Health education: a case for resuscitation

Health education is the component of health promotion designed to achieve learning related to health or illness. While often described by other names, an educational element features in nearly all health promotion activities. Unlike most other public health actions, it focuses on voluntarism and frequently on the individual. Health education and the resources devoted to it grew rapidly in the latter half of the 20th century. However, in the 1970s, many health educators started to question its value. They criticized it as being excessively concerned with disease, victim blaming, politically naive and increasing health inequalities. While promoting knowledge and skills for health was included as one of the five principles of health promotion in the World Health Organization's Ottawa charter, it received much less attention than the other four principles. Health education was also criticized as being ineffective. Methods for evaluating health education are hotly contested but there is evidence that some education interventions are effective. Current health strategies continue to advocate prevention through health education, and workers in many different settings are expected to ensure that health education is provided. These front-line educators should be able to look to those who specialize in health promotion to support their educational activities. This paper argues that the worth of health education compared with other forms of health promotion has been grossly underestimated and it is time to re-assert its importance.     

Environmental health impact assessment: evaluation of a ten-step model.

"Environmental impact assessment" denotes the attempt to predict and assess the impact of development projects on the environment. A component dealing specifically with human health is often called an "environmental health impact assessment." It is widely held that such impact assessment offers unique opportunities for the protection and promotion of human health. The following components were identified as key elements of an integrated environmental health impact assessment model: project analysis, analysis of status quo (including regional analysis, population analysis, and background situation), prediction of impact (including prognosis of future pollution and prognosis of health impact), assessment of impact, recommendations, communication of results, and evaluation of the overall procedure. The concept was applied to a project of extending a waste disposal facility and to a city bypass highway project. Currently, the coverage of human health aspects in environmental impact assessment still tends to be incomplete, and public health departments often do not participate. Environmental health impact assessment as a tool for health protection and promotion is underutilized. It would be useful to achieve consensus on a comprehensive generic concept. An international initiative to improve the situation seems worth some consideration.     

Health education and the ideology of health promotion: a review of alternative approaches

This paper discusses various approaches to the definition of‘health promotion’ and examines the role of theWorld Health Organization in its popularization. Health promotionis conceptualized as any deliberate intervention which seeksto promote health and prevent disease and disability. It incorporates‘health education’ and gives prominence to the influenceof legal, fiscal, economic and environmental measures on communityhealth. Various ‘models’ of health education areexplored and their contribution to health promotion is discussed.It is argued that ‘selfempowerment’ should be themain focus for health education programmes.     

Econology: integrating health and sustainable development. Part One: theory and background

Environmental sustainability is rapidly becoming the most criticalpublic health issue. Prevailing notions of health in environmentaldecision-making do not embody concepts inherent in health promotionand the new public health. Health promotion emphasizes the importanceof income and power equity, and social support/connectedness(health-economy relationship), alongside direct and indirecthuman health threats posed by environmental toxins (health-environmentrelationship). Health promotion also acknowledges the inherentlimitations of scientific research, and the need for value-baseddecision-making in the absence of definitive information. Twelveprinciples are developed from brief reviews of the health-environment-economyrelationships. While fear for personal health underpins increasingpublic concern over environmental degradation, persons withexpertise or a constituency in public health are not membersof any of Canada's federal and provincial Round Tables on Environmentand Economy. Health promotion professionals should not waitto be invited to participate in sustainable development debates;they should invite themselves. Their discipline specific rootsin epidemiology and clinical public health practice will significantlyenrich the vocabulary of the debate. Their current a-disciplinarygeneralism may allow them to function as effective and necessarycross-discipline translators.     

Studying the striving and opposing forces in newspaper journalism: the actantial model of health promotion

The cultural aspects of health promotion are important in policy development as well as in assessing effectiveness of health promotion activities. The discourses on promoting health and well-being in journalism reflect the health promotion culture in society. This article illustrates how health promotion is portrayed by 147 newspaper items from the two Finnish quality dailies during the period 2002-2004 and introduces a semiotic Actantial Model of Health Promotion (AMHP) for studying health promotion cultures. The most popular news themes on health promotion were physical and social environment, welfare services, nutrition and obesity, and mental well-being. The actants (actors, actions and abstract factor) of health promotion were identified and the AMHP with seven key actants (generator, health-object, public, tool, executor, threat and obstacle) was constructed. The model sheds light on two sides of health promotion discourses in journalism. The dominant culture of health promotion was represented by policy actions, information, education and scientific research, which were defined by health experts, decision-makers and researchers. Representations of the opposite culture--'the otherness' of health promotion included external harmful factors and unhealthy behaviours, mentalities opposed to being health-oriented, rationally uncontrolled living, disorder, disharmony and insecurity. The opposing factors were presented by people and institutions lacking the will, ability or motivation for a health-oriented life. To understand better the values of health promotion, it is necessary to assess the characteristics of the opposite side of health promotion culture, because the current dominant values can be described more clearly by the boundaries--by 'otherness'. The study argues that the AMHP can be used as a semiotic method to identify the value dimensions and the boundaries between the dominant and the opposite discourses of health promotion in various communications such as advertising and health education. Also, it provides a tool for the analysis of the media's role in 'victimization' or 'heroization' of various population groups.     

