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 EPIDEMIOLOGY & PUBLIC HEALTH

THE PREVENTIVE DIRECTION OF MODERN THEORIES OF HEALTH

AND HEALTH-SAVING IN PUBLIC HEALTH AND EDUCATION

Shevchenko A.S.1, Shevchenko V.V.2, Brown G.W.3

1
Kharkiv Regional Institute of Public Health Services, Kharkiv, Ukraine
2
National Technical University "Kharkiv Polytechnic Institute", Kharkiv, Ukraine
3
International Public Health Institute, Berlin, Germany
https://doi.org/10.35339/ic.11.1.ssb

ABSTRACT
Background. The modern understanding of health is related to the need to prevent diseases
caused by infections, lifestyle, environmental and genetic factors. Ukrainian legislation guaran-
tees health care, but the practice of implementing laws is imperfect. The teaching of valeological
disciplines in educational institutions is of great importance for the prevention of diseases. But
the content of these disciplines requires constant revision from the point of view of evidence-
based medicine, and the creation of new preventive programs requires theoretical justification.
Aim. To determine the content and practical significance of the modern understanding of
health care in public health care and education.
Materials and Methods. Methods of bibliosemantic and system analysis were used.
Results. The theory of health and health-saving is considered using cross-cultural, discursive,
norm-centric, phenomenological, holistic, axiological and integral approaches, from the perspec-
tive of evidence-based and "4P" medicine. Health-saving is shown as derived from a healthy life-
style and valeological competence formed in the population. The best environment for the for-
mation of a healthy lifestyle is shown to be an educational environment, the tools of formation
are valeological disciplines and education of medical and social non-government organizations.
The need for joint efforts of the population and medical workers to achieve better results in the
prevention of socially significant diseases is determined.
Conclusions. Improvement of the preventive direction of valeological education is closely
related to the competence approach, in particular, with the formation of valeological competence.
The public health system should use the potential of educational valeological programs to form
a healthy lifestyle in new generations during their studies at higher education institutions. For the
formation of high-quality valeological programs, a permanent partnership of educators and med-
ical professionals is necessary.
Keywords: valeological competence, evidence-based medicine, 4P medicine, Health Pedagogy.

Introduction to sanitary and epidemiological well-being, orga-

The need for health-saving is generally recog- nization of conditions for diagnosis, treatment and
nized by Ukrainian society and the state. Health prevention of diseases based on modern scientific
care is guaranteed by the Constitution, regulated methods [2, Art. 3, 27, 49, 50], however, the pre-
by the law of Ukraine "Fundamentals of the Le- ventive direction of health-saving in Ukraine is
gislation of Ukraine on Health Care" [1], provided implemented to a large extent due to the teaching
by targeted national and regional programs in of valeological disciplines in educational institu-
health care and social protection fields. The state tions and medical (sanitary) training.
guarantees regarding health care relate primarily Health is a personal and social value [3]. Its
preservation and restoration depend on 50% of
Corresponding Author: a person's lifestyle, 20% on the influence of envi-
Shevchenko Alexander S. – MD, MM,E&P, Director ronmental factors, 20% on heredity, and another
of the Kharkiv Regional Institute of Public Health 10% on the state of the health care system [4].
Services, 8, Rymarska str., Kharkiv, 61057, Ukraine. Thus, prevention of diseases has a greater impact
E-mail: [email protected] on health care than their treatment.

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 EPIDEMIOLOGY & PUBLIC HEALTH

An important component of health is well-be- logical education, a competency-based approach

