Spiritual_Wellness_Holistic_Health_and_the_Practic

326 Philosophical Foundations of Health Education
reason for the high uninsured rates by ethnicity is affordability. The response most
often given by the majority of Caucasians and Latinos when asked why they are not
insured is that it was too expensive (Brown, 1996). In addition, despite the role that
Medicaid has played in improving access to care, minority children still have a poorer
quality of life than whites (Hall, 1998). Thus, improving access to health services will
require eliminating the gaps in insurance coverage that still persist for the one out of
four Americans who is either uninsured or underinsured.
Political Will
Unfortunately, the basic questions that characterized the debate on health - care reform
of the early 1990s have remained unanswered. Unlike the historical lack of understanding
about public health, Americans have recently raised questions about effectiveness,
efficiency, and cost of the health - care system. However, policy makers appear
to take their cues from other sources and may not have the political will to do what is
necessary to eliminate the disparities in health. Lee and Estes (1997) have argued that
the most powerful constituencies in health care continue to be physicians, hospitals,
insurance companies, and pharmaceutical industries. Although these groups appear to
be concerned about the quality of care, they are generally more interested in surviving
in the increasingly market - driven health care system than changing the system to make
it more responsive to the health needs of an increasingly diverse America
To make matters worse, although there is a consensus about the nature of the
problems in the health - care system, there is little agreement on what should be done to
correct them (Lee & Estes, 1997). At the federal and state level, prevention has
emerged as an important goal of health policy, yet prevention is still competing for a
more equitable share of national resources (Allegrante, 1999). Whether policy makers
will have the political will to shift resources from the investments that have historically
been made in medical care to creating the community capacity and other resources
necessary to eliminate the disparities in health status between poor and those who
have considerably greater economic means remains to be seen.
SOME EXAMPLES OF HEALTH EDUCATION ADVOCACY
Health educators have pioneered the use of advocacy to improve health and social
conditions. The role of political advocacy in shaping public policies that can influence
health can be found in the seminal writings of Freudenberg (1978), McKinlay (1993),
Minkler and Cox (1980), Steckler and Dawson (1982), Steckler, Dawson, Goodman,
and Epstein, (1987), and Wallerstein and Bernstein (1988). In addition, media advocacy,
which is designed to alter the way in which the media frames its coverage of
health issues and to provide a means by which a social or public policy initiative can
be advanced, has been conceptualized by Jernigan and Wright (1996) and Wallack
(1997; Wallack & Dortman, 1996). Below we review some examples of advocacy
from the health education literature.