.........
-·--····~·····-·
-···-· ··---~·-~·-·· ················---············ ..• ···-'-""1
i''
j
I
!
i
!
J
CALIFORNIA STATE UNIVERSITY, NORTHRIDGE
HEALTH OBSERVATIONS:
GREECE,
ISRAEL AND YUGOSLAVrA
A thesis submitted in partial satisfaction
of the requ.irements for the degree of
Master of Public Health
by
Ruth
~orsky
,June, 1973
· · ·-·-·- . . . . . . · · · -----------------1
l
The thesis of Ruth Dworsky is approved:
Cormni ttee Chairman
California State University, Northridge
I
l
June, 1973
l
I
L_____. _ ." . -.. . . ......... · ·-· . .
ii
ACKNOWLEDGEMENTS
The task of the student is to learn; the task of
the teacher is to facilitate that learning.
If this thesis
who have constantly given of their time and spirit throughout my years at California State University, Northridge.
A special note of appreciation to Dr. Lennin Glass
for his continued cheerful encouragement; thanks to Dr.
Athina Baza of Greece, Dr. David Yarom of Israel, and Dr.
!Djordje Jakovljevic of Yugoslavia for their most gracious
hospitality and assistance.
Thanks t_q my children, who
!helped and encouraged, and praises to my husband who made
1it all possible.
iii
,---~-"···---
...... ......
,_
,_
,__.
-.-
__ .........
,.
---------------~·
-·" ........... -·"-- .... ·-· --- -
l
TABLE OF CONTENTS
Page
..
..
1.
2.
.
iii
...
vi
IN'rRODUCTION
1
Statement of the Problem
2
Limitations of the Study •
2
A SURVEY OF THE LITERA'rURE .
4
Concept of Health
4
Concept of Education •
6
Concepts of Health Education .
3.
•
e
a
•
s
•
•
•
•
c
•
~
•
GREECE
17
19
Geographical and Hist6rical
Background • • •
19
Observations
23
In tervie-lrvs
•
*
•
•
~
Summary and Conclusions
Statistics
5.
13
ME'rHODS AND PROCEDURES FOR THE STUDY •
Questionnaire
4.
10
ISRAEL
..
•
v
•
•
•
•
•
•
•
•
~
ft
•
~
•
•
•
•
•
e
Q
•
34
~
Geographical and Historical
Background
• • • • • • • . • • .
iv
27
•
•
35
36
•
36
~':·-t,.'
v
1
-~"'".~''••'··-·-"·''"
, . , , ,_,_., _. ,..,•-•••·' ""'"""'"'" •••••• '"""'"' ' "' ""'•·•
"""-•••w•••'''''''"
Page
Chapter
Observations
I
6.
40
• . • .
Interviews
44
Summary and Conclusions .
46
Statistics
48
......
YUGOSLAVIA
Geographical and Histoxical
Background • • • . • • • • •
49
Observa-tions
53
......
Interviews
55
59
Summary and Conclusion
.
Statistics
7.
49
....
61
62
SUMMARY AND CONCLUSIONS •
BIBLIOGRAPHY
•
•
•
•
•
•
•
•
•
•
e
•
•
•
•
•
•
•
•
66
APPENDICES
A.
CONSULATE OFFICES • • • .
70
B.
POPULATION STATISTICS .
71
n
SAMPLE LETTER . . . .
72
D.
MAP OF STUDY COUNTRIES AND
SURROUNDING AREAS • • . .
'-•
I
L.....
8
•
•
•
e
•
•
•
73
,-~-------
-··----------
-·-·-··-- ---------
---· ..... - .......
·---~-----.-
--·---· -----
1
'
ABSTRACT
HEALTH OBSERVATIONS:
ISRAEL and
GREECE,
YUC~SLAVIA
i
I
by
Ruth Dworsky
Master of Public Health
June, 1973
l tries.
I such as
j
1
The three countries have some similar problems,
urbanization and traffic hazards.
However, each
1 has unique problems relating to the geography, history and
l particular system of government of that country. The
I casual visitor may see various health practices within
I
I country.
If he is truly interested he may learn much about
I
j the health system through interviews with knowledgeable
~~· -~,--~--~. ~"- --------·~-·
a
-· ~·-····•-'-• --- ---······
····- --~---
-----·~-·--4~---~---~
.
-------~- .
.---- .
--. _,_ -·-.-····· ... -'
vi
vii
!.·~~·;pi~ in -~~-~h--~;~~t~y, b~t- -t~~~--~~d~~-~-t-~;~j'j_·;;~-~~-f~-~th~--~~-~d-~l
I
i
!
lof
the people, as related to their value system requires
!
much more than observation; it requires living and loving
1
i
!with the people.
I
l
I!Dr.
As Gordon Allport states,
The alert health worker
. must develop skills
as an oculist, training himself to look at his
spectacleSilnd not merely through them--and to
look both at and through the spectacles of the
client v-Ii th whom he deals . . • • He will discover that culture, social class and personality
lay down stubborn preceptive dispositions that
in part control what a person sees and hears,
what he thinks and feels and what he does.
(2:308)
Allport uses the word "proception" as a term to
1
~ate
desig~-
.
a concept of "the integrated disposition of a person
I
Ito perceive, pay attention to,
e~trac'c
meaning from, feel,
I
I
Jthink about and respond to a situation, and to hold it in
I
I
!memory.
1
'
(2:301)
I
I
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'
,,,l
Chapter 1
INTRODUCTION
Iili ve,
I:some
I
People are people the world over.
love, and die.
They are born,
During the interim they experience
degree of "health"; they fluctuate on a continuum
I
!somewhere between total health and death, their position
I
I
;being determined by a multitude of factors.
To understand
l
!the problems peculiar to a specific group of people, one
l
.needs to become aware of these factors.
!
!
Health practices develop from cul t'.lral roots and
!social systems.
These cultural roots are
r~flected
in the
!religioh, art, medicine, economic practices, government,
I!and
customs of the people.
The patterns of culture have
)
ian effect on_the prevailing beliefs, attitudes and values
Iiof
i
the group, thereby affecting the health practices.
Education, incltiding health education, is dependent
jupon the basic philosophy, government and economic struc!ture
as well as the degree of development and systems of
I
'learning utilized by the persons in authority.
The power,
·motivation, and charisma of one person, at the proper
time, can have great influence on the health and the education of a people.
Each of.the countries studied had a
differe~t
type
of government with varying degrees of central control and
2
·····"· . . ................ ......
!jphilosophy
. .................... _........................................
~
-~-''0•'·-·-
-~-~>T•>,,,.
_____ ~------···-'>U~~---
-~-'"'-~-·~----~-~---------·------
>>>"-
0>>
which directly affect the health and welfare of
the people; each embraced leadership with varying degrees
of power and influence on health and education.
What are some of the factors related to the health
of the people of Greece, Israel, and Yugoslavia?
I have
common or similar obstacles to overcome?
Do they
Can an
j observer from another country discern and distinguish
I
j problems tha.t are unique in a given society?
I people
I tions
How are the
of each nation working to improve the health condi~
in their country?
Statement of the Problem
The purpose of this study
I people
I
~ms
to identify and com-:
living in the selected countries.
~mita~ions
of the Study
A study.of factors affecting the health, education.
I and health education of a
J
I
complex undertaking.
Il author
nation of peoples is a highly
It would be most presumptuous of the.
to assume that a comprehensive study of even one of'
l the four countries could be presented in these pages;
therefore, it is necessary to generalize and to.present
.only the ·most. obvious observ::,tions.
Time spent ·in each country was severely limited
and travel was confined to those areas most easily reacbed.
I
!
l-.~~----•.-- -~
---· --- _, .•
3
["" •~···~
•-~·
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,, _,-_, __ , .,. ·---· "'
•-~· ~"~--- '""'"-"·'~
•-•·-·•-- ,.,,_ ·• •"• .. ~-- -- ,_.,_ ••·--· •·• ., •->"···'"~~-·--• '"""~-''"'~·~--~·~~-~--~---"~-.-~ ""~··• ~~···-~-·'
/0nly a limited number of observations and interviews could
lbe made.
Practices not observed could very well differ
) from those observed.
It was necessary to secure the permission and
,.interviews through agencies of the government of each of
I the
countries, therefore the opinions expressed and the
may reflect a somewhat biased picture.
II data presented
A language barrier could have been a formidable
1,'
obstacle; however, in all four countries, the individual
I in charge
I language.
I
!
in all· of the native ·tongues practiced in Greece, Israel,
Yugoslavia.
Observations are always made with a "colored" eyej
for the observer sees through eyes that have been colored
by his
O\im
I beliefs,
i
i
·coriversations with the "man in the street"
were necessarily restricted by the. authqr' s incompete.nce
I and
I
of health education was fluent in the English
culture and life experiences; by his own
attitudes, and
values~
_.-,.~'•'•
·---~- ..-··
-
~ • • • >•
•'>·~·~•-•-
">
·~·-·
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... ~,_,....._._,....~,~·--T
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......
-~-,
j
I
Chapter 2
II
A SURVEY OF THE LITERATURE
i
!concept of Health
"Health" has been defined by men of great stature
II in the health professions;
I
however, health is an abstract
!word; a thought, a concept.
It is an everchanging
l
I abstract
and varies from moment to moment.
Leavell and
[ Clark stated:
I
I
I
Everyone has health of some kind:
those in
excellent condition with no complaints, those
who are fairly well, those feeling under par,
and those who are definitely ill. Thus, health
may be thought of on a graded scale, just as is
disease or disability . • . neither health nor
disease is static or stationary. Behind every
condition of health or disease is the phenomenon
of almost constant alteration. These conditions
are continuing processes; a battle on the part
of man to maintain a positive balance against
biologic, physical, mental, and social forces
tending to disturb his health·equilibrium. The
potentialities for the success of man's struggle
for health maintainance are manifested in his
internal and external defense mechanisms.
(29:13)
Marston Bates defined health as a "polar 11 word,
relat.i ve to the individual standard or scale; a continuum
with death at one end and perfect health at the other.
Thus, all living things constantly move back and fort.h on
that continuum.
( 4: 59)
C. E. A. Winslow defined "public health" as:
'
.
;
The science and art of preventing disease, prolonging life and promo·ting physical and mental
!
4
5
~-.~--~---·~:~~--~~ -:~~-·~~-~j-~~e~~~
j
effort.
through organized conuuuni ty
(50:23)
"Health is maintained through an awareness of the
!value of physical and mental fitness and the means by
l
I
jwhich they are secured," according to
c.
E. Turner.
(47:2)
Jesse Piering Williams stated that health is "the
I
jquality of life that enables the individual to live most
I
land to serve best."
I
(49 :13)
"Although health is a common need and the effort
jto attain it represents a
co~non
drive it is actually of
I
Isecondary
The
1
I
rather than of primary importance."
dominar~t
(20: 55)
theme of the book, Man Adapting, by
.·
IRene Dubos is the delicate balance between man and his
I
!environment.
I
I
I
I
I
l
i
I
1
He stated:
Health in the case of human beings means more
than a state in which the organism has become
physically suited to the surrounding physiochemical conditions through passive mechanisms;
it demands that the personality be able to express
creativity . . • Human life is thus the outcome of
the interplay between three separate classes of
determinants, namely: the lasting and universal
characteristics of man's nature, which are
inscribed in his flesh and bone; the ephemeral
condi·tions which man encounters at a given moment;
and last but not least, man's ability ·to choose
between alternatives and to decide upon a course
of action.
(9:XViii)
Other definitions of health include:
j
j
''Real th is the quality, resulting from the total
i
ifunctioning of the individual, that empowers him to
a personally satisfying and socially useful life."
6
r--·-·-"---------···-·····-·------····-··-·· ·-----..· ·--------------------------
I
--~······
· -· ·--·· ·- ....... -----. ---------------·-· · .... -----· ------------·--·-·----
-·------·------~------.
