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James
Historically and currently, many health educators misunderstand the definition and meaning of inductive and deductive reasoning, and these inaccurate interpretations are often used to incorrectly distinguish quantitative and qualitative methods. Deduction is typically defined as reasoning from the general to the specific, and induction is typically defined as reasoning from the specific to the general. Contemporary definitions of deductive and inductive reasoning differ from the more typical but antiquated definitions of these terms. Deductive reasoning is defined by contemporary philosophers as an argument in which a person intends to position premises that guarantee a conclusion. In inductive reasoning, on the other hand, a person intends to conditionally or probabilistically accept the conclusion based on the strength of the premises (The Internet Encyclopedia of Philosophy, 2007). The distinction between historical and contemporary definitions of deduction and induction has a meaningful impact on health education and the quantitative and qualitative methods divide.
Health educators often align quantitative research with deductive reasoning and qualitative research with inductive reasoning. Based purely on contemporary definitions of deduction and induction, however, qualitative research does not necessarily use inductive reasoning, and quantitative research does not necessarily use deductive reasoning. The type of reasoning depends on the intent of the researcher, not on the type of research methods. Furthermore, the type of reasoning is set a priori and should not be changed later. Well supported inductive reasoning does not shift in reasoning type from induction to deduction, and a poorly constructed deductive argument does not change to an inductive argument post hoc.
Health educators should also recognize that the history and definition of induction and deduction largely falls under the philosophy of science and that science has preferred the hypothetic-deductive method for approaching 100 years. However , people develop and maintain their values through scientific methods as well as several other modes of valuing and that: 1) the majority of people in the United States and the world are not scientifically literate, and 2) most people do not use science or reason as their primary mode to understand the natural world.
In contemporary literature, a quadrant of types of or models to research that included exploratory-qualitative, exploratory-quantitative, confirmatory-qualitative, and confirmatory-quantitative research has been positioned. In further bridging the quantitative and qualitative divide, an additional level can and should be added to the quadrant scheme. In the revised categorization of research, types of or approaches to research include: inductive-exploratory-qualitative, inductive-exploratory-quantitative, inductive-confirmatory-qualitative, inductive-confirmatory-quantitative, deductive-exploratory-qualitative, deductive-exploratory-quantitative, deductive-confirmatory-qualitative, and deductive-confirmatory-quantitative research (see Table 1 for description).
In health education, researchers often use statistics or qualitative analyses to describe data, summarize data, or draw inferences from collected data. Due to the probability, biases, fallibility, and/or errors in these research methods and the researchers using these methods, it is very likely that the conclusions of deductive arguments within health education are unfounded or at least overstated. Health educators should base their arguments on inductive reasoning in which conclusions are conditionally or stochastically accepted or declined based on the strength of argument, not on the guaranteed conclusions of deductive reasoning. The use of inductive reasoning in both quantitative and qualitative research adds to the trustworthiness, utility, and soundness of health educators’ arguments. By positioning deductive arguments, health educators often extend beyond the truth of their premises and/or the validity of the argument, and as a result, conclusions and recommendations are sometimes overstated and arguments unsound.
The phenomenon of positioning invalid, untrue, or unsound deductive arguments is common among people. Moreover, Albert Ellis positioned that exaggerated conclusions were the foundation of mental health problems. People often argue, especially regarding emotion-laden or ego-focused topics, as if their under-supported premises and invalid argument structures must support exaggerated conclusions. More often than not, regardless of emotional state, however, the support for deductive arguments is less than adequate in the complexity of the naturalistic social environment. Due to either-or thinking and confirmation bias, people often attempt to understand and control the complexity of the natural world through unsupported or under-supported arguments in which the premises, conclusions, and their interconnections are over simplified. The human tendency to use heurisitics is well documented in the economic and psychological literature (e.g., Kahneman & Tversky). Health educators should recognize this tendency in people in general and health educators in particular. Given that the true distinction between deduction and induction is based on the intention of the person arguing and not necessarily the qualities of the argument itself, unjustified deductive arguments in which premises actually do not guarantee the conclusions in the natural world have contributed to much human suffering or to borrow Daniel Leviton’s term– horrendous death. Deduction is based on guarantees that are typically undersupported in naturalistic research designs. Inductive reasoning leaves more room for discussion of premises and conclusions as well as plurality. Through induction one increases the discussion evidentiary truths and avoids oversimplifying the complexity of many public health programs. Whereas deductive works within a dichotomous perspective of black and white, yes or no, or right or wrong, induction works within a continuum thereby leaving room for discussion for a greater breadth and depth of discussion of complexity and variability.
Table 1. Describing eight distinct categories of research approaches.
1) inductive-exploratory-qualitative Using qualitative methods in data collection and analysis, a researcher engages in a process of discovery without an a priori argument structure and believes that the emerging conclusion is not guaranteed to be true but interprets truth or trustworthiness based on evidentiary support of probabilistic premises.
2) inductive-exploratory-quantitative Using quantitative methods in data collection and analysis, a researcher engages in a process of discovery without an a priori argument structure and believes that the emerging conclusion is not guaranteed to be true but interprets truth or trustworthiness based on evidentiary support of probabilistic premises.
3) inductive-confirmatory-qualitative Using qualitative methods in data collection and analysis, a researcher engages in a process of discovery with an a priori argument structure and believes that the pre-determined conclusion is not guaranteed to be true but interprets truth or trustworthiness based on evidentiary support of probabilistic premises.
