Spiritual_Wellness_Holistic_Health_and_the_Practic

140 Philosophical Foundations of Health Education
healthy. Yes, I knew about health insurance. I had my own insurance for me and my
family. But as a professional, I was not involved with treating youths or providing any
type of mental health or substance abuse counseling services that required fee collection
or health insurance reimbursements. I was busy enough just trying to figure out
how to fund projects to develop school health curricula and community health education
programs designed to prevent substance abuse and promote mental health among
teenagers. I often argued that money should be taken from treatment services to fund
prevention programs.
It was as if, in my mind, a schism existed between prevention and treatment,
between health education and health care — to some degree between health and medicine.
Even if I was willing to accept that having such limited vision was not helpful
and perhaps even harmful, I surely did not need to know how health insurance
worked — especially in the current case of behavioral health, which had promulgated
its own idiosyncratic jargon and terms. “ Risk sharing, ” “ gatekeeping, ” “ utilization
management, ” “ contracts for administrative services, ” “ full risk contracts, ” “ carve -
outs, ” and “ product lines ” are examples of such terms and jargon that seemed very far
from the reality of most health educators, including myself.
At some point I changed my mind about wanting to know more about behavioral
health: what the term meant, what it was. As a health educator, I began to see changes
in the health arena, medicine, and public health that forced me as a stakeholder to
reexamine health educators ’ present and future roles. Somehow the line was blurring
between medicine and public health. The schism in my mind was closing. I found
myself agreeing with the Committee on Medicine and Public Health (Lasker, 1997),
which concluded that an imperative exists to address the health needs of people from
a collaborative paradigm with two distinct perspectives: one looking out for the
health needs of individual patients, the other committed to improving the health of
the entire population. The fact is, health educators already span the medicine and
public health sectors. Health educators work in clinical care, with its focus on individual
patients — diagnosing symptoms, preventing and treating disease, providing
comfort, relieving pain and suffering, and enhancing the capacity to function. Health
educators work in public health, with its focus on populations — assessing and monitoring
health behaviors, designing, implementing, and evaluating programs. Health
educators also work across multiple areas such as public, private, and volunteer sectors
of the economy. Health educators work in the public sector in schools and health
departments, voluntary sectors in community agencies and national organizations,
and increasingly, health educators can be found in the private sector in businesses and
consulting.
Working in public health, clinical care, and other sectors of the economy, health
educators stand at the intersection of many very different arenas. Each arena operates
on different principles (Morone, Kilbreth, & Langwell, 2000). Each has its own
assumptions, rules, actors, funding sources, policy debates, and patterns of power. For
example, public health runs on federal and state funds guided by federal and state rules.
The chain of command runs through the state capitol. Public education, in contrast,