9 This chapter addresses the ways that health can be asocial jus t ice i ssue and how adult educators can worktowards social justice, either alone or collaboratively withhealth professionals.

Health Education as an Arena for Adult Educators’ Engagement in Social JusticeLilian H. Hill

In an address given at ihe Highlander Folk School on September 2, 1957, Martin Luther King, Jr. said, “there arc some things in our social system to which I am proud to be maladjusted and to which I suggest that you too ought to be maladjusted. ... I never intend to adjust myself to the evils of segregation and the crippling effects of discrimination. I never intend to adjust myself to the tragic inequalities of an economic system which lakes necessities from the masses to give luxuries to the classes. ... it may be that the salvation of the world lies in the hands of the maladjusted” (King, 1957). Johnson-Bailey, Baumgartner, and Bowles point out that social justice is based on the “premise of equitable distribution of rights, responsibilities and assets” (2010, p. 339). As American political discussion of health care access and costs escalated in view of the November 2010 election, it is clear that access to health care is inequitable. The acrimonious public debate and calls for the health care reform bill to be repealed (Barry, 2010) echo the defeat of the 1993 health care reform bill, which also advocated universal health care access.

In this final chapter, I highlight the ways in which social justice can be served by adult education in regards to health. Working for social justice involves creating an educated citizenry that is enabled to participate demo cratically, ask critical questions, and work to change society for the better ment of all (Johnson-Bailey, Baumgartner, and Bowles, 2010). Health education, viewed broadly, can involve “systematic, planned social action and learning experiences designed to empower people by enabling them to

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exercise control over those factors that influence health and health behavior» as well as the social and environmental conditions that affect their own health status and the health status of others” (Tolsma, 1991, cited in Obilade, 2005, p. 274). Health is best served when the following fundamentals are present: “peace, shelter, education, food, income, a stable ecosystem, sus tainable resources, social justice, and equity” (Daley, 2006, p. 234). This broad view of health encompasses far more than individual health choices and behaviors, which are the focus of many health interventions.

That adult educators persist in the struggle for social justice despite obstacles including poor compensation, little social support, or outright oppo -sition speaks to the strength of the commitment to social justice within our field. Nevertheless, Johnson-Bailey, Baumgartner, and Bowles’ (2010) analy sis suggests that there has been more evidence of societal critique than direct action. They also point out that action for social justice should work to coun teract cultural hegemony based in race, class, and gender. The health care arena is as prone to perpetrate injustice involving race, ethnicity, culture, poverty, immigration status, and gender as any other segment of society.

Poverty is a major determinant of poor health (Quigley and others, 2009) and is often experienced by people with low literacy skills. Poor health and disease may be naively thought of as nondiscriminatory. As bio logical beings, all humans are subject to disease; however, poor and marginalized populations arc more subject to poor living conditions that arc incompatible with good health. People living in poverty can expect greatly reduced life expectancy compared to the more affluent, due to diseases of poverty, compromised access to healthy foods and clean water, poor housing, reduced availability of transportation to health services, more precarious work settings, lack of work benefits that allow recovery time from illness or injury, violence, and increased exposure to environmental pollution in the workplace and at home (Murray, Michaud, McKenna and Marks, 1998; Marmot, 2005). Impoverished and minority adults experience a dis -proportionate amount of preventable disease and disability (House and Williams, 2000). While adult educators are not able to ameliorate all the conditions of poverty, there are many examples of educators working along side people who have decided to combat the circumstances in which they live to achieve better conditions regarding environmental health and climate justice (Walter, 2007; Weinrub, 2009).

Many health care systems are increasing their expectations that patients will lake responsibility for their own self- and preventive care. These demands may not intimidate the well-educated, although even they can experience difficulty because of medical information’s unfamiliar vocabu lary and concepts. This struggle is far more profound for poorly educated and/or low-literate individuals, immigrants learning English, and people whose cultures do not correspond with the dominant, mainstream culture commonly reproduced within health care systems. Medical practitioners

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Rager, K. B. "The Sclf-Directcd Learning of Women with Breast Cancer. 1' Adult Education Quarterly, 2003, 53 (4), 277-293.

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Shaw, S. J., Huebner, C., Armin, J., Orzech, K., and Vivian, J. “The Role of Culture in Health Literacy and Chronic Disease Screening and Management.” Journal of Immigrant and Minority Health, 2009, i i(6), 460-467.

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U. S. Department of Health and Human Services. “Projected Supply, Demand, and Short ages of Registered Nurses: 2000-2020.” Bureau of Health Professions, National Cen ter for Health Workforce Analysis. (Retrieved April 2, 2010, from www.ahcancal.org/ research_data/staffing/Documents/Registered_Nurse_Supply_Demand.pdfl July 2002.

World Health Organization. ' Confronting the Tobacco Epidemic in an Era of Trade Liberalization.” WHO/NMH/TF/Ol.4. Geneva, Switzerland: World Health Organization, 2001.

World Health Organization. “Migration of Health Workers.” Fact Sheet no. 301. [Retrieved January 10, 2011, from www.who.inL/mediacentre/factsheets/fs301/en/ index.html] Updated July 2010.

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MICHAEL L. ROW LAN D is an ass is tant professor at the University of Louisville School of

Medicine and in the College of Education and Human Development at the University of

Louisville, Louisville, Kentucky.

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