Elsevier

Public Health

Volume 117, Issue 2, March 2003, Pages 106-111
Public Health

Short Survey
Health education: a case for resuscitation

https://doi.org/10.1016/S0033-3506(02)00013-6Get rights and content

Abstract

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.

Section snippets

What is health education?

There are wide variations in the understanding, organization and practice of public health, health promotion and health education in different countries. This paper considers the history and state of health education in England, but the lessons learnt here may be relevant to health education in other countries. In the author's opinion, health education in England is in poor health. It is poorly resourced, widely regarded as ineffective, and undervalued by those who should be its champions. The

What is health education?

Tones and Tilford2 defined health education as “any intentional activity which is designed to achieve health or illness related learning, i.e. some relatively permanent change in an individual's capability or disposition”. The definition given by French3 makes the purpose clearer: “Health education is a practical endeavour focused on improving understanding about the determinants of health and illness and helping people to develop the skills they need to bring about change”. More recently,

Why health education is important?

If one takes the notion of informed choice seriously, one must value health education. People cannot make informed choices unless they are aware of the health consequences of their actions, and have the skills which make behavioural choice a reality for them.10 This emphasis on the individual and voluntarism11 contrasts with the utilitarian ethics which inform most other health promotion and public health activities. Even where the chosen method of health promotion involves restricting choice,

The rise and fall of health education in England

Advice and exhortation on maintenance of health appears in medical texts from ancient civilizations, and figured prominently in Hippocratic writings.13 However, the sanitary revolution might be taken as the origin of health education in England. Promoting knowledge and skills and combating ignorance had its place as part of the strategy for improving health of the population alongside improvement of environmental conditions.14 Over the years, the effort devoted to this increased, leading to the

The political correctness of health education

Some attacked health education on the grounds that it was victim blaming.19 Emphasizing the role of individual health behaviours such as smoking, high-fat, low-fibre diets, lack of physical activity, excessive alcohol consumption, taking of illicit drugs and unsafe sex practice was considered to direct attention to the individual rather than the environment in which these behaviours took place. Health education was seen to be unduly concerned with disease, reductionist and worst of all based on

Health education and health equality

Another charge against health education was that it increased health inequality improving the health of the privileged but not of the underprivileged.21., 22. However, in one review of 68 health education initiatives intended to reduce inequalities, 40 were judged to be effective.23 It may be true that the privileged have more capacity to benefit from universally distributed health education, but this is true for most opportunities. The rational response is not to discard health education but

The effectiveness of health education

Health education has also been attacked on the grounds that it was ineffective. This could be resolved into two arguments: first that lifestyle change did not affect health, and second that even if it did, health education was ineffective in changing life style. The relation of life style on health is beyond the scope of this article. Beyond asserting that life style does affect risk, while acknowledging that the size of the effect is often modest, no more will be said.

But is there evidence

Who does health education?

Health education is frequently an essential part of medical management, in which context it is often referred to as patient education. For example, a person with peripheral vascular disease, who smokes, has not been competently treated until the issue of smoking has been discussed with them. Similarly, the whole movement towards expert patients39 implies that they should have a greater understanding of their condition and the possible ways in which it might be treated. In such settings, the

Rebuilding health education

But where in the English health and social care system are the specialists in health education to whom these front-line educators should be able to look for support? This is the role that health promotion specialists should be confidently and proudly claiming. Although many professional groups receive some training in health education, health promotion specialists are the one professional group who have had specialist training in the principles and practice of health education. Furthermore,

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