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t i o n
uc a
E d l t h )
a l th e a
e
H bl i c H
(P u
BY: NAGASA D. (Ass’t Professor)
E-mail: [email protected]
Skype Name: nagasa_dida
Cell phone: 0913174508
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 Course Description
Health Education Course is given for Public
Health students primarily to address the three
educational domains:
Cognitive, affective & Psychomotor on
principles of health education
methods & materials of health education,
health related behaviors,
Health Communication,
research methods in health education and
Health education planning & evaluation.

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 Course objectives
At the end of the course the students will be able
to:
Define health education and explain the
principles, aims, and approaches of health
education
Describe the relationship between health and
behavior and mention the three factors that
influence human health behavior

Definecommunication and describe the six

elements of communication and illustrate
4 communication models
 Course objectives
Explain the rationale for school health
education

Identify & demonstrates the methods and

materials of health education and explain the
principle of their application

Identify methods of qualitative (Health

Promotion) research and explain their
differences from quantitative research
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methods
 Brain storming
What is health?
Who is healthy?
What is health education?
What is health promotion?
When and where health education started?
What are the major factors affecting our health?
Three Broad Concepts/approaches of Health?

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 Objectives
Lesson objectives: At the end of this session
learners are expected to-
Define:
Health
Health Education
Health Promotion
Other health education key terms
Explain history of health education
List and analyze principle of health education
List aims of health education
List and describe major factor affecting health
List and describe the Three Broad
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Concepts/approaches of Health?
 Introduction
Before discussing about HE, it is
imperative to conceptualize what health
itself means.

Health is a highly subjective concept.

Good health
different things to different people,
its meaning varies according to individual and
community expectations and context.
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 … cont’d
People who have a disease or disability -
see themselves as being in good health if
they are able to manage their condition.

Dimension of Health
WHO defined health as “a state of complete
physical, mental, and social well being and
not the merely absence of disease or
infirmity.”
(WHO 1978)
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 … cont’d
A. Physical health – refers to anatomical integrity
& physiological functioning of the body.
Concerned with mechanistic functioning of the
body
Our bodies frequently send messages to us:
Please let me get a good night’s sleep’
Send down some vegetables tonight
My muscles are tense
 These and other messages can guide us toward
physical health.
In many ways, physical health serves as a foundation for
achieving wellness in the other dimensions of health.
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 … cont’d
To be physically healthy:
All the body parts should be there.
All of them are in their natural place and
position.
None of them has any pathology.
All of them are doing their physiological
functions properly.
And they work with each other
harmoniously.
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 … cont’d
B. Mental health - ability to learn and think clearly and
coherently .

encompasses the intellectual process of reasoning, analysis,

evaluation, curiosity, humor, alertness, creativity, logic, and
memory.

 Questioning what goes on around you indeed is a sign of mental

health

A person with good mental health is

able to handle day-to-day events and obstacles,
work towards important goals, and
function effectively in society.
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 Cont’d …

C. Social health – ability to make and maintain

acceptable interactions with other people.

It sometimes means having responsibilities.

Frequently the responsibilities impact other people and
involve meeting others’ needs.

These needs for love, intimacy, safety, companionship, and

cooperation – all important to social health.
When people are deprived of these needs, they at times act
in ways that threaten their overall health and wellbeing

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 The Extended Definition of Health
D. Emotional health: ability of expressing emotions in
the appropriate way.
E.g., our emotional to fear, to be happy, etc

is generally defined as the ability to

feel and express the full range of human emotions,
give and receive love,
achieve a sense of fulfillment and purpose in life,
develop psychological hardiness (seeing change as a
challenge instead of threat, and developing strong levels of
personal commitment and coping skills – hawks, 1994).

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 … cont’d
 Emotions can affect our physical health.
E.g. people with good emotion have low rates of stress-related
diseases such as ulcers, migraine headache, and asthma.

E. Spiritual Health: Some people relate health with religion.

For others it has to do with personal values, beliefs, principles and
ways of achieving mental satisfaction.

All the above aspects of health are interrelated and interdependent.

Physical problems can lead to mental problems and vies versa.
Therefore, health should be viewed as a holistic concept.

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 … cont’d
Health is a dynamic state of complete
physical, mental, spiritual and social well-
being and not merely the absence of disease
or infirmity
(WHO 1998)

Prerequisites for Health are peace, shelter,

education, food, income, stable ecosystem,
sustainable resources, social justice and equity
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 Definitions of terms used in HE:
By definition “The Health Education is
not just an information about health
dissemination
it is an active process of learning through
experience”

Health education has been defined in many ways by

different authors and experts.