Thus, we see that no universal definition of
lhealth exists.
I
What is "bealth" to one man may be
f"illness" to another, but one needs to base his thinking
jand observation on some firm foundation in order to derive
I
.
1any
cone 1 us1on.
.
It 1s
therefore, on this broad concept of
!health, as accepted by the World Health Organization, that
I
I
.
.
lthese observations have been based: health is "a state of
I
!complete physical, mental and social well-being.and not
I
I
'merely the absence of disease or infirmity." (8:3)
From thi's author's point of view, health is that
"state of physical, mental and social well-being 11 that
"enables one to live most and serve· best."
Health is
vital to the total functioning of man in all areas.
There
are many factors involved--society,, culture, heredity,
environment, and all are interrelated and interdependent.
However, "health" can be changed.
Concept of Education
What is education and what are its sources?
A
baby learns to walk, feed himself, .talk and act like thQse
he is most closely associated with.
Freud emphasized the
importance of early experiences and. the effect on an individual's whole living experience.
A child also learns
from his playmates and is greatly affected by the stimuli
presented by
h~s
environment.
Rene Dubos wrote:
11
The
res:ponse of a human being to any environmental factor is
7
1
j highly
personal b.ecause i t reflects all his own past
II experiences." .
{9: 7}
He also commented on early
!experience:
I
I
I
I
I
Practically all events occurring in the very
early period of development have a disproportionately greater influence on physiological
characteristics and on behavior than the events
of the same type or magnitude occurring later in
life. The effects are greater; they are often
irreversible; they extend to a large variety of
characteristics such as longevity, health,
learning and behavior.
(~:13)
c.
E. Willgoose declared:
"A proper definition of
/education includes some reference to aims, purposes or
Igoals.
11
(
I
/
4 8: 1'6)
Webster defined "education 11 as
11
Moral and mental
!discipline gained by study and instruction; the process of
I
.
!acquiring this."
(1:308)
Funk and Wagnall stated:
Ijtrain
"Educate--to develop or
the mind, capabilities and character of by, or as by
I
(17:401)
!formal schooling or instruction; teach."
'
Thus, one. might say that educa·tion is a process by
I
!which a person· learns and to learn is:
11
to acquire kno,,.rl-
1
ledge of or skill in by observation, study, instruction,
I
jete.:
to find out; gain acquaintance with; ascertain."
I (17 :'726)
I
i
;
i·
Many scientists l1.ave contr-ibuted to the expanding
/knowledge on how one learns.
Ivan Pavlov {1849-1936), a
:Russian physiologist, did nclassical.conditioning" studies
dogs causing them to salivate at the ring of a bell.
8
reward) rather than the experimenter ..
(39:215)
Trial and error learning involves solving problems
by trying out alternative solutions and disregarding
unsatisfactory methods.
Edward Thorndike did trial and
error learning experiments and formulated three laws of
learning concerned with readiness, exercise, and effect.
He theorized that
present~
11
conditions·11 for learning must be
that practice of
~uccessful
experience
strengthens learning and that behaviors that result in
satisfying effects tend to be acqui.redi unsatisfactory
effects tend to be avoided. (28:362)
A German psycholo"gist, Hermann Ebbinghause (1885),
·did much research on rote learning or memorization.
He
used lists of nonsense syllables in an effort to study
pure learning without influence from meaning or emotional
(39:196}.
9
f•• • •
>
_
_.. . ,. . _ . • . - , , ,
""•'•>'•
••••
><- • • • · · •
> • • • • • • • • - - ' " ' ' ' " ....... ••••• .. >M••••· • · • • • • • • • •
Much difficulty in educational research stems from
I
!the lack of objectivity in measurement since learning
j cannot
be observed directly; however,· it is important for
jhealth personnel to be familiar with educational research
las health is directly related to what the individual has
, learned..
!
j
lA
( 28: 376)
Modern educators view the child in holistic terms.
child is a complete organism of related components of
i
i
jintellect, physique, social and emotional maturity; a
l
jpsychological, spiritual and political being.
I A multidimensional
11
Man is:
unity with each component--chemical,
!physical, spiritual, intellectual, or emotional--existing
.
)within a complex of interrelationships.
(35:9)
I
lwe see the concept of education is complex.
II
·I
Thus,
One should not; therefore, expect to find a
consistent, fully satisfactory set of learning
principles applicable to all learning situations.
Rather, there exist many principles not always
consistent with one another that must be adapted
to any specific situation at hand. G~neralizations
that can be safely made on the basis
our
present knowledge tend to be broad and inclusive.
To be meaningful in terms of action, they need
to be made specific in terms of the problem
at hand; they must take into account the conditions under which learning takes place and the
kinds of behavior to be learned.
(28:376)
of
1
I
The word "education" comes from the Latin educare
jwhich means to bring up and stems from the Latin educere
meaning "to lead forth" or."out."
Educators ·are leaders,
parents are leaders, friends are leaders--for all te§.c!},
It is with this broad concept of educationt
10
r·: -·~~~~; ·~~- <o~:«'s
I
learning experiences, that
report
lhas been written.
I
IjConcepts
of Health Education
The union of health and education into a concept of
Ijhealth
education is a natural one.
Dorothy Nyswander
Iwrote:
Ii
!
I
l
Health education is a process of change within the
human organization itself which is related to achieving personal and community health goals. Heal-th
education cannot be "given 11 to one person by another; it is not a set of procedures to be carried
out or a ,product to be achieved, rather it is a
dynamic ever changing process of developments in
which a person is accepting or rejecting new information, new attitudes, and new practices concerned
with the objectives of healthful living.
(34:641)
Health education is using the educational process
for promoting health. It is more than the transfer of facts since its ultimate objective is to
result in some form of positive health action. It
involves four major stages, each of which have positive and negative aspects. These are:
(1) Kno'VIrledge
(3} Motivation
(2) Communication
(4) Action
The ultimate degree of effective action on the part
of an individual to promote .health will depend on
the degree of efficiency of each of these stages.
(6:48)
As Beeston put it:
Total health is conveniently based on a four-part
program of activity:
J
Promotion of health--prevention and control of
dise~se--early diagnosis and treatment-rehabilitation.
(6:48)
What cannot be prevented and coni::rolled should
be diagnosed and treated early so that residual
disability is minimized and the need for rehabil~~~:J
tion diminished. Each successive stage of endea~
~
"-••••"
"•"••"
'"
-
--•
-•
~
-•-·--
• ._~ • • -
,.,.--'
·-·
•.0"•
-.c """
11
r-"-·--······- .. ··-·· . -....
1
implies some degree of failure at a previous level.
Ideally, then, optimum health depends on stage 1
by promoting maximum development of the inherited
characteristics by exposure to the best possible environment • • . Stage 1 demands the application of
medical science to the lay individual, singly or in
groups. It is achieved by health education.
(6:47)
1
1
l
i
'
I
I
Health education is concerned with the whole range
\of research, planning and methods for increasing the abil1
lity of people to make these choices in matters of health.
I
iSome
I
of the world's greatest philosophers and thinkers have
.
!extolled the virtues of mind and body.
i
Ancient writings
I.
/from Egypt, China, India, and Babylon have been concerned
Jwith health education.
1
The ancient ruler of Babylo.n, Hammurabi, left his
code of Hawnurabi, compiled in approximately 2000 B.C.,
1
I
\which is a set of laws concerned with the regulation of
!
1
marriage and social relations.
I
'I'he ancient Egyptians were
l concerned with cleanliness and hygiene.
The Mosaic lavlS
1
I
lI of
the Jews included a formal hygienic code.
J?amous Greeks
land Romans (i.e., Socrates, Plato, Aristotle) wrote concerrr
i
I ing
the essentials of health.
The father of medicine, Hip-·
pocrates (460-355 B.C.), left great works of science related to health, but with the Dark Ages came moral and
physical decay, a decline in the search for knowledge and
monstrous epidemics eliminated much of the human population.
With the return of reason in the Renaissance period,
:man again pursued a.n interest in heal·th and heal t:h educa·(31:13-16)
12
r-·-·-··-·--- -- Accor~:n;-~:--·~:~~;:---;::~~-,
health education de-
lveloped differently in Europe than in the United States.
I
I (31: 13-16)
!,gage
In general, official health agencies did not enin health education and voluntary health agencies
I
!were not so well developed; however, certain tools and
I
!channels of communication were more highly developed and
3 00
I::::dm:::s::·e:::n:::e~::f ::r:::e:~i::da::::::~ t~ :~: )
I
I ·
·
?
1v1s1·t·1ng a coun t ry .cLOr a s h ort t1me.
I
Today, nations all over the world are exerting an
I
jeffort to utilize health education for health promotion 1
1
.I
!for the purpose of health education is directly related
Ijto
improvement of the quality of man 1 s life.
I
I
/
Since the purpose of this study was to observe
j factors related to health in the four countries, it follc~
;
i
I
I that
the means and methods of educating the peoples to
jpromote a more positive state of
I)of
II
1
1
I
health" is a vital part
the study, and some effort to establish just what is
"health; 11
11
education;
.
11
and
11
health education" are impor-
/ tant componen·ts of the study.
l
11
Chapter 3
METHODS AND PROCEDURES FOR THE STUDY
I
Where does one begin to organize a study in a
I foreign country? It is of primary importance that
I have some specific means of acquiring the data, as
I
one
well as
I
j some familiarity with the country, and some background
I
i
l knowledge of health and health education.
Course work at
!
i California State University at Northridge provided the
author with a health education background.
Supplementary
library research was necessary to determine what questions should be asked, such as:
1.
structure.
Regulations:
Type of government and political,
Mandates and policies pertaining to education
and health.
2.
Services:
Types of agencies:
voluntary or
government.
Economics of services
Insurance
Medical plans
Facili t.ies - types and availability.
3.
Educa·tion:
Environmental factors, cultural
and societal factors including religion, emot.ions, folk
medicine, family structure, language, food and d.Let, labor
and industry.
i
• ., .._ -.~..-,,-. "•"'-·'"···· ~ ..... ~ --·•·~• ·-··e~ --••••:•••••••·~- •-···--<•-.J
13
14
~~--·
I
.,, . --··->'• ----------·-······· -- ---
----~·-
.., ····--·- ---·-· .... -· ... ----
»
•
-
......
-
-···--·----------------··-·- ... --· ...............
-----·1
4.
What societal needs were expressed and emerg-
5.
What individual needs were apparent'?
ing?
What
interests, knowledge, points of view were expressed?
I! is
I is
I
the individual's health and educational status?
What
What
the plight of women?
6.
J
What methods are used to promote health and
•
ii educat1.on?
What communication systems a.re in effect?
II
What education is required for health profes-
7.
1 sionals?
From this broad outline, the author proceeded to
11
i more specific questions such as:
I
Does school health education contain information on the following subjects?:
Nutrition, hygiene, food handling, water purifica- ·
I
tion, maternal and child health, mental health, communicable diseases, safety and driver's education, physical
fitness~
pollution, first aid, sex and marriage.
All of these subjects pertain to the health status
of the peoples.
The magnitude of the goal seemed insur-
mountable until some logical order could be evolved.
Realizing that the knowledge to be gained \•lOUld be primarily through interviews, it was necessary to leave the
ques-tionnaire somev.rhat open-ended to allow freedom for
transfer of ideas.
With the assistance and review by the faculty
15
f
~-~· A~"• ·-~-·
"'
I advisor,
I
• Or
•
-·-'
-~'"
·····-
·--~--.---~.<~-~-~·~
Dr. Lennin H. Glass; a questionnaire relating to
j health regulations, services and cultural factors, and
i
j
including educational means and specific statistical data
l
jwas formulated.
Revisions were made to provide clarity and
Ithe final questionnaire as presented on pages 17
1 was
I
formulated.
and 18
The questionnaire was duplicated so that
the same set of questions could be presented in each coun- ,
try.
M1o does one contact for permission and to assist
in setting up appointments in various countries?
