write short note on health education

What you need to know about education for health and well-being

Why focus on education for health and well-being.

Children and young people who receive a good quality education are more likely to be healthy, and likewise those who are healthy are better able to learn.

Globally, learners face a range of challenges that stand in the way of their education, their schooling and their futures. A few of these are related to their health and well-being. Estimates show that some 246 million learners experience violence in and around school every year and 73 million children live in extreme poverty, food insecurity and hunger. Pregnancy related complications are the leading cause of death among girls aged 15-19, and the COVID-19 pandemic has vividly highlighted the unmet needs of learners and their mental health.

UNESCO works to promote the physical and mental health and well-being of learners. By reducing health-related barriers to learning, such as gender inequality, HIV and other sexually transmitted infections (STIs), early and unintended pregnancy, violence and discrimination, and malnutrition, UNESCO, governments and school systems can pose serious threats to the well-being of learners, and to the completion of all learners’ education.

Why is health and well-being key for learners?

The link between education to health and well-being is clear. Education develops the skills, values and attitudes that enable learners to lead healthy and fulfilled lives, make informed decisions, and engage in positive relationships with everyone around them. Poor health can have a detrimental effect on school attendance and academic performance. Health-promoting schools that are safe and inclusive for all children and young people are essential for learning.

Statistics show that higher levels of education among mothers improve children’s nutrition and vaccination rates, while reducing preventable child deaths, maternal mortality and HIV infections. Maternal deaths would be reduced by two thirds, saving 98,000 lives, if all girls completed primary education. There would be two‑thirds fewer child marriages, and an increase in modern contraceptive use, if all girls completed secondary education.

At UNESCO, education for health and well-being refers to resilient, health-promoting education systems that integrate school health and well-being as a fundamental part of their daily mission. Only then will our learners be prepared to thrive, to learn and to build healthy, peaceful and sustainable futures for all.

The relevance and contributions of education for health and well-being to the advancement of human rights, sustainable development & peace: thematic paper , UNESCO, 2022

How is UNESCO advancing learners’ health and well-being for school and life?

UNESCO has a long-standing commitment to improve health and education outcomes for learners. Guided by the UNESCO Strategy on Education for Health and Well-Being, UNESCO envisions a world where learners thrive and works across three priority areas to ensure all learners are empowered through:

school systems that promote their physical and mental health and well-being
quality, gender-transformative comprehensive sexuality education that includes HIV, life skills, family and rights
safe and inclusive learning environments free from all forms of violence, bullying, stigma and discrimination

Through its unique expertise, wide network and a range of strategic partnerships, UNESCO supports tailored interventions in formal educational settings at regional and country levels, with a focus on adolescents. Key areas of actions include: technical guidance at global levels, and targeted and holistic action at national levels such as the Our Rights, Our Lives, Our Future (O3) programme; joint efforts through the Global Partnership Forum for comprehensive sexuality education and the School-related gender-based violence working group ; guidance on school health and nutrition; advocacy around the International Day against violence and bullying at school ; capacity-building and knowledge generation such as the Health and education resource centre .

UNESCO aims to make health education appropriate and relevant for different age groups including young learners and adolescents, thus working closely with young people and youth networks. It identifies adolescence (ages 10-19) as ‘a critical window of opportunity to invest in education, skills and competencies; with benefits for well-being now, into future adult life, and for the next generation’ and a time when schools should impart healthy habits that will empower adolescents to become healthy citizens. Young People Today is an initiative aiming to improve the health and well-being of young people in the Eastern and Southern Africa region.

Why is comprehensive sexuality education key for learners’ health and well-being?

Comprehensive sexuality education (CSE) is widely recognised as a key intervention to advance gender equality, healthy relationships and sexual and reproductive health, all of which have been shown to positively improve education and health outcomes.

At UNESCO, CSE is a curriculum-based process of teaching and learning about the cognitive, emotional, physical and social aspects of sexuality. It offers life-saving knowledge and develops the values, skills and behaviours young people need to make informed choices for their health and well-being while promoting respect for human rights, gender equality and diversity. CSE empowers learners to realize their health, well-being and dignity, develop respectful relationships and understand their sexual and health rights throughout their lives. Effective CSE is delivered in an age-appropriate manner.

Without correct knowledge on sexual and reproductive health, learners face risks directly impacting their education and future. For example, early and unintended pregnancy increases the risk of absenteeism, poor academic attainment and early drop-out from school for girls, while also having educational implications for young fathers.

Through its O3 flagship programme, UNESCO contributes to the health and well-being of young people in Africa with a view to reducing new HIV infections, early and unintended pregnancy, gender-based violence, and child and early marriage. The O3 programme has benefitted over 28 million learners so far and has introduced ‘O3Plus’, focusing on actions in favour of young people in tertiary education.

UNESCO’s Foundation for Life and Love campaign (#CSEandMe) aims to highlight the benefits of good quality CSE for all young people. Because CSE is about relationships, gender, puberty, consent, and sexual and reproductive health, for all young people.

Why is UNESCO building back healthy and resilient schools?

As the education of 1.6 billion learners came to a halt as a result of the unprecedented COVID-19 global health pandemic, the world became witness to the crucial importance of schools as lifelines for learners’ health and well-being. Schools are a social safety net providing essential health education and services including meals, identifying signs of mistreatment or violence, establishing links to health services, fostering social connections and promoting physical activity. And without this safety net, millions of learners were at risk.

For example, early and forced marriage and unintended adolescent pregnancy rose during the pandemic and lockdown periods. This resulted in more dropouts from school, leaving learners and girls in particular out of school. The pandemic vividly illustrated the interlinkages between education and health, and the urgent need to work across sectors to advance the interests of future generations, building back resilient education systems to prevent, prepare for and respond to health crises. It also highlighted learners’ unmet need for support around their mental health.

Learner mental health and well-being is an integral part of UNESCO’s work on health education and the promotion of safe and inclusive learning environments. UNESCO joined with UNICEF and the WHO to launch a Technical Advisory Group of experts to advise educational institutions on ensuring schools respond appropriately to crises like the COVID-19 pandemic.

Health Education

(15 reviews)

College of the Canyons

Publisher: College of the Canyons

Language: English

Formats Available

Conditions of use.

Learn more about reviews.

Reviewed by Uma Hingorani, Affiliate Professor, Metropolitan State University of Denver on 10/12/23

There is a Table of Contents, but an index and glossary of terms would both be helpful to find information quickly. read more

Comprehensiveness rating: 4 see less

There is a Table of Contents, but an index and glossary of terms would both be helpful to find information quickly.

Content Accuracy rating: 4

The information is well organized and accurate. Some updates are needed, such as reference to latest edition of The Diagnostic and Statistical Manual of Mental Disorders (DSM), including online tools to track menstrual cycle and Roe vs. Wade overturned stance on abortion in U.S., using more current CDC Fact sheets, including psychodelic mushrooms under drugs of abuse and impacet of legalization of marijuana on abuse potention, and including e-cigarettes, JUUL, and other modern cigarette types. Some minor typographical and spelling errors were noted ('spermacides').

Relevance/Longevity rating: 4

Updating sections to include modern aspects would be helpful.

Clarity rating: 5

The language is clear and conducive to an undergraduate level college audience.

Consistency rating: 5

The book flows well and uses consistent terminology throughout the chapters.

Modularity rating: 5

The text is divided into subsections, making it manageable to read and understand.

Organization/Structure/Flow rating: 4

The book is well organized and flows well.

Interface rating: 4

Use of more diagrams would be helpful. The diagrams and charts used emphasize the textbook reading.

Grammatical Errors rating: 4

Some minor typographical (bullets points not aligned in e-copy) and spelling errors were noted ('spermacides').

Cultural Relevance rating: 4

Culturally and racially sensitive.

This is a well-written, well-organized textbook which provides a good overview of health. Including the WHO definition of health and wellness would be beneficial as well as using more references to college-age students to engage this audience. In addition, updating sections to modern times would be helpful. Nonetheless, it is a straightforward and helpful textbook to use for a general health class elective.

Reviewed by Anna Smyth, Adjunct Faculty, Salt Lake Community College on 4/18/21

Health is a broad subject, and this book has done a nice job of categorizing and explaining some of the most important aspects. The book does not have a glossary or index but provides references at the end of each chapter for further exploration. read more

The data and information presented in the book appears to be accurate but some statistics are over 10 years old. Students would benefit from an updated edition. The information about sensitive topics such as violence in relationships, sexual health, etc. are handled skillfully without bias.

The text is written in a way that it would be relatively easy to update. Some of the topics, legal marriage for example, are changing due to legislation across the country, but the book speaks generally enough about these topics to capture this reality. The reader can pursue the references included at the end of each chapter to find more specific time-sensitive data around such topics.

Clarity rating: 4

The book is very clear in its use of language. This is a particularly appealing element if you have students whose native language isn't English. A moderate proficiency in English will make this book accessible--easy to read and understand. One missing piece of context noted: Section 5.6 seems to refer to a chart, ie "in the lower left corner" but no chart is included.

Consistency rating: 4

The text is consistent in the way the framework has been structured and the terminology is relatively consistent throughout, however there are some occasional verb tense inconsistencies, for example in Chapters 6 and 8 the voice alternates between speaking directly to the reader (you) and in third-person.

Modularity rating: 4

It would be as easy to pull a few excerpts from the book as assigned reading as it would be to review the entire text throughout a semester. There could be more of a contextual introduction to each chapter that may help provide a useful modular framework.

As the text is a presentation of a variety of interrelated topics rather than information that must be presented in a particular sequence for full and proper understanding, the organization seemed appropriate and sufficient. As Maslow's heirarchy is presented, there is an argument for using the order from that framework or the order of the six dimensions of health presented in Chapter 1, but the content therein, aside from Chapter 1, is not determined by the sequence so the current organization is sufficient.

I saw no significant interface issues, however the text could benefit from more illustrative images throughout to support learning and such images could help with minimizing any confusion as well as retention of the information presented. An example of such is Figures 14 and 15 on page 152 and Figure 4 in Chapter 9.

In my review, I noticed very few grammatical or spelling errors.

Cultural Relevance rating: 3

Some of the sections could be updated with more inclusive language, such as the section on fertility and conception. Language such as "pregnant people" rather than "pregnant women" or "birthing person" rather than "pregnant mother" is more inclusive of the transgender community. The text generally tends to reference nationwide statistics without detail or context regarding specific demographics. This could be a valuable addition as illustrated in Chapter 1 that health can be substantially influenced by things such as race and ethnicity, culturally sensitive healthcare, sexual identity and orientation, etc. which are topics included later in the text. Expounding upon some of these critical aspects of health and determinants of health would add value and represent a more comprehensive perspective of health in the US.

This book is a solid resource with lots of useful information to use in health-related course curricula.

Reviewed by Garvita Thareja, Assistant Professor, Metropolitan State University of Denver on 3/16/21, updated 4/22/21

It had covered most of the major topics in health and wellness. However, there are some foundational topics like dimensions or health (they touched these, but need more depth), theories for behavior change that should be added , being foundational in nature. Then again, some concepts are just added there and may not be needed at this level as it adds to confusion than contribution. We don't need that deeper biology part as its a health topic and not anatomy/physiology.

Content Accuracy rating: 5

Its very accurate book. I would re structure some aspects and add some examples at few places, but overall, its up the mark with accuracy.

Relevance/Longevity rating: 3

Content needs an update. For example if its a weight management, then we need to add information about various apps and calorie tracking resources. If its a drug and abuse, I would add an activity that really engages students about how taking shots can affect their cognition and possibly put them in DUI. This text has too much theoretical concepts but less of applied part or case studies.

The information is clear and use simple languages. Not big jargons or difficult terms.

Yes, its consistent with the topics and headings and sub headings. Its just too much information actually VS field work, examples and real applications.

yes, its divided into various parts and sub parts. Easy to navigate and clear layout. I would just add that piece where if we click on a sub topic from table of contents, it takes us to that page automatically instead of scrolling around.

Organization/Structure/Flow rating: 5

Yes, very clear and logical flow.

Interface rating: 5

Its easy to navigate. I would add a little more images as it gets monotonous reading it. WIth a topic like health, lot more colors and contrasts and images can be added.

Grammatical Errors rating: 5

I did not find one.

Cultural Relevance rating: 5

Not offensive. But I would actually add more of culture and diversity when it comes to health. Why are some cultures "Healthy"? or "why is disparity between genders with access to healthcare across the globe/developing nations"?

It is an interesting book. I liked reading it and refreshing some of the topics. I would just add some case studies and activities to make it more interactive instead of passive reading. May be we can have a supplemental lab with it? Its not a perfect book as it covers upper and lower division topics. But definitely, some components can be used as they are well written.

Reviewed by Sara Pappa, Assistant Professor, Marymount University on 2/24/21

The textbook is a comprehensive compilation of personal (individual) health topics, which are clearly defined and described. It would be appropriate for a Personal Health or Introduction to Health/Health Behavior course. It has a table of contents, but not an index or glossary. It does not highlight key terms. There is a reference list at the end of each chapter--this could be expanded to include helpful links. Chapters do not have introductions or summaries.

The content is accurate and relatively unbiased. It includes current public health topics such as the leading causes of death, social determinants of health and health disparities. I might suggest changing the name of Chapter 12 to Chronic Diseases.

Each chapter is made up of many sections, or short descriptions of the topics. This helps with the organization of the content. There are not a lot of case studies, examples, graphics or anecdotal information to enhance the learning process. The material is somewhat dry the way it is presented (not very engaging).

The textbook is written in clear language and at an appropriate reading level for college students.

The chapters are organized in a consistent manner.

The textbook could easily be broken down into smaller units or sections as well as followed in a different order as indicated by a course or instructor. The short sections, as well as the chapter and section/sub-section numbering systems, make it easy to follow.

The textbook is organized in a clear manner, with chapter and section titles that make it easy to follow.

The textbook is easy to read and navigate.

The textbook is well written with few grammatical errors.

The textbook does include some references to culturally competent content. It would be improved with the addition of specific examples, including data and research, about cultural differences and how these affect health.

Reviewed by Sarah Maness, Assistant Professor, Public Health, College of Charleston on 1/27/21

Covers a wide variety of health promotion topics, primarily at the individual level. Lacks a section on social relationships and health. Only covers romantic relationships and in ways that are culturally dated (section on Married and Non-Marrieds). read more

Comprehensiveness rating: 3 see less

Content Accuracy rating: 1

I would not feel comfortable using this text in my class based on issues with accuracy. Section 1.7 about Determinants of Health mentions Healthy People 2020 however does not describe the Healthy People Social Determinants of Health Framework when talking about Social Determinants of Health and includes different factors. Citations are very dated, 2008 or earlier when this edition came out in 2018. Healthy People 2030 is now out so next version should update to that as well. Bias encountered in the chapter about relationships and communication. Only covers romantic relationships and is written with from a heteronomative perspective that also centers marriage and is stigmatizing to those who are not married. ("Marriage is very popular..because it does offer many rewards that unmarried people don't enjoy." "There are known benefits to being married an in a long-term relationship rather than being single, divorced or cohabiting). Also refers to attempts to legalize same sex marriage in this chapter, which has been legal for years now. References are not formatted in AMA or APA style which is standard for the field. Wikipedia is used as a reference in Chapter 2. Chapter 6 discusses "options" for unplanned pregnancy (including taking care of yourself, talking to a counselor, quitting smoking) and does not mention abortion as an option. HPV vaccination recommendations need to be updated.

Relevance/Longevity rating: 2

All topics are relevant but the supporting statistics are outdated by more than a decade in many places. Years are not included in many statistics, nor in the citation at the end of the chapter.

Clarity rating: 3

The sections read as rather disjointed. Chapters could be more aligned and have improved flow for the reader to understand how concepts are related. For example, going right into theoretical models of behavior change in Chapter 1 is early and advanced for an introductory text.

Consistency rating: 2

In the Introduction it states the book is about health, health education, and health promotion. Since health promotion is broader than health education, and fits the topics of the book, it is not clear why this is not the title instead. This book could be useful for an introduction to health promotion class but instructors may overlook it because of the name. Some chapters contain no in text citations despite stating facts, while others contain many. Reference lists and in text citations are formatted differently in different chapters.

Almost too modular, not clear how some sections relate and there is not a lot of detail in many subsections.

Organization/Structure/Flow rating: 3

The sections within each chapter often seem disjointed and do not include enough detail in each section.

Interface rating: 3

In many chapters, only weblinks are provided as citations. If the link is broken, there is no title, author, journal or year for reference. Figures included without citations (ex: Social Readjustment Rating Scale).

Grammatical Errors rating: 3

Did not notice overt grammatical errors.

Includes examples and text of people of multiple races and ethnicities. Is not inclusive based on sexual orientation and in terms of the way it discusses marriage and relationships.

The cover does not appropriately capture what the book includes. It could be more representative of health than just a sports field/physical activity. Health is multi-dimensional and includes in addition to physical - mental, emotional, spiritual, occupational aspects, which the book acknowledges in the text. Hair and clothing style of people on cover also look outdated.

Reviewed by Corrie Whitmore, Assistant Professor, University of Alaska Anchorage on 11/11/20, updated 1/10/21

Comprehensiveness rating: 5 see less

This book was developed for a Health 100 class. It covers a wide variety of personally relevant health topics, with segments defining health, discussing "your bodies response to stress," describing threats to environmental health, and offering a guide to "understanding your health care choices," which includes both nationally relevant and California-specific information. The index is detailed and specific. There is no glossary.

This textbook would be appropriate for a lower division personal health course. Some components would be useful in an introductory public health course, such as the "Introduction to Health," "Infectious Diseases and Sexually Transmitted Infections," and "Health Care Choices" secgments.

The text is not appropriate for a "Fundamentals of Health Education" or "Health Promotion" course aimed at future Health Educators.

Book provides accurate information with clear references to unbiased sources (such as the CDC for rates of diseases).

Content is releveant and timely.

The book is appropriately accessible for lower division students, with clear definitions of relevant vocabulary.

Good internal consistency.

The segmentation of the book into 14 topical sections, each with subsections, makes it easy to assign appropriate chunks of reading and/or draw pieces from this text for use in other courses, such as an introductory public health course.

Well-organized.

Easy to navigate.

Easy to read.

Good discussion of health disparities, acknowledges cultural components in health. Is not insensitive or offensive.

Reviewed by Audrey McCrary-Quarles, Associate Professor, South Carolina State University on 8/17/20

The Health Education book covered all the components usually found in other basic health books. It can be utilized as an Open Textbook for students taking the introduction to health or the basic health course, such as HED 151 - Personal and... read more

The author could use a picture that exhibits diversity on the cover.

Some of the data is just a little outdated but can be updated very easily with an article or current chart.

Clarity is okay.

Consistency is good!

Should be an easy read for students.

Organization and flow are great!

Text can use some more pictures and charts, especially in Chapter 1.

Did not notice any grammar errors in scanning over the book.

The cover should be a picture that depicts diversity as well as showing more diversity throughout the book.

Overall, the book serves its purpose. It is good!

Reviewed by Vanessa Newman, Adjunct Faculty, Rogue Community College on 7/22/20

The textbook successfully covers a wide array of health education topics. The chapters on "Relationships & Love" and "Health Care Choices" were excellent additions to what you find in many health books. Overall, I would have liked to have seen more case studies, illustrations, examples, and quick quizzes to reinforce the content presented and to reach students with different learning styles. Many of the sub-topics could be even more robust with the addition of information on auto-immune disorders for example or a section on health education professionals like personal trainers and health coaches or information on what to do if you suspect a food-borne illness and how to access help.

The contributors have done a great job of presenting accurate information but it is now outdated in many sections and chapters which is what happens in textbooks generally. The language and presentation of material appears unbiased. The addition of more graphics and examples that cross demographics, cultures, and races would be a welcome addition. I found no factual errors but did question the notion that gluten-free diets can assist with anemia and wondered if research about the resilience gene in children might be referenced.

The research presented is all 2015 or before with an emphasis on 2008 information. Sections about marijuana and cannabis, infertility, social disorder, and smoking need refreshing. It would be helpful to have information about genetic testing (23 and me and Live Wello) added, functional fitness addressed, and infectious disease content brought up to date. So much has happened affecting people's health has transpired since 2015 that it is time for updating. Also, more information in sections like how baby birth weight can predict chronic disease development and mindfulness as a practice for improved quality of life.

Content is presented in clear, concise and appropriate language. Every once in a while there is a sentence structure issue or a word ordering that is clarified by a re-read. There is not an emphasis on jargon or overuse of idioms in my opinion. All terminology was defined or given reference as to where to locate additional information. Again the use of diagrams, illustrations, more examples would also improve clarity and accessibility for some. I did not recall seeing information on how many calories are in a gram of protein, carbohydrate and fat presented. And relevance affects clarity. For example, including language about portal of entry and exit in the infectious disease section.