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  “Health education, like general education is concerned with
changes in knowledge, feelings and behavior of people.
 In its most usual forms it concentrates on developing such
health practices as are believed to bring about the best
possible of well beings”
WHO Technical Report Series (# 89 of 1954)
it is a process that aids people to find out their health needs and
activate them for suitable behavior

Entire process of involving people in learning about health and

disease and aiding them to act suitably for overcoming illness
and preserving a positive health is health education

The HE process must result in a permanent change or sustained

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 Cont’d…
“Health education is a process aimed at
encouraging people
to want to be healthy,
to know how to stay healthy,
 to do what they can individually and
collectively to maintain health, and
to seek health when needed” (WHO, 1978)

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 Cont’d…

“Health Education is a combination of

learning experiences designed to facilitate
voluntary actions conducive to health”
(Green.1985).

Combination:
emphasizes the importance of matching the
multiple determinants of behavior with
multiple learning experiences or educational
interventions.
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 Cont’d…

Designed: The word “designed” refers to

distinguishes health education from incidental learning experiences
as systematically planned activity rather than casual, incident, trivial
experiences.

Facilitate
create favorable conditions for action.

Voluntary action
behavioral measures to achieve an intended health effect without
the use of force
(Educators should not force people to do what they
don’t want to do )
i.e. All efforts should be done to help people make
21 decisions and have their own choices.
 Cont’d…

“Health Education is any combination of

learning experience designed to pre-dispose,

enable & reinforce voluntary adoption of
behavior conducive to health” (Green 1991).

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 Cont’d…
Most people use the term health education and health
promotion interchangeably.
However, it is defined as follows:

“Health promotion is the process of enabling people to

increase control over, and to improve, their health”.

To reach a state of complete physical, mental and social

well-being, an individual or group must be able to
identify and to realize aspirations, to satisfy needs, and
to change or cope with the environment.

23 (WHO, 1984, 1986)

 Cont’d…
strategy “aimed at informing,
Health Promotion is a

influencing & assisting both individuals and

organizations so that they will accept more
responsibility and be more active in matters
affecting mental and physical health
“(Lalonde, 1974).

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 Cont’d…
The term health promotion is increasingly being used
to draw attention to the need for both educational &
political action to improve health – especially of
disadvantaged groups.

Health promotion:
“A combination of educational & environmental
supports for actions & conditions of living
conducive to health.”(Green & Iverson, 1982)

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 Cont’d…
Behavior Change Communication (BCC):
Is an interactive process with communities
to develop tailored messages and
approaches using a variety of communication
channels
to develop positive behaviors;
promote and sustain individual, community and
societal behavior change; and maintain
appropriate behaviors.

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 Cont’d…
Social Behavioral Change communication –
 the systematic application of interactive,
theory-based, and research driven
communication processes and strategies to
address tipping points for change at the
individual, community, and Social level.
A tipping point refers for change, where
trends rapidly evolve into permanent
changes.
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 Cont’d…
Health Communication:
is a key strategy to inform the public about health
concerns and to maintain important health issues on
the public agenda (WHO, 1996).

Health Information:
All information related to health.
Is the content of what is communicated through
various channels to be used for informing various
populations about health issues, products and
behaviors.
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 Cont’d…
Information, Education & Communication (IEC):
a package of planned interventions
which combine
Informational,
Educational and
Motivational processes as a component of
a national program to promote health.

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 Cont’d…
Information:
A collection of useful briefs or detailed ideas, processes, data
& theories that can be used for a certain period of time.

Education:
A complex and planned learning experiences that aims to
bring about changes in cognitive/concerned with
acquisition of knowledge, psychosocial and other skills.

Communication:
the process of sharing ideas, information, knowledge, and
experience among people using different channels.
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 Three Broad Concepts of Health
Medical (Traditional)
Behavioural (Lifestyle)
Socio-Environmental (Structural)

These approaches lead to different:

Definitions of problems,
Strategies,
Target groups, and
People responsible for the activities of promoting health.

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 Concepts of Health Promotion:
Medical Approach I (Traditional, Biomedical)

Health Concept is biomedical, absence of disease and/or

disability

Leading Health Problems defined in terms of disease

categories and physiological risk factors such as
physiological deviation from the norm: CVD, AIDS,
diabetes, obesity, arthritis, mental disease, hypertension,
etc.

