Chapter one

Introduction to Health education and

Health promotion

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Learning objectives
At the end of this session, students will able to
- Define key terms such as health ,health education and other related
terms
- Understand concept of determinants of health
- Understand rationale and objective of health education
- Differentiate the concept of health education and health promotion
- List the principles of health education and promotion
- Discuss the role of health education in Primary health care (PHC)

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 1. What is health ?

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 Definition of health

 Before discussing about health education, it is imperative to

conceptualize what health itself means.

 Health is a highly subjective concept.

 Good health means different things to different people, and its

meaning varies according to individual and community. Many people
consider themselves healthy if they are free of disease or disability.

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Cont…
 Generally ,there are two different perspectives concerning people’
definitions of health that you as a Health professional will be
expected to understand; a narrow perspective and a broader
perspective.

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 Cont…
Narrow perspectives of health

 People with a narrow perspective consider health as the absence of

disease or disability or biological dysfunction.

 According to this view (or model), to call someone unhealthy or sick

means there should be evidence of a particular illness.

 Social, emotional and psychological factors are not believed to cause

unhealthy conditions.

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 Cont…
Broader perspectives of health

Defining health :
o The most widely used of the broader definitions of health is that
with in the constitution of the World Health Organization
(1948),which defines health as:

‘A state of complete physical, mental and social well-being, And

not merely the absence of disease or infirmity’.

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A. Physical health/wellbeing

 The absence of diseases or disability or infirmity; biological integrity of

the individual; and physical and physiological capabilities to perform
routine tasks.

 This means, individual is seen as healthy if all the body parts; cells,
tissues, organs, organ systems are functioning well.

E.g. physical fitness needed to walk form place to place

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B. Mental wellbeing
 The mentally healthy adult shows behavior which confirms an
awareness of self or personal identity and willingness to perceive
reality and cope with its difficulties.
 Responds flexibly in the face of stress, receives pleasure from a
variety of sources, and accepts one's limitations realistically.
 has a capacity to live with other people, to understand their needs, and
to achieve a mutually satisfying heterosexual relationship.
 In sum, the mentally healthy person shows growth and maturity in
three areas: cognitive, emotional and social.

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C. Social health/wellbeing

 mental adjustment of the individuals to other around him in the family

or community.

 This is the ability to maintain one's identity while sharing,

cooperating, communicating, and enjoying others; participation in
friendship, family and community life.

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Cont…
 It is in some ways subsumed under mental health.

 It is impossible to be healthy in a sick society like society that

undermines women’s contribution, racist society, countries of extreme
oppression etc...

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D. Emotional health

 The ability to recognize emotions such as fear, joy, grief and anger and
to express such emotions appropriately (coping with stress, tension,
depression and anxiety).

 It is related to mental health

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E. Spiritual health

 For some it is connected with religion, for others with personal creeds,
values, principles of behaviour and achieving peace and being at
peace.

Criticism of WHO definition

Too idealistic and unrealistic to achieve

 No person can reflect/fulfill all of the components at a point in time.

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 What are the factors that determine health of
individual ,family and community ?

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Which one of the following has link with health?

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1.2 Determinants of health
Many factors combine together affect health of individual and
communities.

 Peoples are healthy or not determined by their circumstances and

environment.

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Cont…
Determinants of health includes
 social and economical environment
 physical environment
 individual characteristics and behavior

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o Income and social status : Higher income and social status
o Education : Lower education level linked to poor health
o Physical Environment : Safe water, clean air ,healthy work place ,safe
houses ,communities and roads
o Social support : Greater social support from families ,friends and community
linked to better health
o Genetics : some diseases are inherited through gene
o Personal behavior and life style

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1.3 Definition of health education

Health Education: is any combination of learning experiences designed

to facilitate voluntary action conducive to health”.

The terms “combination, designed, facilitate and voluntary action”

have significant implications in this definition.

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

• Designed: distinguishes health education from incidental learning

experiences as systematically planned activity.

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Cont…
• Facilitate means create favorable conditions for action.

• Voluntary action means behavioral measures are undertaken by an

individual, group or community to achieve an intended health effect
with out the use of force. i.e., with full understanding and acceptance
of purposes.

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 1.4 Rationale for health education

 The continued existence and spread of communicable diseases.

 such as malaria, TB, HIV/AIDS
 About 75% of childhood illnesses are preventable

 For some diseases health education is the only practical choice:

 in order to prevent the spread of the disease or to lead a
normal life. E.g. HIV/AIDS.

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Cont…
Increasing the tendency of chronic conditions.
E.g. Hypertension.

Human behaviors are almost the single causes for the development of
such currently emerging health problems and also the main solution.

Many people do not seek treatment until it is too late. Ignorant, access,
afraid of seeking treatment

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Cont…
Prevention is better than cure. which is generally true especially for non
communicable diseases

Increasing threats to the young from new and harmful behaviors.

E.g. tobacco use, teen-age pregnancy, substance use etc.

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1.5 Objectives of health education
Ultimate goal of health education is to promote, maintain and improve individuals and
community health.
Educational objectives of health education
To provide appropriate knowledge: provision of correct knowledge, facts and
information.
For example, facts about CVD, HIV/AIDS.
To help develop positive attitude: has a lot to do with changing opinions, feelings and
beliefs of people.