4) inductive-confirmatory-quantitative Using quantitative methods in data collection and analysis, a researcher engages in a process of discovery with an a priori argument structure and believes that the pre-determined conclusion is not guaranteed to be true but interprets truth or trustworthiness based on evidentiary support of probabilistic premises.
5) deductive-exploratory-qualitative Using qualitative methods in data collection and analysis, a researcher engages in a process of discovery without an a priori argument structure and believes that the emerging conclusion is guaranteed to be true based on deterministic premises.
6) deductive-exploratory-quantitative Using quantitative methods in data collection and analysis, a researcher engages in a process of discovery without an a priori argument structure and believes that the emerging conclusion is guaranteed to be true based on deterministic premises.
7) deductive-confirmatory-qualitative Using qualitative methods in data collection and analysis, a researcher engages in a process of discovery with an a priori argument structure and believes that the pre-determined conclusion is guaranteed to be true based on deterministic premises.
8 ) deductive-confirmatory-quantitative Using quantitative methods in data collection and analysis, a researcher engages in a process of discovery with an a priori argument structure and believes that the pre-determined conclusion is guaranteed to be true based on deterministic premises.
The Establishment Clause and Free Exercise Clause make it clear, at least to anyone with some semblance of common sense, that no law can be established that supports any State religion or one preference for one religion over another and that people have the right to practice their religion or lack thereof outside of the context of the State (government). Obviously, the amendment is violated on a regular basis: for example, prayer beginning Congressional sessions or the 10 commandments inside or outside of a court room. People have positioned many unsound arguments to justify these violations in order to preserve their own interests with little to no empathy for the diversity within the United States. The First Amendment included the two clauses to ensure freedom of religion and to avoid theocracy, which has a long and bloody history. The United States is one of, if not the most, religious developed countries, which is an expression of the Free Exercise Clause. However, people often seem to make the fallacious leap to position that the popularity of religion negates the Establishment Clause, which it does not. In the same way the Establishment Clause does not override the Free Exercise Clause, the Free Exercise Clause does not negate the Establishment Clause.
I try to avoid the propaganda machine known as the mass media, which atrophies the human brain, as much as possible. A good simile for the current popular thought processes in America is depicted in a movie titled Idiocracy. The first 5 to 10 minutes of the movie extrapolates from current popular culture into the future. As a forewarning, do not watch the movie beyond the first 10 minutes because the remainder of the movie is one of the worst movies ever made. Critical thought and inference are lost on the majority of Americans; look at the response to 9/11 and the initiation/maintenance of the Iraq War. People become hysterical and get caught up in the madness of crowds and make poor and unthoughtful decisions. Similarly, many current popular culture positions on sexual freedom, such as gay and lesbian marriages, absolutely attempt to further reify religion as part of what was intended to be a secular government. The depth of the arguments related to sexual freedom have an even less thinly veiled religious intent than promotion of Intelligent Design, which is quite the accomplishment.
Despite being raised in religious contexts, the morality within religions has never impressed me, especially religions based on monotheism. In most cases of religion in the United States people learn that they should go to a place of worship and be told what to think by an authority figure. This seems to carryover to some degree to other aspects of the cultural climate. When challenged, people can rarely justify their conclusions with sound argument. They typically simply reference some superficial soundbite that they heard on radio or television. Given the lack of depth of thought, developing empathy toward others, a fairly sopisticated task that takes alot of practice, is unlikely for many people. Without empathy for others, people tend to overly simplify the world. For example, “I do X, therefore everyone should do X.” Some respond to this statement by saying that I am following the same position, but I disagree. I believe my stance could be summed in the following statement “I believe X because of Y, and X serves a socially greater good for Z.” My position is less self-centered. I believe that people should practice their religion or irrlegion, while attempting to understand how their position influences them and others. For example, oppressing one group simply so I feel better is immoral to me. For example, others state “I believe in heterosexual marriage only, and other types of relationship make me uncomfortable.” I would say that “all relationships between consenting adults are of equal value, if we value all people equally.” The first position inherently does not give the same value to all people, which is problematic. What happens if I stated that “I believe in all types of relationships except heterosexual marriage because many people have been abused in this type of relationship and most heterosexual marriages end in divorce.” I have tried this social experiment in discussions with some “traditional family values” people, and their responses are interesting. I have heard anything from, “I just disagree” to “what is next marrying animals” as responses. Notice the later response evinces the devaluing and dehumanizing of other human beings. The First Amendment was set up, in part, to protect people from religious tyranny. The current devaluing of personhood by many “moralists” stands as an atrociously immoral act that is neither supported by the First Amendment, decency, empathy, dignity, nor common sense.
