1. Historical Context of Health Education

2. Brief Activity
Talk to your neighbor -- what you think were some of the social and political factors that shaped the development of health promotion - health education?

3. Evolution of Health Education
The development and evolution of health education was part of the larger societal context where public health initiatives were developed in response to important needs…

4. Historically, problems that drove the need for health education:
Poor sanitation conditions
Major diseases (plague strikes & acute, infectious conditions)
Growth of cities during industrial revolution
It is helpful to understand the chronological development of public health, science, and the problems which drove the need for public health.

5. Health Education History

6. Why Study Health Education History?
Can’t fully appreciate the profession without knowing of the origin
Allows to see progress made & trends over time
Causes of health drove prevention approaches…
Provides an appreciation of the obstacles faced by pioneers of the profession
Learn useful lessons from the past about health education practice

7. Education about health has existed for ages!

8. Early Humans
Disease was puzzling; caused by magic or malevolent spirits
To prevent disease - sacrifices were made & spells and chants were used
Health-related knowledge was learned from observation, trial, and error
Knowledge transformed rules or taboos for a society & passed thru generations (community health standards)

9. Evidence of community health found in earliest of civilizations

10. Signs of community health practices through sanitation efforts
India  4,000 years ago
Signs of community health practices through sanitation efforts

11. Babylon
One of the earliest set of laws that specifies the conduct of health practices
Code of Hammurabi: Created by the King of Babylon
Served as a code of conduct for physicians

12. Egyptians ( B.C.)
Smith Papyrus: the world's oldest surgical document (trauma surgery) that is from the only surviving copy of an Ancient Egyptian textbook on medical literature.
Descriptions of primitive medicine practices based in part to priest-physician roles.
Health practices emphasized personal hygiene – well known for personal cleanliness

13. Hebrews (1500 B.C.) Extended the Egyptian hygienic emphasis…
Formulated the world’s first hygienic code in the biblical book of Leviticus.
Biblical book dealt with personal and community responsibilities, including:
Guidance regarding the cleanliness of body
Sexual health behaviors
Protection against contagious diseases and
The isolation of lepers

14. Greeks ( B.C.)
During this period, major focus on community health improvements via sanitation practices.
Health = balance among physical (athletics), mental (philosophy), and spiritual (theology)
Through the Asclepius – god of medicine - 1st to emphasize disease prevention
Hygeia – power to prevent disease
Panacea – ability to treat disease
Hippocrates
Atomic theory
matter is composed of discrete units called atoms
1st epidemiologist and father of medicine

15. Romans (500 B.C.- A.D. 500)
Accepted many Greek “community-health related” ideas (emphasis on relationship b/w health and environmental factors)
Improved upon Greek engineering in the building of aqueducts to protect water supplies & improve sanitation.
Advances in Medicine:
Created the first hospital
Distinguished b/w public medical service & private medical practice
emphasis on science: study of anatomy & practice of surgery

16. Middle or Dark Ages (500 B.C.- A.D. 1500)
During this time, there was an ending of Roman ideology and emphasis on superstitions…
Health problems considered to have spiritual causes and solutions.
Illness considered to be the result of sin.
Failure to consider the role of the environment in health (overcrowding, sewage removal, lack of fresh water) led to epidemics and the inability to control them.
Major problems:
The Black Plague (known as bubonic plague). About 60% of the population in major European cities died in the first two years of the pandemic

17. Renaissance -rebirth (A.D. 1500 – 1700)
Science reemerged as a legitimate field (replaced superstition)
Progress slow - medical care rudimentary with still much disease & plague
Barber–surgeons; bloodletting (withdrawal of considerable quantities of blood to cure/prevent disease)
Hygiene in all was lacking (English royalty lived better)
Microscope discovered; epidemiology studied
Public health boards instituted to fight plague --16th century in Italy

18. Age of Enlightenment (1700s)
A period of industrialization & growth in cities (people in search of work)
Disease & epidemics still frequent
Progress in epidemiology (but medical knowledge still rudimentary):
Miasma theory - disease caused by pollution or “bad air”
James Lind discovered scurvy (disease from deficiency of vitamin C)
Edward Jenner discovered vaccine for smallpox