Devising strategies for preventing drug misuse: the role of the Health Action Model

The aetiology of drug misuse is complex and multifactorial.Before developing educational programmes, it is important tounderstand the various psycho-social and environmental factorswhich contribute to health-related decision making. The HealthAction Model provides an overview of these influences; it describesthe interaction of knowledge, beliefs, values, attitudes, drivesand normative pressures and seeks to show how these relate toindividual intentions to act. It also indicates how environmentalcircumstances, information and personal skills may facilitatethe translation of intentions into health actions. Finally,the relevance of the Health Action Model is considered for developinghealth promotion and health education programmes designed toreduce the onset of drug misuse.     

Environmental health promotion: bridging traditional environmental health and health promotion.

This article highlights the juncture between environmental health and health promotion and underscores the need for health promotion involvement in environmental health practice. It begins with a synopsis of current issues in environmental public health and deficiencies in environmental public health practice that could be partly ameliorated by an increased focus on environmental health promotion. Environmental health promotion lies at the intersection between the two disciplines and can be defined as any planned process employing comprehensive health promotion approaches to assess, correct, control, and prevent those factors in the environment that can potentially harm the health and quality of life of present and future generations. An introduction is also provided to the six articles contained in this special issue focused on environmental health promotion, and a brief discussion of crosscutting themes and issues is presented.     

Family health strategy and analysis of the social reality: input for policies for promotion of health and permanent education

The results of a qualitative study, carried out between 2007 and 2009 in three cities of Greater Florianópolis into the reality of the family health teams are presented. The scope was to investigate if the analysis of social and health reality was conducted and to what extent it contributed to the inclusion of local actions aiming at health promotion (HP) and permanent education (PE). The results showed that HP and PE, respectively, were being confused with disease prevention and ongoing education and were seldom present in the work of the professionals. Also, they revealed an educational and preventive "spirit," with a didactic approach based on unidirectional transmission of content. Social and health reality were not analyzed in depth and in most cases did not create effective actions to promote health, nor were there processes of permanent education. The practices of recording data by the Health Community Agents were merely compliance with a bureaucratic necessity, although healthcare and prevention require actions of an educational nature. The conclusion reached is that permanent education does not exist in these teams and its introduction can contribute to broaden understanding of health promotion practices.     

Environmental health and the family doctors

Medicine, that is human medicine, has a long tradition of the use of biomarkers in assessing multiple departures from the health status: it is assumed that in ecosystem health assessment this experience could be helpfully shared with all those--from many scientific disciplines--involved in this research, crucial for the future of life on earth. The growing importance of ecology is evident in all aspects of modern life. Social and economically the ecological analysis cannot be ignored in future by politicians or medical doctors alike. Environmental Health is thus taking over many responsibilities from the traditional Public Health, mainly the significant challenges put by toxic and hazardous substances released into the environment which is fundamentally an evaluation of relevant environmental data, health outcome and community health concerns associated with toxic exposure. The public has become increasingly concerned about the exposure to synthetic chemical compounds produced by modern industry. Environmental Health is essentially a critical tool to determine the relationship between environmental contamination and human adverse health effects. Environmental Health aims much further than the traditional Public Health. Although Environmental Health has not enjoyed the successes of traditional Public Health such as maternal and child health or the eradication of smallpox, an array of activities is underway that will enhance the health professional's ability to cope with the demanding issue of toxic exposures.     

Nursing practice and public health policy in Campinas, São Paulo, Brazil

Redemocratization in the 1970s brought about changes in the public health system in Brazil. The Unified National Health System (SUS) was implemented in 1988, based on local and regional administrative systems. This was an important step that resulted in greater local control and the introduction of new technologies. This study focuses on the local health system in Campinas, a relatively affluent and technologically advanced region some 100km from the city of S?o Paulo in Southeast Brazil. Qualitative and quantitative methods were used to evaluate the work of 233 nurses in the local health system. The first nurse was hired in 1977, and now there are 53 nurses working in specific areas: 10 in the central health administration, 36 in district administrations, and the rest in local services. Nursing services are organized in six main areas: administration, coordination of human resources, education, information technology, health surveillance, and health administration. Nursing intervention may be found in various areas, but it generally focuses on medical consultations, and there is little emphasis on collective activities and health promotion. Local health objectives can only be achieved by creating new practices that promote collective health.     