Although great amounts of discussion has taken place regarding having versus being, I believe that the arguments should be placed on multiple continua as opposed to a singular dichotomy. What are the proposed continua? I believe that three nonorthogonal dimensions capture much of the discussion: 1) social cohesiveness, 2) individualism/collectivism, and 3) objectification. The having orientation consistently includes the concepts of alienation and human disconnectedness. In order to progress toward being, a person must become familiar with oneself as well as the social environment. Without empathy for oneself and others, one fixates solely on having objects. With a connection only to nonhuman objects, a person neglects important dimensions of objects. In this case, basic salient features dominate perceptions. Social cohesiveness is a basic need of people– similar to food and shelter. As with other unmet basic needs, people tend to use lower level cognitive processes in decision making. Having is a good survival technique. However, the strategy may go too far if it becomes an ingrained response pattern. Having therefore becomes a more dominate feature of a person’s worldview. Collectivism versus individualism is another related factor. Those coming from an individualist perspective tend to be aligned with having, at least in philosophical discussions, and collectivists with being. This is obviously related to social cohesiveness. From a counter perspective, one may state that individualism is the only path to self-actualization, which may be true if people were not inherently social animals with a evolutionary history of collectivism. It is only in developed contemporary societies that mass individualism has been enabled. For the most part people do not have to collaborate little to collect the items for living. For example, most people do not grow their own food. At first glance and due to its common place in developed Westernized cultures, individualism seems to be reasonable because enables having many objects and an delusion of being. An individual must be placed in some sort of collectivism in order to approach being. Some people perceive having as objectification. I will make the naive assumption that human beings do not perceive everything in world as objects. It is impossible to define being in practice as a lack of objectification. The issue again is that having tends to perceive objects in a more simplistic way. In part because having in contemporary societies elicits emotions due to its judging perspective, and emotions shifts decision making to more default cognitive biases. A person only distantly knows where he or she is in the social hierarchy due to the accumulation of objects, but one is at the same time disconnected from many social experiences. In being, one values perceiving more than judging and can therefore tap into higher cognition processes (approach a more rational state even in one’s perspective of emotions). Being integrates emotions and cognitive processes, whereas having places them at a greater distance. To be continued.
Philosophers and theologians have discussed the topics of having and being for centuries. Two frameworks have greatly influenced my thoughts on these topics: the sociocultural psychological perspective of Erich Fromm and E-Prime of General Semantics. Drawing upon cultural and theological perspectives, Fromm positioned that mentally well people avoid a having perspective and concentrate on being. Having is a fairly simple construct to define and exemplify. For example, a person who describes and judges one’s existence based on possessed or desired objects approaches the world from a having perspective. Defining and exemplifying being is a much more difficult task. Fromm tended to use theological or past cultures as examples of the being model. Fromm’s arguments for being tended to extend beyond the human reality and into an idealization of certain groups of people. It seems inherent in the human condition that having is inevitable. Fromm recognized this point by stating that having in an existential sense was reasonable whereas anything beyond existential having was an unhealthy having perspective. Existential having, in this case, meant having knowledge, skills, or objects that met basic needs and enabled life. The threshold of crossing over into unhealthy having was unclear and seemingly arbitrary. Achieving being was in large part defined by decreasing the fixation on having superfluous knowledge, skills, objects, etc. Fromm, who was heavily influenced by religion, implied or declared that the having orientation was similar to sinning: e.g., greed, envy, gluttony.
The proponents of E-Prime proposed to eliminate all forms of the word to be (e.g., be, is, are, was, and were) in order to better identify the subject of an action. For example, instead saying that “My friend is happy with her new job” one should say that “My friend Sally seemed happy with her new job when I spoke with her on Saturday.” Some experts have commented that the assumptions of E-Prime are too strict (e.g., eliminating all forms of to be instead simply reducing them). Or stating the last sentence in E-Prime, some experts believe that the strict assumptions within the E-Prime language framework do not allow for effective communication in all cases. E-Prime would therefore counter Fromm’s position in that the use of “have-s” is better than the use of “be-s.”
The common ground of the Fromm and E-Prime perspective is that actor identity is an important part of defining and guiding human experience. Fromm would suggest that it is unhealthy to use an object, such as a car, define his or her personhood. E-Prime explains that a person should perceive himself or herself as an active participant in one’s experiences. From my perspective, reducing the use of have and be as well as associated words would enable people to better express and potentially understand their position in the human experience. For example, stating that I purchased a car for the use of decreasing travel time from place to place stands a more accurate description of the relationship between a person and object than sentences such as I have a car or I am a car owner. The latter statements overly simplify the relationship between an object and a person and lead to exaggerating the importance of an object in defining identity. People, such as myself, however, use have or be words often, in large part because these words make communication quicker and socially acceptable though likely less accurate. For example, if a person asks you describe yourself, how often do you start with something like: “I am a health educator. I have an appointment within the university. I have several publications. I am grant funded so I rarely have free time. etc.”
I think that the issue of having and being is driven in large part by defining the variability in our lives and in this process, we focus on controllable and socially acceptable portions of that variability to define ourselves. We tend not describe ourselves from the perspective of constants or uncontrollable factors. For example, I would not answer the query above by starting with: “Extensive reading supports that experts categorize me as part of the human species. People call me James. etc.” People would perceive you as eccentric at best and insane at worst. However, a moderate position does exist, though the boundaries are fuzzy, which is the same flaw that Fromm could not eliminate. If one starts with the premise that personhood begins the definition of being, then it is absurd for me to state that “I am a health educator.” The problem with this statement is that I am defining my personhood by my employment status and position. From a having perspective, if I make the statement of “I have a job as a health educator,” this statement places oneself in a precarious position. Without appropriate implicit or explicit qualifiers that express that the job is an object that cannot be possessed in its totality and that the construct of job is transient from a global perspective, one leaves oneself to losing a totality of a thing (i.e, a job) that one never truly possessed.