19. The 1800s First half of 1800s little progress & much disease
1842: Chadwick’s Report on an Inquiry into the Sanitary Conditions of the Laboring Populations of Great Britain
1849: Snow identified the source of the plague outbreak as “the public water pump on Broad Street England.”
Attributed to the conditions of poverty and rapid urbanization.
1862: Pasteur introduced germ theory - microorganisms are cause of many diseases
1876: Koch aligned specific microbes with specific diseases
: bacteriological period of public health

20. Public Heath in the United States

21. 1700s Health conditions similar to Europe
Sanitation poor
Disease rampant
Cities growing, overcrowding, many immigrants
Quarantine & environmental regulations used
1789: 1st life expectancy tables created
1790s: some cities formed local health boards
1798: Marine Hospital Service Act…which later formed Public Health Service

22. 1800–1850 1850-1900 Little progress, still much disease
Industrial Revolution brought more people to cities
Epidemics were common; life expectancy dropped
Public health reform slow…but got started
1850: Shattuck’s Report of Sanitary Commission of Massachusetts
Social Reformers -- Edwin Chadwick and Lemuel Shattuck outlined the public health needs and recommended the creation of the first state board of health
1872: APHA founded
By 1900: 38 states had formed boards of health; county boards were developing too
1879: National Board of Health created

23. 1900–1920: 19th C brought tremendous advances in the understanding of health and medicine. There was an acceptance of link between environment and health.
Increased momentum of public health social reforms
First voluntary health agencies formed
1902: National Assoc. for Study & Prevention of TB
1913: American Cancer Society
Polio hits epidemic proportions by 1916
1918–1919: influenza outbreak - kills over 600,000
1920s
Growing awareness: NEED for health education which was observed via: screening and prevention efforts

24. Early Health Education
1923: Scholarly writings about modern PH and the role of health promotion emphasized “Health Education”
HE Machinery: health bulletins, health news services, health lecture bureaus and institutes, health exhibits, & health radio programs (importance of health communication).
HE Goals: securing community support for promoting health and the prevention of disease through the use of preventive health (education) services.
Outcome: Health education became a major tool for accomplishing these goals during the middle of the 20th Century.

25. 1930s & 1940s
Still a major emphasis on treatment over prevention…why?

26. 1930s & 1940s
1929: Great Depression
Acute, communicable diseases were major problem – polio, TB, influenza
1929: major breakthrough – vaccines/immunizations when Penicillin discovered
Community or population health grew in importance (public health vs medicine)
1933: New Deal of Roosevelt (giving relief to unemployed and badly hurt farmers of great depression)
Social Security Act of 1935 (beginning of federal government’s involvement in social issues) – poor and elderly via medicaid/medicare

27. Why, during the 2nd half of the 20th Century was there a growth in the importance of health education?

28. 1950s & 1960s
1954: problem of greatest significance was chronic disease (a switch from acute diseases); also planted the seed for health educators to play a greater role in prevention

29. Leading Causes of Death: 1900 vs 1997

30. Unlike the 19th Century causes of poor health via infectious diseases (social, economic and physical environments), what were epidemiological studies pointing to as the causes of poor health via chronic diseases?

31. Epidemiological Findings
Studies identified individual health behaviors or personal characteristics to be associated with increased risk for chronic diseases.
What individual behavior do you think was the 1st to receive prominent public health attention?

32. Public Health Major Issues
Smoking (tobacco use)
Landmark Report: U.S. Surgeon General’s Report during the 1960s
Smoking (a preventable behavior) causes lung cancer & heart disease (two of the leading causes of death in US)

33. 1970s… 1974 to present: Health Promotion Era of Public Health
Introduction to Healthy People publication
Emphasizing importance of lifestyle (behavior) and prevention
Principle tool: health education

34. 1980s, & 1990s
1980: Objectives of the Nation; 1st set of objectives to promote health/prevent disease
1990: Healthy People 2000, National Health Promotion & Disease Prevention Objectives…
3 part roadmap to improve health using a 10 year plan
Part I: History, Determinants of health model, How to use a systematic approach, Leading Health Indicators
Part II: Two goals (Increase quality and years of healthy life, Eliminate health disparities), & 467 objectives in 28 focus areas
Part III –Tracking of progress

