazilian Health System were identified.     

Prioritizing environmental issues around the world: opinions from an international Central and Eastern European environmental health conference

BACKGROUND: As the next generation of scientists enters the field of environmental health, it is imperative that they view their contributions in the context of global environmental stewardship. In this commentary, a group of international graduate students facilitated by three experienced environmental health scientists present their views on what they consider to be the global environmental health concerns of today. This group convened initially in October 2004 at an international health conference in Prague, Czech Republic. OBJECTIVES: In this report we identify perceived environmental health concerns that exist around the world, with a focus on Central and Eastern Europe. Additionally, we address these perceived problems and offers some potential solutions. DISCUSSION: At the meeting, students were invited to participate in two panel discussions. One group of young international scientists identified several significant global environmental health concerns, including air pollution, occupational hazards, and risk factors that may exacerbate current environmental health issues. The second panel determined that communication, education, and regulation were the mechanisms for addressing current environmental challenges. CONCLUSIONS: In this commentary we expand on the views presented at the meeting and represent the concerns of young investigators from nine different countries. We provide ideas about and support the exchange of information between developed and developing countries on how to handle the environmental health challenges that face the world today.     

The social in medicine: social techniques in patient education

The article investigates the role of the social in medicine through an empirical study of social technologies in Diabetes 2 and COPD patient education in Denmark. It demonstrates how the social at the same time is the cause of disease but also functions as a solution to the problem. Furthermore it suggests that the patient groups have an ambiguous role in medicine; they appear to be organized as communities of empowerment, critical of the individualizing effects of medicine, but at the same time these groups are embedded in medical practices, transferring responsibility for illness and health to the level of the citizens. The article provides an empirical analysis of how the social in patient education works. The empirical analysis challenges an existing understanding that patient groups automatically support healthy lifestyle changes. We point out the multiple ways in which the social works.     

Contribution to the development of political-pedagogical nursing projects

Based on the concepts of project and political-pedagogic project, authors presented a proposal for the development of such a project. The framework includes: the reference, the philosophy, the concept and the structure. The reference is the starting point, meaning the knowledge and critical view of reality; the philosophy represents the faith and the community's values involved in the project; the concept represents the theory that gives support to the proposal; and, finally the structure establishes the competences and the profile of the professional to be formed as well as the methodologic option for the organization and development of courses and disciplines. The Habermas' theory of communicative action is proposed as a methodology for the development of projects.     

中医医院形象设计与管理探讨

介绍了医院形象设计的概念和重要意义,医院形象设计的内容及组成要素.从中医医院经营理念、行为活动规范、视觉传达设计三方面探讨了中医医院形象管理的实施方法.     

Epidemiologische Erforschung und ökonomische Bewertung gesundheitlicher Umweltrisiken

In environmental health research, methods for quantitative analysis of human population studies data are gaining importance. In recent years, it has been realized that they can also provide an important link to the economic view on environmental health effects. In this review, fundamental concepts and methods from environmental epidemiology and health economics are presented and it is shown how they can be linked in order to support environmental policy decisions. In addition, the characteristics of environmental epidemiology and the role of epidemiologic studies in risk assessment are discussed. From the economic point of view, cost-of-illness studies and cost effectiveness studies are the main approaches, and we have placed special focus on methods of monetary valuation of health effects that are generally proposed in the environmental context. Two conceptually differing strategies to combine epidemiologic and economic evidence are presented: the environmental attributable fraction model as a top-down approach and the impact pathway approach which follows a bottom-up analysis strategy. Finally, two examples are used to illustrate the application of these concepts and methods: health risks caused by fine particle air pollution and their costs, and the cost-effectiveness of radon exposure reduction policies.     

New tendencies in health education in Italy

There have been major advances in the level of awareness oftheoretical concepts of health education in Italy since thedrawing up of the National Health Programme and the Health Reformlaw, yet health practice has failed to reflect them. The conceptual framework of health promotion falls into threeevolutionary phases: a didactic approach, a behavioural one,an approach involving active participation, leading finallyto the development of intersectoral interventions. A catalogueof examples is given of how the new practical tendencies toemerge from these concepts are invariably self-contradictory. Practical intervention models have been developed in responseto the observed tendencies based on their critical analysis(unilateral and bilateral interventions), but have by no meansmet with success. Though the concepts and aims of health education have not beenimplemented effectively on a practical level, they are betterrepresented at planning and guidance level (e.g. Regional HealthPlans). It is their integration into existing socio-health servicesand their operation that is slow and full of difficulties: chiefof these is the failure of its antagonistic medical and non-medicalimplementors to recognize any single or unified tendency oraim. That is the result of conflicts between political aspirations,cultural elaborations and optional proposals on the one hand,and categorical resistance, market interests and distortingpractices on the other. More decisive attention is needed fromcentral and local government to effectively relaunch a unitedHealth For All campaign.     