Karl Mark discussed the perceived experiences of the haves and the have nots and believed that quality of being could be altered by what a person had. Marx proposed an association that went beyond the mutually exclusive positions of E-Prime and Fromm. There is some truth to Marx’s perspective; social determinants of health research findings support that the absence of absolute or relative resources leads to having health disparities in different contexts, though these resources do not seem to consistently influence perceived quality of life. However, do shifts in distribution of external objects alter being? It is hard to say because operationalizing having is much easier than identifying being as an object or construct. The closest measure to being as a process and/or an outcome, currently used by social scientists, is quality of life. The proposed measure of being, quality of life, is much more unreliable and therefore less valid measure than the measure of having better or worse health. Additionally, the correlates of quality of life and health differ. Some variables improve health but not quality of life and vice versa. The result of this argument for health educators is the recognition that trade offs between having and being will likely occur and, as a result, they may need to diminish being in order to increase the having of health and vice versa.
Health education research and practice has historically focused on individual differences. For example, altering attitudes to changes individuals behaviors. This enables one to better understand influences on behavior at a controlled micro level. However, the individual difference model tends to neglect meso and macro level influences. This neglect could lead to false conclusions. For example, the obesity epidemic appears to have less to do with individual differences and more to do with societal differences (a cultural shift instead of individual change). Of course, individuals make up groups. However, an unbalanced focus on the micro level differences tends to miss important social changes. For example, changing a person self-efficacy at the micro level is meaningless if shifts in the meso and/or macro levels are actually responsible for disparities in health. Essentially, this is the difference between individual health and public health. Changing individual factors, such as self-efficacy, is meaningless if the root issues of behavior are social disparities. It is similar to a question that I often posit to psychologists who discuss increases in depression in a sample of people. Clinical psychologists, often see these changes as shifts in individuals that could and should be changed via individual therapy and/or medication. I ask “Are the shifts in depression not a problem of the individuals, but an accurate reaction of these individuals to alterations of the social environment?” In response, I am often looked at as if I was an alien stepping off a spaceship. After all, clinical psychologists rarely if ever attempt to resolve social difference but instead focus on individual difference.
One can also find examples of the importance of group differences in current hot topic of obesity as mentioned previously. It is highly unlikely that Americans woke up one day and changed their genetics or desire for sustenance; an individual difference model. The more likely explanation is that group differences were driven by changes in the social or physical environment. From an individual difference model, a genetics argument may be salient to some people; the genetics model should receive special attention, not only due its dangers (e.g., eugenics movements) but also due to its increase in popularity. Genetics are obviously hereditable and some traits are more hereditable than others. Some may look at obesity as a genetic problem, which it is obviously not; genetics do not shift as rapidly as the changes in obesity. If we altered genes of all people to a thinner predisposition, disparities would still occur as a result of social and environmental differences. Furthermore, obesity is a more objective measure than depression. If we altered genes to rid depression predispositions, it would be irrelevant because interpretations of depression are subjective and relative to context and human judgment. We would likely still have a similar amount of depressed people, due to the relativity of human judgment and the alterations of standards. Social and environmental factors would drive these disparities. Social and environmental disparities are currently better explanations of health disparities than individual differences. Without increasing the attention health educators dedicate to social and environmental disparities, health educators will likely miss the origin of health disparities thereby resulting ineffective and inefficient programming. As a side note in closing, the group differences model has also in part been neglected due to the taboo of using aggregate as opposed to individual level data; a legacy of the ecological fallacy. This is another important issue to address at a different time. The issue being the impact of research influencing research questions. Research methods place limitations on the value of addressing research questions and the perspective from which one addresses research questions.
I have lived in pro-NRA and anti-NRA cultures, and discussions of the firearm control and the Second Amendment have interested me across time. People have come up with elaborate arguments to support their position, and the Supreme Court has positioned even more sophisticated opinions on the topic of the Second Amendment. I try to follow reason and common sense in my decision making, and many of the firearm arguments seem to neglect the original statement of the Second Amendment.
The amendment reads as follows:
“A well regulated Militia, being necessary to the security of a free State, the right of the people to keep and bear Arms, shall not be infringed.”
Many people focus on the third and fourth phrases while neglecting the first and second. John R. Bolton presented us with an example of this form of convenient neglect.
“Just as the First and Fourth Amendment secure individual rights of speech and security respectively, the Second Amendment protects an individual right to keep and bear arms. This view of the text comports with the all but unanimous understanding of the Founding Fathers.”