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cont…

To help exercise health practice/behavior: concerned with helping people in

decision-making and actually performing.
For example helping people choosing alternatives (whether to abstain, be
faithful, or use condom)
Decision-making: means choosing between and/or among alternatives in
the future about health.

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 1.6 Principles of health education

1. Principle of educational diagnosis

The first task in changing behaviors is to determine its causes.

If the causes of the behaviors understood, health educator can intervene
with the most appropriate and efficient combination of education,
reinforcement and motivation.

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Cont…
2. Principle of multiple methods

This principle follows from the principle of educational diagnosis. In

so far as multiple causes will consistently be found for any given
behaviors.

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Cont…

3. Principle of Participation

The prospect for success in any attempt to change behaviors will

be greater if the individuals, families, community groups, etc…
have been participated in identifying their own needs for change
and have selected the methods that will enable them to take
action.

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Cont…

4. Principle of planning and organizing

Planning and organizing are fundamentals for health education which

distinguishes it from other incidental learning experiences.

It involves deciding in advance the when, who, what, how and why of health
education.

It also requires the planning for resources, methods and materials to be used,
identification of target groups etc.

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Cont…
5. Facts
Health education is given based on scientific findings/facts and current
knowledge.

6. Segmentation
Health education should be designed for a specific group of people/specific
target groups

7. Need based
Health education is primarily educational and its purpose is to ensure a desired
health related behavior after real need identification.
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Cont…
8. Culture

Health education should not considered artificial situation or formal

teaching –learning process.

 One has to get into the culture of the community to introduce new
ideas easily

Rigid statements particularly contrary to existing belief, culture,

practices will not be liked.

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Health promotion Vs. health education concepts

Health promotion

Is defined as, “The process of enabling people to increase, control over, and
to improve their health”, (Ottawa Charter 1986).

Another definition of Health promotion by Green & Kreuter is that, health

promotion is, “Any combination of educational, political, regulatory and
organization supports for actions and conditions of living conducive to
health of individuals, groups or communities” – (Green & Kreuter, 1981)

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Cont…

Health promotion is the science and art of helping people change their
lifestyle to move toward a state of optimal health.

It is a process which empowers families and communities to improve their

quality of life, and achieve and maintain health and wellness.

It emphasizes not only prevention of disease but the promotion of positive
good health.

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Cont…
Health promotion is any combination of health, education, economic,
political, spiritual or organizational initiative designed to bring about
positive attitudinal, behavioral, social or environmental changes
conducive to improving the health of populations.

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HE Vs HP

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1.7 Principles of Health Promotion

The key principles of health promotion as determined by WHO are as

follows:

 Health promotion involves the population as a whole in the context

of their everyday life, rather than focusing on people at risk from
specific diseases.

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Cont…
Health promotion is directed towards action on the determinants or
cause of health.

This requires a close co-operation between sectors beyond health care

reflecting the diversity of conditions which influence health.

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Cont…
Health promotion aims particularly at effective and concrete public
participation.

 This requires the further development of problem-defining and

decision-making skills, both individually and collectively.

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Cont…
Health promotion combines diverse, but complementary methods or
approaches including;

communication, education, legislation, organizational change,

community change, community development and spontaneous local
activities against health hazards.

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In general, Health Promotion includes
Promoting healthy lifestyles.

Getting people involved in their own health care.

Creating an environment that makes it possible to live a healthy life.

Recognition of lifestyle diseases as major causes of illness and death.

Strengthening community participation.

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Example of preventable health problems related to lifestyle

Chronic non-communicable diseases such as diabetes and hypertension.

These are major causes of illness and death. They are related to…

• Overweight and obesity.

• Unhealthy diet.

• Insufficient physical activity.

HIV/AIDS is related to unsafe sexual lifestyle, and causes many deaths.

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  Primary Health Care & Health Education

PHC is defined

Essential health care made accessible at a cost a country and

community can afford, with methods that are practical,
scientifically sound and socially acceptable(WHO, 1978)

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  Role of HE in PHC
HE is:

A component of PHC

Core principles of PHC is “community participation”.

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 Role of health education in PHC

Immuniza
tion
Provisions
Food and
of
proper
essential
nutrition
drugs

Health
Treatment of Education
common
MCH
disease and
injuries

Prevention
Safe and
and control
adequate
of locally
water
endemic
supply
disease
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Cont…

HE is the primary means of achieving health for all, thus:

• It is central to primary health care
• All components of primary health care have health education
• Primary health care can not successfully implemented without
health education.

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 Main Principles of PHC

1.Equity

2.Community Participation

3.Inter-Sectoral Approach

4.Appropriate Methods and Technology

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Cont…

5. Health Promotion and Prevention - PHC requires a comprehensive approach

that is based on the following interventions:

• Promotive - addresses basic causes of ill-health at the level of society

• Preventive - reduces the incidence of disease by addressing the immediate

and underlying causes at the individual level

• Curative - reduces the prevalence of disease by stopping the progression

of disease among the sick

• Rehabilitative - reduces the long-term effects or complications of a health

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problem.
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