14 World Health • SOth Year, No. 3, Moy-June 1997
Mutual benefit, mutual respect
Charles Deutsch
The unmatched store of knowledge and expertise in universities will be fully relevant to society when these institutions engage in a true partnership with communities and governments.
Photo Keystone/Camero Press ©
re colleges and universities, as institutions contributing to the public good, using their vast knowledge and expertise to improve the health and well-being of children and families? If we are to achieve dramatic improvements in health worldwide, we need to make better use of all of the resources at our disposal. That is why the theme of WHO's fourth International
Conference on Health Promotion, to be held in July this year, is "New Players for a New Era."
How can colleges and universities become more engaged partners with community, government and non- governmental organizations in the long-term drive towards health for all? In the United States, people put it like this: if American colleges and universities are so good at advancing knowledge and supporting intellec- tual talent, why do so many in the USA feel that conditions in their communities are getting worse?
With support from the Centers for
Disease Control and Prevention (CDC), Harvard University has organized a National Committee on Higher Education and the Health of Youth. Its goal is to support a na- tional network of post-secondary institutions (PSis) committed to partnerships that integrate interdisci- plinary research and teaching with community practice and policy- making in order to bring about a measurable improvement in the health of children and youth. Relatively few PSis as yet make community health improvement a priority in their work.
Most university administrators and faculty staff, like most people, hear the word "health" and think about illness, primarily in medical, physical and individual terms, so they consider only a handful of academic disciplines - such as medi- cine, nursing and public health - to be relevant to health improvement.
But health is largely behavioural, profoundly social, and has important
Colleges and universities need to become more engaged partners with their
neighbouring communities in the drive for health for all.
But these must be
partnerships based on mutual benefit and mutual respect
emotional, cognitive, moral and spiritual dimensions. While involv- ing the traditional health disciplines in community applications of their knowledge, we also need to define creative roles for all of the social sciences, for the arts and humanities, for business and law schools and, above all, for education. To moti- vate such diverse scholars and re- searchers, we have to put them into direct contact with the conditions under which children live. People in higher education understand in their minds that children are highly re- sponsive to new impressions, but we have to help them to experience it in their hearts, and to realize that they have something constructive to contribute.
Mutual benefit
Sustainable partnerships must be mutually beneficial. Colleges and universities have to recognize that they cannot be "ivory towers" be- cause they are too dependent on the society that creates them and on the
World Health • SOth Year, No. 3, Moy-June 1997
people, inside and outside their walls, who sustain them. Even private institutions participate in the public sphere, draw on public rev- enues, and therefore have public responsibilities. Moreover, it is apparent that PSis and communities will thrive or deteriorate together. In the United States, for example, many of the most prestigious universities are surrounded by communities of poor and powerless people. By walling themselves off from the community's pressing needs, PSis can only increase the tension and hostility that will inevitably make it harder for them to attract the faculty staff and students they seek.
Factories can relocate to friendlier environments; universities cannot.
Perhaps the most important but least obvious benefit that PSis will derive from these partnerships for health is that they will help them fulfil their mission of research and teaching. As the following example suggests, any number of crucial health-related research questions, and hands-on teaching experience, can bring together disciplines that now remain artificially separate.
Imagine that an intersectoral priority in a city or district is to increase the spacing of children in families. Now imagine that the nearby university is committed to applying its different role and disci- plines to achieving measurable change in this area. How can it help?
First, it can bring together scholars from different disciplines to help practitioners and policy-makers plan their approaches, based on previous research, sound theory and practical management considerations. Next, it can supply ongoing technical assis- tance to improve the community's measurement, assessment, evaluation and other quantitative procedures.
The university itself needs these real- world contexts in which students can best learn their skills.
The college provides pre-service and in-service training to those who work with children and families, including teachers, nurses, commu- nity health workers and many others.
Progress in family planning requires that these practitioners understand how men and women think about one
another. To advance that understand- ing, the PSI brings together the best ideas and methods from anthropol- ogy, sociology and psychology; religion and literature; biology and linguistics, journalism, law, public policy and public health. Can there be a better way to teach students about these disciplines than through their direct and integrated application to our most pressing social prob- lems?
Another role for higher education is to ensure that there is sound re- search behind the policy made in city, state, and national capitals. Too often scholars wait to be asked and pretend to stand above the political fray. They need to work together, in a planned and considered way, to build relationships with decision- makers based on mutual respect. By sponsoring balanced and thoughtful community forums on family plan- ning, for example, scholars can bring legitimacy, discipline and scientific accuracy to what can otherwise become inflammatory contests of will.
PSis can be the catalysts of new initiatives among government, pri- vate funders and communities. An institution determined to produce tangible community outcomes would design its internships with rigorous supervision, clear objectives and a time frame that allows the comple- tion of a measurable objective. In sum, the university acts as an entity, encouraging, coordinating and re- warding faculty staff and students who participate in achieving specific and measurable community goals.
One obstacle to be overcome when post-secondary institutions engage in these partnerships is that many faculty members are used to traditional and unequal relationships between teacher and student. They have much to learn from mothers, young people, village elders and other non-professionals, and will need to show a degree of respect when they work with communities.
For that matter, community members have their own learning to do if they are not to feel merely intimidated or irritated by these learned men and women. The university is not going to "save" or even "help" the commu-
IS
nity; it is engaged in a partnership of
mutual benefit and mutual respect.
Ideally, we must begin with prestigious scholars, scientists and educators who are already convinced that academia should play this en- gaged role. And we need to gather evidence that partnerships for health are indeed mutually beneficial, and disseminate that evidence so as to enlarge the circle of engagement.
Eventually there will be a new way to measure a good university: not by the number of articles and books its faculty publish for other scholars, but by the improvements in commu- nity life that result from applying what we know to what we do. •
Dr Charles Deutsch is Senior Program Associate, Harvard Pro;ecf on Schooling and Children, Harvard School of Public Health,
14 Stary Street, Second Floor, Cambridge, MA 02138, USA
Health-Promoting Universities
Over the past 2-3 years a number of Universities in the UK and elsewhere in Europe have been experimenting with the settings-based approach to health promotion, with the aim of further developing the contribution that universities can make to health.
Last year, Lancaster University, one of the first universities to set up a Health- Promoting University Project, hosted a conference in collaboration with WHO which discussed the theory and practice of the settings' concept in universities along with examples of practical developments to dote.
As a result of the interest and enthusiasm expressed at the conference, a proposal was made to further develop and 'package' the health-promoting university idea and to launch a network of Health-Promoting Universities.
WHO, under the Healthy Cities umbrella, and in cooperation with Lancaster University and the UK National Health Service Executive (NHSE) North West Regional Office, is at present providing leadership and technical support in preparation for launching the network. A book on Health-Promoting Universities will be published in Autumn 1997 and a first business meeting is being arranged for later in the year.
For further informolion, please contoct Dr Agis Tsouros, WHO Regional Office for Europe, 8 Scherfigsve;, 2 I 00 Copenhagen 0, Denmark. Tel: 0045 39 171 509,
Fox: 0045 39 171 860; e-moil: ots@who.dk