ing, which the WHO appeals to in its definition of is used, the driving force of which is the transfor-
health [5]. To some extent, this well-being is cha- mation of knowledge into skills, and skills into ac-
racterized by satisfaction with one's own life, so- tive, motivated actions. The latter are the key to
cial adaptability and resistance to psychosocial health. Among such actions, key positions are oc-
stress, which is the basis for a wide professional cupied by giving up bad habits, rational nutrition,
discussion about mental adaptation and maladap- sufficient physical activity, rational regime of
tation. Psychological and sociocultural ideas work and rest, avoidance of injuries, environmen-
about health are actually reduced to three models: tal, radiological and toxicological risks, coopera-
ancient (which is based on internal consistency), tion with the medical system (vaccination of in-
adaptation (in which the individual is adapted to fectious diseases, timely treatment of detected dis-
the natural and social environment), and anthro- eases, participation in screening examinations, for
pocentric (in which all-round self-realization and example, annual fluorography, etc.), psychohy-
the disclosure of the creative potential of the indi- giene (maintaining emotional balance), safe sex
vidual are important) [6]. All of them describe nu- [12–16]. The population's understanding of these
merous mechanisms of health preservation (for issues depends on the quality of valeological edu-
example, options for social and psychological ad- cation, which takes into account the current trends
aptation to excessive stress), but do not take into in the development of health theory and focuses
account modern medical approaches (for exam- on its paradigms.
ple, evidence-based medicine [7]). But the pre- The transformation paradigm of modern medi-
ventive direction of medicine needs further theo- cine consists in the transition from a reactive
retical investigation and scientific substantiation model of health care work to a preventive one.
in order to improve its practical implementation. This is the so-called "4P medicine" model (Predic-
The aim of the study is to determine the con- tive, Personalized, Preventive and Participatory
tent and practical significance of the modern un- medicine). "Participatory" means "involved in
derstanding of health-saving in public health and achieving a common result." Its practical imple-
education. mentation requires the participation of the patient
Materials and Methods himself [17]. The participation of the patient im-
The bibliosemantic method (using PubMed plies responsibility for maintaining one's own
and Google Scholar materials) and the system physical and mental health, and medicine per-
analysis method (using the methodology of forms only a service function [18]. Within the
Golubkov E.P. [8]) were used for the investiga- framework of the "4P medicine" model, effective
tion. The system analysis method involves a se- prevention of diseases requires partnership be-
quence in the research: setting the problem, con- tween doctors and the population, commitment of
ducting the research, analyzing the results, prelimi- citizens to a healthy lifestyle, readiness for valeo-
nary judgment, confirmation or refutation, final logical education and self-education. The forma-
judgment, implementation of the decision. The tion of readiness for a healthy lifestyle should
feedback to determine success in achieving the begin in childhood, but the conviction to practice
aim, with opportunities to adjust conclusions and only safe behavior patterns and to minimize all
additional research also used. possible disease risk factors is finally formed at
Results and Discussion the age of 16–20 years [19–21], that is, at the age
In academic psychology, cross-cultural, dis- of the majority of higher education graduates in
cursive, norm-centric, phenomenological, holis- Ukraine.
tic, axiological, and integral approaches are used Disease prevention in Ukraine is carried out at
to study health [9–11]. A cross-cultural approach the international, national, regional, population,
allows us to identify national influences on per- group and individual levels [22]. At the interna-
ceptions of normal health. The discursive ap- tional level, events are held within the framework
proach illuminates the logic of constructing ideas of world days of support for patients with various
about health, considers different health systems diseases, days of remembrance of those who died
and individual health practices. Within the holistic from various diseases, etc. At the national and re-
approach, natural and scientific principles of anal- gional levels, programs are being implemented to
ysis are complemented by humanitarian ones. The overcome various diseases (respectively), their
axiological approach consists in treating health as consequences, promotion and organization of
a universal human value. In the practice of valeo- mass physical culture and sports, rational nutri-

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 EPIDEMIOLOGY & PUBLIC HEALTH