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 Concepts of Health Promotion:
Medical Approach II
Principal Strategies: surgical interventions, drug and
other therapies, health care, medically managed health behaviour
change (diet, exercise, patient education, patient compliance),
screening for physiological and genetic risk factors

Target: high risk individuals

General Approach: Individualized
Actors: physicians, nurses, other health workers

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 Concepts of Health Promotion:
Behavioural Approach I (Lifestyle, Public Health)
Health Concept is individualized, health as
energy, functional ability, disease ‑preventing
lifestyles

Leading Health Problems defined in terms of

behavioural risk factors: smoking, poor eating
habits, lack of fitness, drug abuse, alcohol
abuse, poor stress coping, lack of life skills,
etc.

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 Concepts of Health Promotion:
Behavioural Approach II
Principal Strategies: health education, social
marketing, advocacy for public policies supporting
lifestyle choices (e.g. smoking bans, low fat meat
production, bicycle paths, ad bans)

Target: high risk groups, children and youth

General Approach: individualized, elements of societal
focus as related to public policy

Actors: public health workers, illness‑related advocacy

groups (e.g., Cancer Society), governments
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 Concepts of Health Promotion: Socio-
Environmental Approach I (Structural)
Health Concept is a positive state defined in
connectedness to one's family/friends/community,
being in control,
ability to do things that are important or have meaning,
community and societal structures supporting human
development

Leading Health Problems defined in terms of

psychosocial risk factors and socio‑environmental
risk conditions:
poverty, income gap, isolation, powerlessness, pollution,
stressful environments, hazardous living and working
conditions, etc.
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 Concepts of Health Promotion: Socio-
Environmental Approach II (Structural)
Principal Strategies: small group development, community
development, coalition building, political action and advocacy,
societal change

Target: high risk societal conditions

General Approach: structural, focussed on organization of
communities and society, development of just
political/economic policies

Actors: citizens, social development and welfare

organizations, political movements and parties

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 Major Factors Influencing Health
If you were to sit down with pencil and paper, you
probably could list hundreds of factors that directly
influence your health and the health of others.

Most, if not all, of those factors could be grouped into

four categories:
A. Hereditary
B. Environment
C. Health care services
D. Behavior
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 … cont’d
A. Hereditary
A number of factors affecting our health are inherited via our
genetic background and therefore are beyond our control.
E.g.,
 Disorders such as Down syndrome,
 sickle cell anemia … have their roots in heredity.

Our gender, and possibly our size, can make us susceptible to

certain influence on our health.

B. Health care facility

The cost and availability of health care services have an
obvious effect on the health of every community.
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 … cont’d
C. Environment
The environment is becoming more and more important
to our health and the deterioration of health.
As the ozone layer is being depleted, we humans are
exposed to more ultraviolet radiation.

The risk of eye damage and skin cancer is greater

exposure to sun.
Our water and food supplies are becoming more and
more polluted.

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 … cont’d

D. Behavior
To maximize the health of the population, individuals must
take responsibility for their own actions and the status of
their own health.

What we do is the major influence on our health.

The implications for behavior change, habit formation, and
lifestyle development form the basis for health education.

Lung cancer Vs smoking

High fat diet or low fiber Vs colon or rectum cancer
HIV infection Vs Multi-sexual partners
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 Historical development of health education

History of health education as an emerging

profession is only a little over one hundred years
old.

But the concept of educating about health has been

around since the dawn of humans.

It does not stretch the imagination too far to begin

to see how health education first took place.

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 …cont’d
Someone:
eaten a particular plant or herb and became ill - warn
others.

Official formulation of education policies has been

started in Europe and in USA at the beginning of the 20th
century

The first course of training for health education

specialists was given at London University Institute of
Education in 1957

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 …cont’d
At the time of Alma Ata declaration of PHC
in Russia (1978), health education was put as
one of the components of PHC

Recognized as a fundamental tool to the

attainment of health for all.

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 HE in Ethiopia,
Very difficult to know when and where exactly health
education has started

Beginning of health education could be related to the

introduction of modern medicine

After WW-II opening of Gondar Public Health

College & Training Center with the assistance of the
WHO, UNICEF and Point Four (USAID) in 1954 was
the most important advance in the history of health
services in Ethiopia
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 …cont’d
During this period,
the medical services and training
expanded

Mobile Child Health Centers started to

give health education on
child nutrition
personal hygiene and
Others preventive, curative and promotive
activities.
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 …cont’d
Following the declaration of Alma Ata, health
education was considered as one of the essential
means of:
prevention of diseases and
promotion of health.

