Creating critical consciousness in health: applications of Freire's philosophy and methods to the health care setting.

Paulo Freire's philosophy of "education for critical consciousness" takes on special relevance within the context of the health care system. This dialogical approach to change, stressing action based on critical reflection by the people is seen here as importantly supplementing current efforts to deal with the "health care crisis" in the United States and many developing countries. Applications of the Freir approach in a health context of necessity involve the perception of health and medical care within the total oppressive structure of society. Viewed thusly, health "reform" cannot justifiably be envisioned except within the context of broader structural transformations. Two case studies are presented to illustrate the application of the Freire approach within a health context. Successful utilization of the methodology among peasants in rural Honduras and a relatively unsuccessful application among impoverished elderly residents of an urban United States ghetto are described and analyzed. Modifications of the approach to increase its usefulness in a variety of situational contexts are suggested. The potentials and limitations of this approach to radical change in the health field finally are described, along with lessons learned from initial work in the applications of conscientización to the health field.