Having a quick quiz at the end of every chapter would have added consistency. Also standardized formatting for charts and graphics would improve the textbook overall as well. The chapters, sections and headings all appear consistently presented. There was nothing presented that was jarring or appeared out of context. References looked similar and were all summarized at the end of each chapter.

Modularity was this textbook's strength. Large chunks of information were broken down into manageable sections and sub-sections and the white space was appreciated. Because of this, the information did not seem overwhelming or "too much too fast." Students can take breaks and not lose track of where they were or forget critical information. Again, more examples, quizzes or case studies could also improve modularity and add an interest factor. The table of contents was thorough.

Time was taken to decide which chapters and topics should be presented in which order. The flow was organic, natural and later sections built on previous information. The structure of the textbook made sense and usually my questions about a topic or subject were answered within the same page. I had no complaints about organization and could find sections easily based on the table of contents.

No interface issues for me, but I was reading on a personal computer and perhaps on a tablet or phone there would be.

The paragraph spacing was not what I would have chosen. There were some inconsistencies. There are contractions like isn't which I prefer not to see in textbooks because it is too casual a style for me. Many instances of punctuation coming after quotations, but this may have been a style choice. The font seemed appropriate but more bolding or color would keep the reader's attention. There are spelling errors on the food chart on p. 236. Some issues with singular vs. plural. For example on P. 64 "nightmares" needs to be plural. A few places where punctuation is missing.

The text is not culturally insensitive, but without additional examples, graphics, and diverse charts it becomes a bit bland. The reference to a handgun on p. 56 was uncomfortable for me. Under weight management, there could be more information presented on how different cultures appreciate varying body types and have different food rituals and discussion on how not to "fat shame" others. Some examples of cultural influences could be presented in the infectious disease section like how practices for burying the dead can lead to disease and how food preparation affects disease management.

I thought it was comprehensive and well organized. If it were not for relevance issues, I would choose to use this book in our general health class.

Reviewed by Robert West, EMS Program Director, North Shore Community College on 6/7/20

Health education is an enormous subject area but this text does an excellent job covering the most important topics. The comprehensive nature of it topic coverage does come at the cost of not being comprehensive within any single topic- this book... read more

Topics within Health Education are inherently subject to bias- religious, cultural and generational perspectives often influence the scientific and open-minded exploration of issues in topics like sexuality, nutrition, and relationships. This book clearly strives to support perspectives with research and did not shy away from topics like abortion and gender roles.

The greatest weakness of this text is that it often feels outdated. Health information is dynamic and no text can always be current, but there are sections that are clearly too old to be considered useful unto themselves. Examples: The narcotic abuse epidemic is absent. This is a major issue in substance abuse and the text primarily looks at heroin abuse without examining the larger issue of prescription narcotic gateways to abuse, or even other narcotics of abuse. The use of PrEP for reducing HIV transmission has been available since 2012 but is not mentioned. The section covering sexual orientation and gender identity cites the 1993 Janus Report for its source of statistics. There is no publication date listed in the text- the latest citation that I noticed was 2015 but most come well before 2010, making the text a decade old in a field that changes rapidly.

The text is well-written and easy to comprehend.

Consistency rating: 3

The Acknowledgements page at the front of the book states that it was "compiled by..." and this speaks to the way the text appears. There is no consistency is the writing of the book. Some chapters are broken down into Sections, brief (often only a paragraph long) collections of sentences that seem to address a behavioral objective that we do not see. Other chapters are written like a standard text and then some appear in a question-and-answer format. None of these are inherently problematic, but the changing style may trouble some readers.

Chapters and chapter sections are clearly delineated.

Chapters are well organized- there is no logical order into which one must teach the various issues of health. The readings of this text could easily be sequenced as desired by the instructor.

The interface is clean and simple. There are few images/illustrations- they would be a welcome addition.

The text is well-written and contains no grammatical/spelling errors that I noticed.

Overall the text seems fair and cites studies to provide evidence of its claims, though some sections simply feel less than open-minded. In the discussion of marriage vs. cohabitation (does anyone use that word anymore?), the text lists advantages of being married that include less likely to commit crimes and less addiction. Statistically, perhaps, but is there a causal relationship? A single paragraph addressing "spiritual health" states: The spiritual dimension plays a great role in motivating people’s achievement in all aspects of life. Some people, yes, but it's not a global truth. Race is never addressed as a topic within the text, though it is commonly listed when a risk factor of disease, health care disparity, etc.

If updated, this would be a superb book. As it stands, it provides an excellent framework for a college course in General Health from which the instructor, or students, could be directed to contemporary writings on these issues. An instructor could readily assign chapter readings and then short research projects that would that could be shared with the class as a whole to assure present day relevance.

Reviewed by Kathy Garganta, Adjunct Professor, Bristol Community College on 5/26/20

The textbook covers a variety of topics in a choppy sequence jumping from three chapters on sexuality and sexual health to substance abuse then onto nutrition. The book was limited in depth and many areas needed additional explanation. There are many lists that did not have the background explanations to support the lists. Several areas were lacking details and were not at college level.

Content Accuracy rating: 3

The text was generally accurate, but lacked backup documentations. Several phrases or statements appeared subjective without the supportive documentation that could lead to misinterpretation. For example, page 107, Section 6.6, Sexual Frequency is covered in one paragraph. In it a statement, “although satisfaction is lower in women,” is delivered with no backup explanation. On page 149, section 7.11, Sexually Transmitted Infections begins with a list of twenty different infections without clarity of an opening explanation.

Relevance/Longevity rating: 5

The textbook was written in 2018 and is still current today. Because of the changing nature of health, it will need updating.

The text was basic and often used lists without additional explanations. Many sections were too brief leaving the reader confused. Page 210 contained an example of a diet list. The list for 4 healthy diet approaches was followed by confusing numbering.

The structural set up of headings and subheadings were consistent, but occasionally spacing was off.

The use of headings and subheadings were helpful. The table of contents clear and easy to follow. Often the sub headings were very short and needed additional information to validate their statements. As an OER text, sections could be assigned as resources to courses outside of health.

The topics were arranged with an unusual flow. Having three chapters on sexuality before nutrition changed the flow and weight of importance.

The text is free of significant interface issues. The chapter headings in the table of contents allows for easy navigation. The use of charts, color displays, photos would have assisted in explaining the topics. The chapter’s would benefit with a more engaging approach. Introspective questions or activities would help to relate material to students lives.

The text contains no significant grammatical errors. However, spacing and formatting needed consistency. For example, on page 86, five definitions all begin with the same exact phrase, throwing off the reader’s flow. On pages 285-86 the formatting/spacing is off.

The text should make greater use of photos/drawings that are reflective of a variety of gender, races, and backgrounds.

Grateful to the author for contributing to OER resources.

Reviewed by Sonia Tinsley, Assistant Professor/Division Chair, Allied Health, Louisiana College on 4/28/20

Covers a variety of health topics that are typical to a personal and community health course. However, the information is very brief. read more

Covers a variety of health topics that are typical to a personal and community health course. However, the information is very brief.

Content is accurate. However, some chapters tend to be limited with reference information.

Some chapters include a limited number of statistics and references but could be updated.

Information is basic and easy to follow.

Terminology used is consistent throughout the text.

The information can be divided into modules to use throughout the course.

Topics are organized and easy to follow.

There were not any features in the text that seemed to be distracting or confusing.

There were no glaring grammatical errors.

The text was very basic and seemed to be written for a variety of races, ethnicities, and backgrounds.

Would have been helpful to have more self-appraisals for readers to complete and make information personable.

Reviewed by Jeannie Mayjor, Part-time faculty in the Health and Human Performance Dept., Linn-Benton Community College on 1/15/20

I think this book does a great job of making the material presented easy to understand. Many similar textbooks are more advanced due to more challenging word/term choices, but this book would work well for anyone taking an intro level class in... read more

The book doesn't cover any of the topics in an in-depth manner. Since it's an intro-level textbook, there aren't many complicated ideas to present where accuracy could be a problem. I think some areas, like nutrition, are missing more up to date info, but that could be remedied by incorporating more recent articles and info from various health journals.

Since this text provides an easy to understand overview of health, it would be easy to update. There are no cutting edge or controversial views expressed in the book, so it does have longevity, but again, there will be a need to present more up to date info to supplement the general understanding that the students will have after reading this text. I like the section on sexual health/identity/orientation in the Sexuality chapter. One more chapter that I appreciate is the chapter on psychology: the most common mental health disorders that college-aged students encounter is important and the section on resilience in both the psychology chapter and the stress management chapter are greatly needed.

The book is very clear and understandable. After having taught a health class every term for the past twenty years, I think the way this book is written would appeal to most students.

I did not catch any inconsistencies in this text. Topics discussed in early chapters might come up in later chapters at times, but the info presented the second time around is consistent with earlier explanations of ideas and terms.

Larger type on chapter headings would help improve the ability to divide the book into smaller reading sections, it's easy to miss the start of a new chapter when scrolling through the text. Once you are in a chapter, the subheadings are helpful in dividing the chapter into smaller reading sections. I wish the chapter on cardiovascular diseases (coronary heart disease and stroke) was limited to those two diseases, without including a section on cancer. I think the topic of cancer deserves its own chapter.

The text is well organized and chapters flow into each other in logical ways. There are enough chapters to spread this out over a ten or 15 week term/semester. The chapters are short enough that you could easily assign one and a half chapters or two chapters for one week's worth of classes.

I would have liked to see more photos, although there are plenty of graphs, and I enjoyed the interactive quiz called The Big 5 Personality Test, I would have liked to see more. Some of the links listed in resources are no longer working, and one link in the Fitness chapter is not working, (Adding Physical Activity to Your Life) and I had been looking forward to exploring the topic in more depth. The MyPlate.gov website has been significantly changed, around the time that this book was published, so some of the links to that site no longer work.

I usually notice grammatical and spelling errors, as well as missing words, but I did not encounter anything obviously wrong in my reading.

The text could use more cultural references. I would have liked to see more acknowledgement of cultural differences and references to the health of people from other cultures, especially as it relates to changes they may encounter once a person from another country moves here.

Great overview of the various topics covered in a 100 or 200 level college health class. I will use sections of this book to help simplify some of the topics that my students find challenging, for instance, the fitness and heart health chapters/sections. Due to the inclusion of many of the mental health disorders that our students encounter, I will fit in some of the sections in the psychology chapter. I look forward to implementing some of the material in this text into my health classes.

Reviewed by Jessica Coughlin, Assistant Professor , Eastern Oregon University on 1/6/20

This textbook includes very similar topics to most of the college level health education books that are available today. While the book includes many of the main points related to each topic, it does not go into too much depth. However, this limitation can be solved by supplementing the book with scholarly articles. Based on the number of chapters and the amount of information, I think this book would be beneficial for a 10 week or 16 week term.

The book cites quality sources, however it would be helpful to include in-text citations since the references are only at the end of the chapters and it is difficult to know where the information is coming from. This is especially important for time sensitive information such as statistics. Also, some information seems to be directly from the sources, but it is not cited.

The information is mostly up to date, however as stated before, including in-text citations would help readers have a better idea of the relevance of the material. Also, there are limited references for each chapter.

The material is delivered in a clear and concise way. Adequate context is provided for terms and concepts.

The format of the text-book is consistent as is the type of delivery for the information.

The text includes a good amount of headings and sub-headings, which makes it easy to break the information down into smaller reading sections.

The book has a good flow to it. Each section within the chapters is well-organized and provides a logical progression.

The book is free of any significant interface issues, however there are some small issues such as spacing and formatting errors. Additionally, some small changes such as larger title pages for each chapter would be helpful as well as more graphics and pictures.

I did not notice a significant number of grammatical errors.

The text is not culturally insensitive or offensive. Like most textbooks, it could provide more examples that navigate the relationship between health and different backgrounds.

I would use this textbook, along with other supplemental materials for my course. It reviews the main topics I currently cover in my course and has less limitations than many overly-priced books.

Reviewed by Kathleen Smyth, Professor of Kinesiology and Health, College of Marin on 4/17/19

This textbook covers the myriad of required topics for an Introductory Health Course. The table of contents includes all of the topics I cover in my classes. No textbook is perfect and this book is no different but one should not rely on textbooks... read more

One of the greatest challenges in teaching health is to be unbiased given so many factors affect our health like politics, economics, zip code etc. The textbook does a fine job of explaining the role of government. For example: generic drugs and the abortion debate. Any areas in question can be used by the instructor to create a discussion with the students for better/different alternatives or ideas.

Health is very dynamic so the textbook will need to be updated on a regular basis.

This is an easy to read text. The majority of college students will have no issues with the terminology.

For a textbook that is not professionally published I found the terminology and framework sufficient for my needs. Anything missing can easily be added by the instructor and used as a discussion or research assignment for the students.

Maybe the best feature of the text is the modularity. Each section of the table of contents is hyperlinked so one could easily pick and choose the topics assigned to the students.

The organization follows the same logical fashion as all of the top rated professionally published Health Education textbooks.

There are a couple formatting issues but nothing that affects clarity in my opinion. I think because this is free I have lower expectations vs a professionally published textbook and I am ok with this.

I did not notice any obvious grammatical errors.

The text is not culturally insensitive or offensive but it could include in-depth analysis of health status in relation to one's race, culture and zip code. As I mentioned previously this is a topic that can easily be supplemented by the professor.

This free textbook meets all the requirements for an introductory health course. It leaves room for me to do my job to engage my students in more detail by discussing controversial topics while giving them the opportunity to be critical thinkers. I appreciate all of your efforts on this project.

Reviewed by Amanda Blaisdell, Assistant Professor, Longwood University on 4/11/19

It gives a lot of information, but it isn't very "in-depth." Admittedly, it would be a challenge to be very in-depth with one book that covers so many topics. This book certainly lacks sufficient images/pictures. The amount of information varies by topic. For some reason, some topics (that don't seem as important in relation to other priority issues) have much more text and information, while other topics lack in comprehensive quality to a large extent. Types of intimate partner violence is incredibly insufficient. There are LOTS of ways that people are abusive, those 5 bullets are not enough. There are lots of incomplete sections. It seems like most sub-topics are hand-selected.

There are biases in the information. For example, mental health is described with an emphasis on college-aged students. Why? Mental health issues affect everyone. This makes it seem like a college student problem. Another example, on page. 57 a strategy to cope with stress is to "give in once in a while." What are we promoting here? I have taught health education and stress management for years. There is a better way to phrase the point they are getting to.

It seems like it is up-to-date as of right now, but health facts are only good for five years.

Sometimes more jargon is necessary. Too much relying on cultural metaphor.

Not all facts have footnotes so that the reader can find the source of the information. Why do some have a reference footnote but other facts do not? How can we dig deeper and fact-check? The reference sections are hyperlinks, which come and go. Why are the references lacking any actual APA, MLA, or other format? APA would be appropriate. Students emulate what they find in textbooks. Some seem to be in some formal form, but others are not and the formatting is not correct.

Yes, very much so.

Some topics fit in multiple categories, so there should be some in-document link to information.

Some sections have a space between paragraphs... some do not.. it is not consistent or visually appealing (Example, p. 23). Figure 1 on page 51 seems to have highlighting and blurriness on the image. Look on p. 122, what is that symbol before the "Copper IUD"? WHy does it say it twice? Is there a heading that wasn't bold? What is going on?

I don't know if you call this "grammar" per-se, but formatting is not consistent. For example, on p. 55 there is no consistency in capitalization of first words in bullet points. That just seems sloppy and unprofessional.

Don't refer to sexual arousal as being "turned on," as that is a cultural metaphor. Some language needs to be technical because this book is supposed to provide information. There is lots of evidence of attempts at cultural competence, but it doesn't provide enough of that. There are lots of lifestyles that are OK even if they don't fit our Western model.

To be honest, it seems like portions of this book are plagiarized. Is this a rough draft?

Chapter 1: Introduction to Health
Chapter 2: Psychological Health
Chapter 3: Stress Management
Chapter 4: Relationships and Communication
Chapter 5: Gender and Sexuality
Chapter 6: Sexual Health
Chapter 7: Infectious diseases and Sexually Transmitted Infections (STI's)
Chapter 8: Substance Use and Abuse
Chapter 9: Basic Nutrition and Healthy Eating
Chapter 10: Weight Management
Chapter 11: Physical Fitness
Chapter 12: Cardiovascular Disease, Diabetes, and Cancer
Chapter 13: Environmental Health
Chapter 14: Health Care Choices

Ancillary Material

About the book.

Readers will learn about the nature of health, health education, health promotion and related concepts. This will help to understand the social, psychological and physical components of health.

About the Contributors

Contribute to this page.

Essay on Health Education for Students and Children

500 words essay on health education.

We all know that health education has become very important nowadays. It refers to a career where people are taught about healthcare . Professionals teach people how to maintain and restore their health. In other words, health does not merely refer to physical but also mental, social and sexual health. Health education aims to enhance health literacy and develop skills in people which will help them maintain good health.

Importance of Health Education

Health education is very essential for enhancing the condition of the overall health of different communities and people. It will also help in improving the health of the whole nation. You can also say that the economy of a country is directly proportional to health education. In other words, it means that the higher the life expectancy the better will be the standard of living.

Health education is given to people by professionals in the field known as health educators. They are qualified and certified enough to talk about these issues. Furthermore, they undergo training related to health and hygiene for educating people.

Similarly, health education is very important as it improves the health conditions of the people. It does so by teaching them ways on how to remain healthy and prevent diseases. Moreover, it also makes them responsible enough as a whole community.

The developing nations especially are in dire need of health education. It not only conveys basic knowledge about health but also shapes their habits and way of living. Most importantly, it not only focuses on physical health but also addresses other issues like mental illnesses, sexual well-being and more.

Methods to Improve Health Education

Although health education is very important, we often see how it is not given the importance it deserves. The poor condition of the prevalent health education in many countries is proof of this statement. We need to improve the state of public health education in the world, especially in developing countries.

As the developing countries have many remote areas, the necessary help does not reach there. We must emphasis more on conveying this education to such people. The villagers especially must be made aware of health education and what role it plays in our lives. We can organize these programs which will attract more audience like fares or markets, which already has a gathering.

Moreover, as most of the audience will be illiterate we can make use of visuals like plays, folk shows and more to convey the message in a clear manner. Subsequently, we must also make the most of the opportunity we get at hospitals. The patients coming in to get checked must be made conscious of their health conditions and also be properly educated on these matters.

Similarly, we must target schools and inculcate healthy habits amongst children from an early age. This way, students can spread this knowledge better to their homes and amongst their friends. Therefore, we must enhance the state of health education in the world to help people become healthier and maintain their vitality and dynamism.

FAQs on Health Education

Q.1 Why is Health Education important?

A.1 Health education is very important as it improves the health standards of the country. It further helps in preventing diseases and making people more aware of their health conditions. Most importantly, it not only focuses on physical health but also mental health and others.

Q.2 How can we improve health education?

A.2 We can improve health education by making the people of remote areas more aware. One can organize programs, camps, plays, folk shows and more plus teach it properly at schools too.

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Health Education and Health Promotion: Key Concepts and Exemplary Evidence to Support Them

First Online: 09 October 2018

Cite this chapter

Hein de Vries 8 ,
Stef P. J. Kremers 8 &
Sonia Lippke 9

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8 Citations

Health is regarded as the result of an interaction between individual and environmental factors. While health education is the process of educating people about health and how they can influence their health, health promotion targets not only people but also their environments. Promoting health behavior can take place at the micro level (the personal level), the meso level (the organizational level, including e.g. families, schools and worksites) and at the macro level (the (inter)national level, including e.g. governments). Health education is one of the methods used in health promotion, with health promotion extending beyond just health education.

Models and theories that focus on understanding health and health behavior are of key importance for health education and health promotion. Different classes of models and theories can be distinguished, such as planning models, behavioral change models, and diffusion models. Within these models different topics and factors are relevant, ranging from health literacy, attitudes, social influences, self-efficacy, planning, and stages of change to evaluation, implementation, stakeholder involvement, and policy changes. Exemplary health promotion settings are schools, worksites, and healthcare, but also the domains that are involved with policy development. Main health promotion methods can involve a variety of different methods and approaches, such as counseling, brochures, eHealth, stakeholder involvement, consensus meetings, community ownership, panel discussions, and policy development. Because health education and health promotion should be theory- and evidence-based, personalized interventions are recommended to take empirical findings and proven theoretical assumptions into account.

