Letter to Editor

Health culture is like a cool, clear spring that can nourish and revitalize the withering body of society [1]. Governments, as representatives of the people, should take on the responsibility of guiding and spreading this refreshing and pure spring throughout the entire country. Spreading the correct paradigm about the health system in society (among both the general public and experts) is the first step that must be taken. Refuting the idea that the scope of the health system is limited to the physical domain of the Ministry of Health, as well as emphasizing the notion that the health system’s scope corresponds to the geographical boundaries of the country, are fundamental actions that the government must undertake [2,3]. Each government ministry should consider itself one of the key representatives in promoting public health, alongside its main mission in its assigned management area. The Ministry of Health, as the coordinator, should take on the role of centralizing the efforts of all government ministries. It is evident that, apart from the Ministry of Health, which directly holds the responsibility for promoting public health, each of the other ministries also has some level of involvement with public health through their activities, though to varying extents. In the same way, all institutions and organizations under the supervision of each ministry, which operate as production and service entities, have their activities connected to the health of the community [4]. From the perspective of the architecture of the national health information network, sharing those parts of each ministry’s databases related to public health with the Ministry of Health’s databases in a distributed manner is considered the foundational basis of the aforementioned network [5]. It is important to emphasize that the expansion of health culture requires the implementation of both top-down and bottom-up approaches, and it must follow a specific model [6].

Strengthening the primary healthcare system, which can ensure key characteristics such as comprehensiveness, universal access, public participation, cohesion and integration, as well as the utilization of information and communication technology, is a crucial step that must be taken under the management of the Ministry of Health, in collaboration with other ministries [7,8]. The implementation of a comprehensive strategy to promote health culture through activating organizational driving forces, including the health-promoting family, health-promoting school, and health-promoting university, is another serious and effective measure carried out by the government [9-11]. The family, influenced by the primary healthcare system, is educated and trained to become a driving and effective element, channeling the refreshing and pure spring of health culture into the fabric of society [11]. On the other hand, health-promoting schools and universities, through implementing strategic programs, work to integrate health into their policies, processes, and organizational culture. This approach not only affects staff but also trains all students to become driving elements for promoting and expanding health culture [9,10].

However, health-promoting universities, especially medical universities, train students who can be called “expert health citizens.” Before delving into the important role of expert health citizens in spreading health culture, it is essential to review the emergence of some related concepts. The concept of the Expert Citizen, introduced by Henrik Bang in 2000, is closely related to the idea of the Everyday Maker [12]. At the same time, Jürgen Habermas introduced the concept of the informed and critical citizen in the 1960s. It is said that the foundation for the emergence of the Expert Citizen concept was laid by the introduction of the informed and critical citizen. According to Habermas, citizens can play an effective role in politics and democracy through rational debate in the public sphere. However, Henrik Bang emphasizes that the Expert Citizen is involved in practice and implementation, not just in public discussions. He believed that in the modern world, these two types of citizens have replaced the traditional citizens, who only participated in politics through elections. An Expert Citizen refers to an individual who possesses knowledge and expertise in social and political issues and uses these skills to positively influence society. This type of citizen focuses on using their specific expertise and skills to participate in decision-making and solve social problems. They may be active through social networks, technology, or offering advice on various issues. The Expert Citizen usually approaches problems from a specialized perspective and has the ability to analyze complex issues. Examples of Expert Citizens include environmental activists, technology experts, independent journalists, and leaders of social movements [12-14]. An important point to note is that Peter Drucker, in his works, refers to various terms related to social responsibility and citizenship. However, one of his most important and well-known concepts in this field is the “Responsible Citizen” [15].

An Expert Citizen usually takes on greater social responsibilities due to their expertise and skills, playing an active role in democratic and social processes. This role can include participation in public decision-making, providing advice, and helping to solve societal problems. Another term introduced by the University of Minnesota is “Citizen Professional” [16]. An Expert Citizen is also expected to play an active role in society, similar to a Citizen Professional, and to accept not only their professional expertise but also their social and civic responsibilities. Ultimately, an Expert Citizen, or Citizen Professional, does not limit their role to the scope of their specialty alone, as they are expected to take on social responsibilities toward the community. In fact, an Expert Citizen or Citizen Professional is required to participate in social and democratic processes and utilize their expertise or profession to improve the conditions of society [12].

If universities add health promotion to their mission and become health-promoting universities, the output will be expert health citizens. An Expert Health Citizen specifically refers to individuals who possess health knowledge and play an active role in social issues and health policy-making. The responsible involvement of these individuals in public health programs greatly contributes to the spread of health culture in society. Expert Health Citizens, through social participation, will contribute to improving the health conditions of the community, not only as specialists but also as responsible and active citizens. Each of them, based on a well-planned strategy according to their academic education, will be able to dedicate two hours per week to health groups and primary healthcare to educate and solve existing health problems, leading to lifestyle improvements, the promotion of self-care, health literacy expansion, and the institutionalization of health culture. Diagram 1 illustrates the use of Expert Health Citizens alongside the health-promoting family and health-promoting school as part of the strategy for institutionalizing health culture, following both top-down and bottom-up approaches.

References

1. Jayasinghe Sisitha (2025) The culture of healthy living - The international perspective. Prog Cardiovasc Dis 6: S0033-0620(25)00019-2.
2. WHO remains firmly committed to the principles set out in the preamble of the Constitution.
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6. Carey Annette, Gemma E (2009) Exploring the effects of government funding on community-based organizations: 'top-down' or 'bottom-up' approaches to health promotion? Global Health Promotion 16(3): 45-52.
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9. (1998) WHO. Health Promoting Universities: Concept, experience and framework for action.
10. (2021) WHO and UNESCO. Making every school a health-promoting school: implementation guidance.
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12. Bang Henrik (2005) Among everyday makers and expert citizens.
13. Rountree John (2018) Jürgen Habermas and Communication Studies.
14. Habermas Jürgen (2006) Contemporary Social Theories.
15. Druker, Peter (2006) The Practice of Management. Harper Business Publishing.
16. (2005) University of Minnesota. The Citizen Professional Idea.