Breast cancer health promotion model for older Puerto Rican women: results of a pilot programme

This article focuses on the development of a health promotion model programme for elderly Puerto Rican women intended to minimize barriers for early detection of breast cancer and to increase women's compliance with recommended guidelines. The programme was designed based on the findings of a national sample to assess knowledge, beliefs and practices of breast cancer early detection in Puerto Rican elderly women and their perceptions of barriers associated with non-compliance. It involves the combination of educational and environmental support for actions and conditions conducive to health behaviour and consists of the following components: (i) a culture- and cohort-sensitive health education programme for elderly women on breast cancer screening and assertive strategies for client-physician relationship; (ii) training for primary-care providers on current guidelines and barriers affecting compliance among older women in Puerto Rico; and (iii) coordination of necessary support services to facilitate access to clinical breast exams and mammograms. Programme implementation considers appropriate theories for health promotion and education in the older population. Evaluation measured progress in the plan implementation by assessing immediate products and long-term impact of the programme. Results of the pilot programme revealed a slight increase in knowledge and a significant decrease (p < 0.05) in beliefs after the health education sessions. Interventions in breast cancer early detection practices showed significant changes (p < 0.05) for mammogram and clinical breast examination. Different strategies must be combined to increase older women's compliance with breast cancer screening. Health system and access barriers to preventive care must be addressed.     

Impact of rurality on environmental determinants and hazards

The original of this paper was prepared as invited pre-reading for the Inaugural Rural Health Symposium held in Brisbane in July 2008 under the theme 'The impact of "rurality" ', sub-theme (a) Environmental determinants. The natural environment shapes human activity, both economically and socially. It also directly and indirectly influences health and well-being. People in rural and remote areas are more directly exposed to the natural environment than their urban counterparts. The built environment is largely a product of economic activity; thus, the built environment in rural areas tends to reflect the predominant primary industry/ies. The rural built environment presents many potential hazards and risks to health and well-being, particularly for those involved in the primary industries, which are either not present in urban areas, or are present on smaller or more contained scales. The natural and built environments also influence individuals' attitudes and behaviours, both positively and negatively.
The environmental determinants of rural health, therefore, can be considered in terms of the natural environment, the built environment and individuals' responses to environmental influences. This paper raises some of the common environmental determinants of rural health and well-being and briefly touches on what these mean for rural health service delivery.     

The meaning that health professionals attribute to promotion of the health of adolescents

This article analyzes the meanings attributed to practices that promote adolescent health by 47 professionals from the Family Health Program in Fortaleza in the State of Ceará. It is a qualitative study in which semi-structured interviews enabled the production of data, subsequently organized according to content analysis, resulting in the following core themes: promoting health associated with injury prevention; limitation of health promotion to the school environment; the lack of health promotion for adolescents in the healthcare service; and partnerships as a viable way of promoting health for adolescents. The health promotion actions were developed in a timely manner and mostly in the pre-natal, family planning, and cancer prevention programs. The health professionals found the school environment to be an important and viable place for a partnership for health promotion actions for adolescents. There was evidence, albeit incipient, of the health professionals' desire to reorient this practice in the healthcare service.     

环境与人类和谐发展：公共卫生的重要角色——第五届环境与职业医学国际学术研讨会纪要

2010年4月7—10日,以“环境与健康——气候·城市·职业”为主题的“第五届环境与职业医学国际学术研讨会”在四川省都江堰市召开。此次国际研讨会由上海市疾病预防控制中心、上海市预防医学研究院和《环境与职业医学》杂志编委会主办,加州中国科研合作项目（美国国立卫生研究院资助）、美国疾控中心环境卫生中心、美国《环境与健康展望》杂志和四川省都江堰市卫生局合办,42位中外专家和200多名代表出席会议。与会者就“生态、气候与健康”、“城市与健康”、“职业与健康”、“暴露与评估”、“环境铅暴露与健康”等主题进行了深入交流。本次研讨会的顺利举行必将促进环境与职业医学乃至公共卫生学科的持续发展,为科技和经济发展、构建和谐社会服务。     