An approach to teaching for critical thinking in health education

Teaching for critical thinking represents a vital and emerging priority in school health education. A variety of conceptions of critical thinking and approaches to teaching for critical thinking exist in the literature. This paper explores the relevance of Richard Paul's concept of critical thinking to health education. Paul's work on critical thinking has been widely disseminated and features three inter-related components called the elements of reasoning, intellectual standards, and intellectual traits. Each component appears highly relevant to health education. Paul's approach is also based on natural rather than technical language which improves its utility in learning. Unanswered questions about the approach concern the degree to which the thinking skills and traits can be transferred to health instruction and the lack of evaluation research demonstrating its efficacy. Further inquiry into the applicability and efficacy of the approach is needed.     

The quarantine of philosophy in medical education: Why teaching the humanities may not produce humane physicians

Patients increasingly see physicians not as humane caregivers but as unfeeling technicians. The study of philosophy in medical school has been proposed to foster critical thinking about one's assumptions, perspectives and biases, encourage greater tolerance toward the ideas of others, and cultivate empathy. I suggest that the study of ethics and philosophy by medical students has failed to produce the humane physicians we seek because of the way the subject matter is quarantined in American medical education. First, the liberal arts are seen as the province of undergraduate education, and not medical school. Second, philosophy, when taught in medical school, is seen by students as just one subject to be mastered along with many other more important ones, and not as a way to foster critical thinking and empathy. What is needed is a new pedagogy that combines both cognitive and affective elements to implant and nourish the liberal arts in students. Removing the quarantine of philosophy from other facets of medical education is an important first step.This revised version was published online in October 2005 with corrections to the Cover Date.     

Towards a new (or rearticulated) philosophy of mental health nursing: A dialogue-on-dialogue

The following dialogue takes up recent calls within nursing scholarship to critically imagine alternative nursing futures through the relational process of call and response. Towards this end, the dialogue builds on letters which we, the authors, exchanged as part of the 25th International Nursing Philosophy Conference in 2022. In these letters, we asked of ourselves and each other: If we were to think about a new philosophy of mental health nursing, what are some of the critical questions that we would need to ask? What warrants exploration? In thinking through these questions, our letters facilitated a collaborative enquiry in which philosophy and theory were generative tools for thinking beyond what is and towards what is yet to come. In this paper, we expand the dialogue within these letters—in a ‘dialogue-on-dialogue’—and take up one thread of our discussion to argue that a new philosophy of mental health nursing must rethink the relationships between ‘practitioner’/‘self’ and ‘self’/‘other’ if it is to create a radically different future. Further, we posit solidarity and public love as possible alternatives to foregrounding the ‘work’ of mental health nursing. The possibilities we present here should be received as partial, contingent and unfinished. Indeed, our purpose in this paper is to provoke discussion and, in so doing, to model what we believe is a necessary shift towards criticality in our communities of nursing scholarship.     

Towards an expanded health field concept: conceptual and research issues in a new era of health promotion

The concepts of health promotion contained in the Ottawa Charterfor Health Promotion and the new Canadian government policyare changing the face of health promotion. But these conceptshave yet to be formed into a cohesive framework for the effortsof policy-makers and others. As part of the Canadian policydevelopment exercise, the health field concept of the Lalondereport was re-examined, since it had been influential in shapingearlier policy. In this article, some of the fruits of thatexamination are presented, along with a proposed expanded healthfield concept that takes account of the new concepts. The aimsof the expanded health field concept are threefold: to guidepolicy, to argue for resources and to provide an analyticalframework suitable for programme development and research. Emphasisis put on five areas outside the original health field concept:output aspects of the health promotion process (not just input);positive aspects of input and output (not just negative); subjectiveaspects of input and output (not just objective); increasedemphasis on social and environmental input; and clarificationof the relationship between health and quality of life. It issuggested that, on the input side, the five action areas ofthe Ottawa Charter be used as a starting point, and that onthe output side, measures focus on four areas: morbidity andmortality, positive health indicators, subjective perceptions,and functional capacity and coping. The expanded health fieldconcept represents an evolutionary step beyond the old concept,and is presented as a stimulus to discussion rather than asthe final word.     

Is evidence-based medicine useful for public health?

Evidence-based medicine is a fashionable topic although the discussions is open regarding whether it has any practical interest for daily medical practice or public health policy. One needs therefore to focus on the way evidence-based medicine can improve matters for physicians, but also on some serious challenges facing health professionals. Upon close examination, it appears that evidence-based medicine provides us with concepts and methods likely to be useful in three directions: improvement of the health care decision-making process, reinforcement of professional accountability dedicated to the promotion of human rights, implementation of fair health policy regulations taking into account the intricate relationships between participants dealing with individual or community oriented interventions. When facing these challenges, evidence-based medicine certainly deserves further attention in the field of community and public health.     

Translating critical public health

One of the abiding challenges of engaging critically with public health practice is speaking across disciplinary lines. I ask critical public health scholars to consider the technologies and practices that may render their ideas inaccessible to others, while also exploring the importance of retaining those practices. I propose that if critical scholars must take seriously health promotion’s focus on knowledge translation (KT) to rethink their own forms of communication, they will need to find strategies for doing so without compromising key aspects of their work. Although KT is praised for its paradigm-shifting break from knowledge transfer, it still involves conceptualizing knowledge as a commodity to be packaged for application. Nonetheless, a creative engagement with KT may be possible. Drawing on Emily Apter’s complementary and contradictory theses – ‘Nothing is translatable’ (xi) and ‘Everything is translatable’ (xii) – I suggest a new direction for thinking through the impossible and imperative task of translating critical public health scholarship.     

