History of Health Education and Health Promotion

A brief history of health Education and Health Promotion

1. HISTORY OF HEALTH EDUCATION AND HEALTH PROMOTION Col Zulfiquer Ahmed Amin M Phil, MPH, PGD (Health Economics), MBBS Armed Forces Medical Institute AFMI)

2. A search for the origins of health education and health promotion leads to the earliest civilizations . The writings of the Babylonians, Egyptians, and Old Testament Israelites indicate that various health promotion techniques in relation to shelter, food, water and safety were utilized . There were community systems to collect rain water or otherwise provide safe drinking water . EARLY ORIGINS

3. There were various sewage disposal methods , including the use of earth closets . Personal cleanliness was advocated. Intoxication was recognized as troublesome. Dietary restrictions were numerous, and various sanitary restrictions governed the supply and preparation of food. Exercise was advocated. In some places building regulations were set, and street cleaning and garbage removal began to occur regularly. Mental health and spiritual health (e.g., a sense of harmony) were advocated.

4. In most early civilizations, health and religion overlapped . Organized religion sponsored many of the earliest health care facilities and practitioners of the healing arts. In some civilizations, the first temples were also the first hospitals . Regardless of the motivation, religious practitioners’ desire to improve the health and well-being of others has been a powerful force in the history of medicine , health education, and health promotion.

5. H istories of Public Health show that some form of collective public health measures have always been implemented by societies, although these would not have been called Health Promotion . Examples include: The Roman public baths. Roman laws governing burial of the dead and regulating dangerous animals and unsound goods. The regulation of prostitution in Ancient Rome and Greece. Inoculation against smallpox in India and China before the Christian era. The isolation of people with leprosy in Europe in the Middle Ages. The quarantining of ships by the Venetians.

6. Early Public Health Movement 20 th Century Medical Era 21 Century New Public Health Movement Advocated Housing, sanitation, Food Supplementation for Poor communities. Focused on structural a nd environmental m easures to reduce d isease burden. Emphasized developing and using medicine to treat and p revent ill-health, resourcing t ertiary hospitals and scientific r esearch. 1970: Medical Model & therapeutic Approaches questioned 1974: Lalonde Report- Symbolized start of new PH movement -1900- -1970- -1980- -1990- -2000- Health Education Health Promotion 19 th Century

7. The Early Public Health Movement in Europe The roots of today’s health promotion programs lie in the Industrial Revolution (Period from about 1760 to sometime between 1820 and 1840). The creation of large factories meant that thousands of people were brought together in congested, unsafe worksites located in congested, unsafe cities . Science and technology have had a significant impact on prevention by providing an understanding of the causative roles of pathogens and how to immunize people . Similarly, discovery of the effects of diet, exercise, and substance abuse on chronic disease led to the evolution and elevation of prevention programs.

8. In Northern Europe, the Industrial Revolution (late 18 th century in Britain), resulted in massive changes in population patterns and in the physical environment in which people lived.   In Britain, the overcrowded and unsanitary living conditions of the poor, coupled with the rise of cholera and typhoid as major causes of death, placed pressure on the government to introduce reforms or legislation to promote public health. In 1842, Edwin Chadwick , who was responsible for leading a “Health of Towns Commission” and advocating for the first public health reforms, suggested that the ill health experienced by the poor was a result of poor housing, sanitation and unclean water . His efforts resulted in the 1848 Public Health Act .

9. It was around this time ( 1854 ), that the now-famous incident involving John Snow , one of the first epidemiologists, took place. Snow discovered that cholera was a waterborne disease , by tracing an outbreak to a water pump in Broad Street, Soho, London. When use of the water pump was stopped, the outbreak stopped. Experiences such as these, together with public health legislation led to the appointment of Medical Officers of Health by local authorities, to enforce public health legislation and advise on appropriate measures.

10. The rise in popularity of the Medical Model Motivations aside, at the end of the nineteenth century , the emphasis on improving environmental and social conditions in order to prevent ill-health was overshadowed by the rising popularity and investment in a medical (or curative) approach to tackling ill-health .