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de Vries, H., Kremers, S.P.J., Lippke, S. (2018). Health Education and Health Promotion: Key Concepts and Exemplary Evidence to Support Them. In: Fisher, E., et al. Principles and Concepts of Behavioral Medicine. Springer, New York, NY. https://doi.org/10.1007/978-0-387-93826-4_17

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The Importance of Health Education

Understanding the Numbers When reviewing job growth and salary information, it’s important to remember that actual numbers can vary due to many different factors — like years of experience in the role, industry of employment, geographic location, worker skill and economic conditions. Cited projections do not guarantee actual salary or job growth.

When it comes to building a healthy community, the importance of health education cannot be overlooked. Community health workers collaborate with all stakeholders in a community — from its citizens to its government, education and medical officials — to improve health and wellness and ensure equal access to healthcare.

First, What is Health Education?

According to the World Health Organization (WHO), health education is a tool to improve a population's general health and wellness through promoting knowledge and healthy practices ( WHO PDF source ).

Although the subject is often taught in school settings, students aren't the only ones who need to know about health. In fact, all age groups and demographics can benefit from health education.

Why is Health Education Important?

Community health education looks at the health of a community as a whole, seeking to identify health issues and trends within a population and work with stakeholders to find solutions to these concerns.

The importance of health education impacts many areas of wellness within a community, including:

Chronic disease awareness and prevention
Injury and violence prevention
Maternal and infant health
Mental and behavioral health
Nutrition, exercise and obesity prevention
Tobacco use and substance abuse

Community health educators work with public health departments, schools, government offices and even local nonprofits to design educational programs and other resources to address a community’s specific needs.

“As public health professionals, with aid of community leaders, we strive to ensure community wellness as it pertains to health education,” said Dr. Tanyi Obenson .

Obenson is a public health clinical faculty member at Southern New Hampshire University (SNHU) who holds a PhD in Public Health. “A healthier community is a better community,” he said.

How Does Health Education Impact a Community?

Health education can impact communities by addressing relevant issues and concerns at a local level. For example:

Healthcare Disparities

In addition to providing educational resources and programming to a community, public health educators also work to ensure all members of a community have equal access to wellness resources and healthcare services.

“When considering care access and delivery within communities, health equity and social justice are one in the same,” said Dr. Natalie Rahming , an adjunct healthcare faculty member at SNHU with almost two decades of experience working in the healthcare field. “The social determinants of health classify the various ways in which an individual’s identity characteristics and social positions are woven into a fabric of discrimination.”

According to Rahming, common health disparities include:

Gender health disparities
Racial or ethnic health disparities
Rural and urban health disparities
Socioeconomic health disparities

Rahming said racism and other disparities have manifested into unequal distribution of care across distinct groups over many generations.

“A community health worker seeks to abolish or ameliorate health inequity from a social lens, whereas other health care workers approach it at an individual perspective,” she said. “Both are critical for healthcare advancement.”

Community Health Education and Government Policy

The importance of health education also extends into policy and legislation development at a local, state and national level, informing and influencing key decisions that impact community health.

From campaigns and legislation to enforce seat belt use and prevent smoking to programs that boost the awareness and prevention of diabetes, public health workers provide research and guidance to inform policy development.

Dr. Toni Clayton, executive director of health professions at SNHU

“The collaboration of community leaders is essential to form a shared commitment and results-oriented approach to improving the health of our most vulnerable populations,” she said.

The Economic Importance of Health Education

Health education can also boost a community’s economy by reducing healthcare spending and lost productivity due to preventable illness.

Obesity and tobacco use, for example, cost the United States billions of dollars each year in healthcare costs and lost productivity.

According to the National Collaborative on Childhood Obesity (NCCOR), the annual loss in economic productivity due to obesity and related issues is expected to total as much as $580 billion by 2030 ( NCCOR PDF source ). The total economic cost of tobacco use costs the United States more than $300 billion each year, including $156 billion in lost productivity , according to the CDC.

Programs designed to help community members combat expensive health issues not only boost individuals’ health but also provide a strong return on investment for communities.

According to the CDC, states with strong tobacco control programs see a $55 return on every $1 investment , mostly from avoiding costs to treat smoking-related illness. The national cost of offering the National Diabetes Prevention Program is about $500 per participant , significantly lower than the $9,600 spent on diabetes care per type 2 diabetes patient each year.

Find Your Program

How to become a community healthcare worker.

A community healthcare worker's goal is to help others, starting with education.

To begin your career in community healthcare, you'll typically need a minimum of a high school diploma or associate degree . The work done within public health and community healthcare differs from other healthcare fields and impacts communities in different ways requiring different training and understanding of healthcare.

“Unlike individual healthcare delivery, public health investigates the systems and trends that impact behaviors and outcomes within a community collectively," said Rahming. “This research facilitates the identification of needs and provision of tools to promote disease prevention, individual empowerment, and improved wellness that enhances the quality of life for all."

Earning your bachelor's degree in public health or community health could help you advance your career and better understand your work. On top of your classroom education, many community health care workers are required to complete on-the-job training. According to BLS, training often covers communication, outreach, and information based upon your specific community health focus.

Public Health Education: A Growing Field

As the health, social and economic impacts of community health education continue to grow, so does the field of public health and health promotion.

According to the U.S. Bureau of Labor Statistics (BLS), the role of health education specialist is projected to grow by 7% through 2032, faster than the average for all occupations.*

BLS said that health education specialists usually need a bachelor's degree but that some health education specialist jobs require you to have a master's degree, too.

Earning your Master of Public Health (MPH) degree could be a proactive way to expand your knowledge and prepare for a career in the public health education field. Whether you want to be a health education specialist or an epidemiologist, there are a variety of things you can do with your MPH . You can also focus your MPH studies on specific areas, such as global health, by adding a concentration to your degree.

When considering MPH programs, look for one accredited by the Council on Education for Public Health ( CEPH ), such as SNHU's. CEPH is an independent agency recognized by the U.S. Department of Education, and their accreditation means that the program has met the standards.

In an accredited MPH program, you can gain the skills you need to lead illness and disease prevention efforts, build community wellness programs and advocate for public health policy.

Whether you decide to pursue an MPH or community health education degree, the public health education field has a wide variety of settings where you may work. According to BLS, these settings include:

Government organizations and public health departments
Hospitals and healthcare facilities
Nonprofit organizations
Private businesses and employee wellness programs
Schools and colleges

Michelle Gifford, adjunct faculty member at SNHU

“I believe that more and more communities are seeing benefits from wellness-related initiatives and receiving positive marks about them,” Gifford said. “Hence, community leaders are seeing this as not just a business-driven necessity, but also something that impacts the well being and quality of life of their citizens.”

Discover more about SNHU’s bachelor's in community health : Find out what courses you'll take, skills you’ll learn and how to request information about the program.

*Cited job growth projections may not reflect local and/or short-term economic or job conditions and do not guarantee actual job growth. Actual salaries and/or earning potential may be the result of a combination of factors including, but not limited to: years of experience, industry of employment, geographic location, and worker skill.

Danielle Gagnon is a freelance writer focused on higher education. She started her career working as an education reporter for a daily newspaper in New Hampshire, where she reported on local schools and education policy. Gagnon served as the communications manager for a private school in Boston, MA before later starting her freelance writing career. Today, she continues to share her passion for education as a writer for Southern New Hampshire University. Connect with her on LinkedIn .

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J Educ Health Promot

Health education and global health: Practices, applications, and future research

Daliya s. rizvi.

Sindh Institute of Urology and Transplantation in Karachi, Pakistan

Health education is a crucial consideration in the healthcare system and has the potential to improve global health. Recently, researchers have expressed interest in streamlining health education, utilizing digital tools and flexible curriculums to make it more accessible, and expanding beyond disease and substance abuse prevention. They have also expressed interest in promoting global health through health and safety promotion programs. Amidst the COVID-19 pandemic, climate change, the refugee crisis, and overpopulation, healthcare crises are erupting all over the world. A lack of health education has and will continue to have a profound impact on community healthcare indicators, particularly in low-income nations. Current priorities within the health education sector include digitization, equity, and infectious disease prevention. Studies and data from university journals and other academic databases were analyzed in a literature review. Health education programs have a significant positive impact on attitudes and behaviors regarding global health. Improving upon these programs by digitizing them and expanding upon the scope of health education will help ensure that such interventions and programs make a significant difference.

Introduction

Health education is a social science that draws from a multitude of fields, often taking a biopsychosocial approach towards promoting health and preventing disease. It can encompass instruction in hygiene, reproductive health, nutrition, and more, and help address global healthcare crises by giving community members the tools necessary to engage in preventative care measures.

The majority of health education programs are school or organization based and are taught in standardized curriculums with the common goals of preventing substance abuse, the spread of disease, and premature pregnancy. However, recently, there has been a shift in health education towards a more creative and digital approach, and towards an expansion to mental health, preventative care, and more.

This paper discusses current health education program types and studies, along with the future of health education, up-and-coming methods for health promotion, and suggestions for future research within the field.

Materials and Methods

Studies and data from PubMed and Medline, as well as university journals and other academic databases, were analyzed in a literature review encompassing current innovations in health education. The criteria for the studies used were as follows: studies had to (1) be published in English; (2) focus on implementing health education programs and interventions or designing them; (3) be published in or after 1990 to ensure relevance; and (4) be relevant to emerging research in the field of health education. Findings were synthesized into suggestions for future studies in particularly pressing areas.

Past progress and the current situation

The positive impact of health education on physical and mental health is measurable. Meheba Refugee Settlement in Zambia was established in 1971 and hosts tens of thousands of refugees. In the early 2000s, the United Nations High Commissioner for Refugees (UNHCR) implemented a health education initiative in the camp with a focus on preventing the spread of HIV. The UNHCR volunteers engaged with the local community, provided refugees with resources, and taught them how to take advantage of what was available to them to prevent the spread of HIV. Participants were also encouraged to educate others about the dangers of HIV and help teach those around them about potential prevention strategies. These efforts reduced levels of HIV infection; now, the camp has far lower HIV infection rates than the surrounding areas of Zambia, proving the effectiveness of the program[ 1 ] . Similar results were observed in schoolchildren in Thailand who engaged in a health education program to prevent the instance of head lice[ 2 ] . Six schools were selected for participation in the study, and children (who were all females) were divided into control groups and intervention groups [ Figure 1 ]. Baseline data on the presence of head lice was collected. After two months, the intervention group had significantly higher scores on a KAP (knowledge, attitudes, and practice) test, and the percentage of those with pediculosis (caused by a lice infestation) decreased from 59% to 44%. The control group, however, experienced no significant changes.

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Maatai women participate in a health education program created by the Unite the World with Africa Foundation, focused on sanitation, family planning, nutrition, HIV/AIDS, and more[ 3 ]

A recent study conducted by an epidemiologist at the Global Disease Detection and Response Program and supported by the United States Centers for Disease Control and Prevention (CDC) focused on studying the effects of a hand hygiene–based health education program on influenza and influenza-related disease rates among schoolchildren in Cairo, Egypt.[ 4 ] The control group of students did not receive a health education program. The intervention group received a program that consisted of hand-washing requirements and educational activities related to hygiene. The program was taught in a creative and engaging manner to hold the attention of students and educate them about the importance of preventative hand washing and general cleanliness to combat germs. At the end of the study, school absences caused by influenza were reduced by 50% in the intervention group when compared with the control group,[ 4 ] illustrating the effectiveness of a well-implemented health education program on community health.

Health education programs are beneficial for more than preventing the spread of disease. They can be used to maintain health, improve cognitive functioning, and increase healthy behaviors. In Iran, a study was conducted to determine the effects of a health education program on the overall health and glycemic control of patients with type 2 diabetes. The study found that all clinical measures and lifestyle factors that were evaluated improved in the health education group when compared with the control group.[ 5 ] These findings were crucial because they established that rehospitalizations and complications arising from chronic conditions were not necessarily hindrances for patients. Similar programs could reduce strain on the healthcare system and are discussed in detail below. Another study evaluated the effects of a health education program in improving the cognitive capabilities of elderly participants in a University of the Third Age (U3A) program. The study found that health education program participants had significantly improved their cognitive examination and memory domain scores when compared with control group participants.[ 6 ] These results suggest that health education can expand beyond its traditional uses. The use of cognitive health education to improve the cognitive functioning of older adults could be used to combat the adverse effects aging has on memory, fluid intelligence, learning, and problem-solving, which is extremely promising. Cognitive health education programs are an important consideration for future health education research.

The International Journal of Dental Hygiene published a 2017 study that described the efficacy of oral health education programs among varying age groups. After conducting a systematic review and meta-analysis of 11 studies on the subject, it was apparent that oral health education programs and interventions led to increases in dental visits and improvements in brushing and flossing. These effects were often observed in children but were also observed in adults.[ 7 ] It is clear that health education programs lead to an increase in knowledge and behavior alike, changing the perceptions and practices of patients. They can be used to increase healthy behaviors in even skeptical or reserved patients.

Health education programs can also be utilized to prevent chronic illnesses, improve overall population health, and reduce the burden conditions like obesity and osteoporosis can place on underfunded healthcare systems. A 2017 study researched the impact of a targeted health education program on the lifestyle habits of middle-aged women at risk of osteoporosis.[ 8 ] The study concluded that the women in the intervention group who received a health education program had increased levels of physical activity, an increased daily calcium intake, and increased levels of general knowledge of osteoporosis. Although the progress of the study participants was not tracked in the long term, it is plausible that these changes in lifestyle habits could have delayed or even prevented the onset of osteoporosis in some of these women. Engaging citizens with predispositions to such diseases using programs for diabetes, obesity, and even cancers could be extremely beneficial in both the short and long term.

A 2019 review analyzed studies focused on health education programs designed to promote maternal and child health.[ 9 ] The study focused on 23 articles on various educational methodologies or program designs and technologies. Educational programs focused on various topics, including breastfeeding and pediatric dentistry. The programs yielded an abundance of positive results, including increased confidence, increased birth weight and gestational age at birth, increased prenatal visits to ensure fetus health, and higher rates of safe behaviors during pregnancy (avoiding alcohol, nicotine, drugs, etc.). The review concluded that continued health education programs led to improved outcomes for both the mother and child.[ 9 ]

Poor menstrual hygiene, caused by period poverty, can lead to a variety of negative effects on one's physical health, including urinary tract infection (UTIs) and issues with the reproductive system (UNICEF). In areas where girls are already marginalized in schools, and where many young women skip classes when they menstruate, infections caused by unhygienic practices can take a significant toll on both a young woman's education and her daily life. Many poverty-stricken areas do not have resources such as transportation, pharmacies, and healthcare infrastructure, and home remedies can often be more harmful than helpful. Thus, eradicating dangerous practices like poor menstrual hygiene is imperative. In 2007, a study measured the impact of a community-based health education program on the menstrual hygiene practices of adolescent girls in India. The researchers found that the health education program increased awareness of menstruation and led to a 28% decrease in the unhygienic reuse of cloth and menstrual products,[ 10 ] which in turn improved the reproductive health of adolescent girls in 23 villages.

Health education has been associated with a reduction in risky behaviors and an increase in academic achievement.[ 11 ] Additionally, it can help change the attitudes citizens have towards infectious diseases. Between 2012 and 2013, a study conducted in Gansu, China, recorded differences in knowledge of the spread of infectious diseases between two groups of high school students.[ 12 ] Although education level, income, and gender also affected the results, education had the most significant impact. Those in the intervention group exhibited more cautious behaviors after a health education program.

Among older students, health education programs can improve sexual health and reduce instances of violence and the abuse of certain substances. Often, these programs can involve more than classroom instruction. Programs with multiple components, including parental and community involvement and changes in school policy,[ 13 ] can have a positive effect on sexual safety, nicotine abuse, and bullying in school. Evidence suggests that when compared to other measures such as anti-smoking policies and a targeted approach towards 'at-risk’ students, school-based health interventions and education programs have a greater positive impact on student health.[ 13 ] Similarly, a Japanese study with the goal of measuring the effect of a comprehensive alcohol-focused health education program on alcohol abuse among junior college students found that the program reduced instances of alcohol abuse among the primarily female study group, despite limitations to the research.[ 14 ] Combating risky behaviors through education rather than the systematic targeting of students who are perceived to be at risk is a more beneficial approach.

At times, health education programs can encompass education in nutrition, particularly in areas where it is difficult to control one's meals and readily obtain foods that provide the variety and nutrition that characterizes a healthy diet. Exploring the impact of health education on food sourcing behaviors is a key step when determining how to best combat the obesity epidemic through the people suffering from it. A 2015 study measured the effects of a nutritional health education program on the knowledge and behavior of primary school students regarding nutrition in two low-income counties in China.[ 15 ] Students in the intervention group had increased behavior and knowledge scores, suggesting that the health education program had an impact on the way they approached food and food safety. Attitude scores, however, stayed relatively consistent.[ 15 ] In Spain, researchers found that physical activity and nutrition education programs yielded positive results and increased acquisition of healthy behaviors.[ 16 ]

Evidence has suggested that health education can become a vital aspect of therapy and recovery for patients with physical and mental conditions. A review examining the effects of health education programs on treatment outcomes in patients with heart failure analyzed several studies on the subject.[ 17 ] The studies that were analyzed measured a variety of variables, including the impact of health education on the quality of life of the patient, the patient's knowledge of their disease, the patient's level of self-care, and the patient's adherence to any pharmaceutical prescriptions recommended by their physician.[ 17 ] Data suggests that health education increased patient knowledge about heart failure, and had a significant impact on the patient's adherence to medications.[ 17 ] This suggests that health education programs could be used further to influence lifestyle changes in patients suffering from chronic illnesses. These programs would reduce rehospitalizations and patient health, thereby preserving healthcare resources.

The world is also currently facing a mental health crisis, with levels of anxiety and depression skyrocketing among groups of all ages, and particularly among young people.[ 18 ] Mental health awareness and education programs have the potential to reduce the stigma around mental illnesses and improve the overall mental health of students. Health education programs can also reduce risk factors of mental illnesses. For example, they have been utilized to combat drug addiction[ 19 ] and teen pregnancy: factors with a significant impact on the mental health of young adults. Although many of these programs are in their early stages, they could have a positive impact on the mental and physical health of young people by reducing stigma and rates of anxiety and depression.

Modern students live in a technological era in which cell phones, tablets, computers, and video games are core elements of daily life.[ 20 ] Thus, it is necessary to digitize programs that focus on student mental health and wellbeing. Digital programs and educational games could increase student health by presenting material in a more engaging, relatable, and convenient way. A 2019 review evaluated the impact of digital mental health interventions (internet resources and apps focused on educating users about mental health maintenance) on the psychological wellbeing of college students.[ 21 ] The review analyzed approximately 89 studies and recorded a common trend of improvement in symptoms of anxiety and depression, as well as improvement in the overall mental health among students. However, researchers noted that more rigorous studies were needed to fully measure the impact of these programs.[ 21 ] Making digital health education programs free and widely available is necessary. Ensuring that these programs meet established standards and are scientifically accurate is a significant challenge that must be met with extensive research.

The shift towards digitized health education has given rise to methods intended to educate students more creatively. Researchers designed a sexual health education game-based program for adolescents. The goal of the program was to combat unhealthy sexual behaviors, educate young people about safety and prevention practices, and encourage young people to discuss sexual health matters.[ 22 ] The game program was anonymous, allowing students to learn topics without fear of social pressures or stigma.[ 22 ] Programs like this emphasize learning through interactive activities and educate students free from the biases and reservations that traditional sex education teachers may have. They can also be utilized in areas where levels of STIs (the most common being HIV and chlamydia) are high to educate adolescents about safe practices.

The path forward: Suggestions for future work in health education and health promotion

Many educational institutions have implemented education and prevention programs for students that are intended to curb the usage of drugs and alcohol. Although similar programs focused on nicotine have been successful, programs that target 'at-risk’ students and focus on drugs have largely been unsuccessful. Genetics play a large role in the susceptibility of many to drug and alcohol abuse. Current health education programs do not account for this fact and are not tailored to each student's needs, background, and learning style. Research exploring the nuances of health education relating to the prevention of substance abuse is necessary.

Health education can play a major role in reducing stigma around conditions such as mental illness and AIDS, thereby reducing reservations among patients who avoid seeking care due to the judgment they could face from their peers. Research on widespread health education campaigns has occurred; however, their efficacy must be further investigated. Navigating cultural and social barriers could serve as significant challenges for such programs; thus, prevention strategies must be researched as well. The implementation of stigma reduction programs would likely improve the standard of care for marginalized patients, thus positively impacting global health.