Action oriented health education: a critical review of health campaigns in Denmark

This paper is a critical examination of and reflection about,the notion of action and its implications for modern healtheducation and its campaigns. Based on observations of Danishhealth campaigns, the paper aims to contribute to discussionsabout educational thinking and planning for health. In healtheducation it is important to examine whether contemporary healthcampaigns help or hinder progress towards the official goalfor Health Education in Danish schools, which is to developpupils' capability to act, to promote their own and others'health. In the Danish arena there is, however, much con fusion aboutthe concept of action. The lack of a viable, or generally accepteddefinition is mirrored both in health education in schools,and in nation-wide campaigns. The ward ‘action’isoften used in different ways, as a word meaning activity, abehaviour, habits or reasoned action. It is therefore a necessarypart of educational planning to consider the notion of actionand what it implies for the implementation of goals for healtheducation and health education campaigns.     

Well-being and consumer culture: a different kind of public health problem?

The concept of well-being is now of interest to many disciplines; as a consequence, it presents an increasingly complex and contested territory. We suggest that much current thinking about well-being can be summarized in terms of four main discourses: scientific, popular, critical and environmental. Exponents of the scientific discourse argue that subjective well-being is now static or declining in developed countries: a paradox for economists, as incomes have grown considerably. Psychological observations on the loss of subjective well-being have also entered popular awareness, in simplified form, and conceptions of well-being as happiness are now influencing contemporary political debate and policy-making. These views have not escaped criticism. Philosophers understand well-being as part of a flourishing human life, not just happiness. Some social theorists critique the export of specific cultural concepts of well-being as human universals. Others view well-being as a potentially divisive construct that may contribute to maintaining social inequalities. Environmentalists argue that socio-cultural patterns of over-consumption, within the neo-liberal economies of developed societies, present an impending ecological threat to individual, social and global well-being. As the four discourses carry different implications for action, we conclude by considering their varied utility and applicability for health promotion.     

Promoting critical thinking in health care: Phronesis and criticality

This paper explores the notion of ‘expert’ health care practitioner in the context of critical thinking and health care education where scientific rather than philosophical inquiry has been the dominant mode of thought. A number of factors have forced are appraisal in this respect: the challenge brought about by the identification of complex ethical issues in clinical situations; medicine's `solving' of many of the simple health problems; the recognition that uncertainty is a common and perhaps innate feature of clinical practice; debate about the concepts of illness and disease; plus insights from psychology,sociology and medical anthropology. Together these have prompted alternative ways of thinking which have the aim of identifying the best rather than the right decision (where best equates to good and right equates to correct in the sense of true or approved). It is argued that phronesis adds a necessary corrective dimension to modern Western medicine's over-emphasis on techne and is one of the factors that differentiates novice from expert practitioner. However, this attracts certain conflicts of interest: phronesis can only be gained and assessed from experience of praxis; agencies with legitimate interests in medicine such as government and professional registering bodies require more substantive criteria. This revised version was published online in July 2006 with corrections to the Cover Date.     

Medical schools viewed from a political perspective: how political skills can improve education leadership

OBJECTIVES: Political science offers a unique perspective from which to inform education leadership practice. This article views leadership in the health professions through the lens of political science research and offers suggestions for how theories derived from political science can be used to develop education leadership practice. POLITICAL SCIENCE RESEARCH: Political science is rarely used in the health professions education literature. This article illuminates how this discipline can generate a more nuanced understanding of leadership in health professions education by offering a terminology, a conceptual framework and insights derived from more than 80 years of empirical work. APPLICATION TO HEALTH PROFESSIONAL EDUCATION: Previous research supports the premise that successful leaders have a good understanding of political processes. Studies show current health professional education is characterised by the influence of interest groups. At the same time, the need for urgent reform of health professional education is evident. Terminology, concepts and analytical models from political science can be used to develop the political understanding of education leaders and to ultimately support the necessary changes. CONCLUSIONS: The analytical concepts of interest and power are applicable to current health professional education. The model presented - analysing the policy process - provides us with a tool to fine-tune our understanding of leadership challenges and hence to communicate, analyse and create strategies that allow health professional education to better meet tomorrow's challenges.     

Promoting vitality in health and physical education

Vitality draws together the interests of health and physical education. Already these fields of education have come together, with health, fitness, wellness, and active and healthy living as shared curricular concepts. Vitality furthers these conjunctions by having us rethink prevailing views of the body of knowledge in health and physical education. More than a concept, vitality is promoted phenomenologically in terms of the essential movements of the body. It is explicated as vitality affects, specifically identifiable motions and developmental patterns of movement that provide curricular structure for teaching health and physical education. The promotional implications of this analysis relate to enlivening the baseline criteria currently used in health and physical education assessments; revitalizing the curricular concepts of body awareness, space, time, and relationships on which provincial programs are based; and expanding the reach of these programs to mental, emotional, spiritual, and, particularly, environmental health.