This is an example of logical fallacy and neglect of premises. Neither the First nor Fourth Amendments include the limitations of a well regulated militia. The purpose of the Second Amendment is to secure a free State not a free person; this a collective, not an individual purpose. The segmenting limitation on action is the well regulated Militia phrase. Note that Militia is capitalized further highlighting the formal nature of this collective and limited right. The mechanism for securing freedom of the State via Militia is the uninfringed right to keep and bear arms. It does not follow that people necessarily can or should keep firearms in their homes. Firearms could be kept in a secure centralized building, as an example, for the purpose of accessing the firearms to bear for specified actions that protect the State. As a collective and regulated right with a clear purpose, the idea that the Second Amendment was established to ensure people’s right to individually own firearms for the purpose of hunting, protection from burglars, etc. are unsound, based strictly on the language of the Second Amendment. Human cognitive processes, however, can with limited effort alter a statement to better suit one’s interests and needs. The cognitive warping of statements based on biased perceptions does not change the true meaning of a statement, however; it only succeeds in generating a perceptual false truth of the perceiver(s). False truths rely on social agreements that extend beyond reality of statements. Social agreements can alter reality under the guise of interpretive freedom. Interpretive freedom is widely accepted in post-modern culture, and it has benefits as well as costs. The ability to argue beyond stated rules of an authority, which cannot or should not be questioned, is beneficial. However, interpretive freedom can extend beyond sound reason and justification into individual of collective delusions with relative ease. For example, arguing over the utility of the Second Amendment is different than arguing over its accuracy. The accurate interpretation is quite clear, as describe previously. However, arguments over utility and accuracy are currently blurred. It may be functional or dysfunctional in contemporary culture to follow the language of the Second Amendment. The way to address this issue of utility is not to promote inaccurate interpretations through ridiculous social agreements set to support false truths. The Second Amendment should be amended itself to reflect a current reality or should be followed as written. If followed as written, then substantial limitations should be implemented with regard to firearms in the United States. If the current status quo is to be reified, then another Amendment must be passed. Unsound interpretations lead to unsound actions in large part due to the fact that there is no reasonable anchor to limit arguments or statements. When no limitations are placed on the interpretation of language, then language loses meaning. When language loses meaning by itself and simply acts as a starting point for idiosyncratic interpretations that are only as strong as social support for these interpretations, Amendments are no longer universal laws but tyranny of the most powerful social group. This should frighten anyone interested in freedom because Amendments, in this case, only protect the most powerful groups in society. People cannot, as a result, argue over the soundness of an Amendment but must argue over the soundness or right of socially powerful groups pushing a fluid and flexible agenda that suits the needs of a group, typically a powerful minority, over society as a whole, a dangerous position. The rule of Law becomes the rule of the powerful, which runs contrary to the intent of the Bill of Rights.
Human beings are by default predictably irrational animals. A couple examples of this tendency are the 700 mile border wall between the United States and Mexico and the Iraq War. It is clear that the United States government currently does not follow anything resembling a sound business model and that a large segment of politicians display narcissistic and/or sociopathic characteristics. With these qualities in mind, politicians inevitably make ridiculous decisions; at least from the perspective of reasoned people who value empathy, insight, rationality, reason, and common sense. The question addressed in this commentary is: “What is more ridiculous the United States border wall or the war in Iraq?” At first glance, this question may be perceived as tactless and callous by some people. I believe, in opposition, that not addressing such questions is self-serving, unexamined, and amoral. In addressing this question, I distinguish the analysis on four dimensions: utility, accuracy, propriety, and feasibility. In comparing processes and outcomes, the Iraq was has greater utility but less accuracy, propriety, and feasibility. The Iraq war shows greater utility because it has a possibility, though still improbable, of establishing a sovereign and democrat Iraq, whereas the border wall will have little to no influence on illegal immigration. The border wall is a farce and distraction. Fences have previously been established on the Mexican border, and they have been ineffective. Human creativity, especially when addressing basic needs, will always overcome something as simple as a wall in contemporary culture. The Great Wall of China was constructed about 2,200 years ago and protected China from invaders for about 1,800 years. However, this wall was longer (4,000 compared to 700 miles), 2 to 3 times higher, made of different materials (stone instead of wire and wood), and dozens of times thicker than the United States wall. The bigger problem of the United States wall, really a fence, is that it is now 2008 (not 200 B.C.), and technology has advance exponentially across the last 100 years. As a result of ridiculous premises, the United States wall will serve no function other than a symbolic function. This symbolic function does not fit well with the current world climate. We now have an interconnected network of nations, and the insular position of the United States does nothing but further hurt our reputation on the world stage.
The accuracy of the United States wall plan is greater than the Iraq war. The border wall is simplistic and therefore easier to accurately implement than the Iraq war. The Iraq war is less ethical than the United States wall in that thousands of people have been killed or injured for a cause of questionable utility, accuracy, and feasibility. As a result of the United States wall a handful of people will die and dozens will be injured, but this does not in anyway compare to the Iraq atrocity. To put the Iraq war into context, given that all judgments are relative, let’s think of drug company accountability. If a pharmaceutical is put on the market and many thousands of people are prescribed and take the drug as directed and half a dozen deaths are attributed to the drug, there is public outrage, despite the drugs displaying evidence of benefits prior to distribution. There is relatively little outrage in popular culture over the Iraq war, which has less social benefits and more social costs than any recent drug company scandal. With regard to horrendous death, there is no greater atrocity in United States popular culture than the Iraq war. This is not to say that this is the greatest atrocity in the United States with regard to domestic preventable death. For example, young black males dieing as a result of firearm violence, similar to an urban civil war, is likely as great of an atrocity as the Iraq war, but this and other domestic atrocities receive very little attention in popular culture. With regard to feasibility, the United States wall is a more feasible initiative than the Iraq war in large part due to the relative simplicity and tangibility of the project. In addition, the social and cultural components of the United States war are more easily addressed than those in the Iraq war. In conclusion, the United States wall is more ridiculous than Iraq war from the perspective of utility, whereas the Iraq war is more ridiculous the United States war when judged from the perspective of accuracy, propriety (ethics), and feasibility. The United States must embrace the action of improving rational decision making and increasing reasoned behavior in order to diminish the negative effects of the nation’s current false consciousness. Without an escape from the current false consciousness, the United States will continue on its downward trajectory.
