HISTORICAL BACKGROUND

AND ISSUES AND TRENDS IN

HEALTH EDUCATION

By: Cherry Anne L. Pingad,

LPT
HEALTH
• Derived from the old English word
for heal: HAEL which means whole.
• concerns the whole person and his
integrity, soundness, or well-being .
Dimensions of Health
➢ Individual
• Physical
• Mental (Psychological/Intellectual)
• Emotional
• Social
• Spiritual
• Sexual
➢ Broader
• EnvironmenTal
• Societal
 Dimensions of Health
➢ Physical health
• Refers to the state of one’s body like its
fitness and not being ill
• Biological integrity of an individual where
there is optimum functioning of the physical and
physiological abilities and freedom from disease or
disability
 Dimensions of Health
 Mental Health (psychological health)
• Intellectual capabilities
• Refers to the positive sense of purpose
and underlying belief in one’s own worth
like feeling good and feeling able to cope
 Dimensions of Health

Emotional Health
• The ability to express one’s feelings appropriately
and to develop and sustain relationships
➢ Social Health
• Involves the support system that is available
from family members and friends
➢ Spiritual Health
• The recognition of a Supreme Being or Force and the
ability to put into practice one’s moral principles or
beliefs
 Dimensions of Health
➢ Sexual health
• Refers to the acceptance of and the ability to achieve a satisfactory
expression of one’s sexuality

➢ Societal Health
• The link between health and the way a society is structured
• Includes the basic infrastructure necessary for health.

➢ Environmental Health
• Refers to the physical environment where people live
 HEALTH
➢ State of complete physical, mental, and social well-being and
not merely the absence of disease and infirmity (WHO)
➢ A state characterized by soundness and wholeness of
human structures, bodily and mental functions (Orem)
➢ the goal of public health in general and of community
health is the optimum level of functioning (OLOF) of individuals,
families and communities which is affected by several factors in
the ecosystem (modern concept)
 Factors which Affect the Optimum Level of Functioning (OLOF)

➢ Political Factors
• Involve power and authority to regulate the environment
or social climate

➢ Behavioral
• Refers to a person’s level of functioning and is affected
by certain habits, their lifestyle, health care and child rearing
practices which are determined by one’s culture and ethnic
heritage
Factors which Affect the Optimum Level of Functioning
(OLOF)

➢ Heredity/Hereditary Factors
• Refers to the understanding of
genetically influenced diseases
and genetic risks .
Factors which Affect the Optimum Level of Functioning (OLOF)

➢ Health Care Delivery System

• totality of all policies, infrastructures,
facilities, equipment, products, human
resources & services which address the
health needs & concerns of the people
Factors which Affect the Optimum Level of Functioning (OLOF)

➢ Environmental Influences
• Menace of pollution, communicable diseases due to poor
sanitation, poor garbage collection, smoking, utilization of
pesticides, lack or absence of proper & adequate waste &
sewerage disposal system & management, urban/rural
milieu, noise, radiation, air &water pollution
➢ Socio-economic Influence
• Families in lower income group are the ones mostly served
 Health through the Years
➢ 1800s – health was associated with poor hygiene and unsanitary
conditions: health was the opposite of sickness
• Medical Model – health is an individual issue: the way to improve
an individual’s health was to treat the illness
• Episodic care – seeking treatment for injury or illness
➢ 1900s – health was associated with an individual’s interaction
with the social/physical environment:
• Ecological or Public Health Model –viewed diseases & other
negative health events because of an individual’s interaction with
his/her social and physical environment
• Prevention – identify risk factors to reduce risk of injury or
illness.
Health through the Years
➢ 1947 – World Health Organization (WHO) defined health
as: “Health is the state of complete physical, mental, and
social well-being, not just the absence of disease or
infirmity.”
➢ 1960–1970 – Comprehensive Ecological or Public Health
Model adds to the definition of health the physical, social, &
mental elements of life, as well as environmental,
spiritual, emotional, & intellectual dimensions
➢ Today – “quality” of life is considered just as important
as years of life
➢ Philippine Constitution of 1987
• Article XIII, Sec 11
✓ The State shall adopt an integrated and
comprehensive approach to health development which
shall endeavor to make essential goods, health and other
social services available to all the people at affordable cost.
There shall be priority for the needs of the underprivileged
sick, elderly, disabled, women, and children. The State shall
endeavor to provide free medical services to paupers
➢ World Health Organization (1995)
• Believes that governments have a
responsibility for the health of their
people which can be fulfilled only by the
provision of adequate health and social
measures
3 basic positive concepts of health
• Reflecting concern for the individual
as a total person
• Placing health in the context of the
env’t.
• Equating health with productive &
creative living
Public Health
• The science and art of preventing disease, prolonging life
and promoting health through the organized efforts and
informed choices of society, organizations, public and
private communities and individuals.