35. 2000s 2006: Healthy People 2010, Midcourse Review
Assess progress of 281 of the objectives
National Public Health Performance Standards Program (NPHPSP)
Development of HP 2020 objectives

36. Focus of Health Education Efforts
Main strategies of HE still focused on promoting health and preventing disease via health communication efforts.
Promoting optimal use of health care (screening and immunization) among individuals to expand the capacity of individuals to practice self-care (behavior change)
Promoting that individuals modify behaviors to prevent disease (use of seat belts, stop smoking, stop drinking, safe sex, etc.) and promote health (increase quality of life)

37. Have we met our goals?

38. Ten Great Public Health Achievements–U.S., 1990-1999

39. Ten Greatest Public Health Achievements of the 20th Century
Vaccination
Motor vehicle safety
Safer workplaces
Control of infectious diseases
By the end of the 20th Century there were many great advances. Much of the decline in morbidity and mortality in the 20th Century can be attributed to public health achievements. The ten greatest public health achievements in the 20th Century are:
Vaccination
Motor vehicle safety
Safer workplaces
Control of infectious diseases
Decline in deaths from coronary heart disease and stroke

40. Ten Greatest Public Health Achievements
Decline in deaths from coronary heart disease and stroke
Safer, healthier food
Healthier mothers and babies
Safer, healthier food
Healthier mothers and babies
Family planning
Fluoridation of drinking water
Recognition of tobacco as a hazard

41. Ten Greatest Public Health Achievements
Family planning
Fluoridation of drinking water
Recognition of tobacco as a hazard
Family planning
Fluoridation of drinking water
Recognition of tobacco as a hazard
Image from Images of American Political History

42. 21st Century Health Promotion Bioterrorism/Distaster Preparedness
Emerging Infectious diseases
Strengthening the public health workforce and infrastructure
Anthrax
Public Health is something that many people take for granted. When it is working, it is not seen. Thus it is often easy for decision-makers to undervalue public health. This has led to a systematic breakdown of the public health infrastructure over the past several decades. Unfortunately, it has taken the increase in outbreaks and a catastrophic event and its aftermath to demonstrate the critical role public health plays.
We now have a better understanding of issues facing public health in this century.
A ongoing mission for health promotion
Bioterrorism/Distaster Preparedness
Emerging Infectious diseases
Strengthening the public health workforce and infrastructure

43. 21st Century Health care finance and access. Aging population
Poverty and social justice
Health disparities
Public health genomics
Globalization
The need to strengthen the public health workforce and infrastructure
Issues of health care finance and access.
Poverty and social justice
Public health genomics
Globalization

44. School Heath in the United States

45. Early education practices came from England; school year was short
1837, Horace Mann, Secretary of Massachusetts Board of Education, called for mandatory programs of hygiene
Hygiene education
Mid-1800s, most schools tax supported & attendance required
1850, Lemuel Shattuck’s report called for teaching of physiology
1880–1890, all states passed law requiring teaching on evils of alcohol, narcotics, & tobacco because of pressure from Women’s Christian Temperance Union

46.
Health education characterized by inconsistency & slow progress…
1915, National TB Association introduced “Modern Health Crusade”
Sally Jean Lucas, active leader in Child Health Organization of America, was responsible for changing name from hygiene education to health education
Became imporant to govt agenda: WWI, 29% of men rejected for service on physical grounds; helped show need for school health

47. 1920s, 1930s, & 1940s School Health Profession was moving forward
A number of school health demonstration projects; showed habits could be changed & health improved
A number of other professional organizations include school health in their title or mission
1927, American Association of School Physicians founded; later (1938) becomes American School Health Association (break away from medicine)
Increased need at govt level: WWII, 50% of men rejected for service

48. 1964
School Health Education Study (SHES) directed by Dr. Elena Sliepcevich
Phase 1, Surveys of students & administrators; results were appalling
Phase 2, Health curriculum; 10 conceptual areas
1978
Office of Comprehensive School Health established in USDE

49. CDC Advocated Coordinated School Health

50. Key Elements of Comprehensive Health Education

51. National Health Education Standards

52. Today Schools still hold great promise for health education efforts
54 million K-12 students
121,000 schools
CDC’s six critical behaviors
Alcohol & drug use
Injury & violence (including suicide)
Tobacco use
Nutrition
Physical activity
Sexual behaviors