Initial contact with authorities from the various
countries was made through the consulate offices in Los
Angeles and San Francisco.
(See Appendix A.)
However,
this contact was of little value.
Since each country maintaining diplomatic rela-
in each country.
The ambassadors fonvarded these letters
to the proper officials in each of the various countries.
Upon receipt of a letter from the authority, in
the respective country, a·second letter and the questionna.ire were sent to them.
No response was received from
the Yugoslavian authorities, so the author v1rote directly
to the Director of Health Education in Belgrade and received a cablegram from Dr. Djordje Jakovljevic before
16
j leaving the United States.
II interest
j
Initially Portugal and Sweden were to be included
! in
!
1
in the study were received from Dr. A. Baza in
Greece and Dr. David Yarom of Israel.
I
1
Personal letters expressing
the study, but time was too limited to allow for inter-
views on tours while in Portugal,
A schedule of appoint-
ments was made through the Sv1edish Institute for Cultural
Relations in Stockholm, Sweden and through personal con'l"'
tacts wi·th the medical school at the University at
Uppsala, Sweden.
The author did complete the study visits
/ in Sweden, but for purposes of comparison, felt it best
I to
j
I
present only the observations relating to Greece,
Israel and Yugoslavia.
r ...._.________ .............. - --
-~
..... ,. .... .. ...... -·- ..
--~----·
--·-· ----... ---···-- --. . -. .. -- ... ---· -- ......... ···--· .... ·-----·--............ ----
·------~
---------------------·--··-·------ ...
Questionnaire
I
MEANS AND METHODS OF HEALTH EDUCATION
I
REGULl~TIONS
II
what is the organizational structure relating to health in
1
Jyour country?
I
!What is the organizational structure relating to education
i
'
/in your country?
l
I
IHow are the two related?
lis there a single government agency that is responsible fori
!health in your country?
Are there .other agencies that also
!
!have responsibilities for health?
I
!what are the reportable diseases?
Are.there any difficult-
!
lies or problems with the reporting procedures?
i
I
!SERVICES
i
!
.
!How are preventative, curative, and rehabilitative services
I
i
!provided? Are they integrated?'
I
i
!Are there private as well as government services available?
I If
J
so, who uses them and who regulates the care provided?
i
iHow are health services financed?
i
Is there national medi-
I
i cal insurance?
If so, does it provide
tot~l
patient care?
!
iAre there private health insurance plans also available?
'i
;When a citizen becomes ill, what is the procedure he will
to obtain care?
emotional illnesses cared for?
17
Are mental health
18
services integrated with other medical services or are
they separated?
HEALTH EDUCATION
Is health a subject that is taught in the schools?
If so,
what subject matter is taught in the schools and at what
age levels?
What other health education programs take place?
Do they
use the mass media?
Are there any local or national surveys that have been
done to assess the health kn:ovlledge of the people'?
How does a citizen enter the health professions in your
country?
there?
Wnat different types of health professions are
How many years of study are required for each?
CULTURAL :E'ACTORS
Are there any studies to investigate how cultural factors
affect health behavior in your country?
Are there reli-
gious beliefs that require fasting or have other dietary
rules?
STATISTICS
Latest population estimate:
Crude death rate:
Infant mortality rate:
What are the criteria for a live
birth?
Life expectancy;
Number of hospital-beds:
Number of physicians and other health professionals.
Is
there any distribution problem with the heal·tr1 professionals?
Chapter 4
GREECE
I
\Geographical and Historical
Background
The country known as Greece is composed of a deeply
!indented peninsula and many small islands in the Aegean and
IIIon1an
.
Seas.
Crete and Rhodes are included.
The land is
I
!rugged; mquntainous, dry, and rocky.
The islands are tops
lof mountains, jutting into the blue of the sea.
I
I1
The climate is that of the warm Mediterranean with
little frost and scarce rainfall.
In spite of the lack of
rainfall, farming is a common occupation.
Grapes and
olives, figs, and citrus fruits are grown.
Grains, such as
wheat, barley; and corn are planted, but require irrigation.
There are no navigable rivers.
It is a small country--approximately three hundred
fifty miles long and three hundred fifty miles wide.
The history of
Greec~
(13:21~
is the history of European
civilization, for it is from this small country of mountains surrounded by seas, that today's Western civilization'
sprang.
Concepts of law and government that rule our lives
today were founded_by the early Greeks.
Museums throughout
the world are filled with remnants of ancient Greek
ture and painting.
sculp~
Here began art, literature, sports,
19
20
,....
~
............. , ...
,,,,.,,
... ' ' "
,,_,,,
................ " " - " " ' " " ' ' ...........
,
.....
.
. , , , .,
........ " "
.,
"
.....
__
,,_
......................, .. _, .. .,,,_,.,........._,... __ ,,,.,,,,
........................, ,
i
jcity planning, architecture, logic, geometry, engineering
land astronomy.
I
The written history of man began with the invention
Jof an alphabet 'approximately five thousand years ago.
~ourse,
Of
man existed long before writing; in "prehistoric"
/times, first as a hunter, then as a husbandman when he
!domesticated animals and food plants.
l
lgan to specialize and cluster.
I
Eventually, man be-
The earliest evidence of
!communal life is seen in the fortification of early Jericho,
'I
!constructed almost nine thousand years ago.
Some three
!thousand years later, there is evidence of a more complete
1society arising along the valleys 9f the Nile, the Tigris,
I
Jand the Euphrates Rivers.
This was the beginning of the
I
!historic civilizations of Egypt and Mesopotamia; the inven-:
[tion of writing was accomplished here betw·een 3300 and
13000 B.C.
I
(25:33)
Egypt is a three-day sail from an island in the
!Aegean Sea known as Crete, and the sea became the avenue of
l_i_·the spread of this early civilization. By 2000 B.C., Crete
'
jwas the site of a well developed civilization. The most
!
Ijrenown
ildenced
i
of Cretan rulers was Minos whose influence is eviin the term Minoan Age, applied to a period of
)nearly two thousand years.
!
Evidence of this early Aegean
'
;culture may be seen in the palace at Knossus.
Pottery and
'
paintings adorn the red walled interior.
oldest road in existence today.
Outside one can
21
But the people of the Aegean civilization were not
r
!Greeks.
Ijat
The use of iron became common about 1000 B.C. and
this time barbarians from the north overwhelmed the pen-
!insula of Greece and the island kingdoms.
I
!Greeks •
These were the
(12: 35-36)
These barbarian invaders destroyed the towns and
I
/cities of the Aegean civilization, then built new communi1
They were nomadic herdsmen, but .settled in small
jties.
l
icornn1unities forming the early Greek city states of Sparta,
I
!Athens, Thebes, Argos, and their· common enemy, Troy.
The
!political units were divided by natural geographical bor1
.
lders, for Greece·is divided by mountain ranges and seas.
I
I
iEach city-state was independent, yet they shared a common
i
!language, religion, literature, and the Olympic ga~es.
II
Kingdoms were the early form of
!
!lowed by "rule of the few" or oligarchy.
!
goverP~ent,
fol-
Tryanny often
!followed as a result of one individual seizing power.
Dem-
1
!ocracy--or rule of the people--was firmly Bstablished durl'
ling the fifth and sixth centuries and Athens was the site
j
I
.
'lof the first democracy in the world.
,
I
War of'cen unites former enemies--and so in Greek
!history, for the independent city-states united to defeat
l
!the Persians in 480 B.C.
i
!federacy of city-states.
.Athens became the hub of the con-
Between 600 and 300 B.C. the wise men of Greece
i
!
'conceived the idea that the universe is orderly and that
IL........
22
j''"<--•~
·--
~~··~·~
-w•• •··-~·<·•·•·--
••• ··---•••• _. • --- -·"''·-··
•-·~~-··-~·
·-• ,_
~·«••
I
!man could understand by using reason, which they applied
I to all
!ished.
fields of knowledge.
Science and art both flour-
Learning became fashionable and Athens became a
I
! city of great wealth, power, and intellect.
However, at least two-fifths of the population·
I
Iwere
r
1.
slaves.
Some slaves were educated, treated well, and
able to obtain their freedom, but many suffered all of the
ills of men in bondage.
I
Then came the Peloponnesian War (431-404 B.C.) be-
l tween
Athens and Sparta with its Peloponnesian league of
city-states.
Athens was defeated and the age of great
city-states.was ended, for the divided country was easily
overrun by conquerors from the north under Philip of
Macedon.
After his death, his son, Alexander the Great,
buil·t an empire that encompassed nearly the entire known
world of that time.
This was the beginning of three cen-
turies of art, science, and learning--the Hellenistic age,
which ended in the Roman conquest in 31 B.C.
Greek influ-
ence flourished in Roman schools, but Greece was never
again a great power.
In the fourth century Greece was devastated by the
Visigoths, a Teutonic people from the north.
In the sixth:
century it was overrun by Slavs, a Slavic-speaking group
from the north; and in the tenth century, again by the
Bulgars, another northern group.
In 1453, the Turks took
and it was not until the nineteenth century that
23
r;;-;::~: final~; ~~~~me
an independent.
~~~:;~;. --~~;~2~=;;~)
In.1821, the Greek war for independence began.
I' political
I
instability followed.
I
The Greeks
f ought w1th
.
the Allies in World War I in 1917.
I new
Years of
Ironfisted rulers rose,·
I were deposed, and new dictators took over.
I
--
In 1921
altercations began with the old Turkish enemy and
political instability continued.
Nazis invaded.
In World War II the
Underground forces provided resistance,
but even the common enemy of World War II failed to unite
the divided Greeks.
Communists forces, aided by Russia,
fought government forces aided by England and the
u. s.
in open civil war in 1946, which finally ended in 1949 when
the Co1nmunists surrendered.
The reaction against corrmunism led to extremism on
the conservative side.
During the 1950's Greece began to
recover from the ravages of World War II and the civil
conflicts of the_post-war era.
Economic growth began with'
indus·trial investment and tourism.
The drachma became a
respected currency but political conflicts continued to
smolder on a sub-surface level.
tary coup took place.
On April 21, 1967 a mili-
Martial law was in force in the
major cities for four years after the coup.
The govern-
ment in power today is a military dictatorship led by
Prime Minister George Papadoupoulos.
(27:3)
Observations
First impressions of Greece were formed during the·
24
r--··--··
~
------~-- ~-
.. - -- ..... --· ...................... - ......... ......... ----· .... ... -- ..................
ride from the airport into Athens.
l there v1ere wild
~-
....·
-~
. ··- --····
----~------------"--
It was spring, and
flmvers blooming along the road, but the
I
I l?tnd
looked dry; somewhat like Southern California.
~;:Laster
buildings looked old and decrepit and unkempt for
;:Lack of paint.
gardens.
The
There were no manicured lawns or pretty
The country seemed poor.
But in the heart of the city, there seemed to be a
V(;;"fY different feeling.
1
J
9;:Lean and well kept.
The sidewalks ·and streets were
Modern buildings surrounded the cen-
ter square known as Constitution Square.
Gardens and parks,
/ were apparent everywhere with activities for young and oldJ
i
j
I
f;:l9wer shops adorned the streets and the sidewalk cafes
W§r~
Gr~ek
filled with people.
The warmth and exuberance of the
people was contagious.
The pride of the Greeks is extremely apparent in
the care and preservation of the antiquities.
The grounds
of the Acropolis were immaculate on three different visits.
There was no litter, no papers, bottles, cans, or other
j~nk
lying around even though thousands of people visited
the historic site daily.
The author drank the water from hotel faucets, ate:
~t
the sidewalk cafes, hotel dining rooms, and the Greek
tavernas with no ill effects at any time.
Greek exuber-
ance urged one to taste the zesty Greek beer, Metaxa
brandy, and ouzo, the anise flavored spirit.
Spirited
Greek dances were performed and visitors were encouraged
25
to participate.
There were no freeways but cars filled the city
streets.