tion, giving up chemical addictions, eliminating process. Psychological trainings, support groups
the consequences of environmental disasters, and individual consultations of psychologists,
man-made disasters, etc. Mass media, medical emotion management techniques (self-training)
workers, politicians, public figures, professional are forms of psychological assistance that allow
medical and social public organizations and doc- students to overcome the stress of wartime. Tea-
tors systematically engaged in sanitary education chers are recommended to pay more attention to
(for example, Dr. Komarovsky E.O. [23]) partici- conflict resolution; prevention of bullying; de-
pate in prevention. We specify some mechanisms velopment of empathy and communication skills
of preventive work. of participants in the educational process; setting
According to a number of researchers [24–26], up the collective of education seekers and teachers
medical and social non-government organizati- to provide greater support to forcibly displaced
ons, unfortunately, cannot cover all students with persons, persons with disabilities, persons who
preventive work, but with systematic work with have survived the stress of war; to teach methods
individual student groups, they are able to form of rescuing victims and providing emergency first
valeological competence at a high level. Educa- aid [32].
tors are trying to transfer the content of their edu- Given the greater risk of injury in wartime con-
cational work to the educational programs of vale- ditions, prompt and effective emergency care is
ological disciplines ("Valeology", "Fundamentals both health-saving and life-saving. For training in
of Life Safety", "Health Pedagogy", "Fundamen- emergency care in non-medical higher education
tals of Medical Knowledge and Health-Saving", institutions, it is advisable to involve practicing
etc.) [27]. It is advisable to train students of higher doctors and students of higher medical education
non-medical education in these disciplines after in senior years. Especially those who study and
studying the supporting disciplines "Human Bio- work in practical health care at the same time [33].
logy", "Anatomy", "Physiology" and "Hygiene", It is worth noting that before graduation, a gradu-
as indicated by the authors of the training pro- ate of higher education medical institution is al-
grams of the relevant disciplines [28; 29]. ready sufficiently motivated to engage in preven-
Personal communication between the doctor tion, understanding the advantages of prevention
and patient is effective for individual disease pre- over the treatment of a disease that has already de-
vention. But doctors usually communicate with veloped [34]. But the interaction of non-medical
citizens who have diseases, so they act within the higher education institutions of Ukraine with the
scope of secondary and tertiary prevention of dis- health care system for the construction of health
eases, aimed at preventing their complications and care education is not systematic, it is based on
relapses, at the transition of diseases into chronic volunteer models. The higher education system
stages. At the same time, the optimal environment does not order educational services from repre-
for the systemic primary prevention of diseases sentatives of the health care system. The main
and the formation of commitment to a healthy life- achievement of the episodic interaction is actions
style is educational [30], which in turn should be dedicated to a healthy lifestyle and prevention of
safe for those seeking education. In order to create certain diseases, which medical non-governments
a healthy educational environment, special atten- organizations conduct in higher education institu-
tion should be paid to the issues of physical safety tions, as well as individual attempts to create va-
of learning and stress reduction [31]. leological disciplines with the participation of
The State Service of Education Quality of medical professionals.
Ukraine recommends that the organizers of the ed- Valeological disciplines for students of higher
ucational process in martial law conditions give non-medical education also consider the health-
preference to distance learning, and in classrooms saving educational process from the point of view
to arrange the educational space more safely (re- of ensuring the physical safety of learning and re-
move open shelves, stands that may fall during ducing the level of stress of participants in the ed-
shelling; remove things that will interfere with ucational process [35]. Physical safety includes is-
quick evacuation from premises), study evacua- sues of ergonomics, microclimate and room light-
tion routes, location of storage facilities, conduct ing, safety of physical culture and sports as part of
evacuation drills, periodically repeat safety brief- the educational process, safety of work in educa-
ings and evacuation drills. It is necessary to mon- tional and production workshops, with electrical
itor more carefully the signs of distress and pro- equipment, chemicals, etc. Stress is often seen as
fessional burnout of participants in the educational a manageable risk factor for the development of

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 EPIDEMIOLOGY & PUBLIC HEALTH