The health policy and Health Sector

Development Program of Ethiopia have
identified health education as a major
component of program services.
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 …cont’d

As a course, it has been included in almost all

categories of health professionals training
curriculum.

It is also part of health professional practices in the

public health care delivery systems.

Jimma University in collaboration with the

concerned ministries has launched a training of health
education and promotion officers starting from
1996 E.C.
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 Aims of Health Education
Motivating people to adopt health-promoting
behaviors by providing appropriate knowledge &
helping to develop positive attitude.

Helping people to make decisions about their health

& acquire the necessary confidence & skills to put
their decisions in to practice.

To encourage people to adopt and sustain health

promoting lifestyle and practices.

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 Aims…
To promote the proper use of health services

To arouse interest, provide new knowledge, improve

skills and change attitudes in making rational decisions to
solve their own problems.

To stimulate individual and community self-reliance &

participation to achieve health development through
individual and community involvement at every step
from identifying problems to solving them.

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 Principles of Health education
All health education should be need based.

Multidisciplinary approach is necessary for

understanding of human behavior

It is necessary to have a free flow of communication

The health educator has to adjust his talk & action to

suit the group for whom he has to give health
education.

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 Principles…
Health Education should provide an opportunity for
the client or clients to go through the stages of
identification of problems, planning,
implementation and evaluation.

Health Education is based on scientific findings and

current knowledge.

The health educator has to make himself acceptable

He should to win the confidence of the his clients

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 Principles…
The health educator should not only have correct
information with him on all matters that he has to
discuss but also should himself practice what he
professes. Otherwise he will not enjoy credibility.

The health educator should remember that he is not

merely passing information but he is giving an
opportunity for the clients to analyze fresh ideas
with old ideas, compare with past experience and take
decisions that are found favorable and beneficial.

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 Principles…

bulk of information …

Avoid jargon words

start from the existing culture and

gradually try at change of habit and
practices.
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 Principles…
A differentiated & targeted approach in health
education.

The activating role of health education in

mobilizing the public.
Use audio-visual aids for support and
reinforcement

There should be conducive atmosphere

Patients should be made to know the objective of

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treatment for diseases
 Primary Health Care concepts & health education

WHO and other organization at Alma-Ata in

1978 officially declared "education concerning
prevailing health problems and the methods of
preventing and controlling them " as the
"first" among eight essential components of
primary health care.

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 PHC Cont’d…
PHC is: Essential health care based on:
 practical,
scientifically sound and socially acceptable methods
and
technology made universally accessible to
individuals and families in the community through
their full participation and at a cost that
community and the country can afford …
(WHO, 1978)

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 Cont’d…
It also emphasized the "right and duty (of people) to
participate individually & collectively in the
planning and implementation of their health care".

Hence the importance of health education in giving

peoples the confidence to exercise this right.

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 Cont’d…
Thus,
Since the declaration of PHC, Health education was identified as
a primary means of "Health for All."
Its central role is in improving community participation and
building the capacity of communities to make decisions.
Therefore, health education should aim at enabling people to
make choices.

In order to realize this the focus should be not only on

individual and community levels but also on the
political, professional and policy making levels in
following ways:
1. Promoting community involvement and self-reliance:
 "Experience has shown that the efforts to increase individual and
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community participation in the planning process
 Cont’d…
2. Enhancing decision-making skills at the local level:
 Encouraging and enabling communities to identify their health
problems, select solutions, set targets and translate these into
simple realistic goals that they can monitor

3. Allowing for a diversity of objectives in formulating policy

4. Harmonizing national and local plans

 Community involvement in planning through health education
facilitates the success of national policies.

 Community involvement can ultimately provide

continuous guidance to national policy from the grass roots.
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 Cont’d…
5. Facilitating Inter-sectoral action

 Many collective actions concerning health need to be taken in co-

operation with other sectors. E.g. school health
6. Using appropriate technology

 Policies are required to ensure the use of appropriate technology in

health education.
 This includes the use of:
Modern communication technology such as: radio, television, etc. And
Traditional methods of communication such as: legends songs, plays,
dramas.

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 Cont’d…
6. Measuring Community involvement and the impact of
health education.
More sensitive measures of health education outcomes are
required for monitoring

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