Buses are the main means of transportation and
were very crowded, especially at rush hours.
the waiting buses were quite noxious.
Fumes from
The city is composed
of small shops; very few department-type stores.
Store
hours were from 8 a.m. to l p.m., then closed for the midday meal, reopening at 3 p.m. and closing for the evening
at 8 p.m.
Our taxi driver worked a straight 12-hour day--
6 a.m. to 6 p.m. or vice versa.
Sports were emphasized--particularly soccer.
One
saw children playing soccer in the parks on 'the electrically lit fields at 10 p.m. on a school night.
Provisions
for sports activities were available in most of the numerous parks.
Toilet facilities were somewhat rudimentary, espe-,
cially on the islands.
the old-world
block.
11
Often the "toilet" consisted of
hole in the grou,nd" surrounded by a cement
Hand washing conveniences were absent at this type
of facility.
The buildings on the islands were amazing.
Soft
rounded arches idorned the newly white-washed plaster
buildings.
From afar the island towns shone gleaming white
against the blue sea.
It is the custom of the Greek peo-
ple to whitewash their entire small home and shop just
before the Christmas holidays and again before the Easter
26
.
r;::·~·~~~:·~-~~~-·-··-- -----~-·-··--·~-----~··----------
. . . . -.·- ·- ·- ·.
-·~----------------------·-·--·-------·--·-·---------
The importance of the Greek Or.thodox Church in the
1
!daily life of the Greek citizen cannot be overlooked.
I\Greek
Ithe
The
Orthodox Church is supported by the government; and
church supports the government.
Churches· and chapels
i
!are to be found in every village with people entering and
I! leaving
frequently.
I
Young men in Greece in the spring of 1971 did not
Ijhave
long hair and girls were seldom mini skirted.
Iwomen wore
black, head to toe.
lesque bars or
11
Old
No advertisements for bur-'
topless" entertainment v1ere evident.
villages and cities, women often
w~lked
In
l!
'
alone at night.
Taxi drivers, hotel clerks, waiters, and people
of various occupations did not talk politics.
Shop owners •
gave the impression that business was good and improving.
Evidence of the military regime was inescapable.
The uniformed gun-toting soldier was everywhere, including
the parks, where the romance of· spring and beauty of young ·
. girls held their attention.
This feeling was reinforced
when a visit was made to the Ministry building for the in-,
terviews.
Entrance into the government building was an
awesome experience.
The building had guards posted around:
it and there was no entry permitted except as indicated.
The visitor is required to present his credentials to the
. guard seated in a booth resembling a theatre ·ticket office.
He did not speak English, so the author's appearance
27
r
.
.
···-·'-·--------··----~ ·-~--· -·····--·~·-····--- ~--.-----
._. . . ,. . . . . . ........... - · ----- ·- - - - - - - -
lcaused some consternation.
i
1 spoke
English.
....
--~----------·---
. ·--·-----------.. . . . . . . . ._ . -
A second guard appeared who
Upon presentation of a letter from the
!Ministry of Social Services office, a·phone call was then
l
j placed to that office, and a member of their staff was
sent to escort the author to their offices.
One was not
allowed to enter the building until the staff member came
to receive him.
Interviews
l
The offices had a rather austere and subdued atHealth pamphlets adorned the bulletin boards,
f
me sphere.
I
but were printed in the Greek alphabet so this author was
!! unable
to read them.
iI
In a country where women w·ere first allmved to
i
i
I vote in 1951, it seemed somewhat incongruous to meet a
I
woman, Dr. Athina Baza, who is Director of the Health
Education Division of the Depar·tment of Hygiene.
The Ministry of Social Services has three main
departments:
{!} Hygiene,
(:2} Social Welfare, and (3} Social
Insurance~
The General Director of the Department of Hygiene is also
a woman.
Dr. Heropi Violaki Paraskeva held that position.
Di, Baza is a charming, soft-spoken and warm
per~.
son who served Turkish coffee while discussing the problems relating to health and health education in Greece.
'rhe Health Education Department, being a part of
28
1
I
the Social Services Ministry, is quite separate from the
!Ministry of Education, but they collaborate on programs
I
l for
l1
school children.
In general, health needs of the people are handled
!through government centers.
I
-
There are rural dispensaries
l scattered throughout the islands, staffed with Public
)Health nurses and sanitary_inspectors.
Some have doctors.
!
'
:children receive smallpox and diphtheria-pertussis-tetanus·
'immunizations before beginning school.
Boosters of these
immunizations and Sabin polio vaccine are given when the
child enters school.
Physical examinations are a part of
the school health program.
mary school and then a
Children usually attend a
~'gymnasium"
pri~
school which is some-
what analagous to our "high school."
Financing of health care is through government in-.
surance programs.
Originally, these programs were sepa-
rate for each occupation, but efforts are now being made
to consolidate the various occupational health programs.
Medical care is provided by family doctors and
public health doctors.
The public health physicians at-
tend the Athens School of Hygiene$
After receiving their
diplomas.as public health doctors, they staff the 54 Re_ gional Centers of Social Policy.
The mainstay of t.he
health care is furnished by the public health nurses and
midwives who staff the rural dispensaries and health stai
tions.
L___ -------
Public Health nurses now attend
11
post-gymnasillin 11
!
29
r-------~~-~
..
"--~~--~
·----·
i
ischools for four years--three years in nurses training and
a fourth year for specialization as a public health nurse,
!nurse anesthetist or other field.
Midwives attend separate
!I
!schools for a total of three years.
I
Separate facilities are provided within the Ministry of Social Services for mental and social diseases (tu1
jberculosis and veneral diseases.)
Even diabetes has a
i
!social stigma in Greece.
There is little, if any, birth control or sex edu-
I
jcation provided.
The church is opposed to any emphasis on
lsex education and since government and church are closely
/aligned, no effort to promote sex education is made.
I
Population estimate is 8,800,000 people.
I!urbanization
General
is occurring with more people moving from vil-
1
llages and rural areas into the larger cities.
Ii
IJ
1
(1) cardio-vascular
Main causes of death are:
eases,
{2) cancer,
(3)
( 4). accidents.
influenza,
dis~
Diabetes
i
i
J
I
1
and tuberculosis are included in the top ten causes of
death.
I
Ii outline
I
l may
I
Dr. Baza was kind enough to provide a comprehensive;
I
of the responsibilities of her department which
(5)
be found on pages 30-33.
i
I
I
!
i
' i
'
~'~'''Y<"~ •·<~•••·-·-·~··~U ••-~ ~-.
'• ••>••-
'••-·•~•-•-oww,..-_,,~,,_,,
'"
'"''''"'~•·~-"-"'''·"--••~·-~--•-••·•._,
••»•
h<•
,
0,
"'~••"
·--••
uo
···••-nwo •··-<
._,,_,,_,,,._~ '•''"-''~·--~·-"·-- '"''-•--•""'''-~'~"
J
30
'
l MINISTRY OF SOCIAL SERVICES
EDUCATION PUBLIC AND INTERNATIONAL
I RELATIONS DIVISION
HEALTH EDUCATION SECTION
I
!
I
I
I
I
1)
In Greece the main operating agency in the field of
Health Education is the Ministry of Social Services,
through its Heal·th Education, Public and International
Relations Division, acting as a central service, directly'
responsible for the planning and implementation of rele·vant programmes. Apart from this Division the following
organizations and scientific societies are engaged in
special health education subjects in this field.
-
I
. l
I
I'
I
II
I
II
I
1
i
'
·The Greek Anticancer Society
The National Association for the Health Education
of the public
The Greek Eugenic Society .
The Organization for the Prevention of Accidents
The Panhellenic Hygiene Society
The Social Insurance Foundation
The Panhellenic Union of Mental Health
The Panhellenic Jmti·· Alcoholic: Crusade
The Greek Red Cross
2)
The Education, Public and International Relations
Division is financed as it happens with all State Services, from the State Budget while other organizations
from their own resources •
3)
In regard to its organization, the above mentioned
Division consists of the following Sections:
a)
b)
c)
d)
e)
Studies Section
Extension and implementation Section
Public Relations Section
International Relations Section
Press Office
4)
'I'his Division elaborates programs, prepares and
prints education pamphlets, which are sent to the regional services, together with relevant circulars,
instructions and directives, and sees to· the execution of programs. The Services which are responsible
for the application of the Education Division's programs
are the following:
54
7
1.353
103
Regional Centres of Social Policy
Health Centres
Rural Dispensaries
Health Stations
31
The Health'Education Division:
studies the problems of other Divisions and Services of
the Ministry and selects the most interesting and current questions which have to be brought up to the public's attention,
studies the quarterly health education
lished by the regional Services of the
the Social Policy Centres) , supervises
and assists in facing any difficulties
in connection therewith,
I
II
I
I
I
I
I
/
reports pubMinistry (i.e.
their activities.
that may arise
prepares the education documents, pamphlets, leaflets,
slogans, etc. ,
prepares radio talks f6r· the rural population;
l
i
takes care of the publication of the Ministrys Official
Journal 11 l-irchi ves of Hygiene 11 ,
organizes exhibitions and celebrations such as the
World Health Day, the Children's World Day, etc.,
organizes campaigns and other educational crusades,
it provides training in Health Education for Pub'lic
Health Nurses, Army Nurses, Midwives and for the health
.personnel at the Pharsala (Thessaly) Rural Hygiene
School, and organizes seminars, lectures, etc.
- represents the Ministry at Symposia which take place
either in Greece or q.broad and other events such as
Symposium on the Nature Protection and the 50th anniversary of the International Labour Office, etc.,
releases to press communications on health problems
and is responsible for answering relevant questions,
on the occasion of the World Children's Day, awards a
prize to healthier infants and assignes gratification
diplomas to their mothers(
translates and converts to Greek narration the films
supplied from abroad,
collects data which are useful to the elaboration of
programs,
organizes group visits of pupils to hospitals and
other public institutions,
(
i
../
32
drafts education programs for increased mild consumption,
elaborates monthly and yearly reports referring to the
Ministry's activities,
this Division has undertaken recently a crusade for
the creation of Mothers' Cultural Centres. The experimental part of this program has already been successfully completed and the first course of the Centre.
is now in progress.
I
5)
No extensive research programs.are under way at present.'
During the recent years the following surveys have been
conduct.ed on Health Education subjects, and Primary Schools.
in the area of Athens.
"Teachers' attitude towards Health Education".
"The influence of family environment on children's hy-.
giene habits".
· "Survey on the interests of school children and the
influence on their intellectual and mental health"
(doctorate thesis) .
6)
This Division collaborates with the Ministries of Edu-•
cation, Agriculture, Labour and all Institutions mentioned
above, as well as, with the National Foundation for the
protection of Mother and Child, the Foundation of Social
Security, the Hellenic Red Cross, Committees etc.
7)
We believe that Health Education's influence on school
children is obvious, a reason for which all types of educational programs include activities taking place at
school levels. We plan also to have a much closer cooperation with the Ministry of Education and to include the
health education in the teacher's school syllabus.
8}
The same Division cooperates also with the National
Broadcasting Station and the Armed Forces' Broadcasting
Station, and their Television Stations, as well as with
newspapars' editors and cinema managers.
9}
The Director of the Division is a Public Health Doctor
and has obtained a special Health Education Diploma from
London University.
10) In each of the 54 Regional Centers of the Social Policy
there is a specially trained sanitary inspector or a P. H.
nurse who carry out film projections and give talks on
Health Education subjects among primary school pupils.
The health·education lesson is included in the 3rd
33
r--------------------------- -----------------·--------------·---·---- ----~Class syllabus of both schools of Public Health Nurses and
!Midwives. The Public Health Nurses are informed on the
modern media and methods of health education, both during
their theoretical and practical training (field work) and
!performs their work with efficiency.
·
!
!
.
.
i1wives
- Allandhealth
personnel: doctors, visiting nurses, midsanitary inspectors are trained by groups at the
i
Pharsala School of Rural Hygiene, on heal·th education
media and methods.