This commentary includes two primary purposes. First, grounded in the model of values-based decision making (e.g., Bensley, 1993; Seedhouse, 2001, 2002, 2005, 2006), two influential definitions of health education and health promotion are described and critically examined. Second, research and paradigms are positioned that substantiate an expanded form and function of health education. The discussion of paradigms, models, and prejudices is an essential component of gaining insight into both the form and function of the field of health education (Seedhouse, 2006). The critical review concludes that the traditional distinction between health education and health promotion has little rational or pragmatic support. Additionally, the critical examination and contemporary research shows that modifying the perspective and traditional form of health education would enable health educators to improve the health of priority populations.
Lawrence Green and Marshall Kreuter are considered two of the most influential figures within contemporary health education and health promotion. They defined health education as “any combination of learning experiences designed to facilitate voluntary actions conducive to health.” Health promotion, on the other hand, was defined as “the combination of educational and ecological supports for actions and conditions of living conducive to health” (Green and Kreuter, p. 27, 1999). These definitions are normatively accepted distinctions of health education and health promotion. David Reisman has encouraged people to “[l]ook at all the sentences which seem true and question them” and Bertrand Russell stated that “in all affairs it’s a healthy thing now and then to hang a question mark on the things you have long taken for granted.” In the tradition of doubt and questioning (e.g., Hecht, 2003), the premises of volunteerism, education/schooling, and free will/determinism are examined, and alternate conclusions are positioned with regard to the distinctions between health education and health promotion.
The assumption of volunteerism
Based on Greene and Kreuter’s definitions, the distinctions between health education and health promotion depend primarily on the discriminatory power of 1) volunteerism/coercion and 2) scope of learning. Note that health education is included as part of health promotion. In the definition of health education, volunteerism is explicated, whereas volunteerism is implicated only in part in health promotion through the inclusion of health education. The critical health educator must speculate on the role, place, and meaning of coercion in health education. However, this speculative process leads to very different processes and outcomes depending on the path a health educator follows.
The following four statements are non-exhaustive two-layered examples of health education actions. The purpose of these examples is to show the functional scope of health education as well as the diversity of health education approaches in theory and practice. 1) Health educators have advocated for stakeholders to voluntarily enact changes that predispose, enable, or reinforce voluntary changes among other people; 2) Health educators have coerced stakeholders to enact changes that predispose, enable, or reinforce voluntary changes among other people; 3) Health educators have advocated for stakeholders to voluntarily enact changes that predispose, enable, or reinforce coercive changes among other people; or 4) Health educators have coerced stakeholders to enact changes that predispose, enable, or reinforce coercive changes among other people. The first example displays health education from the classic educational model (Tones and Tilford, 2001). Health educators subscribing to the second example are those who follow social action figures, such as Saul Alinsky and Paolo Freire, who attempted to redistribute power within society (e.g., Alinsky, 1989; Freire, 1993, 2001; Rothman, Erlich, and Tropman, 1995). The enactment of the third example can be found in public health tobacco smoking prohibition campaigns. The fourth example can be found in multiple United States civil rights movements in which policy makers were forced to pass laws that enforced greater equality within the United States. All of these examples stand as legitimate forms and functions of health education and, thereby, weakens the distinction of volunteerism.
Upon reflection on these four examples of health education, if health educators assume that the necessity of complete volunteerism is untrue, then the health promotion and health education divide decreases due to the weaknesses of the premise of volunteerism. Additionally, from the perspective of principlism (Childress, Meslin, and Shapiro, 2005), health education’s sole focus on volunteerism neglects other standard principles of research and practice such as beneficence and justice. In practice, health educators apply models and theories that do not require the full understanding or acceptance of the action (e.g., awareness raising strategies of the Transtheoretical Model; health communications campaigns; policy advocacy). Given the weakness of the volunteerism distinction, the primary difference between health education and health promotion would be found in the inclusion of social environment supports in the definition of health promotion; another unnecessary and under-supported premise.
The assumption of education and schooling
In the interpretation of the definition of health education, the term education should not be misunderstood to mean schooling. Education is superordinate to schooling and therefore it is possible that schooling has little to no influence on a person’s education. Schooling is simply one structured form of education. As Mark Twain wrote “I have never let my schooling interfere with my education.” With a broad view education in which the acts of imparting or acquiring knowledge via any learning method, the definitions of health education and health promotion become semantically the same, though syntactically different. Since health educators can use any learning method, they can use alterations of physical or social environments to support learning. Moreover, by not including social or physical environmental changes, health educators inevitably fall into the trap of victim blaming (Seedhouse, 2006; Tones and Tilford, 2001). The definition of health education therefore does not preclude health educators from intentionally tailoring any internal (e.g., an individual’s physiology) or external environment (e.g., physical or social environment) to bring about learning experiences. The functional discriminatory weaknesses of volunteerism and education as well as the ethical interest to prevent victim blaming and embrace broad principles of research/practice shows that the typical discrimination of health and health promotion has weak foundation. Health educators must, however, directly address issues of free will and determinism in defining health education in order to develop a clearer perspective of the form and function of health education.
The assumption of free will and determinism
Given health education’s interest in behavioral health determinants and outcomes and free will’s association with volunteerism, the issues of free will and determinism must receive additional attention and explication in the field of health education. Hard determinism means that all present events are caused by past internal and external natural environments in the context of current natural environments and thereby negates the agency of free will and alters traditional perspectives of responsibility and freedom. Free will positions that people have the ability to make choices that transcend natural antecedents and environments. Libertarians completely negate determinism and express that free will is the only explanation for behavior. Compatibilists positions that free will and determinism can coexist. With regard to free will (compatibilism or incompatibilism) and determinism (determinism or indeterminism), there are four general philosophies under which a health educator could be categorized: hard determinist, libertarian, compatibilist (soft determinist), and blind random chance theorists (Pink, 2004; and the Stanford Encyclopedia of Philosophy, Metaphysics Research Lab, 2007).