There are multiple health education models that must also be taken into consideration. Thus far, the rational model is the most promoted of the available models. Focusing on presenting unbiased information, this model is based on the belief that becoming educated on a subject will change a person's behavior. However, this is not always the case. The health belief model emphasizes the fact that people often make irrational decisions when it comes to their healthcare, regardless of the educational resources available to them; many prefer to live in blissful ignorance rather than face the fact that one has a terminal illness. Hypochondria, low self-efficacy, and perceived obstacles can serve as barriers to healthcare. The extended parallel processing model takes a more biased and emotionally charged approach to health education in order to strongly persuade people to take charge of their own health and practice better prevention strategies. These theories are crucial for the development of a health education program that balances science and education, with successful management of the often erratic and unpredictable behavior of patients. Future studies must consider which combination between the available models is the most effective, both in the short and long term.[ 23 ]

Behavioral theories have been helpful to psychologists and sociologists when determining the best methods of education and persuasion for the general public. Social learning theory describes the idea that people are disproportionately impacted by their environments. This is crucial to note; health education programs must vary depending on the area and the cultural background of the people partaking in the program. Different strategies will work in different populations, and future studies must take this into account.[ 24 ]

Currently, citizens with disabilities (physical and intellectual alike) are discriminated against in the workforce. In fact, the unemployment rate for those with disabilities is over two times that of those without disabilities.[ 25 ] Health education programs can be utilized for sensitivity and diversity training in various corporations to emphasize the importance of reducing discrimination against potential employees with disabilities. Establishing mandatory programs focused on educating company employees about common disabilities such as autism and Down's Syndrome, for example, could increase levels of understanding and empathy, and lead to a more inclusive work environment. Studies have repeatedly correlated employment and reemployment with better physical health.[ 26 ] Those who are employed have higher levels of security and better mental health because of the lack of stress caused by financial instability. Thus, employing more citizens with disabilities would likely have a positive impact on global health by increasing the physical and mental well-being of a marginalized population.[ 27 ]

The United States and other nations are suffering from epidemics of obesity, heart disease, cancers, and diabetes. The onset of such diseases can be prevented by a reduction in inflammation and the maintenance of a healthy bodyweight and diet, along with stress management techniques. These lifestyle factors can be instilled into students at a young age, thereby vastly improving global health. Currently, most school-based health education programs are limited to substance abuse prevention and family life education or sex education. Health education programs in mindfulness, nutrition, and effective exercise routines can help improve the overall health of student populations. Current literature has suggested that theory-based interventions could reduce the risk of those who are predisposed to cardiovascular diseases.[ 27 ] Because such programs have not been implemented in most public-school systems, research into the nuances and standardization of this type of curriculum is crucial.

Health education programs must be used to empower patients to make their own decisions about their healthcare. Thus, tailoring programs according to the type of intervention and end goal is necessary, as differing program formats can yield different outcomes.[ 28 ] The same is true for the type of theory used.[ 29 ]

This study conducted a systematic search of PubMed and Medline databases to identify 42 studies that were published after 1990 in English, and that focused on implementing novel health education programs. Priority was given to studies that had digital components, focused on cognitive science, or focused on rehabilitation and recovery rather than disease prevention (although some studies discussed also focused on disease prevention). Many of the studies used were discussed in an in-depth literature review, and findings were synthesized into suggestions for future work to streamline, modernize, and greatly improve health education practices.

This study is novel as it evaluates varying types of health education programs as they relate to health promotion beyond the widely known scope of health education. By discussing the relation of health education to mental health, cognitive functioning, digital healthcare, and supplemental care, this study places an emphasis on future research and discovery and provides valuable insights into a rapidly approaching era of health education rather than simply summarizing what is already known. Additionally, this study provides concrete, implementable suggestions for future research into a variety of aspects in health education.

Despite this, the study also has its limitations. There is a lack of adequate research regarding the potential cognitive benefits of health education programs, as the concept is relatively new. Additionally, relevant research studies may have been omitted from the paper as a result of gaps in literature-searching practices.

Health education programs and advocates can help change the way we approach healthcare by championing preventative care to minimize the risk of chronic illnesses, outpatient care, and infections. They can also help reverse some of the negative effects associated with addiction and aging. Digitizing programs and utilizing flexible curriculums is particularly beneficial. As the world recovers from the COVID-19 pandemic and the current healthcare system is reevaluated, health education programs are a crucial consideration that can have a tremendous positive impact on the lives of citizens around the world.

Ethical approval

Financial support and sponsorship, conflicts of interest.

The author declares no conflict of interest.

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6.4 Health promotion, health education, and the public’s health

Published: November 2021
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Introduction

Health promotion is a complex, ambiguous concept and set of practices. While many have linked it, primarily, to a revolution in health education, its roots go much deeper into the history of public health. It had its contemporary beginnings in the throes of the backlash against bureaucratic and professional dominance exemplified by the new social movements of the 1970s and 1980s. At its heart, health promotion is centred on the values and principles of equity, participation, and empowerment. These concepts are embedded in health promotion’s founding document, the Ottawa Charter for Health Promotion. However, exactly how these values are articulated is often ambiguous. In this chapter, the authors contend that health promoters must intensify their reflection on these core values and principles; particularly in the light of the tendency to slip back into a comfortable paternalism, which reinforces existing power imbalances. We are specifically concerned with the precise interpretation of health equity in health promotion. In order to pursue a deeper level of reflection on the meaning of equity, it is argued that health promotion must engage more deeply with recent developments in political philosophy, political economy, and social theory. Following up from the work of the World Health Organization (WHO) Commission on the Social Determinants of Health, one of health promotion’s emerging priorities is a reinvigorated push for the global development of ‘healthy public policy’ as seen in the Health in All Policies (HiAP) movement. This chapter, also addresses the need for health promotion to engage more directly with core social-theoretical concepts related to the generation of social inequalities that underlie health inequities; finally, we explore the relevance of complexity science and systems thinking for health promotion research.

Health promotion, health equity, and action on the determinants of health: an introduction

Previous attempts ( Green and Raeburn 1988 ; Tones and Tilford 1994 ; Tones 2002 ) to situate health promotion within the broad field of public health have often used ‘health education’ as the starting point. This is an entirely sensible approach which we will discuss but it tends to underemphasize the radical departure health promotion aims to make from traditional public health approaches in general. Without claiming health promotion means everything all at once, thereby leaving its lofty rhetoric in the realm of the aspirational yet ineffectual, we aim to place health promotion more centrally in the ongoing saga of an increasingly globally aware public health. As one of the acknowledged founders and innovators of the modern health promotion movement has unceasingly argued, health promotion, at its most persistent and radical, heralds a ‘new public health’, not merely a more fine-tuned and effective tool-box for a less paternalistic health education (Kickbusch 1989 , 2007 ).

We will begin with a clear definition of health promotion. Then, by unpacking the dense and sometimes opaque wording that define the elements of health promotion as a concept, we intend to open up some of its central, yet often hidden, connections to much broader themes in contemporary social and political movements and ideas.

Next, we situate health education and its internal critique as an important part of the history of health promotion, while providing more context concerning the specific historical/national trajectories that made the genesis of the modern health promotion movement a mixture of different influences, of which health education is only one.

We will consider how health promotion manages its ambiguous relationship with the history and ideological background of public health, and how it sees itself in relation to the past, present, and future of public health.

We suggest there is a new opportunity for health promotion to reconnect with the avant-garde in public health, which can be examined along two broad dimensions, namely how to achieve health equity, and the question of health in a global political-economic context. Particular attention will be paid to the recent work following up the WHO Commission on the Social Determinants of Health, led by Sir Michael Marmot, and the renewal of the Ottawa Charter action area of ‘healthy public policy’ in the Health in All Policies global movement, spearheaded by the WHO.

In this chapter we argue that there is insufficient engagement with social theory within the health promotion field. We offer some suggestions and map out potential pathways towards more serious reflection on this missing social-theoretical base. Finally, we consider the emerging role of complexity theory and systems thinking in health promotion research.

In general, this chapter on health promotion is critical in the positive sense of the word. Previous surveys of the concept and practice of health promotion that provide excellent guidance to the field are referenced. However, we consider that practitioners and researchers in public health can benefit from a reflexive inquiry into the rich ambiguities and tensions that are embedded in the discourse and practice of health promotion. This is particularly the case if, as we argue, the development of health promotion is the development of a ‘new public health’ ( Baum 2016 ).

‘Health promotion’: a definition and conceptual critique

In this chapter, we will follow the Ottawa Charter for Health Promotion ( WHO 1986 ) definition of health promotion as ‘the process of enabling people to increase control over, and to improve their health’. However, we will also draw upon the expanded definition in the updated Health Promotion Glossary :

Health promotion represents a comprehensive social and political process, it not only embraces actions directed at strengthening the skills and capabilities of individuals, but also action directed towards changing social, environmental and economic conditions so as to alleviate their impact on public and individual health. Health promotion is the process of enabling people to increase control over the determinants of health and thereby improve their health. ( WHO 1998 , our emphasis)

Here, the ‘how’ and ‘why’ ideology is linked to the ‘what’ of the determinants of health ( WHO 1998 ). This is crucial, because if health promotion is about anything, it is about action taken across the broad spectrum of health determinants, particularly directed towards the social, environmental, and economic conditions that support health ( WHO 1984 ).

The Glossary also emphasizes that ‘participation is essential to sustain health promotion action’, and identifies the three Ottawa Charter strategies for health promotion: ‘ Advocacy for health to create the essential conditions for health indicated above; enabling all people to achieve their full health potential; and mediating between the different interests in society in the pursuit of health.’

These strategies are supported by five priority action areas as outlined in the Ottawa Charter :

Build healthy public policy

Create supportive environments for health

Strengthen community action for health

Develop personal skills, and

Re-orient health services ( WHO 1986 )

As one can see from these definitions, we already have started the ‘unpacking’. A more nuanced analysis of some of the key elements in this definition is described in the following subsections: the ‘process’ of health promotion; ‘enabling’ and ‘empowering’; and for what, the outcome, ‘improved health’. This will be followed by an analysis of the Ottawa Charter strategies and its priority action areas (often called ‘action strategies’).

As soon as we begin, we find ourselves in murky waters, though not without some guidance. Ironically, although health promotion is, as Tones and Green (2004) noted, an ‘essentially contested concept’, there has been a remarkable degree of effort, and consensus, concerning its ostensive definition. Few, if any, health promoters dispute the Ottawa Charter ’s now canonical phrasing ( WHO 2005 ).

The real ambiguity that surrounds the concept of health promotion is embedded in the elision of the concrete meaning of the elements that make up its agreed upon definition.

Health promotion as a process

The emphasis on process is important, if only because it warns against reducing health promotion to merely a technical function of public health. It connotes the wider meaning of the concept by signalling that the radical departure and critique of traditional public health lies in its advocacy for changing the way we do public health, just as much as what we change and why we change.

Health promotion, whether it be generated from an internal critique of health education or from other dissatisfactions with the way public health was being practised, is fundamentally concerned with change and, specifically, with the failure of traditional, paternalistic, and professionally dominated public health processes to bring about positive changes in health, particularly for those groups that suffer disproportionately negative health outcomes and the consequent disadvantages. What is substituted is a call for health promoters to create a dynamic, participatory engagement with individuals and communities, to help or ‘enable’ them to take control over the determinants of their own health.

The first ambiguity we meet when trying to analyse this ‘process’ turns on whether one interprets the health promotion process as, primarily: a revamped tool-box of health education techniques and social marketing devices, with a rhetorically efficient participatory gloss; or, as a values-based process of communicative interaction that has as its central premise the ethical foundation of respect for human dignity and autonomy. These are certainly polar extremes and there is no doubt that there is room for both aspects in a broad, ecumenical attitude to a diverse field of practical action. Yet, because health promotion is a process often dominated by professionals, in a context where its supposed beneficiaries are often those in a position of relative powerlessness, the tendency for professionals to retreat to an insulated cocoon of technical expertise is strong. The essence of the health promotion process is a focused shift of power from professionals to the community and to individuals within their communities who historically have had less power. To do this, it is crucial that the ‘process’ we focus on is the one that involves negotiating values, principles, ethics, and power, not the less complicated one of transferring a packet of new skills and technical tools to a community that is presumed to lack capacity. In order to achieve this shift in power, health promoters need to begin by examining their own values and assumptions that inform their actions.

Beliefs and assumptions underlying health promotion

Health promotion practice is influenced by the beliefs and assumptions we hold. While a detailed discussion of this topic is beyond the scope of this chapter, we outline how certain beliefs and assumptions influence how we act in health promoting ways in given situations.

Beliefs are learned through life experiences; they are what we hold as ‘true’. They are convictions that influence the way we think, feel, and act. Health promotion practice relies on a set of underlying assumptions that guide those who work in the field. Hartrick et al. (1994) contend health promotion is a ‘way of being’ that requires certain convictions in order to act in health promoting ways. These include:

All people have strengths and are capable of determining their own needs, finding their own answers, and solving their own problems.

Every person and family lives within a social-historical context that helps shape their identity and social relationships.

Diversity is positively valued.

People without power have as much capacity as the powerful to assess their own needs (people are their own experts).

Relationships between people and groups need to be organized to provide an equal balance of power (this includes professional/client relationships).

The power of defining health problems and needs belongs to those experiencing the problem.

The people disadvantaged by the way that society is currently structured must play the primary role in developing the strategies by which they gain increased control over valued resources.

Empowerment is not something that occurs purely from within (only I can empower myself), nor is it something that can be done to others (we need to empower the group). Rather, empowerment describes our intentional efforts to create more equitable relationships where there is greater equality in resources, status, and authority.

Shared power relations do not deny health professionals their specialized expertise and skills. Rather, professional expertise and skills are used in new ways that result in greater power equity in interpersonal and social relations ( Hartrick et al. 1994 , p. 87).

So, for example, if we consider the first assumption in the list, believing that people are able to find their own answers and solve their own problems leads one to act in empowering ways because of the belief that people have this capacity to figure things out. On the other hand, if one believes that people need to be told what to do, or that they are not able to figure out issues on their own, it is more difficult to create conditions that are enabling. For some, it might even feel irresponsible to put people in these circumstances or to allow them to have control over these types of decisions.

Enabling and empowerment

At the time of the Ottawa Charter , the word ‘enabling’ was favoured, although later this tended to be replaced with the more direct and comprehensive concept of ‘empowerment’. Essentially, this meant that a prerequisite for the new approach was that individuals and communities were to directly participate in the planning and implementation of health promotion activities. The assumption was based on the notion that only by genuinely participating in the health promotion process would people be ‘enabled’ or ‘empowered’ to take control of what determined their health. However, the concept of ‘enabling’ also referred to the more general process of changing the social, economic, and environmental conditions that made it difficult for people to become empowered. There is a deep ambiguity here: it is not clear, for some commentators, whether more macro-scale action, at a policy level, also requires active participation of local communities. There is some room for an interpretation that tends to retain a traditional paternalism when it comes to healthy public policy, leaving the ‘participatory’ aspect of health promotion to the realm of ‘community action’. As will be argued throughout this chapter, health promotion is constantly at risk of sliding back into this paternalistic approach, leaving the more ‘complex’ and high-level ‘technical’ decisions to the experts. Yet, if there is a direct link between human dignity, autonomy, and equity, then all aspects of health promotion must integrate the fundamental perspective of participation. In fact, it is argued that the rhetoric of ‘empowerment’ often masks a continuing bureaucratic and professional dominance of the process of improving public health ( Baum 2007 ).

A key aspect of this ambiguity can be seen when we consider the link to health inequity. Without a genuinely participatory, empowering process, it is those worst off who are left further behind as they suffer, not only a failure to affect those conditions most important to their health, but also a direct assault on their human dignity ( Sennett 2003 ). Those who tend to manage any gains from processes that lack true participation are usually segments of the population that already have access to positions of status and the resources and capacities to take advantage of the interventions on offer. The distinction here is between a situation where already disadvantaged people are assumed to be too ignorant or incapable of participating and thus have solutions imposed on them, and a situation where people of a privileged status delegate, as equals, to professional experts. This is not to say that a participatory process is not better for everyone, regardless of class position or status; rather, it is to emphasize that non-participatory processes have a disproportionate adverse effect on disadvantaged groups.

On the positive side, an empowering health promotion process leaves the ownership and control of a health promotion activity or programme in the hands of the community itself. This is particularly important in communities that have suffered historical social injustices and have thus been actively ‘disempowered’ (an ugly but accurate term). Allowing people to participate in a genuine way in determining not only what they want but how they want to get it is demonstrably the most effective strategy for change. It is also the only strategy for sustaining progress in improving health and shifting control back to the community and away from a negative dependence on bureaucratic and professional power. In this model, professionals are not demons; they are just transformed from arrogant experts into supportive servants of the will of the community.

There is in these simple terms (‘enable’ or ‘empower’) the entire, complex, and ambiguous story of health promotion. All the themes that will be touched upon in this chapter can be traced back to just what is at stake in the ostensive goal of ‘empowering’ people to take control over what determines their health.

What is the ‘health’ in health promotion?

Understanding how we conceptualize health is a key reflective step in health promotion. How we think about health largely determines the types of action we take to promote health. We see next how different historical conceptions of health still shape the contemporary health landscape and continue to sustain ambiguities in how people approach health promotion itself. In the twentieth century, due to the relative success of the sanitation approach to public health and the emergent hegemony of the germ theory of disease, an implicit biomedical definition of health as the absence of disease dominated, and along with it, a narrow, individual treatment focus, centred on the healthcare system, was the preferred solution. The WHO had, in 1946, introduced the positive definition of health as ‘a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity’ ( WHO 1946 ). Nevertheless, this definition had little concrete impact on actual health systems, leaving the absence of disease approach to health as the default option when governments turned their attention to the public’s health.

The Lalonde Report, an official document produced by the Canadian Department of Health and Welfare ( Lalonde 1974 ), marked a significant change in thinking about health. Although the report is recognized internationally as the first government document to suggest that health promotion could be a key strategy for improving health, its other, more significant contribution, was to redefine how we view health. Lalonde’s report argued that the healthcare system plays only a small part in determining health, and suggested that health was determined by the interplay between human biology, healthcare organization, environment, and lifestyle. This view of health became known as the ‘lifestyle or behavioural approach to health’, partly because the ‘environmental’ dimension was either ignored or treated narrowly.

With the publication of the discussion paper on concepts and principles of health promotion ( WHO 1984 ) and the endorsement of the Ottawa Charter for Health Promotion (1986), a third view of health arose: the socioecological approach. This approach defined health as ‘a resource for everyday life, not the objective of living’. ‘Health is a positive concept emphasizing social and personal resources as well as physical capacities’ (1986, p. 1). In order to reach this state of physical, mental, and social well-being, people must be able to identify and realize their aspirations, to satisfy their needs and to change, or cope, with their environment. This inextricable link between people and their environment provides the conceptual basis for this socioecological perspective on health and it forms the conceptual base for health promotion practice.

At first glance, these different views of health may appear to be developmental or historical. However, Labonté and others (Labonté 1993; Rootman and Raeburn 1994 ; Raeburn and Rootman 2007 ) argue that, in fact, all three views of health (along with many other definitions) continue to be endorsed by different people in the field of health promotion and, furthermore, that the view of health one holds influences one’s health promotion practice. Table 6.4.1 illustrates this connection between how we think about health, our view of health, and our actions (health promotion practice). For example, if we hold a view that health is the absence of disease, we are likely to talk about disease processes and risk factors and to manage the problem professionally by prescribing a treatment. If we hold a socioecological view of health, we are more likely to focus on the conditions in which the person is living, the factors that are influencing their ability to meet their needs, and to use enabling strategies to assist the person to have more control over their health.

The Ottawa Charter strategies

The three strategies mentioned in the Ottawa Charter are: to advocate , to enable , and to mediate . We have already reflected upon the second strategy, as it is part of the definition of health promotion. However, a few words need to be said about the other two strategies.

The concept of advocacy receives very little elaboration in the Ottawa Charter . In the Health Promotion Glossary , it is stated that advocacy ‘can take many forms including the use of the mass media and multimedia, direct political lobbying, and community mobilization through, for example, coalitions of interest around defined issues. Health professionals have a major responsibility to act as advocates for health at all levels in society’ ( WHO 1998 , p. 6). This raises one of the many thorny issues that come up when professionals are caught between highly mobilized and often highly critical communities and a state bureaucracy that is extremely reticent about providing funding that sanctions and supports the capacity for critical attention to its policies and programmes. Even at the level of independent professional organizations, the participation and funding provided by government bodies creates a tension around the organization taking strong critical perspectives. Another aspect of this strategy, as defined in the Glossary and glossed over, is the potential contradiction between activities such as ‘political lobbying’ and ‘community mobilization’. Often, the same organization or individual will be less effective as a political lobbyist to the extent they are perceived to be directly associated with community mobilization efforts that the powerful are either indifferent to, or actively disfavour.