hypertension, peptic ulcer disease, obesity, myo- The inclusion of some issues in the programs of
cardial infarctions, cerebral strokes, and other dis- valeological disciplines and the refusal to discuss
eases that can affect students. Diseases with con- others is the right of the authors of such disci-
trolled and conditionally controlled risk factors plines, but it is advisable to check the formed pro-
are the main objects of preventive interventions grams for compliance with the recommendations
and sanitary education [36; 37]. Stress is caused of leading international organizations. For exam-
by overload during education, high competitive- ple, "Characteristics of an Effective Health Edu-
ness in the educational environment, and conflicts cation Curriculum" of the USA Center for Disease
between students [38]. Control and Prevention (CDC) [44]. According to
Educational programs of higher education stu- the developers of these recommendations, an ef-
dents of Ukraine and other countries of the world, fective educational program should be aimed at
according to a number of researchers [39; 40], we- achieving behavioral results, without overloading
re compiled without proper calculation of a ratio- with scientific facts. In addition, according to the
nal academic load, which causes chronic stress, CDC’s experts, it is necessary to practice health
against the background of which the risk factors care skills in order to teach a healthy lifestyle; the
of diseases are more easily realized negatively, exis- formation of personal values and beliefs that sup-
ting diseases are aggravated or go to the chronic port healthy behavior, which corresponds to our
stage. ideas about the components of valeological com-
Excessive requirements regarding the number petence [12]. The best health-saving curricula go
of program competencies in the higher education beyond the cognitive level and consider determi-
standards contribute to the information overload nants of health, risk factors for diseases, social
of the students. The discussion about the need to opinions, values, norms of behavior, customs that
reduce the number of such competencies has been affect health, build educational strategies on theo-
going on for two decades. But, in our opinion, the retical approaches (for example, on the theory of
list of competencies in the standards of higher social cognition by Berger P. & Lukman T. [45]),
non-medical education cannot be shortened at the are aimed at a long-term result. Meanwhile, health
expense of valeological competence [41]. Howe- care values should promote protective behavior
ver, the content of this competence should be sep- and negative perception of risky behavior, rein-
arated from issues of spiritual development, which force positive beliefs of a healthy lifestyle based
can be discussed within other disciplines. When on the principle of feedback using critical think-
studying valeological disciplines ("Health Peda- ing, and help confidently overcome social pres-
gogy", "Fundamentals of Medical Knowledge and sure. An effective curriculum should take into ac-
Health-Saving", etc.), it is important to discuss count the needs and interests of learners, levels of
only certain issues of psychology, ecology, moral development and emotional maturity, experience,
and ethical norms (when discussing abortions, knowledge and skill levels, provide tools for eve-
contraception, euthanasia, rights and responsibili- ryday life, cover topics in a logical sequence;
ties of patients, relationships with doctors, other should not contain culturally biased information,
higher education students, family members, disa- but provide examples of various cultures, cus-
bled people, respect for family, religious and cul- toms, traditions, ways of life, take into account
tural food traditions, etc.). But the transfer of em- cultural diversity, teach intercultural interaction;
phasis from medical issues to moral, ethical and if possible, rely on the cultural resources of fami-
spiritual issues while simultaneously ignoring the lies and communities. An effective curriculum de-
issues of physiology, pathology, and the possibil- votes sufficient time to both key health concepts
ities of prevention harms the formation of valeo- and practical skills. Changing behavior requires
logical competence and optimal understanding of systematic and long-term training, is based on pre-
the principles of a healthy lifestyle. The inclusion viously learned concepts and skills, and takes into
of pseudo-scientific data about the "undeniable account age determinants. An effective curricu-
benefit" of folk medicine methods into the pro- lum connects learners with influencers promoting
gram causes even more damage; naturopathy; ho- health and successful learning strategies.
meopathy; the advantages of Eastern medicine This understanding of health-saving programs
over European medicine; refusing vaccinations not demonstrates a close connection with competen-
because of medical reasons, but because of personal cies, the list of which contains both scientific pub-
convictions; home births; practices of "hungry", lications and some national education standards
vegan diets; hardening methods, etc. [42–44]. [46–48], according to which a healthy lifestyle is

INTER COLLEGAS, Vol. 11, No.1 (2024) ISSN 2409-9988

 EPIDEMIOLOGY & PUBLIC HEALTH

associated with the absence of harmful habits, pro- DECLARATIONS:

tective behavior, prevention of known health risks. Disclosure Statement
The authors have no potential conflicts of in-
Conclusions terest to disclosure, including specific financial in-
Our findings suggest that the improvement of terests, relationships, and/or affiliations relevant
the preventive direction of valeological education to the subject matter or materials included.
is closely connected with the competence ap- Statement of Ethics
proach, in particular, with the formation of valeo- The authors have no ethical conflicts to disclo-
logical competence. The public health system sure.
should use the potential of educational valeologi- Data Transparency
cal programs to form a healthy lifestyle in new The data can be requested from the authors.
generations during their studies at higher educa- Funding Sources
tion institutions. For the formation of high-quality There are no external sources of funding.
valeological programs, a permanent partnership of Consent for publication
educators and medical professionals is necessary. All authors give their consent to publication.

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Received: 14 Jan 2024

Accepted: 31 Mar 2024

Cite in Vancouver style as: Shevchenko AS, Shevchenko VV, Brown GW. The preventive direction of modern
theories of health and health-saving in public health and education. Inter Collegas. 2024;11(1):7p. In press.
https://doi.org/10.35339/ic.11.1.ssb

Creative Commons license (BY-NC-SA) Shevchenko A.S., Shevchenko V.V., Brown G.W., 2024.

INTER COLLEGAS, Vol. 11, No.1 (2024) ISSN 2409-9988

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