Incorporating environmental health into pediatric medical and nursing education

Pediatric medical and nursing education currently lacks the environmental health content necessary to appropriately prepare pediatric health care professionals to prevent, recognize, manage, and treat environmental-exposure-related disease. Leading health institutions have recognized the need for improvements in health professionals' environmental health education. Parents are seeking answers about the impact of environmental toxicants on their children. Given the biologic, psychological, and social differences between children and adults, there is a need for environmental health education specific to children. The National Environmental Education and Training Foundation, in partnership with the Children's Environmental Health Network, created two working groups, one with expertise in medical education and one with expertise in nursing education. The working groups reviewed the transition from undergraduate student to professional to assess where in those processes pediatric environmental health could be emphasized. The medical education working group recommended increasing education about children's environmental health in the medical school curricula, in residency training, and in continuing medical education. The group also recommended the expansion of fellowship training in children's environmental health. Similarly, the nursing working group recommended increasing children's environmental health content at the undergraduate, graduate, and continuing nursing education levels. Working groups also identified the key medical and nursing organizations that would be important in leveraging these changes. A concerted effort to prioritize pediatric environmental health by governmental organizations and foundations is essential in providing the resources and expertise to set policy and provide the tools for teaching pediatric environmental health to health care providers.     

Improving the practice of pediatric patient education: A synthesis and selective review

Patient education within the pediatric-care setting can be defined as any combination of planned learning experiences designed to facilitate adaptations of behavior conducive to health. It is directed both toward patients and toward significant adult caretakers in the child's environment. Additionally, health promotion and health education outside of the patient-care setting are required to promote child health. These efforts include legislation directed toward environmental hazards as well as community- and school-based health education programs. Although educating children and their parents is a routine part of pediatric health care, patient education efforts often reflect poorly applied principles of learning. Social learning theory provides useful constructs that can serve as a basis for developing, implementing, and evaluating pediatric patient education. These constructs focus attention on environmental influences on the learner, the role of modeled behavior for health outcomes in children, and the key concepts of perceived self-efficacy and family and social support.     

Health promotion in Brazil

The evolution of health promotion within the Brazilian health system is examined, including an assessment of the intersectoral and development policies that have influenced the process. Particular attention is paid to the legal characteristics of the Unified Health System. Human resources formation and research initiatives in health promotion are outlined, with a summary of the obstacles that need to be overcome in order to ensure the effective implementation of health promotion in the future. Up to the end of the 20th Century health promotion was not used as a term in the Brazilian public heath context. Health promoting activities were concentrated in the area of health education, although targeting the social determinants of health and the principle of intersectoral action were part of the rhetoric. The situation has changed during the last decade, with the publication of a national policy of health promotion, issued by the Ministry of Health and jointly implemented with the States and Municipals Health Secretaries. More recently there has been a re-emergence of the discourse on the social determinants of health and the formation of intersectoral public policies as the basis of a comprehensive health promotion. Health promotion infrastructure, particularly around human resources and financing, requires strengthening in order to ensure capacity and sustainability in health promotion practice.     

The determinants of First Nation and Inuit health: a critical population health approach

Environmental dispossession disproportionately affects the health of Canada's Aboriginal population, yet little is known about how its effects are sustained over time. We use a critical population health approach to explore the determinants of health in rural and remote First Nation and Inuit communities, and to conceptualize the pathways by which environmental dispossession affects these health determinants. We draw from narrative analysis of interviews with 26 Community Health Representatives (CHRs) from First Nation and Inuit communities across Canada. CHRs identified six health determinants: balance, life control, education, material resources, social resources, and environmental/cultural connections. CHRs articulated the role of the physical environment for health as inseparable from that of their cultures. Environmental dispossession was defined as a process with negative consequences for health, particularly in the social environment. Health research should focus on understanding linkages between environmental dispossession, cultural identity, and the social determinants of health.     

Health education–the case for rehabilitation

The emergence of health promotion in the 1980s was a direct response to critiques of health education which centred on its victim-blaming orientation and a growing appreciation of the need to address the wider determinants of health and health-related behaviour. This paper argues a priori that such critiques centre on a preventive model of health education and overlook its broader potential. It reviews a number of alternative models of health education and locates these within the core values of equity and empowerment which underpin the Ottawa Charter and subsequent WHO documents. It suggests that, despite the rhetoric of health promotion, practice frequently remained focused on individual behaviour change and the use of persuasive health education. The move to health promotion effectively stifled further debate about the broader role of health education in achieving individual empowerment and social change. This paper calls for a broader conceptualisation of health education–the New Health Education–and concludes that this should be the driving force behind health promotion.