Mediation is an even more delicate strategy for health professionals. Its original Glossary definition in relation to health promotion was: ‘A process through which the different interests (personal, social, economic) of individuals and communities and different sectors (public and private) are reconciled in ways that promote and protect health’ ( WHO 1986 ). In the expanded definition of 1998, more explicit emphasis is given to the potential conflicts that often arise between the competing interests mentioned in the original definition. However, the goal of mediation as ‘reconciliation’ is left unchanged. While there is nothing inherently wrong with the idea of reconciliation, professionals should be extremely self-critical and reflexive when operating with this strategy. Two dangers are apparent with the strategy. First, in striving for ‘reconciliation’, one may simply paper over a conflict for the purposes of short-term peace, while leaving the principal reasons behind the conflict intact, thereby creating the potential for longer-term embitterment and strategic action by all parties, which ultimately undermines the appearance of agreement. Second, a very real threat to equity can arise when professionals reconcile a conflict between the powerful and the powerless and end up re-enforcing the powerful at the expense of the powerless. This tendency is very strong given the fact that professionals have little to gain personally from any radical re-structuring of power relations. Despite these important caveats, mediation has become even more critical for the success of health promotion in the future, especially in relation to the new global, multilayered context of health governance that the Bangkok Charter ( WHO 2005 ) has set out to address and which will be discussed later.

The Ottawa Charter action areas

The priority action areas of the Ottawa Charter were identified as those areas that were seen at the time of the charter (and still to this day) as critical arenas for health promotion’s strategic activities. We will not try and survey the myriad accomplishments of health promotion activity; rather, consistent with our general approach, we will offer a few critical comments on each action area:

Building healthy public policy

There are three elements of healthy public policy emphasized in the Ottawa Charter :

If, as the Lalonde Report (1974) argued, the determinants of health lay mainly outside healthcare itself, then policy action must come from policy sectors other than health. The health sector would still play an important, but not exclusive, role in public policy action to support health.

Healthy public policy requires the coordinated use of all policy levers available, including ‘legislation, fiscal measures, taxation, and organizational change’ ( WHO 1986 ).

Healthy public policy requires the identification and removal of obstacles to the adoption of such policies in non-health sectors.

Without going into a long list of efforts and results in this area, the progress made can be summed up as substantial and encouraging in regard to changes in the rhetoric and discourse around health, in both developed nations and in many of the global institutions responsible for improving health and development worldwide. Conversely, one can equally characterize progress as ephemeral and demoralizing when it comes to the concrete goal of ‘coordinated action that leads to health, income and social policies that foster greater equity’ ( WHO 1986 ). For a variety of reasons discussed in the later subsection on the political economy of health promotion, given the increasingly urgent crisis of widening inequities in health both between and within societies, the collective policy response of the most powerful countries on earth has been miserly and despicable. To call it ‘inadequate’ is a gross understatement and an unconscionable euphemism.

When action finally starts to catch up with some of the lofty rhetoric behind the calls for ‘health in all policies’ ( Ståhl et al. 2006 ), health promotion can begin to find some satisfaction in the area of building healthy public policy. The COVID-19 pandemic which started in 2020 has seen many governments in high-income countries adopt social and economic policies which would fit under the rubric of Health in All Policies including increased income support, free childcare, and support to workers to maintain their employment. The WHO (2010) is supportive of and is promoting the use of the Health in All Policies approach. We will discuss some of the latter recent developments in relation to the Health in All Policies movement in a later section.

Creating supportive environments

This area forms the basis for what is called the socioecological approach to health. Here it is asserted that both the natural and built environments are inextricably linked with people’s health. It is crucial to understand that the conceptualization of supportive environments given here is consistent with the expanded, positive understanding of health as a ‘resource for everyday life’. It is not merely about threats to physical health, but involves creating conditions that allow people to have ‘living and working conditions that are safe, stimulating, satisfying, and enjoyable’. This entails the complex relationships between rapidly changing technologies, working conditions, resource use, climate change, urbanization, and health (among others). At the 2019 global meeting of the International Union for Health Promotion and Education was on the theme Promoting Planetary Health and Sustainable Development for All and demonstrated the extent to which the international health promotion community has embraced the need to ensure planetary health. The conference statement defined planetary health in a holistic way:

Planetary health is the health of humanity and the natural systems of which we are part. 1 It builds on Indigenous peoples’ principles of holism and interconnectedness, strengthening public health and health promotion action on ecological and social determinants of health. It puts the wellbeing of people and the planet at the heart of decision-making, recognising that the economy, as a social construct, must be a supportive tool fit for this purpose in the 21st century. ( IUHPE 2019 )

In considering progress, past endeavours, and future prospects in this area, one must take into account the lofty ambition (and some would say naïvety) of this programme of action. As a project of knowledge development, its referral to the ‘complex interrelatedness’ of contemporary societies is but a cipher for the entire corpus of theoretical and empirical dispute and debate within the social sciences over how to characterize what are now acknowledged to be multiple, interrelated, global, national, regional, and local processes of socioeconomic and cultural change ( Held et al. 1999 ). Later we consider some recent moves towards adopting complexity science and systems thinking to more adequately address this complex interrelatedness.

In the real world, we are not able to coordinate all the best knowledge sources available and neatly calculate what is best for health. Instead, we are left with tools like ‘health impact assessment’ (HIA) and health equity impact assessment ( Povall et al. 2014 ). The action area of creating supportive environments can be seen as a great boon to academic productivity, both theoretical and empirical; yet, before the final judgements of the academy can be handed down, actions must be taken and decisions must be made.

Communities and developers, politicians, and bureaucrats must decide whether to build this or that highway, licence this or that mining operation, enact this or that employment regulation, and build this or that oil pipeline. We are thus forced, by the necessity to decide and act, into an inevitable reduction of complexity. The question is not whether this is a good or bad thing; it is how , by what process , is complexity reduced? Whither participation and empowerment in a field dominated by professional expertise and the cloistered secrecy of executive and administrative decision-making in both the public and private sectors?

We argue against the implication that instruments like HIA inevitably involve participatory processes ( Kemm 2006 ). The natural tendency is always to define ahead of time, objectively, what elements of the built or natural environment are most important for enhancing people’s health. From a utilitarian perspective, locally defined needs and wishes may even legitimately be ignored in the name of some greater good for a larger population. However, health promotion should always err primarily on the side of the fundamental value of the autonomy and the dignity of people and their communities. In this mode, participation is foundational, even in what are prima facie obvious areas for the guidance of refined professional expertise. In enquiring into the best way to protect and enhance the built and natural environment for health, the first step is to find out what people actually identify as the things that would make life ‘safe, stimulating, satisfying, and enjoyable’. From the professional perspective this route has one incontestable drawback: people are inevitably confused, ignorant, inconsistent, contradictory, and even just ‘wrong’. ‘People’ will disagree with each other; will get annoyed or, even worse, angry; will disrespect experts, politicians, lawyers, and any number of people who ‘actually know’ about the issue. What is feared here is what is fondly called deliberative politics; in other words, the foundation of democratic civil society.

We are, as is universally acknowledged in the health promotion community, a long way from creating supportive environments for health, especially for those suffering gross inequities in social conditions and in consequent health outcomes. What is less often acknowledged is that part of the reason this is so difficult is that we consistently exclude the very people we are meant to be helping from determining the goals, and strategies necessary to move from here to there. Once again, we are led to believe that the ends can justify the means; we can have non-participatory processes as long as we intend to make changes to enhance the lives of the less fortunate. That we end up in a place we did not intend, is inextricably linked to the fact that, at crucial junctures, when inevitable changes of directions and compromises are made (local development processes are a prime example), the people who have an inherent interest in speaking up for the powerless (the powerless themselves) are nowhere to be seen, or are barely heard.

Strengthening community action

This action area is at the very heart of health promotion; in fact, it can be argued that this action area is the one where the basic principles of health promotion lie. You can imagine (wrongly) participation, equity, and empowerment to be contingent add-ons to the other action areas; with strengthening community action the essential unity of all the values of health promotion are embedded as necessary features of its realization. Indeed, what we see in this area is the place where the true spirit of health promotion is anchored in community development as a process. In fact, in the Ottawa Charter itself, there is a strange ellipsis where the term community development is introduced in the section on strengthening community action. It is as if one missed something: there is no linking phraseology relating community development to strengthening community action. This, we surmise, is no error: strengthening community action quite simply is community development.

Consider the definition of community development as agreed upon at the International Association for Community Development at a meeting in Budapest in 2004. Community development is a:

way of strengthening civil society by prioritising the actions of communities, and their perspectives in the development of social, economic and environmental policy. It seeks the empowerment of local communities, taken to mean both geographical communities, communities of interest or identity and communities organizing around specific themes or policy initiatives. ( Craig 2005 , p. 3)

For a more sustained treatment of the need to recognize the central place processes of community development and empowerment should play in health promotion, Raeburn and Rootman’s People-Centred Health Promotion is an essential reference ( Raeburn and Rootman 1998 ). Raeburn and Rootman draw heavily, in their chapter on community development, on Meridith Minkler’s important piece, ‘Improving health through community organization’ (1990) . In this seminal piece, Minkler outlines the five principles she sees as foundational to community organization or development:

Empowerment

Community competence

Participation

Issue selection

Creating ‘critical consciousness’.

As is now obvious, we have run into some of these principles already, the key to which is that the community itself has collective control over the process of identifying issues and planning how to address them. In addition, the important notion of ‘critical consciousness’ is raised. This refers to the need for critical dialogue in the Freirian sense ( Freire 1972 ); this is particularly important when working with historically oppressed or disadvantaged communities.

Developing personal skills

The new wave of health promotion has often downgraded attention to this critical aspect of its mandate. The Ottawa Charter tells us that health promotion ‘supports personal and social development through providing information, education for health, and enhancing life skills’. However, since the Ottawa Charter , health promoters, with some exceptions, have tended to either ignore or aim strong criticism at the developing personal skills area. This has come about for three reasons. First, as part of the critique of health education, it was argued that individually focused education approaches were generally ineffective in bringing about health promoting behavioural change; instead, a switch to an emphasis on the social factors that influence health was necessary to overcome the limitations of traditional counselling and other interventions circumscribed by the discipline of psychology. Second, the emphasis on developing personal skills was associated with the ‘victim-blaming’ element that many health promoters saw as the consequence of an interpretation of the Lalonde Report and other government documents (particularly, the approach taken in the United Kingdom under the Thatcher governments) in the context of the neo-liberal rolling back of the state’s commitment to a strong social safety net. Finally, although developing personal skills is a central mechanism for empowering individuals to take control over their own health, many worried that, in this narrow approach, the collective strengthening of communities was adversely effected by too much emphasis on individual empowerment.

All of these concerns are legitimate, though in each of them there is a high risk that we will miss important opportunities by mistaking what are contingent tendencies for essential features.

As has recently been argued, the ignorance of, or even hostility to, work in this area may seriously damage health promotion’s potential impact ( Godin 2007 ). First, while many health education and behaviour change approaches are limited in their effectiveness, there are some demonstrably effective interventions that should not be ignored ( Kok et al. 1997 ). Furthermore, we can learn and are learning about why some approaches in this area have not been effective. Second, the fact that this area of health promotion can be enlisted as part of a more general ‘victim-blaming’ culture of health promotion, does not mean it must be enlisted; in fact, to the extent that genuinely empowering health education is taken seriously, the resulting improvements in self-esteem should work against victim blaming. Third, individual and community empowerment should not be a zero sum trade-off. It is only when an exclusive focus on individuals is emphasized that we will have the phenomenon of rescuing survivors from a sinking ship. We also note that social media is offering more and more opportunities for effective health promotion. The pervasive use and influence of the Internet and social media in nearly all parts of the world, presents new opportunities and challenges for health promotion and health education (see Chapter 4.3 for extended discussion of new communication technologies). A key feature that differentiates social media from more traditional communication processes is its interactive nature, where communications are not a one-way process, and where users also play an active role. This allows the formation of new online communities, which can enable virtual participation and collaboration among its members and lead to effective mobilization of social movements and the development of personal skills.

In summary, while we must be vigilant against the temptation and limitations of an individually focused, skills development approach, we must also re-engage with the most advanced and progressive elements in this area of work. If we fail to do this, we will jeopardize a key aspect of health promotion.

Reorienting health services

While we have made some important gains in the previous four areas, reorienting health services has proved more difficult. In general, throughout the world, health services remain medically dominated, cure and treatment focused, and individualistic. The Ottawa Charter states ‘the role of the health sector must move increasingly in a health promotion direction, beyond its responsibility for providing clinical and curative services’. However, ‘across the world, there appears to have been a stubborn resistance to systematic change in healthcare services and only limited examples of effective and sustainable health services reorientation’ ( Wise and Nutbeam 2007 ). Health services need to embrace an expanded mandate which is sensitive and respects cultural needs. This mandate should support the needs of individuals and communities for a healthier life, and open channels between the health sector and broader social, political, and physical environmental components.

Health services are broad and far-reaching, with the most complex service for health promotion being the acute care hospital setting. There has been some advancement in this area with the creation of the healthy hospital settings movement, with some research evidence that it is possible to practice from a health promotion perspective even within this particularly medically dominated environment, for nurses at least ( Hills 1998 ). However, we want to focus in this chapter on the area where health promotion should flourish but has not as yet—primary healthcare. Many who work in health promotion would argue that the Alma-Ata Declaration ( WHO 1978 ) was the precursor for the Ottawa Charter . These two documents share the same values, principles, and basic tenets; the Alma-Ata Declaration addresses health systems more particularly while the Ottawa Charter has a broader mandate. But it is their relationship that provides the key to reorienting health services. That is, primary healthcare is a place for health promotion to focus its energy in terms of reorienting health services. In fact, the more that health promotion disassociates itself from primary healthcare, the more we give the impression that it is in the domain of medicine, not health. ‘The more health promotion becomes distinct from the world of curative care, the more the latter is allowed to continue to be seen as the real work of medicine’ ( MacDonald 1992 ).

We want to be clear that when we are talking about primary healthcare, we are not talking about primary care. These terms are often confused or used interchangeably. Primary healthcare refers to the philosophy and principles articulated in the Alma-Ata Declaration ( WHO 1978 ). It calls for universal access to health services (universality) and the removal of geographic, social, economic, or cultural barriers to access (accessibility); it demands community participation in planning, operation, and evaluation of health services (participation); it requires integration across health and other sectors such as housing, education, and employment; it recognizes the power of multidisciplinary teams working as equal partners for the health of the community; it focuses on a range of services, determined by the community, that include health promotion, primary prevention, rehabilitative, and curative (essentiality); and, it demands a commitment to equity concerning issues of power and resources (equity and access). Therefore, primary healthcare resists the conceptual and operational separation of treatment and prevention which fits the engineering model of healthcare, with prestige and often scarce resources going to clinical medicine to the neglect of prevention, promotion, and rehabilitation ( MacDonald 1992 ). The importance of primary healthcare was reinforced by WHO in its Astana Declaration ( WHO 2018 ).

People who work in health promotion and understand its philosophy and principles must be involved in the development and implementation of primary healthcare. Many people working in health promotion are of the opinion that health promotion and healthcare are distinct and separate entities. They are critical of health promoters who talk about healthcare or health service delivery at the same time that they are talking about health promotion. We have a different opinion: it is necessary, not only to talk but to act as health promoters to facilitate primary healthcare reform.

Besides the Ottawa Charter outlining our responsibility to take up this challenge, there are two other reasons why it must be people who work in health promotion who participate in the reorientation of health systems to primary healthcare.

First, the health system is controlled by the powerful. There is a hegemony that supports a predominant treatment/cure paradigm. Power resides in these structures and with the health professionals who work in those systems. So, as advocates for equity and social justice, health promoters have a responsibility to take up this challenge. If we continue to work only in the community where we are comfortable, we will avoid confronting one of the greatest challenges of our times: creating a health system that is based on the principles of health promotion. We are not neutral in this process. As Paulo Freire (1972) said, ‘washing one’s hands of the conflict between the powerful and the powerless, means to side with the powerful, not to be neutral’. Kickbusch (1989) confirms this concern. She states, ‘herein lies the great historical opportunity and challenge. Maybe health promotion can break the deadlock of the health policy debate that is basically about medical care and provider dominance’ (p. 14). As she suggests, we are well beyond the burden of proof needed to claim that health promotion is successful—we have demonstrated this through our change in attitudes towards smoking, drinking, and nutrition—even if these are mainly concerns of the middle class and of high-income countries. ‘Accountability and the burden of proof should now lie with the medical system’ ( Kickbusch 1989 , p. 14).

The second reason that health promoters must take up this challenge can be summarized in one question: if health promoters do not advocate for primary healthcare based on the principles of the Alma-Ata Declaration and the Ottawa Charter , what model of primary healthcare will dominate our countries?

Health promotion: history and influences

Health education.

Health education plays a profound role in the history of health promotion. While it is true that health promotion is an ‘essentially contested concept’ claimed by a variety of different interests and actors ( Green and Raeburn 1988 ), many of its most prolific commentators, particularly in the area of health promotion research and knowledge development, have been from the field of health education ( Green and Kreuter 2005 ).

These writers have often been concerned with the failure of traditional health education approaches to help motivate individuals to act on health information. Following Tones, we adopt his definition of health education as: ‘Any intentional activity which is designed to achieve health or illness-related learning, that is, some permanent change in an individual’s capability or disposition’ ( Tones and Green 2004 , p. 7). This refers to what knowledge, attitudes, or skills can be acquired by individuals through a variety of health education processes. In relation to health promotion, key health educators have radically restructured the traditional approaches to influencing health behaviour. Most of this work has revolved around challenging what are now seen to be simplistic and mechanical models of health belief and health decision-making. At the centre of this change has been an adoption of the concept of empowerment and an advocacy for using participatory learning processes that break down the power imbalances between health professionals and lay members of society. Crucially, the relationship between devolving control, developing self-esteem, and bridging the gap between knowledge, attitude, and behaviour is highlighted.

In relation to the overall theme of health equity, the move away from traditional health education models has been critical. Without the concept of empowerment, and the development of capacities and self-esteem, the traditional ‘health action model’ of raising awareness and changing attitudes to health behaviours tended to exacerbate health inequalities, as the ‘prepared’ middle classes quickly adopted the new healthy practices of more exercise, less smoking, and a healthy diet. The efforts to help population groups that had both the worst health outcomes and the most intransigent health-related social conditions have not been nearly as successful.

A detailed account of these changes can be found in Tones and Green (2004) . One very important aspect of his account is how health promoters can learn, as professionals, to overcome the social gap in both power and understanding between them and the groups and individuals they aim to enable and empower. As Tones notes, the ‘holy trinity’ of counselling (respect, empathy, and genuineness) is pertinent here. Often the more socioecological accounts of the health promotion process gloss over this crucial interactive aspect of health promotion. Whether it is with individuals or with groups, health promoters cannot act effectively without using highly developed skills of empathic understanding and facilitation. Particularly with group interactions, where often highly charged community issues are discussed, the professionals striving for neutrality and objectivity will find themselves unable to cope with the anger and resentment felt by people who perceive a history of grave social injustice behind their ‘health’ problems. It is important that these basic counselling skills are imparted to health promoters-in-training before they go out into communities and work with them on issues relevant to their health.

This shift in health education from an information-giving, pamphlet distribution approach to an empowerment liberatory approach has brought renewed interest in Freire’s emancipatory education paradigm (1972). Health promoters in several countries, most notably those in Brazil, have reclaimed and embraced his basic premises and have employed his dialogical problem-posing teaching strategies that help make health education more consistent with the principles and values of health promotion and the ‘new’ public health. Freire’s (1972) model of empowerment education describes a three-stage methodology consisting of listening, participatory dialogue, and action. Freire proposes that the main strategy of empowerment education, critical dialogue, requires us to engage in a process of problem-posing rather problem-solving. Problem-posing is different from problem-solving because it does not seek immediate solutions to problems. Rather, generative themes arising from the listening phase are ‘codified’ and posed as problematics to raise group consciousness about specific issues. Wallerstein and Hammes (1991) contend that this process recognizes the complexity and the time needed to create effective solutions to societal issues. ‘An effective code shows a problematic situation that is many sided, familiar to participants and open-ended without solutions’ ( Wallerstein and Bernstein 1988 , p. 383). Freire describes these as ‘generative’ themes because they generate energy and motivate people to act. Freire contends that, through a process of dialogue that reflects on the generative themes raised through listening, people become masters of their own thinking in interaction with others (1972, p. 95). As Wallerstein and Bernstein explain: ‘The goal of group dialogue is critical thinking by posing problems in such a way as to have participants uncover root causes of their place in society—the socioeconomic, political, cultural, and historical contexts of personal lives’ (1988, p. 382).