Based on parsimony and health education in practice/theory, health education typically utilizes naturally deterministic explanations and avoids directly addressing the free will problem. Libertarianism directly opposes the philosophies of hard or soft determinism. Libertarian health educators would assume that nothing is naturally causally determined and that all human actions and inactions are freely chosen regardless of natural antecedents or current environments. These health educators would be labeled victim blamers. Compatibilists position that both free will and determinism influence behavior and therefore a person has the freedom to choose sometimes but is causally determined at other times. The compatibilist philosophy also suffers from the potential for victim blaming but, more importantly, the possibility of arbitrary attributions—how does one decide when a behavior is freely chosen or causally determined? How should a health educator distinguish acts of free will as opposed to manipulations of determinism, especially considering that free will is an amorphous and immeasurable construct? The health educators of random chance believe that neither free will nor determinism exist nor influence behavior. As a result, people are neither a reflection of nor an influence on their environments, and life is nothing more than independent periods of happenstance. Health education theories certainly oppose purely libertarian and random chance philosophies. However, the theoretical position of health education on hard versus soft determinism is less clear.
Based on fields of study (i.e., medicine, psychology, and sociology) that health promotion and health education have used to develop theoretical foundation, the libertarian appears unsupported. For example, in the past, some psychologists believed in dualism, which meant that the mind and body were separate entities thereby allowing for a larger role of free will (Hunt, 1993; Wertheimer, 1987). Contemporary psychological research, however, discounts the mind-body distinction. Primarily, a person’s natural environment both internally and externally determines behavior (e.g., social cognitive theory and the ecological model), and free will is simply a psychological epiphenomenon (Wegner, 2002, 2004, 2008). Health educators should therefore reject free will dominance models and follow a naturally causally deterministic framework. Contemporary research necessitates the inclusion of external social and behavioral factors as well as internal factors (e.g., Bensen, 1997; Kawachi, Subramanian, and Kim, 2008; Levy & Sidel, 2006; Marmot & Wilkinson, 2005, Raphael, 2004; Scales and Leffert, 1999).
Prejudice in theory and practice
Health educators have recognized the importance and utility of the ecological model of health promotion for 20 years (McLeroy, Bibeau, Steckler, and Glanz, 1988), and the PRECEDE-PROCEED planning and evaluation model has included individual and environmental factors for over 15 years (Green and Kreuter, 1991). Although internal and external influences on health have been theoretically recognized by health educators for many years, the most widely used models in health education have historically remained intrapersonal (e.g., Health Belief Model, Theory of Planned Behavior, and Transtheoretical Model) or interpersonal models and constructs (social cognitive theory). Health education includes a paradigmatic prejudice toward focusing primarily on individual or dispositional factors and secondarily on situational or environmental factors (Crosby, Kegler, and DiClemente, 2002; Glanz, Rimer, and Lewis, 1997/2002; Noar and Zimmerman, 2005; Redding, Rossi, Rossi, Velicer, and Prochaska, 2000). Additional research has shown that 1) health educators most preferred the philosophy of individual behavior change and least preferred social change in practice, and 2) academics were significantly less interested in social change and more interested in behavior change than practitioners (Welle, Russell, and Kittleson, 1995).
As further evidence of the historical prejudice of health educators to focus on intrapersonal factors, the philosophy of decision-making was reported to best match the beliefs of health education practitioners and academicians (Welle, Russell, and Kittleson, 1995). Greenberg (1978) also directed health educators to focus on the decision making processes linked to arriving at a behavior instead of evaluating behavior in and of itself. These principles were also stated in another influential article in health education—Are health educators warriors against pleasure?—in which people were to make evaluations through conscious and critical thought processes thereby resulting in better health and well-being (Russell, 2001).
More recently, Buchanan (2006) called for a new ethic of health promotion. A broadened vision of health education was presented that suffered from a narrow view of education by advocating for a well educated populace in which people thought like those with a well rounded liberal arts education. However, others have explained that the empowerment model is superior to both the traditional educational and medical model. The empowerment perspective has traditionally focused more extensively on social determinants of health than the educational or medical model (Tones and Tilford, 2001).
Through the perspective of reasoned prejudice— codified, articulated, and examined biases or preferences—(Seedhouse, 2006), the prejudices of social and individual change must find a functional equilibrium in health education. Research on social determinants of health (SDOH) and the social justice paradigm support a shift in the focus from the individual to society. Proponents of the SDOH (Levy and Sidel, 2006; Marmot and Wilkinson, 2005, Raphael, 2004) recognize the influence and prevalence of lifestyle-focused explanations of individual’s health and quality of life but encourage extending beyond individuals and their lifestyles to the contexts in which people live—communities, cultures, and societies.
