Health Education

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Health Education, teaching and counseling on healthy living. Health education covers topics such as hygiene, nutrition, and sex education. It also addresses alcohol and drug misuse, smoking, and other threats to health. In most secondary schools, health education is included within a course of personal and social education; it may also be integrated into subjects such as biology, home economics, or physical education.

Health education is a profession of educating people about health.[1] Areas within this profession encompass environmental health, physical health, social health, emotional health, intellectual health, and spiritual health.[2]

Health education can be defined as the principle by which individuals and groups of people, learn to behave in a manner conducive to the promotion, maintenance, or restoration of health. However, as there are multiple definitions of health, there are also multiple definitions of health education. The Joint Committee on Health Education and Promotion Terminology of 2001 defined Health Education as "any combination of planned learning experiences based on sound theories that provide individuals, groups, and communities the opportunity to acquire information and the skills needed to make quality health decisions." [3]

The World Health Organization defined Health Education as "compris[ing] [of] consciously constructed opportunities for learning involving some form of communication designed to improve health literacy, including improving knowledge, and developing life skills which are conducive to individual and community health." [4]

The Role of Health Education Specialists.

From the late nineteenth to the mid-twentieth century, the aim of public health was controlling the harm from infectious diseases, which were largely under control by the 1950s. By the mid 1970s it was clear that reducing illness, death, and rising health care costs could best be achieved through a focus on health promotion and disease prevention. At the heart of the new approach was the role of a health educator [5] A health educator is “a professionally prepared individual who serves in a variety of roles and is specifically trained to use appropriate educational strategies and methods to facilitate the development of policies, procedures, interventions, and systems conducive to the health of individuals, groups, and communities” (Joint Committee on Terminology, 2001, p. 100). In January 1978 the Role Delineation Project was put into place, in order to define the basic roles and responsibilities for the health educator. The result was a Framework for the Development of Competency-Based Curricula for Entry Level Health Educators (NCHEC, 1985). A second result was a revised version of A Competency-Based Framework for the Professional Development of Certified Health Education Specialists (NCHEC,1996). These documents outlined the seven areas of responsibilities which are shown below.

Responsibility I: Assessing Individual and Community Needs for Health Education.

-Provides the foundation for program planning

-Determines what health problems might exist in any given groups

-Includes determination of community resources available to address the problem

-Community Empowerment encourages the population to take ownership of their health problems

-Includes careful data collection and analysis

Responsibility II: Plan Health Education Strategies, Interventions, and Programs.

-Actions are based on the needs assessment done for the community (see Responsibility I)

-Involves the development of goals and objectives which are specific and measurable

-Interventions are developed that will meet the goals and objectives

-According to Rule of Sufficiency, strategies are implemented which are sufficiently robust, effective enough, and have a reasonable chance of meeting stated objectives

Responsibility III: Implement Health Education Strategies, Interventions, and Programs.

-Implementation is based on a thorough understanding of the priority population

-Utilize a wide range of educational methods and techniques

Responsibility IV: Conduct Evaluation and Research Related to Health Education.

-Depending on the setting, utilize tests, surveys, observations, tracking epidemiologicaldata, or other methods of data collection

-Health Educators make use of research to improve their practices.

Responsibility V: Administer Health Education Strategies, Interventions, and Programs.

-Administration is generally a function of the more experienced practitioner

-Involves facilitating cooperation among personnel, both within and between programs

Responsibility VI: Serve as a Health Education Resource Person.

-Involves skills to access needed resources, and establish effective consultative relationships.

Responsibility VII: Communicate and Advocate for Health and Health Education.

-Translates scientific language into understandable information

-Address diverse audience in diverse settings

-Formulates and support rules, policies and legislation

-Advocate for the profession of health education

Motivation.