Freire cautions that ‘the liberating educator has to be very aware that transformation is not just a question of methods and techniques’ (1972, p. 35). If that were the case, we could simply substitute one set of methods for another. ‘The question is in a different relationship to knowledge and to society’ (1972, p. 35).

Public health

Many health promotion researchers preface their scholarly remarks on the birth and development of health promotion with a discussion of its relationship to its older, more developed discipline, public health ( Kickbusch 1986 ; Terris 1992 ). How this history is understood is perhaps the most telling aspect of how health promotion and its progress are viewed as a contemporary phenomenon. The argument developed next is that there has been a tendency within health promotion to tell a story of public health as a ‘fall from grace’—a fall from its original reforming, perhaps even zealous, focus on the social and environmental causes of ill health, to a more restrictive, preventive biomedical era, and finally, to a broader scale but narrower scope in the ‘lifestyles’ approach focused on individual risk factors and behavioural change ( Kickbusch 1986 ). Health promotion steps into the story to herald the era of a ‘new public health’, as a sort of re-emergence of the spirit of the nineteenth-century socioenvironmental model, with a modern gloss on the more subtle socioeconomic determinants of health. The purpose of this critical analysis is to challenge this tendency to nostalgia, and to explicate some of its continuing consequences for health promotion’s rather schizophrenic relationship to public health. The ‘golden age’ of public health was influenced by a particular philosophical and political outlook that still finds its expression today in its most modern and rigorous proponents.

The history of health promotion conventionally begins with the publication of the Lalonde Report, entitled A New Perspective on the Health of Canadians ( Lalonde 1974 ). The report was the first high-level national government document in the world to advocate for health promotion as a basic strategy for improving population health. It was influential internationally and set the stage for future debate with its concept of the health field as the articulation of the argument that the medically dominated healthcare system was only one and perhaps the least significant determinant of health, alongside biology, the physical and social environment, and individual lifestyles. The Lalonde Report relied explicitly for its argumentation on such critiques of the healthcare system found in ‘social medicine’ as those comprehensively outlined by ( McKeown 1976 ), but which had their roots in the classic public health tradition of William Petty, Johann Frank, Rudolf Virchow, and William Farr ( White 1991 ). The report contains not only the notable tension between an emphasis on individual lifestyles and the subsequently neglected socioenvironmental factors, but also an equal tension, given its own chapter heading, of ‘Science versus Health Promotion’. Here it is made very clear that the ‘science base’ of the health field concept is epidemiology and, in this context, health promotion is seen as that type of action that must be taken even though the pertinent scientific questions have yet to be definitively answered. In some ways, this attitude allowed some initial breathing space for health promotion to prosper; however, by setting up this dichotomy, it ensured that, eventually, when ‘science’ made its accounting, health promotion would have its day of reckoning with epidemiology.

Meanwhile, many in the health promotion community, especially in Europe and Canada, were starting to develop an independent conceptual basis for their work, based on a rigorous reflection on the type of actions necessary to most effectively promote the health of individuals and communities. Much of this work evolved out of a complex internal critique of the failure of traditional health education approaches and a more sophisticated understanding of behavioural change ( Kickbusch 1986 ; Tones 1993 ). Yet, in some countries, such as Canada, the absence of a strong health education tradition contributed strongly to a more socioecological approach to promoting health (with some of its most influential leaders being sociologists and nurses, rather than psychologists and health educators). Furthermore, for a variety of complex reasons (including, again, individual leadership), much of the discourse of contemporary social movements (new leftist, feminist, gay/lesbian, environmentalist) found its way onto the official agenda of major institutions such as the WHO and Health and Welfare Canada ( Labonté 1994 ). As has been recognized by one of the leaders in health promotion internationally, Canada provided a hybrid and fertile mixture of traditional welfare state values and innovative community activism that seemed to provide the perfect ground for a push for the new socioenvironmental approach to health promotion ( Kickbusch 1994 ). Out of this productive interaction between European ‘health promotion tourists’ (Kickbusch 1986 , 1994 ) and many able Canadian activist/public health practitioners, grew the idea and finally the accomplishment of the Ottawa Charter for Health Promotion (1986).

To fully understand the impact that the Ottawa Charter had and continues to have, it is important to see that there was a crucial transformation from the epidemiological and bureaucratic dominance of the Lalonde Report to the emerging ‘more pluralistic (and messier) social-science paradigm of human and social relations’ embedded in the Ottawa Charter ( Labonté 1994 , p. 86). This shift is key to understanding the constant tension between a ‘scientific’ approach to health promotion and the ‘values’ underlying the Ottawa Charter that is renewed whenever health promoters are asked to more rigorously account for their activities. It raises the uncomfortable question for those who, correctly, see the importance of reconnecting health promotion to the new public health, of just how ‘new’ the new public health is willing to be, when it comes to its underlying philosophical commitments.

This same tension underlies some of the confusion within the health promotion research community about how to relate to the more recent ( Evans and Stoddart 1990 ) emphasis on ‘population health’ (Labonté 1997; Poland et al. 1998 ; Raphael and Bryant 2002 ). On the one hand, there is a justified admiration for the advocates of population health for their influential arguments about socioeconomic determinants of health, even so far as to single out progressive population health researchers such as John Frank ( Raphael and Bryant 2002 ). On the other hand, there is the well-articulated angst about the lack of health promotion principles within the population health perspective. The critiques of the population health perspective for its lack of emphasis on values, its weak or non-existent orientation to action, and its somewhat imperious attitude to what is to count as proper ‘knowledge’, are all cogent and well-aimed. The question is: why should this be a surprise? It is not enough to point out the baleful influence of a replacement ideology for health promotion. Where did it come from, and why is it so influential? Furthermore, is this newly emergent approach ( Evans and Stoddart 1990 ) really so new? How far is it simply a modern, sophisticated renaissance of that very same ‘golden era’ of public health that health promoters so often return to as their intellectual and moral heritage?

Although health promoters themselves (especially Canadians, who were the ones facing this challenge directly) reacted strongly and were able to defend the rationale for keeping a health promotion focus, the more incisive critiques were often too ‘reactionary’ and came off rhetorically as overly defensive. A more accommodating response came from within Health Canada itself with Hamilton and Bhatti (1996) introducing the concept of population health promotion . This was clearly an attempt to marry these two potentially adversarial positions and to cement the term health promotion as an integral component of population health that could not be ignored.

Why is it that health promotion often seems ‘behind the game’ in the science debate? Partly, this is due to the fact that, as Labonté says and a Companion to Social Theory attests ( Turner 2000 ), the social science world is ‘messy’. However, it may also be partially true that, for too long, health promotion has neglected its need to develop an independent ‘science base’ having unconsciously bought into that original Lalonde dichotomy. This is becoming increasingly clearer as many of the leading proponents in the field are pushing for more intensive theoretical development, a pressure that has become especially acute as the need for demonstrating effectiveness has increased ( McQueen 2001 ; McQueen and Jones 2007 ; McQueen et al. 2007 ). To understand why health promotion has such a complex and ambiguous relationship to public health, it is necessary to dig more deeply into the foundations of modern public health and to unpack its driving philosophy and world view.

Politics and philosophy in public health and epidemiology

It is crucial to understand that the roots of the modern public health epidemiologists’ focus on individual risk factors and randomized controlled trials (RCTs) is not in contradiction with or a deviation from the Edwin Chadwicks, the John Simons, and the John Snows of the classical public health. Rather, the full flowering of a utilitarian calculus, an uncompromising economism, and an obdurate scepticism of anything but positivistic scientific knowledge, can be seen as the late fruit of more than three centuries of development in public health and epidemiology.

There is a dilemma and prima facie paradox that health promotion faces when confronting its genealogy in the history of public health. In terms of lives saved and healthy years lived, the early public health interventions to combat the spread of deadly and debilitating communicable diseases cannot be underestimated. However, it is no accident that once the environmental risk factors of the major communicable diseases were effectively neutralized, a shift in focus took place to providing preventive, immunization measures. As Kerr White (1991) so convincingly puts it, the history of public health and epidemiology can be read as successive and iterative ‘redefinings of the unacceptable’. Public health has always been concerned with an economistic and utilitarian approach to the health of the population; when things start to ‘cost too much’, the unacceptable becomes miraculously ‘visible’. To understand this history, one has to ignore the facile disciplinary chasm between public health and economics, which has only recently and tentatively been bridged ( Evans et al. 1994 ). While economics became progressively theoretical and mathematical, public health continued the original classical liberal tradition of reformist, practical utilitarianism, most powerfully apparent in the Benthamite tradition’s attempt to rationalize government and public services. There is a great irony that the humanitarian idealism (an idealism at the core of health promotion’s values base) of the British ‘public health doctors’, such as Haygarth, Heysham, Thackrah, Baker, and Millar, was never the driving force behind concentrated public health action ( Fraser 1973 ).

As we will discuss in the subsection on health promotion and social justice, public health shares with economics a default, often merely implicit, utilitarian ethics. This shared history is seldom acknowledged, but it is a history that health promotion must confront explicitly. Fortunately, and ironically, recent developments in public health have brought into question the utilitarian approach, finding it inadequate, particularly in relation to the question of health inequity ( Anand et al. 2004 ). The argument fleshed out in the following is that health promotion must forcefully engage in helping public health move in the direction advocated for by Amartya Sen and others ( Anand et al. 2004 ).

Social movements

In this section, we briefly review one of the constitutive ambiguities at the heart of health promotion—many public health practitioners in the 1970s and early 1980s were increasingly cognizant of the lack of participatory involvement of the ‘public’ in public health programming.

A strong feature of the so-called ‘new social movements’ in the post-1968 period was a trenchant critique of bureaucratic structures and an increasingly administered society alongside the traditional leftist critique of capitalism. Some public health institutions, particularly urban public health units, decided to transform local public health practice by integrating a participatory model of programming that was heavily influenced by this antibureaucratic critique ( Labonté 1994 ). However, as Dupéré et al. (2007) argue, despite its ambitions, health promotion is still not accurately described as a ‘social movement’, but rather a ‘professional movement that had successfully advanced a discourse about health and the production of health’. Yet, despite this acknowledged status, health promoters have recognized that much of their effectiveness depends on very high levels of social engagement. The more recent emphasis on health in the context of globalization (Labonté et al. 2011) makes the necessity for health promotion to engage with larger social movements, particularly on the global development agenda, even more apparent.

Nevertheless, we find health promotion once again suspended between its constitutive desire to become one with the ‘community’ and its real position as a mediating professional fraction, often acting on behalf of formal public institutions. In the future, health promotion will have to sacrifice some of its cherished professional neutrality to choose sides, especially in its responsibility to advocate for health. While this new form of activist engagement must be balanced with the legitimacy attained from professional status, the balance must shift quite radically, given the growing threats to health represented by the inequity of contemporary societies in a globalized world. An example of a social movement which involves many health professionals is the People’s Health Movement which operates as a global network with country circles around the world. It also ‘watches’ international organizations such as the WHO and World Bank and comments on their policies and proposals ( Baum et al. 2020 ).

Health promotion, health inequities, and social justice

We have, throughout this chapter, alluded to the commitment health promotion has to the principle of health equity. This is a fundamental and central value for health promoters and is often the touchstone for deciding why, where, and how to enact health promoting practice and policy. Yet, despite this nearly constant refrain, there is still confusion within health promotion about the theoretical and conceptual basis for its concern with health equity. While most, if not all health promoters, would see health equity as a basic goal of health promotion, seldom is the specific normative dimension that underlies this commitment fleshed out. The basic understanding is that health inequities are undesirable and should be eliminated because they are a set of systematic inequalities in health outcomes that are based on unjust inequalities of access to resources that provide for health. The Health Promotion Glossary describes what equity in health entails: ‘That all people have an equal opportunity to develop and maintain their health, through fair and just access to resources for health.’

However, this definition begs many key questions, such as: what is ‘fair’ and ‘just’ access? And, what are ‘resources for health’? While health promoters have often reflected deeply on health inequity, much of the appeal has been to an intuitive basis for supporting the elimination of inequity. We argue that this stance is no longer good enough. Health promotion must fully engage with recent work in political philosophy, particularly in the arguments surrounding the concept of social justice that have been developing since the publication of John Rawls’ A Theory of Justice (1971) . Since Rawls’ ground-breaking work, an ongoing debate has taken place concerning what is the proper approach to justice for whole societies ( Kymlicka 1990 ; Aveneri and de-Shalit 1992 ). More recently this debate has been expanded to consider how we are to think of justice in the global context ( Nussbaum 2006 ). Health promoters should pay close attention to what is at stake in these debates for two reasons.

First, without an awareness of these important arguments, health promotion is liable to accept a default utilitarianism that it inherits from public health, which in turn the latter shares with orthodox economics. It is argued here that this unacknowledged utilitarianism is in direct contradiction to two profound moral intuitions that form the core of health promotion values: that it is wrong to increase overall health at the expense of the least well off; and, that human dignity and personal autonomy are overriding values.

Second, important developments in these debates are directly relevant to concerns with acting on the social determinants of health. Recent arguments have been refined concerning why and how we should address the issue of health inequity, both within and between societies ( Nussbaum 2000 ; Anand et al. 2004 ). As health promoters, charged with the responsibility to advocate, enable, and mediate for equity in health, we should be armed with the very best arguments supporting our position.

We argue here that the one of the most promising theoretical developments in political philosophy that have implications for health promotion are in the evolving ‘capabilities’ approach to social justice and equity ( Nussbaum and Sen 1993 ; Nussbaum 2000 , 2006 ). This approach most nearly matches the health promotion approach to health as a ‘resource for everyday living’; according to this doctrine, the ‘social bases for health’ would count as a primary good, or capability that should, by right, be provided to all citizens (and by extension, all human beings) at a minimum standard ( Nussbaum 2006 ). It cannot be assumed that arguments for equity in health are unassailable and intuitively obvious for two reasons. First, without some substance behind what is meant by equity and what kinds of resources are to be distributed equitably, the demand for equity in health can be dismissed as either empty or naïvely utopian. Second, differing conceptions of what is just will lead to different outcomes in terms of actions to promote health. For example, unless we are very clear, ‘equal opportunity’ can be understood in an absolute minimalist sense and can allow powerful institutions to continue to support vast inequities in resources for everyday living. As we will see next, how we conceive of social justice has a profound impact on the types of actions we can imagine as solutions to the gross inequities in health we find across the world. Specifically, it has become apparent that the goals of health promotion are intimately related to the goals of a socially just global development agenda. Next we focus on an important element that tends to be lost in much of the discourse on health equity: what are the political, economic, and social mechanisms by which the social determinants of health are reproduced as unequal resources for health? This is followed by considering one emerging global initiative aimed at policy solutions in this area: the Health in All Policies agenda.

The political economy of health promotion

Much good work has been done on the ‘political economy of health’ (the analysis of how different politico-economic social structures affect health outcomes), yet an enormous amount is still required ( Navarro and Shi 2001 ; Navarro 2002 ; Langille 2003 ; Raphael 2003 ). Furthermore, there have been some excellent analyses of the ‘political economy of healthcare’ (the analysis of the effect of different political and economic arrangements on the quality and differential access to health services). In this subsection, we outline a different question: what is it about our contemporary political and economic structures that vitiates against the implementation of health promotion strategies and actions as they are conceived in the Ottawa Charter ?

To begin to answer this question, we need to consider the three fundamental dimensions to health promotion: empowering communities and individuals, building health public policy, and creating supportive environments.

As has already been argued, empowerment is a key dimension of health promotion. By its very nature, empowerment aims to rebalance existing power arrangements by enabling those currently without power to gain access to the resources necessary to live fulfilled and happy lives. In order to do this with any success, health promoters must do two things: they must have a clear-headed view of existing power structures and relations; and, they must recognize, as professionals, how they themselves fit into those power relations and how they help, often unconsciously, to reproduce them. One way of seriously addressing this issue is to pay more attention to the concepts of class and status mentioned on the section on social justice and health promotion.

Health promotion, to be successful, must rely on concerted action by governments around the world, both within their own territories and in cooperation to address needs that require global action, such as on climate change. However, while these wishes are often articulated ( WHO 2005 ), seldom are we offered an analysis of the structure and dynamics of the contemporary state system in a global context. A more reflective perspective is important here, as theorists of the state argue that certain issues and certain groups, using specific strategies, are more or less likely to be successful changing the nature of hegemonic projects and reversing the direction of state policies ( Jessop 2002 ). Health promotion must become more strategic in how it operates vis-à-vis the state; it must recognize in an explicit way the limitations and opportunities available and integrate theoretical perspectives and practical actions in regard to one of its key areas: building health public policy.

Finally, creating a supportive environment is even more wrapped up in the dynamics of global capitalism than all the other areas combined. The fundamental prerequisites for health as outlined in the Ottawa Charter are: peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice, and equity. These are the elements that, when in adequate supply, make up many of the properties of a supportive environment for health. Yet, each of these elements is in large part determined by the particular structure and dynamics of our global socioeconomic system.

It is necessary to develop an awareness of the fundamental political and economic drivers behind the dynamics of contemporary societies in both the developed and developing worlds. If equity in health relies on the fundamental fairness of social, political, and economic institutions, then ignoring these basic realities is no longer an option for a serious approach to health promotion. These important insights should no longer be gained in an ad hoc way but should be seen as part of what should constitute core knowledge for competent health promoters.

Social theory and health promotion

Recently, particularly following the report of the WHO Commission on Social Determinants of Health (2008), there has been a raft of activity by both academia and governments aimed at developing knowledge about the social determinants of health. There has also been a marked (and needed) shift of emphasis to what types of action societies need to take to address the consequences of the iniquitous distribution of resources that support health. Less prominent are attempts to confront theoretically the main causal mechanisms that produce and reproduce the social inequalities that lead to health inequities. While there have been recent attempts by some health promotion researchers to re-engage with fundamental debates in social theory ( McQueen et al. 2007 ), for the most part the public health community as a whole, and health promotion by proxy, is still mainly dominated by the narrowly focused methodological lens of epidemiological science although there is increasing use of theory in health promotion as can we seen in recent editions of Health Promotion International (see for example Harris et al. 2017 ). This reluctance to confront the ghost of social theory’s past is most apparent in the way that the categories of class and status are dealt with in health promotion and public health discourse. Where they are mentioned at all, they tend to be conceptualized as epidemiological variables that measure an individual or group’s socioeconomic attributes or properties (e.g. income, education level, wealth, job status), not as social processes that reproduce structural disadvantages for most and accumulate power and privilege for a few (see Scambler (2012) for an excellent review of this problem). The key elements of social theory that should be at the forefront of debate in health promotion circles are considered more extensively in two recent sources ( McQueen et al. 2007 ; Carroll 2012 ).

The Health in All Policies movement

Launched as Finland’s main theme of its 2006 European Presidency, Health in All Policies (HiAP) is a strategy to help link health and other policy sectors in an overarching intersectoral approach to improving health and well-being and reducing health inequity ( Leppo et al. 2013 ). It is aimed at reinvigorating the original emphasis in the Ottawa Charter on healthy public policy, and to follow up on the work done at the WHO conference in Adelaide, Australia in 1988 ( WHO 1988 ). Since that meeting, there has been much reflection on both the details of how to implement healthy public policy and the particular challenges posed by integrated, coherent, intersectoral action for health. More recently, the WHO reconvened in Adelaide to produce an international statement on HiAP called the ‘Adelaide statement on health in all policies: moving toward a shared governance for health and well-being’ ( WHO 2010 ). It is no coincidence that it lays heavy emphasis on ‘governance’. This was followed by two important publications in 2012, also focusing on governance ( Kickbusch and Gleicher 2012 ; McQueen et al. 2012 ). The central challenge of implementing HiAP has been the difficulty of managing the governance and accountability structures necessary to sustain both vertical (levels of government, non-governmental, and private sector) and horizontal (cross-ministry, interdepartmental) intersectoral collaboration. We are only now beginning in public health and health promotion circles to appreciate the different type of knowledge base required to assess the effectiveness of policy implementation. We are still largely stuck in an outmoded attempt to squeeze what are really matters for political science, economic sociology, and the sociology of the state into the narrow methodological confines of standard epidemiological research designs. Increasingly ( Lawless et al. 2012 ; Carroll et al. 2013 ; Baum et al. 2017 ) HiAP Research applies political theory case studies of HiAP in order to better understand the key mechanisms underlying success and failure. Clearly, HiAP is required to move forward on the intersectoral action agenda outlined in the Ottawa Charter ; however, improved knowledge on implementation and sustainability are required the future.

