Understanding Health Education Behavior: Definitions, Evolution, and Impact

Health education is a dynamic field that plays a crucial role in shaping individual and community well-being. Its influence stretches from ancient practices to modern, comprehensive programs aimed at fostering healthy behaviors and preventing disease.

Historical Roots and Evolution of Health Education

It is often thought that health education began with the beginning of healthcare in the earliest parts of history as knowledge was passed from generation to generation. Some people might be surprised to hear that health education's roots date back to the Greeks between the sixth and fourth century B.C.E. They shifted their focus away from superstitious and supernatural conceptions of health and toward the physiological causes of ailments, according to documents that have been uncovered. They discussed how physical health, social settings, and human behavior are connected to preventing disease and sustaining good health. The Greeks wanted to empower people and communities by establishing supportive settings and regulations that would promote taking medication and upholding healthy behaviors.

The purpose and approach of health education in the United States have evolved over time. 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. mostly as a means of communicating healthy medical practices to those who should be practicing them. By this time, 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. In the 1980s definitions began to incorporate the belief that education is a means of empowerment for the individual, allowing them to make educated health decisions. became "the process of assisting individuals… to make informed decisions about matters affecting their personal health and the health of others." This definition emerged in the same year as the first national-scale investigation of health education in schools in the United States, which eventually led to a much more aggressive approach to educating young people on matters of health.

Defining Health Education

Health education has been defined differently by various sources. Health education aims to immediately impact an individual's knowledge, behavior, or attitude about a health-related topic with the ultimate aim of improving quality of life or health status for an individual. Health education is a social science that draws from the biological, environmental, psychological, physical and medical sciences to promote health and prevent disease, disability and premature death through education-driven voluntary behavior change activities. Health education is the development of individual, group, institutional, community and systemic strategies to improve health knowledge, attitudes, skills and behavior. The purpose of health education is to positively influence the health behavior of individuals and communities as well as the living and working conditions that influence their health.

The Role of Health Educators

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 other words, they conduct, evaluate, and design activities that pertain to the improvement of the health and well-being of humans. Examples of this include "patient educators, health education teachers, trainers, community organizers, and health program managers." There is a variation in job titles and because of this, there is not a definite system of one health education system.

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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.

Intervention Strategies in Health Education

Health education utilizes several different intervention strategies in its practices to improve quality of life and health status. Peer health education is described as student's taking initiative to inform their peers on how to live healthy lifestyles. Prevention is the biggest aspect of this idea and often includes alcohol, sexual health, and emotional wellbeing education in addition to many other aspects. The most research on peer educators has been done within colleges and universities within Western-civilizations. However, a specific example of peer health education being utilized is seen within The Shantou Experience in China. In this experience, medical students were selected to educate their peers on topics from diet and safer sex to mental and physical health. Self-administered questionnaires were used to track results from the participants as well as from the peer health educators. According to the questionnaire results, "All peer educators responded positively and the majority of students respondents positively evaluated.

Health Education in Schools

Health education is part of the primary mission of schools. It offers young people the health knowledge and skills they need to become successful learners and healthy adults. Youth behaviors and experiences set the stage for healthy adulthood. Receiving health education as early as possible can help youth develop positive well-being, academic success, and healthy outcomes into adulthood.

In the United States, around forty states require the teaching of health education. A comprehensive health education curriculum consists of planned learning experiences that will help students achieve desirable attitudes and practices related to critical health issues.

Quality health education starts with quality curricula and student learning standards. District and school staff can use CDC's Health Education Curriculum Analysis Tool (HECAT) to select or develop curriculum. The aim of health education standards is to establish, promote, and support health-enhancing behaviors for students at all grade levels. These learning standards are routinely updated by professional organizations. The National Sex Education Standards outline basic knowledge and skills students need to navigate sexual development and become sexually healthy adults. The standards help schools focus on the most essential topics for students to learn. CDC's Mental Health Action Guide identifies school-based strategies to help prevent mental health problems and promote positive behavioral and mental health. Professional development programs and technical assistance supports are key to successful health education.

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Mental Health Literacy (MHL)

The topic of mental health has been getting more awareness and is becoming a more socially acceptable concept. However the average individual's mental health literacy, one's ability to "…recognize, manage, and prevent mental disorders", is not acceptable. Having a well-developed MHL will allow for students to not only manage their own mental health but help support others too. Teaching children about mental health in school can help them see mental health as a normal occurrence and not something that should be ignored. In recent times we have seen an effort of increasing this way of teaching in health programs. The issue now is that "…teachers have limited skills to manage complex mental health difficulties". Mental health and MHL are complex ideas. Teachers do not have that kind of medical training to teach students everything that they need to know. Students can be taught about mental health with community-based interventions as well. This allows for experts to be brought in and teach youth about the signs of a mental illness and the ways to help manage them. This information can help increase an individual's MHL and help them in their future. Parents should also be informing their children about these topics.

National Health Education Standards (NHES)

The National Health Education Standards (NHES) are written expectations for what the 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-KâGrade 12.

Certification and Professional Development

The National Commission for Health Education Credentialing (NCHEC) is a non-profit organization that provides certification and professional development opportunities for health education specialists in the United States. NCHEC was established in 1988 to improve the quality and consistency of health education in the United States. NCHEC offers several credentialing programs, including the Certified Health Education Specialist (CHES) and the Master Certified Health Education Specialist (MCHES) designations. NCHEC also provides continuing education opportunities for health education specialists, hosts an annual conference, and advocates for the profession of health education.

