Health Education, Health Promotion, Health Educators, and Program Planning

1. Health Education, Health Promotion, Health Educators, and Program Planning Chapter 1

2. Looking back; the 20th Century Many infectious diseases were controlled; chronic diseases became a greater concern Average life span increased 29.4 yrs. Health promotion era of public health began in 1974 Lalonde Report in Canada Health Information & Health Promotion Act in U.S. Healthy People; behavioral risk factors became more important Looking ahead; the 21st Century Behavioral patterns are the single most prominent domain of influence over health prospects in U.S. (McGinnis et al., 2002) Health Status in the U. S.

3. Biology/Heredity (19.8%) Environment (20.1%) Inadequate healthcare (10%) Lifestyle (51.5%) Health Field Concept(Lalonde, 1974)

4. Leading Causes of Death in the U.S in 2000 (USDHHS, 2002) • Diseases of the heart 709,894 • Malignant neoplasms (cancer) 551,833 • Cerebrovascular diseases 166,028 • Chronic lower respiratory diseases (COPD) 123,550 • Unintentional injuries (accidents) 93,592 • Diabetes mellitus 68,662 • Influenza and pneumonia 67,024 • Nephritis, nephrotic syndrome & nephrosis 37,672 • Septicemia 31,613 • Intentional self-harm (suicide) 28,332

5. Actual Causes of Death, U.S. 2000 (Mokdad, Marks, Stroup, & Gerberding, 2000)CauseEstimated No.% of Deaths • Tobacco 435,000 18.1 • Poor diet & physical inactivity 400,000 16.6 • Alcohol consumption 85,000 03.5 • Microbial agents 75,000 03.1 • Toxic agents 55,000 02.3 • Motor vehicle 43,000 01.8 • Firearms 29,000 01.2 • Sexual behavior 20,000 00.8 • Illicit drug use 17,000 00.7 Total 1,159,000 48.2

6. Leading determinants of health (McGinnis, Williams-Russo, & Knickman, 2002) Genetics (30% of all deaths) 60% of all late onset disorders (e.g., diabetes, CVD, & cancer) Social circumstances (15%) e.g., education, employment, income disparities, poverty, housing, crime, & social cohesion) Environmental conditions (5%) e.g., toxic agents, microbial agents, & structural hazards Behavioral choices (40%) 900,000 deaths per year; 400,000 associated w/ tobacco Medical Care (10%) 15% of GNP; during 20th Century 5 of the 30 yrs. Of life expectancy attributable to better care; 2-4% of all deaths attributed to medical errors Determinants of Health

7. Determinants of Health (con’t.) “Ultimately, the health fate of each of us is determined by factors acting not mostly in isolation but by our experience where domains interconnect. Whether a gene is expressed can be determined by environmental exposures or behavioral patterns. The nature and consequences of behavioral choices are affected by our social circumstances. Our genetic predispositions affect the health care we need, and our social circumstances affect the health we receive” (McGinnis, Williams-Russo, & Knickman, 2002, p. 83) Medical Care Environ. Genetics Behavior Social Circum.

8. Health Education defined “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” (Joint Committee, 2001, p. 99)

9. Health Promotion defined “any planned combination of educational, political, environmental, regulatory, or organizational mechanisms that support actions and conditions of living conducive to the health of individuals, groups, and communities” (Joint Committee, 2001, p. 101).

10. The Relationship Between Health Education and Health Promotion

11. Health Educator defined “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, 2001, p. 100).

12. A Competency-Based Framework for Professional Development of Certified Health Education Specialists • Role Delineation Project - 1978 • Seven responsibilities • Assessing, Planning, Implementing, Evaluating, Coordinating, Acting, Communicating; • Advanced responsibilities • Applying appropriate research, administering programs, advancing the profession • Framework • CHES, NCATE, SABPAC • U.S. Dept. of Commerce & Labor - singular occupational classification code

13. Goal of Health Education • Goal of health education is to promote, maintain, & improve individual & community health (NCHEC, 1996) • This goal can be accomplished by: • compressing morbidity • decreasing premature mortality • “The highest goal in life is to die young, at as old an age as possible” (Ashley Montagu, 1968).

14. Prevention defined “The planning for and taking of action to forestall the onset of a disease or other health problem before the occurrence of undesirable health events” (McKenzie, Pinger, Kotecki, 2002. p. 606).

15. Levels of Prevention Source: Adapted from Hanlon & Pickett (1990)

16. The Limits of Prevention(DHHS, 2002; McGinnis, 1985) • Biological limitations • Life Expectancy • 1900 • Birth: A 47.3 yrs.; greater for females & whites • At 65: A 11.9 yrs.; greater for females & whites • 2000 • Birth: A 76.9 yrs.; greater for females & whites • At 65: A 17.9 yrs.; greater for females & whites • Life span - 80 to 110 yrs. • Longest life ~ 120 yrs. • No guarantees

17. The Limits of Prevention (con’t.) • Technological limitations • Infectious diseases (e.g., HIV / AIDS, malaria) • Noninfectious diseases (e.g., arthritis, Alzheimer’s) • Ethical limitations • Government’s enforcement of good health (e.g., laws for the common good, economic penalties via taxes) • Economic Limitations • ~5% of health care $ spent on prevention • Reimbursement for service vs. prevention • Prevention for economic vs. health reasons

18. Health status can be changed Health & disease are dynamic Disease theories & principles can be understood Appropriate prevention strategies can be developed Many things contribute to health & influence behavior change Initiating & maintaining a behavior change is difficult Individual responsibility should not be viewed as victim blaming For behavior change to be permanent, the person must be motivated & ready to change Assumptions of Health Promotion

19. Health Education, Health Promotion, Health Educators, and Program Planning Chapter 1 - The End