The SDOH framework sets forth influential social predictors (social gradient, income, locality, social network, social exclusion, education, employment, transportation, physical environment, health services, biology, gender, ethnicity, and culture) of health disparities that can be measured both within and between societies. For instance, the SDOH framework helps explain the larger disparities in health in the United States compared to other countries. SDOH refocuses the attention of health education researchers and practitioners by bringing socioeconomic factors to the forefront of program planning, implementing, and evaluating. Canadian, British, and American research evinces the importance of extending health from individual behavior change to social change (Levy and Sidel, 2006; Marmot and Wilkinson, 2006; Raphael, 2004; Townsend, Davidson, and Whitehead, 1992; World Health Organization, 1986). For example, sociodemographic factors predicted 56% of the variance in life expectancy among Canadians, whereas individual behaviors only added between 0% to 8% (with a median percent change between 0% and 1%) above and beyond sociodemographic factors (Shields and Tremblay, 2002).
Some health educators would use counterarguments to the proposed shift in the process of health education. First, health educators could position that lifestyles are the most important influence on health. For example, health educators have used information extrapolated from A new perspective on the health of Canadians: A working document (LaLonde, 1974) to justify a lifestyle model of health that extended beyond the traditional medical model (Macdonald, and Bunton, 1995). LaLonde Report reified that: 1) lifestyle is the best predictor of disease; 2) lack of self-restraint, self-control, and responsibility result in large healthcare costs; and 3) society should not be responsible for individual lack of responsibility (Leichter, 1981). Contemporary research supports that the lifestyle model of health has more basis in ideology than evidenced-based explanations of health determinants (Berridge and Blume, 2003; Leichter, 1981; Levy and Sidel, 2006; Raphael, 2004; Townsend, Davidson, and Whitehead, 1992; Wilkinson, 2001). Furthermore, other historical reports, such as the as the Universal Declaration of Human Rights (Morskin, 1999) oppose LaLonde’s conclusions. Second, health educators could claim that social change is unethical. Given the support for determinism, lifestyle and social change both use the same processes, manipulation, to bring about change, and, as a result, justification for these manipulations should be based on health outcomes. Social determinants of health are highly predictive of health outcomes; it would be an ethical mistake to neglect their contribution. Third, some could position that social change is outside of the scope of health education. The National Commission for Health Education Credentialing’s Responsibilities and Competencies (NCHEC, 2008) does not negate but supports the proposed broader vision of health education that includes social determinants.
Lifestyles (Buchanan, 2006; Glanz, Rimer, and Lewis, 1997/2002) certainly influence health, but evidence supports that an imbalanced emphasis has been placed on lifestyles. Focusing more on social factors offers opportunities to implement more effective health education. The field of health education must undergo a process of values clarification to improve health education alignment with contemporary evidence; especially since health education has been described as an extinct predecessor of health promotion (Macdonald and Bunton, 1995). Evidence from SDOH and social justice shows the need for health education to revise outdated definitions and to adapt its form and function to achieve the goal of improving public health. In the contemporary cultural climate in which accountability and evidence-based practices drive funding opportunities and program sustainability, health educators must better align philosophy and practice with research evidence. With the goal of promoting health and a broad deterministic view of education, health educators can meet the challenge of improving the public’s health through changing social as well as lifestyle factors.
The mass media offers little but dangerous distracting entertainment for the typical person on a typical day in a typical frame of mind. This focus inevitably degenerates media coverage to that which is salient to those who find comfort and ease in living in consistent state of false consciousness. A typical response to statement like this is something like “to each their own” or “its relatively harmless entertainment.” Unenlightened post-modernism is an unfortunate ally of the mass media, though most post-modern positions are built upon unsubstantiated foundations (e.g., misinterpretations of Heisenberg’s Uncertainty Principle and Quantum Mechanics). For example, not everything is equal in process or outcomes simply because a person expresses a less than thoughtful opinion that this is so. Furthermore, the idea that the mass media is simply a benign form of entertainment is ridiculous. One can reach this conclusion from the study of recent history quite clearly. For example, the mass media was complicit in causing the Iraq war (the War of Terror or Operation Iraqui Freedom). The proposed harmless form of entertainment was a necessary condition in the enacting of a falsely substantiated war that has cost over half a trillion dollars and more importantly thousands of innocent lives that have been lost. This is a horrible atrocity. There were reasoned people in the media and government who tried to speak out before and shortly after the beginning of the war, but they were labeled as un-American (e.g., Dixie Chicks, Dennis Kucinich, and Cindy Sheehan) and shunned from “mainstream” society. The media fixates on finding and punishing a murderer of a white middle class wives or children, which are also tragic. However, from a societal perspective, the magnitude of those murders falls far below a tragedy such as the Iraq war, which has rarely been questioned in great depth. To rephrase a Karl Marx quote: Media is the sigh of the oppressed creature, the heart of a heartless world, and the soul of soulless conditions. It is the opium of the people. The media has hooked people on pointless sensationalism and has convinced them that this nonsensical sensationalism is important, reasonable, and representative of reality. Though some people state that shows such as South Park and Family Guy are tactless or improper, I perceive these shows (cartoon comedies) to be a better reflection of society than the mass media’s portrayal. The depth of these shows greatly exceeds that found in the mass media. All it takes in the mass media to be successful is the ability to exhibit a stern countenance and commanding voice when discussing something serious and to be able to switch from that look and tone into an appearance of approachable happiness within 30 seconds (e.g., between the sequential stories of 1) a school shooting and 2) the world’s oldest acrobatic parrot). The internet has offered some opportunity to avoid the mass media, but there is discussion on how the variability on the internet could be controlled, regulated, or minimized.