11. Questioning the Medical Model   The social climate of the 1960s and 1970s was characterised by protest, activism and challenging of the status quo or existing conditions. In addition, during the early 1970s, many countries were experiencing a crisis in health care costs . People began to consider that whilst medicine might be good against acute illnesses like TB or pneumonia, it did not appear to have much to offer in other areas such as cancer. The rates of cancer were still the same and there was still no cure for the disease . Thus, value or returns from the investment in medical technology appeared to be decreasing.

12. Questioning the Medical Model   An important hypothesis or theory proposed by Thomas McKeown (1976) re-confirmed the importance of non-medical factors in improving the health of populations in industrialised countries. IN A BODY OF RESEARCH published from the 1950s to the 1980s , the physician and demographic historian Thomas McKeown put forth the view that the growth in population in the industrialized world from the late 1700s to the present was due not to life-saving advancements in the field of medicine or public health, but instead to improvements in overall standards of living, especially diet and nutritional status, resulting from better economic conditions . The “ McKeown thesis” sparked the inquiries and shaped the research hypotheses of many scholars and became the subject of an extended controversy.

13. The New Public Health Movement   The Lalonde Report ( 1974 ) is the first major landmark in what came to be known as the New Public Health Era . This report suggested that greater emphasis should be attributed to the environment and to behavioural factors as causes of disease and death, rather than biophysical characteristics.   The Lalonde Report described four health fields as having an influence on health and illness: - Medicine and health care services. - Lifestyle or behavioural factors. - The environment. - Human biology.

14. Health education has traditionally been used to refer to educational interventions . The basic approach evolved from the moralistic (“Don’t do it because God or the church doesn’t want you to.”) to the legalistic (“Don’t do it because it’s against the law.”). With this shift, educational programs began to focus on possible harmful effects of certain substances or behaviors and why they were illegal. Of course, one objective was to explain what would happen to lawbreakers if caught. Another was to urge legislators and others to engage in social engineering , such as passing laws mandating safety-related provisions , such as the use of air bags.

15. The educational process has changed as well. The original models were cognitive (presenting the facts) , but they were replaced by affective models (changing attitudes ) , peer-counseling and peer support models, decision-making models, and , most recently, behavioral models.

16. WHO: Global Strategy for Health for All by the Year 2000 (1977), and the International Conference on Primary Health Care , Alma-Ata (1978)   In 1977, the thirtieth World Health Assembly decided that the main health-related goal of governments and the World Health Organisation in the coming decades should be directed at ensuring that all the people of the world attain a level of health that would permit them to lead socially and economically productive lives . This became know as the Global Strategy for Health for All by the Year 2000 (HFA 2000). The significant feature of HFA 2000 was the recognition that the main determinants of health lay outside the health sector - namely food, water, sanitation, housing, employment etc.

17. International Conference on Health Promotion, Ottawa, Ontario, Canada (1986)   In 1986, the first international conference on Health Promotion was held in Ottawa, Canada. The Ottawa Charter for Health Promotion outlined five areas in which Health Promotion action should be directed:   - Building healthy public policy. - Creating supportive environments. - Strengthening community action. - Developing personal skills. - Re-orienting health services.  

18. GLOBAL CONFERENCES ON HEALTH PROMOTION Conference Venue Year Ottawa Charter of Health promotion Canada 1986 Adelaide Recommendation on Health Public Policy Australia 1988 Sundsvall Statement on Supportive Environment for Health Sweden 1991 Jakarta Declaration on Leading Health Promotion into the 21 st Century Indonesia 1997 Mexico Ministerial Statement for the Promotion of Health Mexico 2000 Bangkok Charter for Health Promotion in a Globalized World Thailand 2005 Global Conference on Health Promotion, Nairobi Kenya 2009 Global Conference on Health Promotion, Helsinki Finland 2013 Global Conference on Health Promotion, Shanghai China 2016

19. City Country Year Theme Alma Ata USSR 1978 Health for All by 2000 Ottawa Canada 1986 Ottawa Charter Adelaide Australia 1988 Building Healthy Public Policy Sundsvall Sweden 1991 Supportive Environment for Health Jakarta Indonesia 1997 New Player for a New Era Mexico City Mexico 2000 Bridging the Equity Gap Bangkok Thailand 2005 Policy and Partnership for Action Nairobi Kenya 2009 Call to action Helsinki Finland 2013 Commit Health as a Political priority Shanghai China 2016 Healthy Cities and Good Governance