• Public health is the combination of sciences, skills, and

beliefs that is directed to the maintenance and improvement
of the health of all the people through collective or social
actions.
 Characteristics of Public Health
1.It deals with preventive rather than
curative aspects of health.
2.It deals with population level-rather
than individual-level health issues.
Essential Public Health functions
•Monitor health status to identify community
health problems.
•Diagnose and investigate health problems and
health hazards in the community.
•Inform, educate, and empower people about
health issues.
•Mobilize community partnerships to identify
and solve health problems.
•Develop policies and plans that support
individual and community health efforts.
Essential Public Health functions
•Enforce laws and regulations that protect health and
ensure safety.
•Link people to needed personal health services and
assure the provision of health care when otherwise
unavailable.
•Assure a competent public health care workforce.
•Evaluate effectiveness, accessibility, and quality of
personal and population-based health services.
•Research for new insights and innovative solutions
to health problems.
 Health Education
• Disseminating information
• Teaching people how to take care of their
health.
• Telling people what to do to protect
themselves from disease, etc.
 Health Education
• “Comprises of consciously constructed
opportunities for learning involving some form
of communication designed to improve health
literacy, including improving knowledge and
developing life skills which are conducive to
individual and community health .“ (World Health
Organization definition)
SCOPE OF HEALTH EDUCATION

• Health Services systems

• Health behavior and
motivation
• Environmental hazards
 HEALTH BEHAVIOR
• Any activity undertaken by an individual
regardless of actual or perceived health
status, for the purpose of promoting,
protecting and maintaining health,
whether or not such behavior is
objectively effective towards that end”.
(WHO, 1998)
3 Cathegories of Health education
• Preventive Health Behavior: Any activity undertaken by an individual
who believes himself to be healthy for the purpose of preventing or
detecting illness in an asymptomatic state
• Illness Behavior: any activity undertaken by an individual who
perceives himself to be ill; to define the state of his health and to
discover suitable remedy.
• Sick Role Behavior: any activity undertaken by an individual who
considered himself to be ill for the purpose of getting well. It includes
receiving treatment from medical providers, generally involves a whole
range of dependent behaviors, And leads to some degree of exemption
of one’s usual responsibilities.
Purpose of Health Education
• To contribute to health and well-being by promoting
lifestyles, community actions and conditions that
make it possible to live healthful lives
➢ Health Educators take on profound responsibilities
in using educational processes to promote health
and influence well-being (Code of Ethics of the
Society for Public Health Education, Inc.-SOPHE)
 Legal Basis of Health Education

➢ The Philippine Constitution of 1987, Art XI,

Sec 15
• The State shall protect and promote the
right to health of the people and instill health
consciousness among them
Various settings of Health Education

• Health care settings

• Schools
• Communities
• Work settings
 HEALTH EDUCATION FOUNDATIONS:
• Philosophical foundation – it serves as a beacon light so that health
educators may be properly guided in their work.

• Biomedical foundation – it gives health educators the content or the

what of health education programs. This is based on the finding of
biomedical sciences. Health educators must be updated in the recent
findings in this field so that messages that are disseminated may be
scientifically accurate.

• Behavioral Science foundation – it provides the educator the how or

the theories or methods of bringing about behavioral change.
 Primary purpose of Health education
Primary purpose of HE Influence antecedents of behavior so
that health behaviors develop in voluntary fashion
• Awareness
• Information
• Knowledge
• Skills
• Belief
• Attitudes
• Values
 Role of Health educator
• implement health education strategies, interventions and
programs
• administer health education strategies, interventions
and programs
• conduct evaluation and research in relation education
serve as a health education resource person
• assess individualand community needs education
• plan health education strategies, interventions and
programs
• communicate and advocate for health and health education
 Community Health
Apart of paramedical and medical intervention or approach which is
concerned with the health of the whole population.
A discipline that concerns with the study and betterment of the health
characteristics of biological communities.

Its aims are:

1.Health Education/promotion
2.Prevention of disease
3.Management of factors affecting health
Endemic
The amount of a particular disease that is usually present in a
community. It's also called a baseline.

Epidemic
An increase — often sudden — in the number of cases of a
disease above what is normally expected in that population in a
specific area.