Complexity, context, and causality in health promotion research

Over the past 15 years, a series of publications have charted the specific methodological challenges for evaluating the effectiveness of health promotion interventions ( IUHPE 1999 ; Rootman et al. 2001; Zaza et al. 2005 ; McQueen and Jones 2007 ). There has been some scepticism about applying the methodological protocols of evidence-based medicine (EBM) and RCTs as the gold standard because of the problems of complexity and context ( McQueen 2007 ). One emerging alternative has been to use different methods for synthesizing evidence, such as the realist ( Pawson et al. 2005 ) or meta-narrative ( Greenhalgh et al. 2005 ) review approaches. A more detailed treatment of these latter approaches is beyond the scope of this chapter; however, one further potential for advancing beyond traditional EBM-type methods, is in the use of so-called ‘systems thinking’ or ‘complexity science’ to understand the rich complexity and contextual subtlety of the settings within which health promotion interventions take place, and of the interventions themselves.

Key to understanding the critique of EBM and some of the proposed alternative strategies is the different nature of how causality is conceptualized. The realist alternative has a direct, philosophical critique of the underlying empiricist-positivism of EBM’s approach to causality ( Bhaskar 2008 ) and has been applied to health promotion Baum et al. 2019 ). Conversely, systems thinking and complexity science approaches are more concerned with EBM’s inability to take account of the interactive, emergent, and non-linear dynamics of causation that are crucial to understanding health promotion interventions as complex adaptive systems that intervene in the context of settings that are themselves complex adaptive systems.

Some health promotion researchers have started to take seriously the potential for a complexity or systems approach to health promotion interventions ( Rickles et al. 2007 ; Shiell et al. 2008 ; Hawe et al. 2009 ; Trickett et al. 2011 ). These emergent attempts to apply complexity science have yet to show fruit (though systems thinking in public health has a longer pedigree), yet they hold much potential to transcend the current impasses in health promotion effectiveness research.

We have attempted to offer the reader a chance to reflect on a set of core conceptual issues that underlie the health promotion problematic. The five key messages we want to impart about health promotion are listed here:

Health promotion is a complex, often ambiguous concept and set of practices. Health promotion finds its core values and principles in the Ottawa Charter which bears careful examination to comprehend the essence of health promotion.

Health promotion has an intimate connection to health education, with many of its most important and prolific thinkers having a health education background. The revolution in health education practice is directly connected to the birth of health promotion but beyond this, health promotion has its roots in the deep history of public health and has been invigorated by contemporary social movements.

Health promotion is fundamentally about ethics, values, and social justice. Only secondarily is it about technical strategies for behaviour change. The foundational principles of health promotion are equity , participation , and empowerment .

Health promotion is a professionally dominated movement. This requires health promotion professionals to be critical and reflexive in their practice; they must acknowledge power imbalances that favour professional dominance and work to restore power to individuals and communities.

Health promotion must take its duty to enable people to control the determinants of their health seriously. To do this it must engage more directly with contemporary arguments in political philosophy and it must be aware of the dynamics of the global political economy and its effect on the potential for health promotion.

Some of these issues are well known, such as the problem of professional dominance; while others, such as the political economy of health promotion, or the engagement with political philosophy, are not addressed or require much deeper reflection.

We have argued that, at its heart, health promotion is about a radical shift in values for public health. It is not that public health was never concerned with equality or alleviating the misery of the poor; arguably, the so-called ‘golden age’ was driven by exactly these moral questions. However, these intuitive commitments were not sufficiently followed through when it came to not just what outcomes to change but how to change them. Too much of public health, for too long, was driven by a benevolent paternalism that, particularly when it came to dealing with chronic diseases and with vulnerable populations, ended up being counterproductive. Indeed, not only was this paternalism ineffective in many areas, it was unethical. It assumed the authority of experts and professionals, not only to determine technical solutions, but to determine needs. If we are to take the concepts of equity and empowerment seriously, they have profound implications for how we do public health interventions. We have learned that by addressing needs without first establishing a participatory framework that enables individuals and communities to determine those needs for themselves, we fatally undermine one of the most crucial capacities for health: human dignity and self-respect. This is particularly so in communities that have suffered historical social injustices. As Richard Sennett says, people subjected to this disempowering process, experience ‘that peculiar lack of respect which consists of not being seen, not being accounted as full human beings’ ( Sennett 2003 , pp. 12–13).

We hope to have demonstrated that there are many barriers to realizing this change in power relations; yet, there are also very important opportunities, such as with the Millennium Development Goals and the Commission on the Social Determinants of Health, where there is an increasing clamour for action to redress health inequities through empowering processes. It is notable that even the World Bank, often the subject of brutal criticism for exacerbating inequalities ( Stiglitz 2003 ), has made significant moves towards recognizing the importance of reducing inequity in human development and has integrated an empowerment approach ( World Bank 2006 ). It remains to be seen whether these gains can be translated into major policy changes and effective implementation; nevertheless, it is at this level where health promoters and all public health practitioners and researchers must have a strong advocacy position.

We hope that it is apparent that, in our interpretation, health promotion is much more than a set of technical public health interventions aimed at revamping traditional health education for the twenty-first century. We cannot let go of the core competencies built up by health education and other contributing fields, but we cannot be limited in our vision either. Health promotion has to face up to the fact that, while it may only be a junior partner in the global struggle to develop a more just and equitable world, when it comes to a key human capability and resource, health , it must take a lead role in making the argument for equity, develop and present the evidence for what action is necessary to achieve equity in health, and finally, to hold the powerful accountable where they fail to live up to the demands of justice for health. Embedded in health promotion is an imperative to act ethically and justly. In this case, unlike most, there is no choice.

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1: Introduction to Health

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Page ID 53303

Garrett Rieck & Justin Lundin
College of the Canyons

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In this section, readers will learn about the nature of health, health education, health promotion and related concepts. This will help to understand the social, psychological and physical components of health.

1.1: Narrow Perspectives of Health
1.2: Broader Perspectives of Health
1.3: Dimensions of Wellness Wellness is being in good physical and mental health. Because mental health and physical health are linked, problems in one area can impact the other. At the same time, improving your physical health can also benefit your mental health, and vice versa. It is important to make healthy choices for both your physical and mental well-being. Remember that wellness is not just the absence of illness or stress. You can still strive for wellness even if you are experiencing these challenges in your lif
1.4: Behavior Change and Goal Setting
1.5: SMART Goal Setting
1.6: The Six Dimensions of Health
1.7: Leading Causes of Death
1.8: About Determinants of Health
1.9: Health Disparities
1.10: Risk Factors and Levels of Disease Prevention

Thuimbnail: Health is a critical aspect of human life. (CC BY-SA 2.0 Generic; Tulane Public Relations ).

References Behavior Change and Goal Setting https://courses.lumenlearning.com/su...se-prevention/ CC BY SA Centers for Disease Control https://www.cdc.gov/nchs/data/hus/hus16.pdf%23019 CC BY SA Contemporary Health Issues hlth21fall2012.wikispaces.com/home CC BY SA Healthy People https://www.healthypeople.gov CC BY SA Transtheoretical Model https://en.Wikipedia.org/wiki/Transtheoretical_model CC BY SA

The Importance of Community Health Education – and Where You Might Fit In

Community health education is an important part of our world today. In fact, if the year 2020 has taught us anything, it is that community health education is a vital part of our society. The outbreak of COVID-19 – a pandemic that has infected millions of people around the world — crippled the global economy and changed the way we live. However, there have also been great strides made in preventing the spread of the novel coronavirus, thanks to infectious disease experts and public health educators who work diligently to keep the public informed.

One of the few positive outcomes of this life-changing virus has been the acts of kindness — big and small. Doctors and nurses have been working 18-hour shifts in areas hit hardest by the outbreak, and healthcare workers in other areas have flown to major cities to volunteer their services. Manufacturers have been shifting focus toward producing personal protective equipment (PPE) and donating thousands of items to hospitals. Even amateur crafters have been hard at work making cloth masks to donate to their local nurses! These powerful signs of hope may have inspired you to take action. It may even inspire you to make a career change, or help you decide what you’d like to do with your life.

One of the most important roles in public health today is in community health education. Public health educators teach people about behaviors that promote wellness. Within this field, there is a variety of public health issues to address, such as disease prevention, environmental health, nutrition, safety and disaster preparedness, and more.

Public health educators typically work in public health divisions of states, counties, cities, and towns. They may also work in private sectors, such as health insurers or counseling programs. They often create and assess health education programs, write grants and find proposals, conduct research, and oversee health education programs within their communities.

Whether working with individual residents, organizations, or entire populations, public health educators make a real impact on society. But what exactly can you do within community health education? Where do these types of health professionals fit?

There are many different paths available in the public health education field. The job opportunity for aspiring public health professionals is bright. In fact, the U.S. Bureau of Labor Statistics (BLS) expects employment of community health educators to grow 11% over the next several years.

Professionals who specialize in this field may work in the following settings:

Community Health
Consumer Health
Environmental Health
Family Life
Mental/Emotional Health
Injury Prevention and Safety
Personal Health
Prevention and Control of Disease
Substance Use or Abuse

But how does one break into the community health education field ? According to the BLS, health educators need a bachelor’s degree before teaching others about health and wellness. Depending on the area of focus, public health educators may also need to earn the Certified Health Education Specialist (CHES) credential before starting their careers. This also requires a bachelor’s degree, and is where an undergraduate public health program comes in handy.

A Bachelor’s in Public Health , such as the one at Goodwin University, can prepare you for a future of powerful impact. Classes at Goodwin are taught by industry professionals who understand the inner workings of the public health field. Their experience can prepare you better than any textbook ever could. The program at Goodwin is also one that offers flexibility to students. Courses are available days, nights, and even in a hybrid online/on-campus format. This offers the kind of flexibility needed to complete a degree without putting your life on hold.

You may dream of working for the Centers for Disease Control and Prevention (CDC) or the World Health Organization (WHO) to help tackle massive pandemics like COVID-19. Or perhaps you have a passion for health and wellness and want to make a positive impact on your own local community. Either way, the Career Services team at Goodwin can help you get there. This group of passionate professionals is available to Goodwin students and grads — for free — for life. The Career Services team does not stop until you are in a role that you love.

Are you ready to jumpstart your career in community health education? You will make a positive impact in your community — or around the world — within no time once you have completed your degree. Learn more about the Public Health program at Goodwin University by calling 1-800-889-3282, or visit us online to request more information.

Goodwin University is a nonprofit institution of higher education and is accredited by the New England Commission of Higher Education (NECHE), formerly known as the New England Association of Schools and Colleges (NEASC). Goodwin University was founded in 1999, with the goal of serving a diverse student population with career-focused degree programs that lead to strong employment outcomes.

Principles of Health Education: Importance, Aims & Objectives

The goals of health education are to increase overall well-being as well as decrease the prevalence of diseases caused by unhealthy behaviors. In other words, the focus of health education is on building or inducing changes in the attitudes and behaviors of individuals and groups that are conducive to healthier ways of living.

Importance of Health Education

If one's health is such a valuable asset, then education regarding one's health should take precedence. The following are some of the ways that health education is helpful to us:
Students and teachers both benefit from receiving information about the functions of the body, the rules of health and cleanliness, and the preventative actions that may be taken to avoid contracting diseases through health education.
An education in health promotes the development of healthy behaviors, such as the requirement for clean air, the practice of hygienic eating, and other varied classroom behaviors.
Children with a variety of abnormalities can be identified through the use of health education, which assists in the identification of children with physical defects.
Knowledge about healthy behaviors was imparted through the medium of health education.
The development of stronger human interactions between the school, home, and community is one of the goals of health education.
Knowledge gained via health education can be applied to the prevention and management of a variety of diseases.
Health education demonstrating the necessity of first aid training for all individuals. It is possible for anyone and at any time to find them in a dire situation.

Aims of health education

The following is a list of some of the primary goals that health education strives to accomplish:

To disseminate knowledge regarding health and the importance of health as a communal resource - The goal of health education is to acquaint the etchers with standards of health and cleanliness that should be followed. There should be an implementation of precautionary steps to prevent the spread of disease and to ensure that employees are not exposed to contagious illnesses while on the job.
To main good health norms - It is the responsibility of the government to create a hygienic environment, which should include sufficient ventilation, an appropriate temperature, good sanitation, and overall cleanliness. It provides the government with assistance in maintaining specific health standards.
To take preventing and precautionary measures against some communicable diseases - Its purpose is to ensure that proper safety measures are taken to prevent the contamination & spread of illnesses. In this way, appropriate arrangements for sanitation are made, taking necessary precautions and preventative actions. If implemented correctly, they have the potential to contribute to an overall improvement in the health of the population.
To aid school-aged children in gaining an awareness of the nature & function of health facilities and services - Its purpose is to identify any physical flaws or other anomalies that the child may have and, if the conditions can be treated easily, to work towards eliminating them.

To promote and develop emotional and mental health - Alongside one's physical health, mental and emotional well-being is also considered to be of equal importance. While maintaining one's emotional and mental well-being enables a person to keep his temper in check and keep a positive attitude, one's physical health is what makes one physically fit.

To develop civil responsibility - The classroom is a microcosm of society as a whole. No single person should be held accountable for the state of their ability's health. Even some of the factors that contribute to poor health have their roots in social situations, and in order to eliminate these factors, the society as a whole needs to take action. Its goal is to make it possible for individuals to collaborate in order to improve the health of the community.

Objectives of health education

The following is an extensive list of the functional goals that should be embraced by schools as part of their health education programs.

To provide the means for the students to cultivate scientific points regarding health making reference to both the conventional and the contemporary notion of health.
In order to equip students with the ability to recognise health issues and comprehend both their place in maintaining their own health and the role that medical institutions play in addressing these issues,
To open the student up to the possibility of taking an interest in recent issues that is health-related.
In order to give students the ability to draw appropriate conclusions based on their scientific knowledge and to act as individual members of their families and communities in order to preserve, maintain, and promote individual and community health, this lesson will show students how to do both.
To give the pupils the opportunity to demonstrate positive, health-promoting behaviors to their peers
The purpose of this lesson is to provide the student with the knowledge necessary to comprehend the factors that lead to the pollution of air, water, soil, and food.
To assist to acquire an adequate level of understanding on first aid
To impart useful information regarding sexuality, marriage, and the management of family plans onto the pupils.
In order to assist students in comprehending the significance of physical education, and not limited to sports, games, and yoga exercises, in addition to their connection to the health education curriculum.
The detrimental repercussions of smoking cigarettes and drinking alcohol, among other vices, are driven home to the kids.
Students will become familiar with the operations of a variety of organizations that are dedicated to the promotion and protection of health.
The purpose of health education is to teach students how the rapid technological and scientific advancement in the modern world has raised the risks to people's lives and health, as well as how to deal with these risks and avoid them.
Education about health matters is of utmost significance to us. One should be aware of the basic education of health education to help community as a whole.

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Health Education

For the promotion of health-related activities, health education is an important part. These activities are done in schools, workplaces, and communities.

The behavior of individuals plays a vital role in the development of many health problems and influences the development of the nation. Health education is a professional and scientific field.

For community health, health education is an essential way to provide information about health due to which community or individuals use that information for their protection.

It changes the attitude positively and promotes and makes people aware of health-related issues.

Principles of Health Education

Learning by doing
Participation
Community leaders
Good human relation

Definitions

1. physical health:.

Physiological functioning of the body means physical health and an individual are considered healthy when all body is present at their natural place and position, doing their functions properly in the desired manner.

2. Mental/Emotional Health:

The way of thinking and expressing your feelings and thought means mental health and good mental health is developed by thinking positively and expressing yourself in a healthy way.

3. Social Health:

Social health means building relations with individuals, communicating with them, and having respect for them.

Importance of Health Education

Increases the quality of life for all individuals.
Decreases premature deaths.
Physical development is essential for mental development.
Reduces mortality rate.
Brings positive attitude/behavior among people towards health.
Guides the people regarding the proper use of health services.
It helps individuals to make rational decisions to solve their problems.
Participation in health development programs.

Paragraph on Health - Check Samples for 100, 150, 200, 250 Words

There is a famous proverb stating, “Health is Wealth,” which is self-explanatory. Health is an asset to human life, which leads to a stable and calm mind, ultimately leading to a wealthy life. If a person is taking good care of their health, they get mental peace and can focus on their work further. When we fall sick, it makes us irritated and unstable. Staying healthy is about being physically, mentally, and socially fit.

If you are writing about health, then check the sample paragraphs on health provided below for your reference and get an idea about the same.

Paragraph on health in 100 words, paragraph on health in 150 words, paragraph on health in 200 words, paragraph on health in 250 words, frequently asked questions on health.

The best earning of life is staying healthy. Staying healthy means being physically, mentally and socially fit and stable. Suppose one knows how to have control over their health, then they know how to lead a successful life. If a person is healthy, they will always be ready to work and be productive at work. If one wants to lead a healthy life, one must eat well and maintain the sleep cycle. One can stay fit by exercising daily and maintaining a proper timetable for everything. Keeping a healthy life will definitely encourage you towards a wealthy life.

Health is the condition of the human body which is free from any injury or illness. But staying healthy is defined as staying mentally, physically and socially fit. Maintaining good health will ultimately lead to a happy mind which is more valuable than any precious gift in today’s life. Having a healthy life must be a part of everyone’s lifestyle. If one has a healthy and happy mind, then one will always stay motivated towards one’s work and will be productive at work. It is essential for every individual to feel good about themselves, which will keep them happy. It is necessary to lead a healthy life to avoid any kind of chronic disease. To maintain a healthy life, a person can go running or take a morning walk, can exercise daily, and support healthy food habits. Therefore, it is essential to do what is suitable for your health and maintain good health from a very young age.

Maintaining good health is not only about having a good physique and appearance. It is about self-satisfaction, inner peace and your behaviour. In today’s competitive era, maintaining a healthy mind and body is not so easy; but if you make it a habit from a young age, then you stay fit and healthy throughout your life. We might not understand the value of good health at a very young age, but health should be an individual’s first priority. It is only when an individual is healthy they can work dedicatedly along with extracurricular activities. It is the most valuable asset than food or money. Greed, dishonesty, and deceitful behaviour are the primary causes of sadness. As a result, it is essential that we inculcate positive ideals in ourselves and teach others to follow the same in order to spread happiness throughout the world. It is essential to maintain a healthy relationship with everyone that keeps you in a positive surrounding. It is necessary to spend some quality time with family and friends. This will not only keep you happy but also give you good energy.

It is a blessing if a person is born with no health issues. Yet, no one should take advantage of being healthy and be overconfident. Being healthy is about having good physical health and being mentally and socially fit. A healthy person can be more focused and more determined and can lead a happy life. If we look into human history, the biggest asset to human beings is good health and a healthy mind. Good health and a calm mind are interrelated, which helps individuals grow intellectually and make them wealthy. A person with poor mental health is unable to sustain physical strength and stamina. Only a stress-free mind and a positive mindset may contribute to good physical health. This combination allows us to recognise and experience the actual eternal happiness that comes from the inside. We’re told as children that leading a healthy lifestyle can lead to the best health. However, only as we get older do we realise that introspection, self-awareness, and reflection of one’s own ideas are all essential aspects of sustaining excellent mental health, which may lead to a fit and lovely physique. When this method is missing, it might lead to a depressing thought process in which one fails to realise what is bothering them and what they are missing in particular. As a result, maintaining good health is critical for the general development of our personality and outlook on life.

Why is it important to maintain good health?

It is important to maintain good health because it is an asset to everyone. Good health helps to have a peaceful mind which will lead to a wealthy life.

When is World Health Day celebrated?

World Health Day is celebrated on the 7th of April every year to commemorate the anniversary of WHO’s establishment in 1948.

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Why writing by hand beats typing for thinking and learning

Jonathan Lambert

A close-up of a woman's hand writing in a notebook.

If you're like many digitally savvy Americans, it has likely been a while since you've spent much time writing by hand.

The laborious process of tracing out our thoughts, letter by letter, on the page is becoming a relic of the past in our screen-dominated world, where text messages and thumb-typed grocery lists have replaced handwritten letters and sticky notes. Electronic keyboards offer obvious efficiency benefits that have undoubtedly boosted our productivity — imagine having to write all your emails longhand.

To keep up, many schools are introducing computers as early as preschool, meaning some kids may learn the basics of typing before writing by hand.