·
I
For any further information required, you are requested
ito apply to Dr. Athina Baza D.H.E. London, who is the di1 rector and the responsible official of the Ministry in ·
I the field of Health Education. (5)
1
I
I
l
;
I
i
I
I:
I
I
I
'
(
34
r··,··d·.,--~~·~· -----~------·
·-
-~-.
··~-- ~'"····-~--
... ·----·--'"-
-"·.,~·--~-. -·····~··-~
!
j§ummary and Conclusions
j
I
Greece is a developing country with many of the
j
!problems of developing countries, i.e.,urbanization, pol-
l
.
llution; but it also has special problems.
The destruction.
land loss of life during World War II and the civil conI
lflicts following have left scars that will not easily heal.:
1
!The totalitarianism of the government is likely to foster
I
!unrest and possibly further revolution, and when people
I
.
/concentrate on
1
1
warfa~e,
there is likely to be little empha-
si.s on health and health-measures.
In addition, from an
I
ieconomic point of view, it is difficult to support an army
Iand at the same time, provide
1
I
funds for health and educa-
tional facilities.
Other problems unique to Greece are related to its
geography.
The island villages are separated from all
others by the sea.
It is not physically easy to get from
one to the other and involves hours of boat travel.
travel between the islands is not common.
Air
Lack of communi-
cation is a related problem.
Certain advantages are also apparent.
The wannth
of the Greek people, their love of home and family provide'
a good basis for emphasis on health improvement.
mon language and religion are also assets.
The com-
Centralized
government power could be an asset if health and health
education were- emphasized by such a government and funds
provided to build the facilities.
35
f"'•'·----·~
l
...~----~-
M.-
--~-~---·~·----·~---·-.-
o'•OY-
----.,·~~--~- ~-~-~ -~--·
0
o• ' ' '
0. 0
--~~ --~--
·--
00
0- o 0 ' 0-•
0
>•o•
~-T
0
o•-~'>0
0
·-~----, -~ ~--~·-······--
o
-<--~---~··-··---~-~~~L-Y-0~~
What happens in the next few years in the country
I that
1
>< ·-·~-· - ' '
was once the center of the world for health and edu-
cation will be interesting to see.
j Statistics (1970)
Mid-year population estimate
8.89 million
Crude death rate
8.1/1000
Crude birth rate
17.~/1000
I
Infant mortality rate
31.8/1000
I
Life expectancy
I
!
I
Males
67.46 years
Females
70.70 years
I (See Appendix B)
Ii
I!
)
Chapter 5
l
ISRAEL
l
I
I Geographical and Historical
Background
I
In the Bible, "Israel 11 is the surname given to the
1
I
I patriarch, Jacob, and to his descendents, and refers to a
Il theologically-based
society.
Loosley translated, i t means
j"He who sees God."
{30:696)
When one speaks of "Israel"
I today,
one generally refers to a
repub~ic
in southwest
Asia bounded by Lebanon, Syria, Jordan, the United A.rab
Republic (Egypt) and the Mediterranean Sea.
The land was
once known as Palestine and is regarded as the Holy Land
by Christian, Jew, and Arab.
To the Christians, it is the'
land where Jesus was born, lived, and was buried; to the
Arabs i t is less holy than Mecca but is the site where
Mohammed tethered his horse -v.rhen resting while on his
miraculous ride.
To the Jews, it is the Promised Land to
which :r-1oses led his people in their flight from Egypt
around the year 1200 B.C.
(14:77)
Before World War I the land was a part of the vast
Turkish empire.
But the Turks were aligned with the Ger-
mans, and lost much of their empire in the post-war nego,..
tiations.
It was inhabited by Arabs and Jews.
The land,
then known as Palestine, came under British rule as a manL
gate from ·the .l:Jeague of Nations •. J'ewish peoplt: __ then
36
~~gan_
37
r-::::d~:::: ::r:::::u:o:c::r:::o:r::~:: ::i:e:o~:c:917
j statement established in a letter from Lord Balfour to one
i of the leaders of the Jewish community in England, Lord
1,
1
Rothschild.
It stated:
His Majesty's Government view with favour the
establishment in Palestine of a national home for
the J'ewish people, and will use their best endeavors
to facilitate the achievement of their object, it
being clearly understood that nothing shall be done
which may prejudice the civil and religious rights
of the existing non-Jewish communities in Palestine,
or the rights and political status enjoyed by Jews
in any other country. (11:48)
The other allied nations, France, Italy and the
United States accepted the policy shortly after its publi-;
cation.
The Arabic people were alarmed at the idea of a
Jewish State in their midst.
Outbreaks of hostility per-
sisted in Palestine, and in 1937 the British proposed the
Peel Partition Plan which would allocate certain areas to
Jews and other areas to the Arabs.
This plan w·as com-
pletely rejected by the Arabs and was, at best, an undesirable compromise for the Israelis.
In May of 1939 the British government issued the
notorious White Paper restricting i:rrtiltigration of Je'1,,7S into:
Palestine at a time when Jews were facing elimination in
Nazi Germany.
To the Jewish people, this was betrayal by
the British.
During the ensuing World War II, the great lTevlish
leader David Ben Gurion formulated the only course open to
l
38
r----~·--"---··--····
---- ........... ······ ............- .. ····---·-- ..." .......... -- .... .
I Jews:
"They would fight the war as if the White Paper did
I not exist,
i
exist."
II
and fight the White Paper as if the war did not'
(11:62)
After the war, negotiations continued in an effort
to provide a homeland for Jews from all nations.
relinquished its mandate on May 14, 1948.
Britain
That afternoon,
in Tel Aviv,·David Ben-Guri6n, provisional prime minister,
read a document proclaiming the establishment of a new
state to be called, "Israel."
planes were dropping bombs.
A few hours later, Arab
(14:318)
The modernized Israeli army drove the enemy back
on all sides.
In February, 1949, :the United Nation's medi-;
ator, Dr. Ralph Bunch, persuaded Egypt to sign an
tice.
The other Arab nations followed.
has never.rea1ly experienced peace.
armis~
However, Israel
War erupted in 1956
and again in the Six Day War of 1967, when the Israelis
severely defeated the allied Arab nations and enclosed the
Gaza strip and the Wes·t Bank of. the Jordan without the
boundaries of the Jewish State.
Peace has not yet been attained.
Outbreaks of
hostility continue, and the people of the .land of "milk
and honey" live in a constant state of war alert.
The country is small; about the size of Vermont.
The southern part is the Negeb desert.
coastal area
i~
The Mediterranean
a plain rising to a ridge of stony hills
that run through the entire country from North to South.
39
r ...
Ill
~."
........ .
These hills rise to a height of nearly 4000 feet and
plunge to the lowest spot on earth where the Dead Sea lies
!
'
Il approximately
.
one quarter of a mile below sea level,
(14:
I 78)
I
The climate is warm and dry, much like Southern
I California.
I
There is very little rainfall from May to
The industrious Jewish iromigrants quickly com-
.1
October.
1
pleted pipelines for irrigation and began to make the
I desert
bloom, restoring fertility to long-neglected fields.;
To assist newcomers, Israel set up hundrEdsof
socialistic agricultural settlements known as "kibbutzim."
Members share in the work and the profits of the business
operated by the kibbutz.
They raise fruit, vegetables,
citrus fruits, cotton, tobacco, and peanuts.
There are three major cities.
(32)
Haifa, in the north;
is a fine seaport and a center of heavy industry.
Tel
Aviv, also on the Mediterranean, is a bustling grmqing
city and a center of light industry.
Jerusalem is the
capitor and lies some fifty miles inland.
The old city
of Jerusalem remains much as it did a thousand years ago.
The old city has its Jewish section, Christian section,
and Moslem section.
Here, in one place, is the beautiful
Mosque of Omar situated on the site of the ancient Solomon's temple.
of that temple.
The sacred Wailing Wall is the western wall
Through these streets walked Jesus of
Nazareth al.ong the Via Dolorosa of this Holy City.
The
40
r .- -· ... -----'--- .
.---........... - .............. _ .
i ne\v Jerusalem lies outside the walls of the old city and
i
J
is quite modern.
lby side.
Thus, ancient and modern persist, side
Jews and Arabs still toil side by side, building
!homes and shops in the new Jerusalem.
I
!observations
I
I
Lod International Airport near Tel Aviv is a large
!modern airport with numerous ticket counters and shops.
) Usually it is a bustling center of activity, but at certain times it is quiet and nearly deserted.
One might
i
won~
der if a new war had suddenly erupted, until one realizes
I
it is Saturday, the Sabbath for people of the Jewish faith,:
and business does not go on as usual,
From sundown Friday
to sundown on Saturday, activities in Israel are at a minimum.
After sundown Saturday, the city of Tel Aviv come.s
alive and hums with vitality,
Sidewalk restaurants do a booming business.
Teen.-.
agers and oldsters stroll the side\valks and stop to chat
with acquaintances.
Shops are open and the atmosphere is
light and gay,
One sligh_tly disturbing sight is that of the young
Israeli soldier strolling with civilian friends, wearing
his automatic rifle as though he'd feel naked without it.
Old men, some limping or maimed patrolled the entire block
of the Shalom Mayer Tower, the tallest building in Tel
·t
Aviv, and an important communications center.
Tel Aviv is a modern city surrounding an ancient
41
city.
Many buildings show signs of the ravages of war,
but construction of new and modern buildings transpires
at an amazing rate.
Jaffa.
The ancient city is the area known as
Here one may see the black caftans and white head-
cloth of the Arabs as they carry on their business activi-'
ties in the flea market.
Just a short walk away the old
fort of ancient Jaffa has been rebuilt and transformed
into an art and cultural center, housing many fine shops.
The flea market looks very unhealthy and unkempt.
Horses pull carts down narrow streets laden with sidewalk
shops that are dingy and very dirty.
Street vendors
serve food and drinks and throw their refuse in the
streets, attracting many flies and insects.
As
on~
leaves the Tel Aviv area and drives toward
Jerusalem one sees olive trees growing on the terraced
hills and irrigated fields covered with flowers.
Flowers
are an important export crop of this desert country.
The
roads are fairly wide and well kept.
Jerusalem is a city of hills.
It must be one of
the most confusing cities in the world for the tourist to
drive in.
The streets wind and change names every few
blocks in an effort to honor all of the great citizens of
the country.
Street signs are sometimes posted in Hebrew
and Arabic; often they are not posted at all.
ple who live in
J~rusalem
find new addresses.
Even pea-
find it somewhat difficult to
42
Here, too, the construction of apartments and office buildings goes on at a frenzied pace.
construction work seems to be done by Arabs.
Much of the
One could
see their draped heads on almost every construction site.
Outside of Jerusalem to the South is the Hadassah
Medical Center, one of the most modern medical complexes
in the world.
It includes a medical school, nursing
school, school of public health, school .of medical technology, microbiology institute, school of dentistry, school
of pharmacy, and school for graduate study and research;
all under the auspices of the Hebrew University and
Hadassah.
There are hospitals in all of the major cities in
Israel, but not quite as complex as the Hadassah Medical
Center of Jerusalem.
One can easily determine which areas have been a
part of Israel since its inception, and which areas were
Arabs' lands.
1
. J
I
The roads are wider and in better condition·
in the Israeli territory, there are more modern buildings,
and the farm equipment is mechanized and modern.
I fields
are greener--they are irrigated.
l Bank hillsides
The
Some of the West
I
1
are covered with tents of the Bedouin shep-,
herds,- nomadic Arab tribes that wander over the middleeastern deserts, subsisting mainly on the products of
animal husbandry. •
On a few occasions, the author had the opportunity
43
to speak with Arabs in various places.
were not happy with Israeli rule;
prefer to become a part of Jordan.
In general, they
however~
they did not
They wanted the coun.,...
try to return to the way it was as Palestine.