Education for health begins with people. It hopes to motivate them with whatever interests they may have in improving their living conditions. Its aim come is to develop in them a sense of responsibility for health conditions for themselves as individuals, as members of families, and as communities. In communicable disease control, health education commonly includes an appraisal of what is known by a population about a disease, an assessment of habits and attitudes of the people as they relate to spread and frequency of the disease, and the presentation of specific means to remedy observed deficiencies.[6]

Health education is also an effective tool that helps improve health in developing nations. It not only teaches prevention and basic health knowledge but also conditions ideas that re-shape everyday habits of people with unhealthy lifestyles in developing countries. This type of conditioning not only affects the immediate recipients of such education but also future generations will benefit from an improved and properly cultivated ideas about health that will eventually be ingrained with widely spread health education. Moreover, besides physical health prevention, health education can also provide more aid and help people deal healthier with situations of extreme stress, anxiety, depression or other emotional disturbances to lessen the impact of these sorts of mental and emotional constituents, which can consequently lead to detrimental physical effects.,[7][8]

Credentialing.

Credentialing is the process by which the qualifications of licensed professionals, organizational members or an organization are determined by assessing the individuals or group background and legitimacy through a standardized process. Accreditation, licensure, or certifications are all forms of credentialing.

In 1978, Helen Cleary, the president of the Society for Public Health Education (SOPHE) started the process of certification of health educators. Prior to this, there was no certification for individual health educators, with exception to the licensing for school health educators. The only accreditation available in this field was for school health and public health professional preparation programs.

Her initial response was to incorporate experts in the field and to promote funding for the process. The director if the Division of Associated Health Professions in the Bureau of Health Manpower of the Department of Health, Education, and Welfare, Thomas Hatch, became interested in the project. To ensure that the commonalities between health educators across the spectrum of professions would be sufficient enough to create a set of standards, Dr. Cleary spent a great amount of time to create the first conference called the Bethesda Conference. In attendance were interested professionals who covered the possibility of creating credentialing within the profession.

With the success of the conference and the consensus that the standardization of the profession was vital, those who organized the conference created the National Task Force in the Preparation and Practice of Health Educators. Funding for this endeavor became available in January 1979, and role delineation became a realistic vision for the future. They presented the framework for the system in 1981 and published entry-level criteria in 1983. Seven areas of responsibility, 29 areas of competency and 79 sub-competencies were required of health education professionals for approximately 20 years for entry-level educators.

In 1986 a second conference was held in Bethesda, Maryland to further the credentialing process. In June 1988, the National Task Force in the Preparation and Practice of Health Educators became the National Commission for Health Education Credentialing, Inc. (NCHEC). Their mission was to improve development of the field by promoting, preparing and certifying health education specialists. The NCHEC has three division boards that included preparation, professional development and certification of health educator professionals. The third board, which is called the Division Board of Certification of Health Education Specialist (DBCHES), has the responsibility of developing and administering the CHES exam. An initial certification process allowed 1,558 individuals to be chartered into the program through a recommendation and application process. The first exam was given in 1990.

In order for a candidate to sit for an exam they must have either a bachelor’s, master’s, or doctoral degree from an accredited institution, and an official transcript that shows a major in health education, Community Health Education, Public Health Education, or School Health Education, etc. The transcript will be accepted if it reflects 25 semester hours or 37 quarter hours in health education preparation and covers the 7 responsibilities covered in the framework.

In 1998 a project called the Competencies Update Project (CUP) began. The purpose of the CUP project was to up-date entry-level requirements and to develop advanced-level competences. Through research the CUP project created the requirements for three levels, which included entry-level, Advanced I and Advanced II educators.[9] [10]

Recently the Master Certified Health Education Specialist (MCHES) was created. The MCHES exam measures the knowledge of the advanced levels and sub levels of the Seven Areas of Responsibilities. The first MCHES exam was given in October 2011.

In order to be eligible to take the MCHES exam you must have at least a master's degree in health education or related discipline along with a least 25 credit hours related to health education. In addition, five years of documented information of practice in health education and two recommendations of past/present supervisors must be provided. A vitae/resume must also be submitted.

