A people-centred approach to health education takes the opposite position. It recognises that the ill health of the poor is, in large part, the result of a social order that favours the strong at the expense of the weak. Its main goal is not to change the poor, but to help them gain understanding and skills needed to change the conditions that causes poverty and poor health.

In education that focuses on behaviour and attitude change, people are acted upon by the system and the world that surrounds them where as in education that works for social change, people act upon the system and the world that surrounds them.

In making these points, I am not saying that there is no need for changes in personal attitudes and behaviour. But whose attitudes need changing the most?

Whose attitudes and habits cause more human suffering - those of the poor or those of the' well-educated ' dominating class?

The unhealthy behaviour of both rich and poor results partly from the unfair social situation in which people live. So rather than trying to reform people, health education needs to focus on helping people learn how to change their situation.

As people become more sure of themselves and their capacity for effective action, their attitudes and behaviour may change. But lasting changes will come from inside, from the people themselves.

George Kuias is a registered senior nursing officer in the medical clinic at Divine Word University