The young men of Israel must devote thirty-six
months to active military service; the young women,
.
twenty~
I
four months; and ·they all seem to hitchhike to get from
one place to another.
They all speak Hebrew, which is the
official language of the country, and some other language.
That other language may be French, Greek, Yugoslavian,
even on occasion, English.
But one can always resort to
drat•Ting pictures for purposes of communication and the
challenge can be most intriguing and fun.
.Of course, one
leaves the stranger thinking he has understood while, in
fact, the message may have been completely misinterpreted.
The area around the Sea of
Tiberi~s
is especially
picturesque, and the water is delightful for swimming-fresh and clear.
s~..vi.mming--very
The Dead Sea is also delightful for
warm, and one floats well, but the salt is
somewhat abrasive.
There are many street restaurants and some very
fine dining places.
Wine is served with meals in some of
the fine dirdng rooms, bu·t many of the hotels and restaurants do not serve any type of alcoholic beverage.
of the Hoslem faith do not imbibe.
People
In general, it would
seem that the consumption of alcohol must be minimal in
44
r·----.,--.,- - , "-- -· -- ---· -'"·- ...,__ ______ -. ··- ,__ ------- ---·---·-- ·--~
~_.,.
·----------~-
-····----·-.
------.,------~-.,
..--_.,..
!Israel.
i
Again,
the author ate food and drank the water as
convenient with no ill effects at any time.
1
Interview
Israel's Ministry of Health has five divisions:
Hospitals, Public Health, Medical Economics, Administra·1tion, and Finance.
The Public Health division has twelve
!
Idepartments,
I
one of which is Health Education.
.
Hr. David
.
/Yarom heads the department of Health Education ,from his office ·in Jerusalem.
I
He is most gracious, and well informed
on the problems of health education in Israel, many of
-v1hich are unique to the ·country, and some which are uni ver-;
1
sal health education problems.
One universal problem
I
!relates to the attitude of the medical profession toward
I
Ithe
i
i
I
.
professional health education.
Traditionally, heal-th
education was the prerooative of the physician; however 1
-
-
I
imodern medicine places such demands on a physician that
'
his time for
educ~ting
resulting in
a
patients has necessarily diminshed,
need. for a professional Y.7hose purpose is thct
of health education.
Such is the case in Israel where
the health educator is now beginning to find a place
on the health team.
to learn
~-vhat
A research approach has been taken
knov.rledge the people have; what attitudes
and beliefs they hold.
This approach is particularly im-
• portant in any country where there are great variations
in background of the people.
Again, such is the case in
;
•--
>••
, _ , , , , ____ ~
••-"'••-·-~·-•--''""'---··••-o'
•••"--'"""-•"••-•-
-•
••••-.,..~,_,,,
•
·--~-.-~.0
45
i Israel, where people have immigrated from
I the world, bring.ing with them some of the
I
I
i tude:.:.,
.
many areas of
i
I
culture and attiJ
beliefs and practices of the land from which they
I1 came.
Another universal health problem relates to the
I
I problem
of motivation.
Profusions of health education will:
I not produce behavior changes
j
I to the·expressed need of the
unless the program is geared
I
people for whom it is pre-
pared and offers some opportune pathwayfor the action to
be taken.
Again, this problem exists in Israel and is of
unique importance there because of the·ingathering of peoples from many areas of the world, speaking different
languages and expressing differing needs.
Dr. Emanuel Chieger,
According to
(44:9), national secretary of the So..-:
ciety for Rehabilitation of the Handicapped, eight out of
every one hundred Israelis are handicapped in one form or
migration policy.
Health education for the Arab population is another
specific problem in Israel, as well as provisions of medical services and educational facilities.
When the Israeli
.•
government was established in 1948 a special health division was set up to serve the Arab population; however, it.
was discontinued in 1952 and efforts were made to integrate the Arab population into the general health services.
46
ance program of the General Federation of Labor or Histadrut.
Kupat Holim insures, approximately 90 percen·t of the
workers and employees, including agricultural workers and
organized Arab workers.
Preventative, curative, and restorative medical services are extended to members and their dependents
through Kupat Holim's network of out-patient clinics
and home care programmes.
(18:236)
I
I
.!
There were nearly two million members and dependents in
1966.
•
Other insurance plans include the Sick Fund of
the National Labour Federation, the General Zionist Sick
Fund, and the Maccabi Sick Fund.
There are numerous volunteer agencies concerned
with specific ailments such as tuberculosis, cancer, dia"'"'
betes, and vision or hearing problems.
In general, the
health care system in Israel is excellent; geared to pro ....
vide every Israeli citizen with superior professional
care.
The challenge to health education is, therefore,
prodigious, focusing on specific plans to motivate diverse peoples to utilize the services available to them,
and produce a·nation of healthy citizens.
(51)
Summary and Conclusions
Programs direct.ed toward specific health goals for
47
the people of Israel are unique in many ways.
problems to be considered include:
variation of the group;
(1)
Specific
the language
(2} the diverse cultural back-
grounds of the citizens, and;
(3} the disparity in edu-
cational backgroundsof the peoples.
Certainly any health
education program of the Arab people must take into
account the animosity felt by some toward the government
of the country.
Specific assets of the country include:
excellent health care system with an enviable
tor ratio;
works;
(1)
an
patient-doc~;
(2) good communications and transportation net-
t3} an enthusiasm and spirit in the people, dedi-
cated to making a life in Israel a happy life.
Nevertheless, one cannot dismiss the possibility,
even probability, of another war in the Mid East, which
could vastly cripple the efforts being exerted in Israel
toward a healthy life for all.
Endeavors continue today to bridge the chasm of
hate that exists between the Arabs and the Jews.
Newspapers seldom mention them; only the acts of violence
become known.
Perhaps one day the Jew and the Arab will
work together to make the desert bloom.
48
Statistics (1970)
Mid-year population estimate
2. 89 milLion
Crude death rate
7.0/1000
Crude birth rate
27.0/1000
Infant mortality rate
II
. 23.6/1000
Life ~xpectancy
Males
69.19 years
Females·
72.84 years
·(See Appendix B)
r----·--··-····-·------·-····-··. ----···----.. -._,__________ ·--·--·-· --·--·-· --.. . . . -.. . . .
--------~
. . . . . ._______________._. . . . . . . . . ---··r
Chapter 6
Il
YUGOSLAVIA
I
Geographical and Historical
Background
I
I
Yugoslavia is a very diverse and beautiful land of
!approximately one hundred thousand square miles situated oni
I
!the Balkan Peninsula.
It is
bo~dered
by Italy, Austria,
!Hungary, Rumania, Bulgaria, Greece, Albania, and the Adri1
)
/atic Sea.
There is great variety in the terrain in this
. I
!predominately mountainous land.
Rock-strewn craggy lime-
·lstone ridges rise out of the Adriatic Sea; Julian and
I
'
!Dinaric
Alps surge skyward in the central part of the coun~
I
i try, and the fertile Panonian pli1in of East Central Europe
ex·tends to form the northern region. · The climate of the
coastal area is that of the warm Mediterranean 1;.vhile inland
climates are seasonal with cold winters.
(33:916)
Zagreeb is the center of importance in the
north~n
plains area; Belgrad is the capitol, also situated in the
north at the junction of the
Danub~
and Sava Rivers.
Sara-:I
l
;.
jevo is a population center in the mountain areas and the
small port cities of Rijeka, Split and Dubravnick are on
the Adriatic Coast.
(16:392)
The ruggedness of the terrain has contributed to the
independence of the individual and provided ideal conditions for guerrilla activities in times of conflict.
49
It is
j
50
-----
--------------- ------ -------------------------------------------·---,
~-:f"-p~ime importance in the perpe-tuation of the autonomy of
-
-
--
-~-------
I
!the various states.-
The present official name of the coun-
1
itry is the "Socialist Federal Republic of. Yugoslavia 11 and
:
lis composed of six member republics: Slovenia, Croatia,
i
!serbia, Bosnia, Herzegovnia, Montenegro, and Macedonia.
bhe people of these independent republics speak four dif1
-
lferent languages, use three different alphabets, and pracjtice various religions.
The majo,r languages are· Serbian,
I
lcroat-i.an, Slovenian, and Macedonian.
Serbian is the official
I
I
jlanguage.
All are related and can generally be understood
l
.
-
lby the residents of the other republics.
l
Serbian is usu-
-
Ially written in the Cyrillic alphabet and Croatian in the
IJLat1n
·
A11
plab et.
l
·
·
db y St.
The - Cyr1·1 l1c
alphabet was d ev1se
!Cyril, the Greek "Apostle to the Slavs" in the ninth Cen<~
Ijtury. -
Borba, a :major newspaper, was publi_shed in Cyrillic
lin Belgrade and in Latin in Zagreeb. The lingua franca is '
I
ja dialect that is a mixture of Serbian and Croatian.
!Religions include Orthodox, Roman Catholic, Moslem, and
1
Protestant.
(42 :921) -
There are five national groups:
I
Serbs (88 percent),
i
~Croats
(42 percent), Slovenes (24 percent), Macedonians (8 _
!percent), Montenegrins (3 percent), and "undeclared Mos-
l
ilems
I
in Bosnia-Herzegonia as well as several minority
J groups (Albanians, Magyars, Italians, etc.)
(21:37)
-1
'
l
Yugoslavia, situated between the East and the West,
1
ihas retained the influence of both.
llJneans
1
11
The name "Yugoslavia"
1and of the _South Slavs," but the land
51
r~-~~~~~~~~ and -~-~-~~~~~~~~-~; Greeks, Roman~-,-·;·~-~~~--~~ ;~~-....... -··------~
IAustro-Germans.
Turks ruled from the fourteenth century
i
!until the end of World War I.
Slovenia and Croatia were
lonce a part of the Hapsburg Empire.
11
I
!
Each people who lived
I
1
in and ruled over South Slavic lands left traces of its
civilization--its language, its cultural forms and its
jhabits.''
I
I!War
(52:5)
The present country was created in 1918 after World
I by the union of Serbia and Montenegro and the addi-
I
1
ltion of parts of the Austro-Hungarian Empire which was
I
.
!predominantly
populated by South (Yugo) Slavs.
!conflict persisted from its
I!struggled
l
for greater power.
~
"f
1
•
i~ception.
Political
.
1 group I
Each nat1ona
.
I
This struggle persists today •.
•
It was occup1ed by Naz1 Germany 1n 1941..
Simultaneously,
I
jthe Yugoslavs fought a war of liberation from Germany and
a ciyil war between two guerritla forces.
Over one million .
I
seven hundred thousand Yugoslavian lives were lost. {52: 39),
!
The "Chetniks" were led by Mihailovic and the "Partisans"
j
by Joseph Broz, today known as Marshall Tito.
(21:69-80)
After World War II, Yugoslavia was established as a Com-munist military dictatorship under Tito with a constitution
modeled after the Stalin constitution of 1936.
However, an
open break with Communist Russia occurred in 1948; for the
first loyalty of the Yugoslav Communists was to Tito, not
to Russia.
(42:920)
The revised 1963 Constitution, based on the idea of
52
r~···f~-~~~~~-~i~~-~ ~-i- ~~~~~l·i-~~~----~~-~~i·i-~~~d general . social and
I
. .
!political principles transcending State and Society.
The
i
I
jFederation and the individual Republics have independent
i
!constitutions.
The constitutions of the Republics go into
I
.
.
.
!greater d~tail than the Federal constitution on such mat1
I
1ters as education, science, culture, public health, social
Iwelfare,
.
and local government.
The Constitution assigned the following responsi-
l
I
lbilities to the corrununes:
I
1.
To make decisions and co-ordinate relationships
lin distribution (prices, taxes)
for organizations providing
1communal services--trades, water supply, sewage, electric-
i
I _1' t y,
e t c.
1
-
2.
j
To make decisions on and coordinate
relation~
!ships between workers and citizens as consumers of these
I
·!services, and the working collectives charged with dis-
lpen~ing
such services."