The Competency Update Project (CUP), 1998-2004 revealed that there were higher levels of health education practitioners, which is the reasoning for the advancements for the MCHES. Many health educators felt that the current CHES credential was an entry-level exam.

Teaching.

In the United States some forty states require the teaching of health education. A comprehensive health education curriculum consists of planned learning experiences which will help students achieve desirable attitudes and practices related to critical health issues. Some of these are: emotional health and a positive self image; appreciation, respect for, and care of the human body and its vital organs; physical fitness; health issues of alcohol, tobacco, drug use and abuse; health misconceptions and myths; effects of exercise on the body systems and on general well being; nutrition and weight control; sexual relationships and sexuality, the scientific, social, and economic aspects of community and ecological health; communicable and degenerative diseases including sexually transmitted diseases; disaster preparedness; safety and driver education; factors in the environment and how those factors affect an individual's or population's Environmental health (ex: air quality, water quality, food sanitation); life skills; choosing professional medical and health services; and choices of health careers.

The National Center for Education Statistics share that 99% of public schools conduct come type of nutrition education. For each grade from kindergarten through eighth, 50 percent or more of all schools have district or state requirements for students to receive nutrition education. However, only 40 percent have these requirements for ninth and tenth grades; and about 20 percent for eleventh and twelfth grades. The issue still lies with the content and thoroughness that is being taught. Topics taught in a most all of the schools are: the relationship between diet and health, finding and choosing healthy foods, nutrients and their food sources, the Food Guide Pyramid, and the Dietary Guidelines and goals. However, with the exception of the Food Guide Pyramid, less than half of schools cover these topics thoroughly. Overall, schools focus on increasing students’ knowledge about what is meant by good nutrition, with less emphasis on influencing students’ motivation, attitudes, and eating behaviors. Four of the five topics covered by more than 90 percent of all schools are related to knowledge. With the exception of finding and choosing healthy foods, less than one-third of schools provide thorough coverage of topics related to motivation, attitudes, and eating behaviors. Not often are there teachers specific for nutrition. Most of the time the nutrition content is taught by the primary teacher. https://nces.ed.gov/pubs/96852.pdf

National Health Education Standards.

The National Health Education Standards (NHES) are written expectations for what students should know and be able to do by grades 2, 5, 8, and 12 to promote personal, family, and community health. The standards provide a framework for curriculum development and selection, instruction, and student assessment in health education. The performance indicators articulate specifically what students should know or be able to do in support of each standard by the conclusion of each of the following grade spans: Pre-K–Grade 12. The performance indicators serve as a blueprint for organizing student assessment.[11]

Health Education Code of Ethics.

The Health Education Code of Ethics has been a work in progress since approximately 1976, begun by the Society of Public Health Education (SOPHE). Various Public Health and Health Education organizations such as the American Association of Health Education (AAHE), the Coalition of National Health Education Organizations (CNHEO), SOPHE, and others collaborated year after year to devise a unified standard of ethics that health educators would be held accountable to professionally. In 1995, the National Commission for Health Education Credentialing, Inc. (NCHEC) proposed a profession-wide standard at the conference: Health Education Profession in the Twenty-First Century: Setting the Stage. Post-conference, an ethics task force was developed with the purpose of solidifying and unifying proposed ethical standards. The document was eventually unanimously approved and ratified by all involved organizations in November 1999 and has since then been used as the standard for practicing health educators.

"The Code of Ethics that has evolved from this long and arduous process is not seen as a completed project. Rather, it is envisioned as a living document that will continue to evolve as the practice of Health Education changes to meet the challenges of the new millennium." [12]

Health Education Code of Ethics Full Text.

PREAMBLE The Health Education profession is dedicated to excellence in the practice of promoting individual, family, organizational, and community health. The Code of Ethics provides a framework of shared values within which Health Education is practiced. The responsibility of each Health Educator is to aspire to the highest possible standards of conduct and to encourage the ethical behavior of all those with whom they work.