But giving up this slower, more tactile way of expressing ourselves may come at a significant cost, according to a growing body of research that's uncovering the surprising cognitive benefits of taking pen to paper, or even stylus to iPad — for both children and adults.

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In kids, studies show that tracing out ABCs, as opposed to typing them, leads to better and longer-lasting recognition and understanding of letters. Writing by hand also improves memory and recall of words, laying down the foundations of literacy and learning. In adults, taking notes by hand during a lecture, instead of typing, can lead to better conceptual understanding of material.

"There's actually some very important things going on during the embodied experience of writing by hand," says Ramesh Balasubramaniam , a neuroscientist at the University of California, Merced. "It has important cognitive benefits."

While those benefits have long been recognized by some (for instance, many authors, including Jennifer Egan and Neil Gaiman , draft their stories by hand to stoke creativity), scientists have only recently started investigating why writing by hand has these effects.

A slew of recent brain imaging research suggests handwriting's power stems from the relative complexity of the process and how it forces different brain systems to work together to reproduce the shapes of letters in our heads onto the page.

Your brain on handwriting

Both handwriting and typing involve moving our hands and fingers to create words on a page. But handwriting, it turns out, requires a lot more fine-tuned coordination between the motor and visual systems. This seems to more deeply engage the brain in ways that support learning.

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"Handwriting is probably among the most complex motor skills that the brain is capable of," says Marieke Longcamp , a cognitive neuroscientist at Aix-Marseille Université.

Gripping a pen nimbly enough to write is a complicated task, as it requires your brain to continuously monitor the pressure that each finger exerts on the pen. Then, your motor system has to delicately modify that pressure to re-create each letter of the words in your head on the page.

"Your fingers have to each do something different to produce a recognizable letter," says Sophia Vinci-Booher , an educational neuroscientist at Vanderbilt University. Adding to the complexity, your visual system must continuously process that letter as it's formed. With each stroke, your brain compares the unfolding script with mental models of the letters and words, making adjustments to fingers in real time to create the letters' shapes, says Vinci-Booher.

That's not true for typing.

To type "tap" your fingers don't have to trace out the form of the letters — they just make three relatively simple and uniform movements. In comparison, it takes a lot more brainpower, as well as cross-talk between brain areas, to write than type.

Recent brain imaging studies bolster this idea. A study published in January found that when students write by hand, brain areas involved in motor and visual information processing " sync up " with areas crucial to memory formation, firing at frequencies associated with learning.

"We don't see that [synchronized activity] in typewriting at all," says Audrey van der Meer , a psychologist and study co-author at the Norwegian University of Science and Technology. She suggests that writing by hand is a neurobiologically richer process and that this richness may confer some cognitive benefits.

Other experts agree. "There seems to be something fundamental about engaging your body to produce these shapes," says Robert Wiley , a cognitive psychologist at the University of North Carolina, Greensboro. "It lets you make associations between your body and what you're seeing and hearing," he says, which might give the mind more footholds for accessing a given concept or idea.

Those extra footholds are especially important for learning in kids, but they may give adults a leg up too. Wiley and others worry that ditching handwriting for typing could have serious consequences for how we all learn and think.

What might be lost as handwriting wanes

The clearest consequence of screens and keyboards replacing pen and paper might be on kids' ability to learn the building blocks of literacy — letters.

"Letter recognition in early childhood is actually one of the best predictors of later reading and math attainment," says Vinci-Booher. Her work suggests the process of learning to write letters by hand is crucial for learning to read them.

"When kids write letters, they're just messy," she says. As kids practice writing "A," each iteration is different, and that variability helps solidify their conceptual understanding of the letter.

Research suggests kids learn to recognize letters better when seeing variable handwritten examples, compared with uniform typed examples.

This helps develop areas of the brain used during reading in older children and adults, Vinci-Booher found.

"This could be one of the ways that early experiences actually translate to long-term life outcomes," she says. "These visually demanding, fine motor actions bake in neural communication patterns that are really important for learning later on."

Ditching handwriting instruction could mean that those skills don't get developed as well, which could impair kids' ability to learn down the road.

"If young children are not receiving any handwriting training, which is very good brain stimulation, then their brains simply won't reach their full potential," says van der Meer. "It's scary to think of the potential consequences."

Many states are trying to avoid these risks by mandating cursive instruction. This year, California started requiring elementary school students to learn cursive , and similar bills are moving through state legislatures in several states, including Indiana, Kentucky, South Carolina and Wisconsin. (So far, evidence suggests that it's the writing by hand that matters, not whether it's print or cursive.)

Slowing down and processing information

For adults, one of the main benefits of writing by hand is that it simply forces us to slow down.

During a meeting or lecture, it's possible to type what you're hearing verbatim. But often, "you're not actually processing that information — you're just typing in the blind," says van der Meer. "If you take notes by hand, you can't write everything down," she says.

The relative slowness of the medium forces you to process the information, writing key words or phrases and using drawing or arrows to work through ideas, she says. "You make the information your own," she says, which helps it stick in the brain.

Such connections and integration are still possible when typing, but they need to be made more intentionally. And sometimes, efficiency wins out. "When you're writing a long essay, it's obviously much more practical to use a keyboard," says van der Meer.

Still, given our long history of using our hands to mark meaning in the world, some scientists worry about the more diffuse consequences of offloading our thinking to computers.

"We're foisting a lot of our knowledge, extending our cognition, to other devices, so it's only natural that we've started using these other agents to do our writing for us," says Balasubramaniam.

It's possible that this might free up our minds to do other kinds of hard thinking, he says. Or we might be sacrificing a fundamental process that's crucial for the kinds of immersive cognitive experiences that enable us to learn and think at our full potential.

Balasubramaniam stresses, however, that we don't have to ditch digital tools to harness the power of handwriting. So far, research suggests that scribbling with a stylus on a screen activates the same brain pathways as etching ink on paper. It's the movement that counts, he says, not its final form.

Jonathan Lambert is a Washington, D.C.-based freelance journalist who covers science, health and policy.

handwriting

What's in this year's federal budget? Here are all of the announcements we already know about

Jim Chalmers stands in front of a vibrant red tree.

Treasurer Jim Chalmers will hand down his third budget on Tuesday night, but has been tempering expectations for weeks in the lead-up, warning Australians not to expect a "cash splash".

Inflation remains a key challenge for the government, and we already have a pretty good idea of how Mr Chalmers plans to use his budget to provide cost-of-living relief while also trying to jump-start a slowing economy and navigate growing uncertainty overseas.

Here are the measures we already know about before the treasurer reveals all at 7:30pm AEST.

Short on time?

There's been no shortage of announcements in the lead-up to the budget. If you're interested in a specific topic, tap on the links below to take you there:

Cost-of-living relief

Education, training and hecs changes, tax changes, future made in australia, health and aged care, paid parental leave, domestic violence, defence and foreign affairs, environment, infrastructure, additional announcements.

Is your area of interest not covered?

Tell us what other cost-of-living measures you're hoping to see included in this year's budget .

The bottom line

A graphic drawing of a persons hands typing on a laptop and writing out a budget.

Will the budget be in surplus or deficit?

The budget will deliver a surplus of $9.3 billion for the 2023-24 financial year, making it the second consecutive budget surplus in almost two decades
That said, the following three financial years are all forecasted to have larger deficits than previously expected in December, but the size of each deficit is not yet known
Overall, the treasurer says Australia's total debt has been reduced by $152 billion in the 2023-24 financial year, and the budget will benefit by a $25 billion boost in revenue upgrades

What does the budget mean for inflation and interest rates?

The treasurer has repeatedly said he's kept inflation in mind when crafting this year's budget, and is confident that the measures won't contribute to it
In fact, Treasury predicts inflation will fall to 2.75 per cent by December — well before the Reserve Bank's most recent forecast for the end of 2025 — due to yet-to-be-announced budget measures taking pressure off inflation
For what it's worth, RBA governor Michele Bullock wasn't too concerned about the upcoming budget last Tuesday, saying she would wait to see its impact first , but she said the treasurer reassured her that he was focused on curbing inflation

The reworked stage 3 tax cuts form the centrepiece of the government's budget. They were announced in January, legislated in February and come into effect on July 1.

The changes to tax cuts originally legislated by the Morrison government mean that all Australian taxpayers who earn more than $18,200 (that is, more than the tax-free threshold) will get a tax cut.

Before Labor's changes, the original stage 3 tax cuts were skewed more heavily to higher-income earners .

A person with a taxable income between $45,000 and $120,000 will receive a tax cut of $804 more come July 1 under the revised stage 3 changes compared to the Morrison government's tax plan.

However, the government has hinted at other cost-of-living measures, with the treasurer calling the tax cuts the "foundation stone" of broader assistance.

Among those measures appears to be energy bill relief (in addition to what some states have already announced), with the treasurer pointing out that last year's measure curbed living costs and eased inflation.

Adjustments to rent assistance also seem likely, as do increases to JobSeeker and the aged pension.

The biggest announcement in this area is the wiping out of $3 billion worth of HECS debts triggered by last year's indexation of 7.1 per cent.

It means student debts will be lowered for more than 3 million Australians, with the average student receiving an indexation credit of about $1,200 for the past two years.

The debt relief will also apply for apprentices who owe money through the VET Student Loan program or the Australian Apprenticeship Support Loan.

Speaking of university, the government is aiming to tackle "placement poverty" by providing financial support to students to help make ends meet while they complete practical hands-on training as part of their course.

Under the scheme, those studying nursing, teaching or social work will receive a Commonwealth Prac Payment of up to $319.50 a week, but they will be subjected to means testing.

Similarly, apprentices willing to learn clean energy skills as part of their trade will be eligible to receive up to $10,000 in payments . The scheme already exists, but the government has broadened the eligibility to include apprentices in the automotive, electrical, housing and construction sectors based on industry feedback.

Universities will also be required to stop a surge in the number of international students, as part of the government's broader plans to cut annual migration levels back to 260,000 a year — much to the concern of peak education bodies .

Another $90 million will be put towards 15,000 fee-free TAFE and VET places to get more workers into the housing construction sector , with an extra 5,000 pre-apprenticeship places provided from 2025.

Tradies work on the roof frame of a new home under construction.

While we can expect to hear more about the stage 3 tax cuts, it seems likely that the government will unveil other changes to tax in the budget to encourage business investment.

One such change will be the extension of the government's instant asset write-off scheme for small businesses for another year, allowing businesses with a turnover of less than $10 million to claim $20,000 from eligible assets.

However, the same measure from last year's budget is still yet to pass parliament — and businesses are urgently calling on them to pass the measure before it expires on June 30 .

In addition to spending more to attract skilled workers in the housing and construction sectors, the government is also tipping billions of dollars into building new homes across the country .

It's estimated the government will be putting roughly $11.3 billion towards housing, as the government works to deliver its promised 1.2 million new homes by 2030.

$1 billion will be spent on crisis and transitional accommodation for women and children fleeing family violence and youth through the National Housing Infrastructure Facility, which is re-allocated funding.

The government has also committed to providing $9.3 billion to states and territories under a new five-year agreement to combat homelessness, assist in crisis support, and to build and repair social housing — including $400 million of federal homelessness funding each year, matched by the states and territories.

Another $1 billion will be given to states and territories to build other community infrastructure to speed up the home-building process, including roads, sewerage, energy and water supplies.

The government has also committed to consulting with universities to construct more purpose-built student accommodation.

Overall, the funding announcements for housing build on the $25 billion already committed to new housing investments, with $10 billion of that in the Housing Australia Future Fund, which is designed to help build 30,000 social and affordable rental homes.

The government says the housing funding measures will also help take the pressure off the private rental market, which is experiencing record-low vacancy rates and surging growth in weekly rent prices.

High density housing with predominantly dark roofs.

Aside from the revised stage 3 tax cuts, the revival of local manufacturing is the other centrepiece of the government's budget this year.

The Future Made in Australia Act (which is often referred to without the "act" on the end) is bringing together a range of new and existing manufacturing and renewable energy programs under one umbrella, totalling in excess of $15 billion.

In other words, the government is putting serious taxpayer money towards supporting local industry and innovation, especially in the renewable energy space.

A number of measures have already been announced (or re-announced), including:

$1 billion for the Solar SunShot program to increase the number of Australian-made solar panels
$2 billion for its Hydrogen Headstart scheme to accelerate the green hydrogen industry
$470 million to build the world's first "fault-tolerant" quantum computer in Brisbane , matching the Queensland government's contribution
$840 million for the Gina Rinehart-backed mining company Arafura to develop its combined rare earths mine and refinery in Central Australia
$230 million for WA lithium hopeful Liontown Resources , which is also partly owned by Gina Rinehart
$566 million over 10 years for Geoscience Australia to create detailed maps of critical minerals under Australia's soil and seabed
$400 million to create Australia's first high-purity alumina processing facility in Gladstone
$185 million to fast-track Renascor Resources' Siviour Graphite Project in South Australia
A $1 billion export deal to supply Germany with 100 infantry fighting vehicles , manufactured at Rheinmetall's facility in Ipswich

A cluster of houses at Alkimos Beach all with rooftop solar panels.

All up, the government is spending an extra $8.5 billion on health and Medicare in this year's federal budget, with $227 million of that put towards creating another 29 urgent care clinics.

Millions of dollars are also being poured into medical research, including $20 million for childhood brain cancer research , and a $50 million grant for Australian scientists developing the world's first long-term artificial heart .

Another $49.1 million is being invested to support people who have endometriosis and other complex gynaecological conditions such as chronic pelvic pain and polycystic ovarian syndrome. The funding will allow for extended consultation times and increased rebates to be added to the Medicare Benefits Schedule.

As for aged care, the government hasn't announced anything specific for the sector, nor has it outlined its response to the Aged Care Taskforce report that was delivered in March.

Parents accessing the government-funded paid parental leave scheme will be paid superannuation in addition to their payments from next July .

Under the current program, a couple with a newborn or newly adopted child can access up to 20 weeks of paid parental leave at the national minimum wage — however that figure will continue to rise until it reaches 26 weeks in July 2026 .

The plan, which Labor will take to the next election, would see superannuation paid at 12 per cent of the paid parental leave rate, which is based on the national minimum wage of $882.75 per week.

The cost to the budget is not yet known, however a review commissioned by the former government estimated that paying super on top of paid parental leave would cost about $200 million annually.

About 180,000 families access the government paid parental leave payments each year.

A newborn baby peeps over a woman's shoulder.

The federal government has pledged almost $1 billion to combat violence against women , including permanent funding to help victim-survivors leave violent relationships, and a suite of online measures to combat online misogyny and prevent children from viewing pornography.

The $925.2 million will go towards permanently establishing the Leaving Violence Program over five years, after it was established as a pilot program in October 2021 known as the Escaping Violence Program.

The program will provide eligible victim-survivors with an individualised support package of up to $1,500 in cash and up to $3,500 in goods and services, plus safety planning, risk assessment and referrals to other essential services for up to 12 weeks.

While the funding has been broadly welcomed, survivors and advocates want to see more investment .

The package also includes funding to create a pilot of age verification technology to protect children from harmful content, including the "easy access to pornography" online, which the government says will tackle extreme online misogyny that is "fuelling harmful attitudes towards women".

The federal government is planning to spend an extra $50 billion on defence over the next decade , meaning Australia's total defence spend will be equivalent to 2.4 per cent of its gross domestic product (GDP) within 10 years.

All up, the government is planning to invest a total of $330 billion through to 2033-34, which includes the initial cost for the AUKUS initiative to purchase nuclear-powered submarines.

Part of that $50 billion will be spent on upgrading defence bases across northern Australia, with $750 million to be allocated in the budget for the "hardening" of its bases in the coming financial year.

More than $1 billion of that funding will also be spent on an immediate boost on long-range missiles and targeting systems.

In the Pacific, Australia has committed $110 million to fund development initiatives in Tuvalu , including an undersea telecommunications cable and direct budget support.

The government has also pledged $492 million to the Asian Development Bank to provide grants to vulnerable countries in the Asia-Pacific.

An aerial photograph of a black submarine at the surface of the sea

The only dedicated announcement for the environment so far is the scrapping of the waste export levy , also known as a "recycling tax".

The proposed $4 per tonne levy was first legislated by the Morrison government in 2020 in a bid to reduce and regulate waste exports, after China announced it would no longer handle Australian rubbish.

Waste industry players had been concerned that once the levy was introduced in July, it would have caused more waste to be sent to landfill instead of being recycled.

The scrapping of the waste export levy is part of Australia's broader move to manage its own waste.

A slew of funding commitments have been made around the country, including a $1.9 billion funding commitment for upgrades in Western Sydney, ranging from road improvements to planning projects and train line extensions.

The government is also putting $3.25 billion towards Victoria's North East Link, which is being built between the Eastern Freeway and M80 Ring Road in Melbourne.

Ahead of the Brisbane Olympics in 2032, the government is also chipping in $2.75 billion to fund a Brisbane to Sunshine Coast rail link , matching the amount promised by Queensland Premier Steven Miles. (That said, $1.6 billion had been previously announced by the federal government.)

Also in Queensland, the Bruce Highway will receive $467 million for upgrades, while Canberra will receive $50 million to extend its light rail.

A proposed high-speed train line between Sydney and Newcastle will also receive $78.8 million to deliver a business case for the project.

The government will also put $21 million towards the creation of a national road safety data hub.

Cars driving aklong the highway. A electronic speed sign says the limit is 110 kilometres per hour.

There are several other funding commitments the government has made in the lead-up to the budget that don't fit neatly into the categories above.

The government will spend $161.3 million on creating a national firearms register , which will give police and other law-enforcement agencies near real-time information on firearms and who owns them across the states and territories.

The money will be spent over four years to establish the register, and comes after state and territory leaders agreed to set up the register in December last year. The government has described the register as the biggest change to Australia's firearm management systems in almost 30 years.

Another $166.4 million will be spent on expanding anti-money-laundering reporting obligations , requiring real estate agents, lawyers and accountants to report dodgy transactions in a move that will bring Australia in line with the rest of the developed world.

And ahead of the 2032 Brisbane Olympic Games, the government has given the Australian Institute of Sport (AIS) a $249.7 million funding boost to upgrade its facilities to support local athletes.

The government has also committed to a $107 million support package for farmers, after announcing it will end Australia's live sheep export trade by 2028 .

Farmers and regional communities will also benefit from a $519.1 million funding boost to the government's Future Drought Fund.

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Note: a) Write your answer in the space given below. b) Compare your answer with those given at the end of the unit. 3. List the factors affect our health..... 1.5 HEALTH EDUCATION 1.5.1 Meaning The first question coming to, your mind will be "What is Health Education." If we take the layman's meaning - it is a kind of education aware ...
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4) Comments: Use to write . short notes if needed (i.e., name of pamphlet, f/u needed). Write referral(s) if applicable. 5) Check or write in appropriate language in "Instructed In" box. 6) Check who received the education . 7) Check the teaching method(s) used. 8) Circle the knowledge level of the patient after instruction.
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Paragraph on Health in 250 Words. It is a blessing if a person is born with no health issues. Yet, no one should take advantage of being healthy and be overconfident. Being healthy is about having good physical health and being mentally and socially fit. A healthy person can be more focused and more determined and can lead a happy life.
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Essay on Health Education for Students and Children

Importance of Health Education

Methods to Improve Health Education

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Health Education and Health Promotion: Key Concepts and Exemplary Evidence to Support Them

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Online Students

International Students

Campus Students

The Importance of Health Education

First, What is Health Education?

Why is Health Education Important?

How Does Health Education Impact a Community?

Healthcare Disparities

Community Health Education and Government Policy

The Economic Importance of Health Education

Find Your Program

Public Health Education: A Growing Field

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Health education and global health: Practices, applications, and future research

Introduction

Materials and Methods

Past progress and the current situation

The path forward: Suggestions for future work in health education and health promotion

Ethical approval

6.4 Health promotion, health education, and the public’s health

Introduction

Health promotion, health equity, and action on the determinants of health: an introduction

‘Health promotion’: a definition and conceptual critique

Health promotion as a process

Beliefs and assumptions underlying health promotion

Enabling and empowerment

What is the ‘health’ in health promotion?

The Ottawa Charter strategies

The Ottawa Charter action areas

Building healthy public policy

Creating supportive environments

Strengthening community action

Developing personal skills

Reorienting health services

Health promotion: history and influences

Public health

Politics and philosophy in public health and epidemiology

Social movements

Health promotion, health inequities, and social justice

The political economy of health promotion

Social theory and health promotion

The Health in All Policies movement

Complexity, context, and causality in health promotion research

Acknowledgements

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1: Introduction to Health

The Importance of Community Health Education – and Where You Might Fit In