Health educators may gain professional certification in teaching health education in the United States by passing the Certified Health Education Specialist (CHES) exam. The CHES credential was created in 1989 and was later accredited in 2008 by the National Commission of Certifying Agencies. The National Commission for Health Education offers this exam in April and October each year to individuals that qualify. The CHES exam consists of 150 multiple choice competency-based questions that test individuals in the Eight Areas of Responsibility for Health Education Specialists. These eight areas include assessing individual and community needs, planning health education programs and interventions, implementing health education programs and interventions, evaluating and researching health outcomes, programs, and interventions, advocating for health education, leadership and management in health education, communicating health education, and ethics and professionalism for health educators. Individuals are eligible to take the exam if they meet certain academic and educational requirements.

Professional Organizations

"The Code of Ethics that has evolved from this long and arduous process is not seen as a completed project. The Society for Public Health Educators (SOPHE) is an independent professional society of health educators, academics, and education researchers that was founded in 1950. Their mission is to "Promote the health of all people through education".

Originally called Interim Commission, the International Union for Health Promotion and Education (IUHPE) was created in 1951 by Lucien Viborel, a then consultant to the WHO and United Nations, to focus a division for health education. Their mission is to promote global health and create health equity. Every three years they hold a World Conference on Health Promotion and Health Education. The Executive Board is made up of the President, the past-President, a maximum of 15 global members, and the regional Vice-Presidents. The organization is also made of memberships that are individual or institutional subscriptions that Health Educators can join.

Health Education Around the World

Since 2001, the Ministry of Education, Research, Youth, and Sports developed a national curriculum on Health Education. For the development of students' acquirement of practical skills and knowledge to have a new specialization in Nutrition and Dietetics, the study program was initiated in the University of Medicine and Pharmacy (UMF) of Iuliu HaÈieganu in 2008. Other universities continued to have the authority of this study including the University of Medicine, Pharmacy, Science, and Technology (UMFST) of TÃ¢rgu MureÅ, IaÅi, and TimiÅoara. The 104 students from these universities also participated in "Nutrition Medicine of the Future," the first National Symposium of Nutrition and Dietetics on 6â7 May 2011 to give and hear lectures.

School nurses in Japan are called yogo teachers also known as hoken kyoushi (Kanji: ä¿å¥æå¸«). Yogo teachers take a part of the educational staff to support students growth through the health education and services which are under school educational activities. Yogo teachers are trained to take care of student's physical health and their mental health. Through their observations of student's actions, the yogo teachers are able to identify students early-stage mood disorders and help support them as a school education. The problems causing mood disorders may include, family history, physical illness, previous diagnosis, and trauma. As many students have traumas, yogo teachers are able to detect physical or mental abuse cases (which could be a cause of trauma) more than other teachers.

Shokuiku (Kanji: é£è²) is the Japanese term for "food education". It was initiated by Sagen Ishizuka, a famous military doctor and pioneer of the macrobiotic diet. Following the introduction of Western fast food in the late 20th century, the Japanese government mandated education in nutrition and food origins, starting with the Basic Law of Shokuiku in 2005, and followed with the School Health Law in 2008.

Health education in Poland is not mandatory. However, research has shown that even with implantation of health education that the adolescents of Poland were still not choosing to live a healthy lifestyle. Although Polish schools curricula include health education, it is not a separate subject but concluded in other subjects such as nature, biology, and physical education.

One school in Ireland has been teaching health education since 2004. The children are able to learn about their physical health, for instance, the students were able to go on a school walk, learn traditional Irish dancing, and learn how to swim. However, not all their activities are based on physical health. The kids also learn about healthy eating. One activity involves a food pyramid. Here students will learn about different foods and how they affect our health. At the bottom of the food pyramid are fruits and veggies like apples and carrots and at the top of the pyramid are fried foods like fries. The pyramid is wooden and has different colors corresponding to the level of the pyramid. Green corresponds with the lowest level of the pyramid and so on.

The UK had implemented health education in their school system since the early 2000s. According to Gov.UK "… all pupils will study compulsory health education as well as new reformed relationships education in primary school and relationships and sex education in secondary school (Gov.UK, 2018)". However, these are not the only things being learned.

Health Education and Sustainable Development Goals (SDG)

Health Education is crucial in working towards achieving Sustainable Development Goals (SDG) created by the United Nations (UN).

The Broader Impact of Health Education

When considering care access and delivery within communities, health equity and social justice are one in the same,â said Dr. Natalie Rahming, an adjunct healthcare faculty member at SNHU with almost two decades of experience working in the healthcare field. âA 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,â she said.

In alignment to work on policy, community health leaders are needed to support the community with prevention strategies, interventions and programs designed to improve disparities of care based on social, economic, and environmental factors,â said Dr. Toni Clayton, executive director of health professions at SNHU.

Preventive health measures, including health education, can significantly reduce healthcare costs. For example, tobacco control programs have demonstrated a substantial return on investment by preventing smoking-related illnesses.

Pursuing a Career in Health Education

To begin your career in community healthcare, you'll typically need a minimum of a high school diploma or associate degree. âUnlike individual healthcare delivery, public health investigates the systems and trends that impact behaviors and outcomes within a community collectively," said Rahming. 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. Earning your Master of Public Health (MPH) degree could be a proactive way to expand your knowledge and prepare you 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. When considering MPH programs, look for one accredited by the Council on Education for Public Health (CEPH), such as SNHU's. 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. âI believe that more and more communities are seeing benefits from wellness-related initiatives and receiving positive marks about them,â Gifford said.

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