Article I: Responsibility to the Public A Health Educator’s ultimate responsibility is to educate people for the purpose of promoting, maintaining, and improving individual, family, and community health. When a conflict of issues arises among individuals, groups, organizations, agencies, or institutions, health educators must consider all issues and give priority to those that promote wellness and quality of living through principles of self-determination and freedom of choice for the individual.

Article II: Responsibility to the Profession Health Educators are responsible for their professional behavior, for the reputation of their profession, and for promoting ethical conduct among their colleagues.

Article III: Responsibility to Employers Health Educators recognize the boundaries of their professional competence and are accountable for their professional activities and actions.

Article IV: Responsibility in the Delivery of Health Education Health Educators promote integrity in the delivery of health education. They respect the rights, dignity, confidentiality, and worth of all people by adapting strategies and methods to the needs of diverse populations and communities.

Article V: Responsibility in Research and Evaluation Health Educators contribute to the health of the population and to the profession through research and evaluation activities. When planning and conducting research or evaluation, health educators do so in accordance with federal and state laws and regulations, organizational and institutional policies, and professional standards.

Article VI: Responsibility in Professional Preparation Those involved in the preparation and training of Health Educators have an obligation to accord learners the same respect and treatment given other groups by providing quality education that benefits the profession and the public.[13]

All versions of the document are available on the Coalition of National Health Education's site: http://www.cnheo.org/.[14][15] The National Health Education Code of Ethics is the property of the Coalition of National Health Education.

National Organizations for Public Health/Health Education.

American Public Health Association (APHA) APHA is the main voice for public health advocacy that is the oldest organization of public health since 1872. The American Public Health Association aims to “protect all Americans and their communities from preventable, serious health threats and strives to assure community-based health promotion and disease preventions.” Any individual can become a member and benefit in online access and monthly printed issues of The Nation’s Health and the American Journal of Public Health [16]

Society for Public Health Education (SOPHE) The mission of SOPHE is to provide global leadership to the profession of health education and health promotion and to promote the health of society through advances in health education theory and research, excellence in professional preparation and practice, and advocacy for public policies conducive to health, and the achievement of health equity for all. Membership is open to all who have an interest in health education and or work in health education in schools, medical care settings, worksites, community-based organizations, state/local government, and international agencies. Founded in 1950, SOPHE publishes 2 indexed, peer-reviewed journals, Health Education & Behavior and Health Promotion Practice. [17]

American School Health Association (ASHA) The American School Health Association was founded in 1972 by a group of physicians that already belonged to the American Public Health Association. This group specializes in school-aged health specifically. Over the years it has snowballed and now includes any person that can be a part of a child’s life, from dentists, to counselors and school nurses. The American School Health Association mission “is to protect and promote the health of children and youth by supporting coordinated school health programs as a foundation for school success." [18]

American Association of Health Education/American Alliance for Health, Physical Education, Recreation, and Dance (AAHE/AAHPERD) The AAHE/AAHPERD is said to be the largest organization of professionals that supports physical education; which includes leisure, fitness, dance, and health promotion. That is only a few; this incorporates all that is physical movement. This organization is an alliance with five national associations and six districts and is there to provide a comprehensive and coordinated array of resources to help support practitioners to improve their skills and always be learning new things. This organization was first stated in November 1885. William Gilbert Anderson had been out of medical school for two years and was working with many other people that were in the gymnastic field. He wanted them to get together to discuss their field and this organization was created. Today AAHPERD serves 25,000 members and has its headquarters in Reston, Virginia.[19]Eta Sigma Gamma (ESG) Eta Sigma Gamma is a national health education organization founded in 1967 by three professor from Ball State University. The mission of ESG is to promote public health education by improving the standards, ideals, capability, and ethics of public health education professionals. The three key points of the organization are to teach, research, and provide service to the members of the public health professionals. Some of the goals that the Eta Stigma Gamma targets are support planning and evaluation of future and existing health education programs, support and promote scientific research, support advocacy of health education issues, and promote professional ethics. [20]