Changing theory and practice: from health education to education for health

The current focus of education for health has moved a long way from the roots of health education in Australia. Ritchie (1991) identified 4 stages to illustrate this progression.

Stage 1: education through health information provision - 1910 to the 1960s

This approach was characterised by:

• providing people with logical, rational and scientific information about health
• a belief that people would adopt appropriate attitudes and behaviours if they were given the facts
• some limited successes, but generally, the approach did not work. Providing health information alone did not lead to changed behaviour

Stage 2: education through varied audio-visual channels - mid 1960s to 1970s

This approach was characterised by:

• sophisticated social marketing approaches used in health promotion to raise awareness and set health agendas
• bombarding clients with information in a variety of forms - TV, posters, radio, written material
• belief that patients would retain information, and change behaviour, if they received the information in a form that attracted them (called the 'hypodermic needle approach' by Rogers, in Ritchie 1991) health professionals continuing, as the experts, to make the decisions about what information was shared

Stage 3: education incorporating adult learning principles - 1970s to mid 1980s

This approach was characterised by:

• including the patient or community member as an active participant in the education process
• recognition that people can change, but on their own terms
• belief that information needs to be relevant and meaningful to be effective
• recognition that opportunities for discussion, for challenging new ideas, and for reflection can enhance learning
• acknowledgment that the social and environmental conditions within which a person lives may prevent them from making changes or taking control of their health
• continuing emphasis on individuals changing their behaviour or choosing not to
• concern raised about the danger of 'victim blaming' when people are unable to make changes. It was argued that many people have limited control over their lives, and lack resources to take the recommended steps

Stage 4: education for health within the Ottawa Charter Framework - 1986 to present

This approach is characterised by:

• recognition of education for health as one component of a broad approach to improving health
• less focus on disease prevention or management
• more acknowledgment that the determinants of health are social and environmental
• adoption of the Ottawa Charter, which outlines five action areas for health promotion with the health educator having a role in:
  - strengthening community action through an enabling and supporting role
  - developing personal skills in others both to practise desired health behaviour and to build their personal capacity to make wise health choices
  - creating supportive environments to better support and sustain individual change
  - building healthy public policy through influencing policy decision makers
  - reorienting health services towards prevention and health promotion

The Jakarta Declaration of 1997

The Ottawa Charter for Health Promotion is still current and has been strengthened by the outcomes of the Jakarta Declaration. The Declaration describes health promotion as "an essential element of health development, as a process of enabling people to increase control over and to improve their health". Health promotion through investments and actions, aims to:

• act on the determinants of health and create the greatest gain for people
• contribute significantly to the reduction of inequities in health to ensure human rights
• build social capital The ultimate goal is to increase health expectancy, and to narrow the gap between countries and groups (WHO 1997).