I
3.
J
I
To work out a city development plan and solve
l
!housing problems.
4.
To provide equal conditions for the conduct of
business between the socialized and the private sectors in·
communal services.
5.
To maintain law and order.
6.
To prepare the population for the country's
:defense in case of need.
7.
- _(2_1_ :.6 2:-6 3)
To ensure that the citizens obey the laws.
53
;
~s
There
J
I
great.disparity in the economic develop-
lrnent of the different Republics.
I)made
i
to equalize the Republics.
Federal efforts have been:
I
The revised version of the
!constitution adopted in 1963 provided Federal adrninistra-
l
ltiori departments including:
I
Federal Secretariats of the (1) Interior,
ltice; (3) Education and CQlture,
(2) Jus-
(4) Health and Social
I
!Policy,
1
I
(5) Budget and Organs of Administration, and sev.
.
ieral others; but the emphasis remained on the autonomy of
I
l the republics. (22:245) Further Constitutional. amendments
J
.
i
l
lin 1967 reinforced the tights o-f the Republics with ern-
I
I
lphasis on polycentrisrn and autonomy.
!
!
i
1
The great feat of President Tito has been his abil-
!ity to hold these diverse and fiercely independent peoples
I
I
1
together.
However, Tito is aging and knows his regime vdll
I
Trern~ndous disparity in the welfare of the va-
!soon end.
lrious peoples still exists.
IJtle
Many rural villages have
or no educational or health facilities.
lit~
Croatia, one
l
!of the more wealthy republics, has been inclined to break
Ii away
f-rom its Serbian neighbors.
I .
j T1 to dies?
i
-l Republics
. What will happen when
Can a central government hold the independent
together, or vlill another blood bath ensue?
(37)
I
j
;
i
Observations
Belgrad, the capital of Yugoslavia, is a rather
. typical old world city, situated above the Danube and Sava
The center of the city seems rather old, but new
54
.•.
..
rb;il~di_'~gs
! ern
----- .........
are going up in many suburban areas.
·-···-----·-- .·- --·
--·~--
........................................ ·•··· .. .
··-·-· ·---·--· ........._.. ·--.. ....
-.~--··---------··
..·--·-
---· .....................
The West-
influence was apparent immediately--department stores
1
II packed
vd th goods and people,. girly magazines on street
!corner newsstands, people wearing the same type of clothing
I
las found in any western city.
Parks and gardens adorn the ,
!city and the sidewalk cafes did a steady business.
I
Five
teenagers sitting at a nearby table ordered coke and french:
!fries; all five were smoking cigarettes.
I
Nearly everyone
Jin the cafes and restaurants smoked cigarettes and the
\adults usually drank plum brandy--with lunch, coffee, and
I dinner.·
One learned that plum brandy is their "national"
!drink and the munificent
cigarette smoking is the result
jof four hundred years of Turkish influence.
Ii
The Turkish influence was especially evident in
th~
I
/small villages where there were always peaked minarets and
.,the morning hours were filled with chants of holy men sum-
!
lmonsing
the Moslems to prayer.
.
I
One often saw Moslem women
I
!wearing the Turkish pantaloons as they walked along the
!;
I
!streets and as they labored in the fields.
I
There were few cars on the country roads.
Vil-
llagers hauled their goods on wooden wagons drawn by horses
!or oxen, much as was done in the United States some fifty
1
jyears ago.
i
J
School-aged children often sat along the road-
way tending their grazing livestock~
'rhe individual farm-
seemed to have archaic equipment, but the communes had
tractors and other more modern farm machinery.
55
~--- ·~·-·~~-------i)l;~i~;-
1
-world
·vi~-;;-ii, mo~~
-tlian 20
P~-~~~~-t·--c;:E~--aii---~--i
I
Ithe
living quarters were destroyed; thus, housing construe..-!
ltion became a major effort of the govemment.
Driving
!through Belgrad, ·one can see many new apartment complexes.
I
I
The whole area of Novi-Be6grad is composed of comparativelyj
l
I
new apartments and the people in the area seemed very
!young--many of them students at the nearby ·university.
I
.
In rural areas there were many new homes under con-
!lstruction.
-
Nearly every village house had a stash of
)bricks sitting ready for building during free time.
The
!mountain area homes looked small but sturdy, with high
!pointed roofs.
I times
I
1
They were often painted bright colors; s~!
two or three different colors.
Here, too, one could eat at roadside restaurants
and hotels, and drink the tap water with no ill effects.
I Hodern
sanitary facilities were available at the hotels
and in the cities, but in the villages the old world "hole
j in the ground" was the standard facility; often unclean and
'
infested with flies.
No hand-washing facilities were ava£b
able.
Interviews
One of the most well informed individuals regard·ing health and health education, its problems and goals
for the people of Yugoslavia is Dr. Djordje Jakovljevic,
Secretary of Health and Social Services of the Socialist
Republic of Serbia.
His offices are in Belgrad.
He is
56
~irectly responsible to the Minister of Health.
I~ratislav
kducation.
Tomic is Director of the Institute for Health
Dr. Sofija Djuric is in charge of family plan-
bing and school health education,
~rea
Dr.
Dr. Ramilla Popovich's
of concern is veneral disease education.
All were
most kind, considerate and helpful in presenting the plans
I~nd
problems of health and health education in Yugoslavia.
I
II .
The Institute for Health Education has five divi-
(1} Education of health workers, particularly the
iSl.OflS:
i
!health visitors that serve in all areas of the country;
1(2)
Health education in the schools, involving cooperation
land planning at the level of the Ministry of Health and
IJthe
Ministry of Education;
(3)
Health education in indus-
1
I
!try;
(41 Health education in community organizations,
/including villages and communes; and (5) Health propaganda
I
-
[by means of press, radio, television vTi th the assistance
I:of
a special committee for technical materials.
I
As with all health education programs, the great
i
l
~problem
expressed was the question:
I
(people for health action?
How does one motivate
Since Yugoslavia is a country
i
lwith such great diversity in its peoples, health education
I
!planning is particularly difficult.
The backbone of the
I
i
!health education system in Yugoslavia is the health visi-
! tor,
an individual whose.· work is similar to that of a
public health nurse.
Legislation has now been passed to
·provide one health visitor for every five thousand people.
57
r-·---- - - - - ..
IEfforts-
are focused on training the "medical brothers'' and
!"medical sisters" (:as they· are called) , required to meet
this goal by 197 4.
1
I£or
all Moslem
Ipabies.
The medical sisters serve as mido;.v:i ves
women~as
men are not permitted to deliver
These people serve in all of the remote villages,
bften walking miles up steep mountain paths to reach the
I
!isolated homes. Nutrition in -these areas is often poor
I
!during the work (spring and summer) season as the women
l
!labor in the fields and do not take the time to prepare
I
~uch
for the families.
Meals are more carefully prepared
I
jin the winter.
Ilin
A school lunch program has been instituted
some areas to provide breakfast and lunches for the
!children.
Four meals are served to children in the city
i
iday~care centers when their mothers are working.
l
Grand-
lmothers are often the target for health education programs
I
~in the villages as they are often the baby sitters and
I
.
lmost responsible for the child's health needs and pracj
!tices.
l
Health education is integrated into the secondary
middle schools, but little is provided at the elemenltary level.
1
!
i prehensi ve
Efforts are being made to provide more com'
health education at. all levels.
Professional health care is organized in a regional planning system, but the most comprehensive care
;is provided only in the cities.
If a person becomes ill
)in Belgrad, he may visit a doctor of general practice who
!
58
r-"-
------~---
'"------ --------- - .---- ----- __ .,_ ---- ----------------- ---------------- ----------- -------- -- ---- .--·-- ------ -----------·<.·------------- ____________________..______ .. ------..-.... _____,. _
I may refer the patient. to the home health center which is
a clinic with a dispensary for drugs.
If the patient-is
in need of more complex care, he is referred to the regional hospital.
Financing of medical care is through group insurance which is obligatory for-all working people; however,
emphasis is generally on .curative measures rather than
preventative.
All working people pay a fixed percentage of their
personal earnings into health insurance funds of·
the commune. The co1umune negotiates with health
institutions on the price of total health protec~
tion.
(40:55)
Prom a primarily backward _and devastated agricultural country in 1945, Yugoslavia has progressed to the
highest standard of living.of the communist states.
Industrial production has increased substantially.
Although many industries are located in small towns
throughout the nation, there is a concentration of industry in the capital cities of the Republics and a trend
toward urbanization.
This
h~s
produced changes in the
social structure.
With the exception of the Slovenes, whose cultural_
patterns more closely approach those of the neigh~
boring Austrians . . . large kinship groupings
have been, and continue to be a very important
feature of Yugoslav life. The term 11 zadruga" is
comr11only applied to the extended family group of
the South Slavs. It has two general meanings:
"the joint family 11 and "cooperative enterprise."
It is generally a patrilineal and patrilocal extended family, working and consuming as a unit.
(19:329)
59
,-----······-· ···~············;~~--··-~~-~~-~-~-~-----~-~---·~~-~~~~-i ~-~~~:~ -~~-~ ·---~~-~~-;~~--~~~~-----------~
I1patr1.arch1a
· ·1
h ouseho ld an d s1ze
·
o f the househo ld ha a
II
jgradually diminished. Status of women has changed. In
'
!
!the "zadruga" women were always inferior.
I
Trends are now
toward more equality.•
the people do not need warm clothes and substantial homes.
Yugoslavia is a country with geography as diverse
jas its people; both present great problems for health edu1
ilea t.
.1on
programs.
(24)
I
I;summary
and Conclusion
1
The problems of health and health education in
!Yugoslavia are complex.
!
One of the most impelling is the
'
jlack of cooperation between the Republics; the fierce
I
!independence of each.
l
The great need appears to be to
i
!plan national goals, but to gear them most specifically
lto the needs in each of the Republics since there is such
I
!great disparity in requirement.
I
The remoteness of the mountain villages poses
another problem.
Methods of communication and transporta-
tion facilities are quite inadequate.
r·t takes
a
full two
I!
Ii
1
60
r--~--,--,--,--,
--~---
.............................. ··--·-·······-···--··-·--.... ···-
j
I days of driving over narrow mountain roads to reach the
II Adriatic
I
I ences
Coast from Belgrad.
The variations in languages and religious differ-
!
.
are also important considerations and the trend
toward urbanization brings with it the health ills experienced by all developing countries.
Hmr1ever, health education seems to be a felt need
of the Yugoslavians as expressed by many people at working
levels.
The legislative body has continued to support
efforts aimed at improving health care.
In addition, a
core of people working through the Institute in Belgrad
seem to be a dynamic force moving .toward objective health
I goals.
Of course, the most important question must
I
I
l remain:
What will happen when Tito no longer rules?
Will
the goals of better living conditions motivate leaders to
I
I work
together, or will the independent goals of power pre-
vent cooperation?
I
61
~---····--
.
.-
.. - .... - - ..... ---· -- -
I Statisics
.
- .. ··-
.. ... .••......
(19 70)
I
Mid-year population estimate
20.53 million
Crude death rate
8.9/1000
. Crude birth rate
17.6/1000
Infant mortality rate
56.3/1000
Life expectancy
Males
67.74 years
Females
68.99 years
{See Appendix B)
Chapter 7
SUMMARY AND CONCLUSIONS
The purpose of this study was:
"to identify and
compare through observation and interview specific factors relating to health, education, and health education
of people living in the selected countries."
Thus, the question becomes:
that goal?
(page 2)
Has this_ study accomplished
The answer must be:
partially.
One can
identify the most obvious factors relating to health and
health education through astute observation; other factors'
not readily apparent to the visitor can be discerned
through interview with people knowledgeable about the subject in that country.
more one can learn.
The more interviews one has, the
However, those factors most close to
the hearts.of the people are not easily perceived.
Reli-
gious beliefs, superstitions and practices such as clay
eating are not easily manifest and the vast variety of
such beliefs and practices requires intimate contact and
participation in the culture to fully
under~tand
their
I impact.
