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Why Teach Health? Excerpt from The ABE Curriculum Framework for Health,
Massachusetts Department of Education
1. Poor health interferes with the success of adult learners. Teachers have long been aware that the academic success of students relies heavily on their physical, emotional, and family health. Adult education teachers in particular have noted that many adult students miss school often due to personal or family illness so that they cannot make the academic gains they desire. In fact, many students in ABE (Adult Basic Education) and ESOL (English for Speakers of Other Languages) classes have extremely limited access to comprehensible health care information and affordable health care services. This is often due to low literacy or insufficient English language skills, and myriad social and economic circumstances. 2. Low literacy and poor health are interrelated in a number of ways. Adult educators’ observations are substantiated by numerous medical studies confirming that adults with less education experience more health problems than adults with higher education levels. For example, medical researchers have found that as less-educated adults age, they are more likely to be depressed than adults with more education (Journal of Health and Social Behavior, 2000). Another study indicates that less-educated individuals show more signs of physiological wear and tear than those who are more educated (Annals of Behavior Medicine, 2000). Research also indicates that people with lower literacy skills are likely to be under more stress, to have less self-confidence, and to feel more vulnerable than better-educated people. Another factor in the literacy and health connection is poverty. Poverty, low literacy, and health problems are interrelated in a number of ways. For example, many babies born into poor families have low birth weight, which increases their risk of developing health and learning problems. Literacy affects people’s access to decent jobs and thus to adequate incomes. Poverty affects people’s ability to access and use both literacy and health services. Adult educators report that many students are hindered in their learning by problems directly related to living in poverty, such as inadequate nutrition, substandard housing, lack of transportation, crime, unsupportive home lives, and affordable child care. Language and culture also affect access to health services and information. People with limited literacy skills in English have trouble reading and understanding health information unless it is clearly presented and linked to their realities (although even people with higher literacy skills articulate a need for personalized health information and communication). People with limited literacy tend to have less background health knowledge and vocabulary and therefore may not understand written or verbal information. They may not know about the services available to them, and may feel powerless and intimidated in relation to health professionals and institutions. 3. Health information and practical skills can be applied directly to adults’ lives and incorporated into daily decision-making. Learning skills, such as how to keep a personal health record, access community health services, and call 911, are not only empowering but also can make critical differences in everyday life. The power of this direct relevance to real life is evidenced in this true account:
In a landmark participatory action research study, Marcia Hohn (1998) documented adult students’ perceptions of health education. Students recognized that health topics facilitate and motivate literacy learning. One student reported that when she realized that what she said was more important than how perfectly she said it, she was “released” from the fear of speaking “not so perfect” English. Teachers reported an intense engagement in conversation about health topics that enhanced speaking, listening, reading, and writing activities. The classroom became an “open” space to talk about health, not only for the students but also for the teachers and other staff. 5. Students find ABE and ESOL programs to be good places to learn about health. ABE and ESOL programs, students said, provide a supportive environment to develop understanding of health information and time to relate the information to everyday life. Students preferred to choose which health areas to explore and perceived health broadly to include such issues as street safety, housing conditions, the stress of immigrant life, as well as diet, exercise, and prevention/early detection of disease. They reported enjoying a “learning together” approach with teachers and community educators that eases reliance on “expert knowledge.” Dr. Hohn also documented what students perceive to be the problems with health education among limited literacy individuals and groups. While ABE and ESOL students agreed that easy-to-read materials are essential, they said that there is too much reliance on written materials and that difficult materials are only the tip of the iceberg. Much more important is the provision of a psychologically safe environment in which to learn about health – an environment that also helps people connect health education with everyday life. Adult learners want to know: “What does this health information mean for me as an individual, for my family, friends, neighbors, co-workers, and people in my other social networks?” The opportunity to consider health information in the context of everyday life is critical, they said, as is a “safe” opportunity to ask questions.6. Adult educators are experienced in presenting content to limited literacy groups. ABE and ESOL students observed that too many community health educators do not understand how to work with limited literacy groups. Such health educators talk too fast, make too many assumptions about what people know, and use scientific jargon and statistics. Adult learners noted that limited literacy groups, especially those from other countries, cultures and traditions, may not understand concepts of prevention and early detection, and that they may not know that access to community health services is both a right and responsibility in the United States. Such groups may also fear discrimination in accessing community prevention, screening and health services, especially when they do not have health insurance (which is often the case) and/or may be limited in the English they speak. They feel afraid of how they will be treated and insecure about their rights and responsibilities. 7. Health content is a vehicle for student leadership development. But when given the opportunity to learn and teach about health issues they identified as important, these same students became outspoken and eloquent, designing and presenting workshops, skits, brochures, and community meetings. One woman (a Spanish-speaking GED student) exhilarated after teaching her first CPR class (in English!), announced, “I have never done anything like that in my life!” In addition, we have learned that we teachers do not have to be health experts to teach health. Indeed, our students can take on that role, dramatically changing the dynamics in the classroom. In contrast to preparing a student for a driving test where we teachers are presumably “expert” and our students “novices,” when it comes to health we are all “novices” and we are all “expert,” depending on the topic. For example, a student infected with HIV can demonstrate expertise and first-hand knowledge that not all health care professionals have. Teaching and learning about health is most effective as an interactive process in which all perspectives are valued and everyone in the classroom recognizes that they are learning together. When adult students and teachers engage with health issues in this equalizing process, they become serious advocates for themselves, their families, and their communities. Sharing health information has given scores of ABE students and teachers the confidence to address personal health situations, to participate in community health efforts, and to begin the process of taking control of their education and their lives. 8. Literacy and health goals have a better chance for success when pursued together. Partnerships between people working in the health and adult education fields have great potential for mutual benefit. From a health standpoint, literacy programs offer ways to reach people who are most often at risk. The adult literacy classroom is a safe place where health information can be shared, discussed, and analyzed. As members of families and communities, literacy learners can act as a channel for health promotion among low-income, immigrant, and minority populations. From a literacy point of view, health issues provide important content around which reading, writing, speaking and math skills can be learned and practiced. Because of their critical importance to adult students, these issues help provide motivation for learning basic skills. Through learning about health issues students develop skills and knowledge used in making everyday health choices for themselves and their families. While addressing health in the classroom offers tremendous benefit to teachers and students alike, health as a content area can also present unique problems. Because health issues can be intensely personal and private, health content
may elicit strong emotional reactions in both teachers and learners. While
some students and teachers might be ready and willing to investigate the
difficult issues of family violence, cancer, and sexually transmitted
diseases, others most certainly will not. Cultural differences can also
heighten the volatility of certain health discussions in the classroom.
These potential problems, however, should not deter anyone from addressing
health. When choosing or creating a health curriculum, teachers can take
guidance from the class itself. Focusing on those health issues that everyone
feels willing to address allows for many valuable educational experiences
that can improve the literacy, leadership, and life skills of learners.
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