Big-Picture Health Information (for PTPH pattern language)

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Jenny Epstein

Health information cannot focus solely on individual change. Many detriments to health cannot be eradicated without changes to the physical and social world that people inhabit. If environmental and social changes are necessary to get well, individual patients cannot do so solely by seeking health care and avoiding health risks. Expert medical information and advice is inadequate to create a healthy environment that in turn creates healthy people.


Poor people bear a disproportionate burden of global ill-health, such as diabetes, malaria, HIV/AIDS and TB. Health discrepancies between rich and poor will not be solved through better access to information alone. Good food, less stress, clean air and water, and a life with a purpose will increase health and healthy behaviors. Real change to improve health comes from a shift away from acknowledging only expert clinical opinion and toward a real-world awareness of the effect of environment on health: a shift from passive diagnosis and treatment to active engagement with the causes of and solutions to health problems.


We are not, for the most part, born unhealthy. We become unhealthy. And even for those born unhealthy, a great deal of ill health may have been preventable. The campaign to find the cure for breast cancer is a good example of health information that neglects any causal connection between ill-health and the environment (in this instance, an environment which includes the use of estrogen in prescription medication), and ignores political or social change that might address environmental causes of the disease. This pattern of information, in which action comes only after the individual becomes ill but nothing has been done to prevent illness in first place, focuses on individual responsibility with no questioning of the established social order. The unspoken message is that breast cancer just happens. It is up to the individual to get involved with a screening program for early detection and treatment. Information on research that investigates environmental effects to the development of breast cancer is not part of mainstream health information.

Public health information about diabetes further illustrates the lack of emphasis on the connection between environment and health. Among Native Americans, diabetes (like most other non-infectious chronic diseases) was virtually unknown before World War II. Now, in some tribes, over 60% of adults have diabetes and the age of onset is decreasing with each generation. Much of the research on diabetes among Native Americans focuses on genetic causes or on molecular level differentiations of diabetic types. It gives short shrift to how the disruption in traditional diet and life style and the devaluation of traditional medicine correspond with the dramatic increase in the disease. The connection of indigenous people to the environment that they come from, the types of foods they eat, and activities they perform to prepare those foods are not considered an active component in their health. Diabetic health information focuses on what the individual can do to access mainstream diets and medicine. It does not validate traditional knowledge that prevented diabetes in the past, and ignores how the community as a whole can work together to recreate that knowledge. This does not mean trying to reestablish life as it was 60 years ago, but it does mean putting the current problem in a holistic context that includes history, indigenous knowledge, the interaction between diet and environment, and reasons for lack of access even to non-traditional healthy food.

In 1854, John Snow removed the handle from a London neighborhood water pump that was located a few feet from a sewer ("John Snow Pub," 2006). He believed that this sewage was causing the epidemic of cholera deaths in the neighborhood. Epidemiology textbooks emphasize Snow's connection of cause and effect as the first public health intervention of the modern era. They ignore an analysis of cause: industrialization and dislocation, poverty, over-crowding etc. What options for water did people in the neighborhood have without the pump? Seldom mentioned is that, due to the demand of a thirsty public, the handle was replaced six weeks after its removal.

Public health programs must include methods to share power with communities they hope to help. What are the contributors to ill health in their communities? What are the barriers to good health that the communities identify? Information needs to realistically address what is within the control of the individual and what will take groups of people working together to solve. Methods to improve health in disadvantaged communities must reflect the larger social change and shift in power needed.

Health information such as Fast Food Nation (Schlosser, 2002) needs to be the norm, not the exception. This book chronicles the entire environment that produces fast food, including social norms and values. Similarly, the documentary film “Life and Debt” ( shows the destruction of healthy, local food production in Jamaica by the combination of multinational food businesses and international government policy.

Health information needs to do more than simply inform. What does not question the present state of affairs will not, for example, bring affordable nutritious food to poor neighborhoods. Nor will it create safe neighborhoods in areas where children cannot exercise. Better access to information may improve health care decisions to some extent; unless it also generates momentum and optimism for social change then it simply perpetuates a focus on individual behavior and treatment of symptoms that have already occurred. Health information needs to look honestly at the conditions that cause ill health, and engage not only those who suffer illness but the entire social and regulatory apparatus that can play a role in improving the conditions that people live in.


Demand and produce health information that identifies environmental and social causes of ill-health. Analyze the interconnection between these causes and their solutions, and bring individuals, communities and governments together in putting the solutions into effect. If the struggle with disease becomes a struggle with established power, you may be on the right track.

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