.II
It is quite obvious that all of the countries
! visited do have some 'common problems such as funding, government. red tape, urbanization, traffic and problems
62
63
r~el~t:·~ to g;~:~~.
I has problems unique
It. is also obvious that each country
I
unto itself.
In Greece, urbanization is pulling the young peo-
I' ple
away from the agricultural villages into the cities;
I thus,
I
the health programs in the villages should probably
pertain more to the needs of the very young and the older
Ii generations.
In the cities, health education programs
have been developed through the labor unions, geared to
I
the needs of the working people.
In Yugoslavia, the six republics, to some extent
form boundaries indicating variety in health needs, but
I even
I have
I
within each republic, the Moslems and the Christians
cultural differences that pertain to their health
education.
i
The small farmer and the
co~~une
farmer have
differences in health needs.
I
In Israel, the background of each immigrant brings
I with it a variation in health need. The Arab population
I living in Israel is especially at risk, for they are a
minority group under suspect.
Each of these situations demonstrate three of the
basic premises of health education:
1.
The importance of knowing the people for whom '·
) the health education program is planned; to understand
r their values, attitudes and beliefs;
r
2.
The significance of involving the people for
i whom the program is intended in the planning stagesi
I
t.~' ~-~·· · · · - .,_,- -'•-
64
3.
The need to pre-test the material to assure
its relativity to ·the people involved.
The health educators of the country may fulfill
all of these premises and yet never accomplish much toward
the goal of better health for the people for, though the
people of Greece share a common language, religion, and
cultural background; there is great division amongst the
fiercely independent people.
The island and mountain ter-
rain foster this independence, but other countries with
equally remote areas such as Non1ay, Sweden and Switzerland do not seem to experience this national unrest.
Yugoslavia, with its variety of languages, religious cultures and geographic terrain also shares this
extreme national unrest.
Israel, on the other hand, with its tremendous
variety of peoples, cultures, and languages
united.
seem~highly
One reason for this great unity in Israel is, of
course, a common threat from outside, a factor that fosters great unity.
Each of these countries share one coro.mon threat to
the heal thf v-7elfare and education of its people:
war.
Greece is held together by the iron hand of Papodopolous.
Student rebellions have already begun.
Yugoslavia has
remained united under Tito, but Tito's advanced age
threatens this unity, and Israel is under constant threat
of the Arab nations surrounding it, as well as from some
65
["·-----·---·--------· --·····-·· -·····-···- --·-·
t of
the Arab groups within the country.
''"'
I
.
I
·Perhaps one might come to the conclusion that
I government
Ii of
I
all constituents is therefore the single most important
I factor
I can
of a. people which fosters unity and well being
in health, education, and health education; for it
implement or destroy all of the dreams that man can
dream.
~-···--·----··
.------------·---.. ---_--·. ----------- -..... ·-·--· -----------·-·--i
I
BIBLIOGRAPHY
1.
Adams·, L. M. (ed.} · Webster's New American Dictionar_y_.
New York:· Books, Inc., 1969.
2.
Allport, Gordon. Personality and Social Encounter.
Boston: Beacon Press, 1960.
3.
Athenian.
Inside the Colonel's Greece, Richard Clo:rg
(trans.). New York: W. W. Norton and Company,
Inc., 1972.
4.
Bates, Marston.
"The Ecology of Health," Medicine
and Anthropology, Iago Galdstome (ed.). New
York: International Universities Press, 1959.
5.
Baza, Athenia.
6.
Beeston, John.
"Promoting Health by Visual Methods,"
Journal of the Biological Photo~hic Association,
1959.
Personal interview, April 27, 1971.
er
7.
Burton, John. International Journal of Health Education, .!_, No. 2 (April 1958).
8.
Constitution of the World Health Organization,
Chronicle of the World Health Organization, 1:29-'
43. Geneva: World Health Organization, 1947.
9.
Dubos, Rene. Man Adapting:_.
sity Press, 1968.
Nevi Haven:
Yale Univer-
10.
Ebbinghaus, H. Memorv: A Contribution to Experiment.al Psychology. H. A. Ruger and c. E. Bussenius
(trans.). New York: ColwmJia University Press,
1913.
11.
Eckardt, Alice., Eckardt, Roy. Encounter With
Israel: A Challen9.e to Conscience. New York:
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12.
11
Ford, Guy Stanton (ed.).
Aegean Civilization, 11
Compton's Pictured Encyclopedia, Vol. I. Chicago: F. E. Compton and Company, 1957.
13.
Ford, Guy Stanton (ed.).
"The Stirring Days of
Ancient Greece," Comoton's Pictured Encyclgpedia,
Vol. VI. Chicago: F. E. Compton and Company,
1957.
66
67
~--~~-~----;::~-, -~:;···;~::~~:~--~-~·;:; .----;~~:~~~1--An
Ancient Nation
Reborn," fompton's Pictured EncycloEedia, Vol.
VII. Chicago: F. E. Compton and Company, 1957.
I
I
15.
Ford, Guy Stanton (ed.).
"Palestine--Changing Land
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:1:6.
Ford, Guy Stanton (ed.)
"Yugoslavia--The New South
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1957.
17.
Funk and Wagnalls. Standard Dictionary of the
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18.
Gruska, Th. (ed.). Health Services in Israel.
Jerusalem: The Ministry of Health, 1968.
19.
11
Halpern, Joel.
Yugoslavia: Modernization in ari
Ethically Diverse State" in Contemporary Yuqoslavia. Vucenich, W. S. (ed.). Berkeley and
Los Angeles: University of California Press,
1969.
20.
Hanlon, John J. Principles of Public Health Administration. St. Louis: c. v. Mosby Co., 1969.
21.
Hoffman, G. W. , Neal, F. W. Yugoslavia and the New
Communism. New York: Twentieth Century Fund,
1962.
22.
Hondius, F. W. The Yugoslav Community of Nations.
The Hague, Netherlands: Mouton and Co., 1968.
23.
Jacobs, Paul.
New York:
24.
Jakovljevic, Djordje.
1971.
25.
Janson, H. W. History of Art. New York:
Abrahams, Incorporated, 1969.
26.
Johns, Edward B.; Sutton, Wilfred; and Webster,
Lloyd. Health for Effective Living. New York:
McGraw-Hill Book Company, Inc., 1962.
27.
Katris, John A. Eyewitness In Greece.
New Critics Press, Inc., 1971.
Between the Rock and the Hard Place.
Random House, 1970.
L_ ________________________ ._.......................... ________________ ........ ------·--····-····· -------
Personal interview, May 10,
>
. . . . . . . . . . . . . . . . . .>
_ _ _ _ _ _ _ _ _ _ _ _..
--·
•
Harry N.
st. Louis:
68
28.
Knutson, Andie L. The Individual, Society and Health.
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·
1965.
29.
Leavell, Hugh R.; and Clark, E. Gurney. Preventative Medicine for ·the Q£ctor in His Community.
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30.
McKenzie, J. L.
"Israel" in Encyclopedia Britannica,:
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'
Inc., 1965.
31.
Means, Richard K. A History of Health Education in
the United States. Philadelphia: Lea & Febiger,
1962.
32.
Mikes, George. Coa~. of Many Colors:
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33.
Newbigin, Marion I., and Herdman, Thomas. "Yugoslavia, Natural Region, 11 in Encyclopedia Britannica, Vol. XXIII. Chicago: Encyclopedia Bri tan·nica, Inc., 1965.
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Nyswander, Dorothy.
"What is Health Education?"
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35.
Oberteuffer, Delbert, and Beyrer, M. K. School
Health Education, 4th ed. New York: Harper
and Row, 1966.
36.
Pavlov, Ivan P. Conditioned Reflexes: An Investigation of the Psychological Activity of The Cerebral Cortex. F. c. Anrep (trans.). New York:
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37.
Popovic, N. D. Yugoslavia, The New Class in Crisis.
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38.
Rosen George. A History of Public Health.
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39.
Ruch, Floyd L. ~c~ology and Life. Glenville,
Illinois: Scott, Foresman and Company, 1967.
I
i
Israel.
Bos-
New
69
------· ---.............____.._________________.............................................. ·-··-·· ........................
.
Skinner, B. F. The Behavior o~ Organisms.
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r·--·-~---------
41.
~--------~---- --~---------·---------
-·---·-·1
New
I
I
I
42.
i
Smogorzewski, K. M.
"Yugoslavia---Territory and
l
Population" in Encyclopedia Britannic~, Vol.
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1965.
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Statistical Office of the United Nations. Demographic Yearbook.
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44.
The Jerusalem Post, May 5, 1971.
'
45.
Thorndike, Edward L. Human Learning.
Century ComP,any, 1931.
New York:
46.
Todd, Helen J.
II Analysis
of Health Education r.tlethods
and Practices in the Soviet Union, .. Unpublished
Master's thesis, U.C.L.A. Biomedical Library,
1960.
47.
Turner, Clair E. Personal and Community Health,
13th ed. St. Louis: The c. v. Mosby Company,
1967.
48.
Willgoose, C. E. Health Education in the E].em~ntary
School, 2nd ed. Philadelphia: W. B. Saunders
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49.
Williams, Jesse Fiering. Pe~nal Hygien~- ApJ2lied,
9th ed. Philadelphia: W. B. Saunders Company,
19 50.
50.
11
Winslow, Charles Edward Amory.
The Untilled Field
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51.
Yarom, David.
52.
Zaninovich, M. George. The Developmen·t of Socialist
?Lugoslavia. Baltimore: Johns Hopkins Press,
1968.
Personal interview, May 3, 1971.
II
I
APPENDIX A
CONSULATE OFFICES
Portugal:
1800 Avenue of the Stars
Los Angeles, California
Phone:
Greece:
90067
277~1491
2441 Gough Street
San Francisco, California
Israel:
659 South Highland Avenue
Los Angeles, California
Phone:
Yugoslavia:
90036
938-3691
1919 Sacramento Street
San Francisco, California
Sweden:
94J23
94109
615 South Flower Street
Los Angeles, California
Phone:
628-6308
70
90017
r--------------------------------,--------------------------------__,
l
:
APPENDIX B
POPULATION STATISTICS·
Rates per 1000
1970
Population
Estimate
In Millions
Approximate
'Life
Expectancy
Males Females
Crude
Birth
Rate
Crude
Death
Rate
Natural
Increase
Rate
Infant
Mortality Marriage
Rate
.:Rate
Divorce
Rate
Country
Year
Greece
1969
8.89
67.46
70.70
17.4
8.1
9.3
31.8
8.2
0.4
. Israel
1970
2.89
69.19
72.84
27.0
7.0
20.0
23.6
10.1
0.8
Yugoslavia
1970
20.53
67.74
68.99
17.6
8.9
8.7
56.3
8.9
1.0
U, S .A.
1970
205.40
66.6
74.0
18.2
9.4
8.8
19.8
10.7
3.5
'
Source:
'
Statistical Office of the United Nations, Demographic Yearbook, twenty second issue,
New York, 1971 pages 120-133. (43: 120-133)
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APPENDIX C
23110 Mulholland Drive
Woodland Hills, California
January 23, 1971
91364
Honorable Ambassador from
(country)
~~~--~---=--~--- Embassy
Washington, D. c.
Dear Sir:
I am a registered nurse, working toward a Master's
degree in_public health education at San Fernando Valley
State College in Northridge, California. I am interested
in doing my thesis on health education--means and methods
in other countries. My husband and I plan to visit
(country)
on
(dates)
Would it be possible to obtain permission to interview some individual in your country \vho is knowledgeable
about health education as practiced in your coun·try, and
would you direct me to such an individual? Any informa~
tion you can send to me will be greatly appreciated.
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Thank you.
Most sincerely,
I
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Mrs. Ruth Dworsky, R.N.
23110 Mulholland Drive
Woodland Hills
California 91364
72
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