Pandemic
An epidemic that has spread over several countries or continents
and affects many people.
 HISTORY OF PUBLIC HEALTH
IN THE PHILIPPINES
(based on socio-political periods)

1. Pre-American Occupation ( up to 1898 )

2. American Military Government ( 1898-
1907)
3. Philippine assembly (1907-1916)
4. The Jones law (1916-1936)
5. The Commonwealth (1936-1941)
6. Japanese occupation ( 1941-1945)
7. Post World war II (1945-1972)
8. Post EDSA revolution (1986 to present
Pre-American Occupation
• 1577- Public health began at the old Franciscan Convent in Intramuros
where Fr. Juan Clemente put up dispensary for treating indigents in
Manila. -San Juan de Dios Hospital

1.2 During Spanish Time

• Creation of Vaccination to prevent smallpox
• Creation of Board of Health
• First medical school in the Philippines- UST
• School of Midwifery
• Public Health Laboratory
• Forensic Medicine
1.3 Hospital before the Americans came to
Philippines

1.3.1 General Hospitals

• San Juan de Dios Hospital
• Chinese General Hospital
• Hospicio de San Jose
• Casa dela Caridad in Cebu
• Enfermeria de Sta. Cruz in Laguna
 American Military Government
1. Control of epidemics such as cholera, small pox and plague
2. Fight against communicable diseases such as common cold, Hepa A-D,
chickenpox, SARS, flu, mumps, malaria, herpes, STD, measles

3. Projects and activities:

• Garbage crematory
• First sanitary ordinance and rat control
• Cholera vaccine was first tried
• Confirmed that plague in man comes from infected rat
• Opened the UP College of Medicine
• Establishes Bureau of Science
 3. Philippine Assembly
1. Hygiene and Physiology were included in curriculum of
public elementary school
2. Anti-TB campaign was started
3. Philippine Tuberculosis Society was organized
4. Opening of PGH (Phil. Gen. Hospital)
5. Use of anti-typhoid vaccine was initiated
6. Dry vaccine against small pox was first use
 Jones Law
1. Retrogression rather than progression in so far as the
health was concern
• Increase CDR
• Increase IMR
• Increase Morbidity

2. Increase deaths from smallpox, cholera, typhoid,

malaria and TB
3. They reorganized the health service and encouraged effective supervision)
• Study the cause and prevalence of typhoid fever

• Schick test was used to determine the causes of diphtheria

• Campaign against Hookworm was launched

• Anti-dysentery vaccine was first tried

• First training course for sanitary inspector was given

• Women and child labor law was passed

• Mechanisms of transmission of dengue fever through Aedes aegyti was studied

• Establishment of School of Hygiene and Public Health

• National Research Council of the Philippines was organized

• BS in Education Major in Health Education was opened in UP

• (PPHA) Philippine Public Health Association was organized

 Commonwealth Period
1. The epidemiology of life threatening disease was
studied- diphtheria, yaws, dengue
2. Research in the field of health was promoted
3. UP School of Public Health was established
4. Development of Maternal and Child Health
(MCH)
5. 1939 – Creation of Dept. of Public Health and
Welfare
Dr. Jose Fabella as the First secretary
6. 1940- Bureau of Census and Statistics was
created to gather vital statistics
 Japanese Period
• During this time, all public health
activities were practically paralyzed.

2. Increase incidence of TB, venereal

diseases, malaria, leprosy and
malnutrition.
Accomplishments during this period:
1.Formulation of National Health Plan
•Construction of Tertiary Hospital
1. Philippine Heart Center
2. Lung Center
3. Kidney Center
4. Lungsod ng Kabataan /Phil. Childrens Medical Center

•Adaptation of the Primary Health Care

5. Phil was the first country to implement PHC
•Launching of Operation Timbang and Mothercraft
6. Nationwide program providing supplementary food for infants, pre-
school and school children.
NUTRIBUN- bread with vitamins
2. Progress in Public Health research
•RITM-Research Institute for Tropical Medicine
•PCHRD-Philippine Council for Health Research and
Development

EDSA REVOLUTION:
•From Ministry of Health, it was renamed again as Dept. of Health
•Increase in life expectancy slowed down
•Increased incidence of malnutrition
•Declined practice of family planning
 RAMOS ADMINISTRATION
•“Health in the Hands of People” and “Let’s DOH it” –by Sen Juan
Flavier
•Memorable initiative during leadership of Flavier

•National Immunization Day

• BCG(Bacille Calmette-Guérin(BCG)
• DPT(diphtheria, pertussis (whooping cough) and tetanus)
• OPV–Oral Polio Vaccine
• MMR- Immunization shot against measles, mumps, and rubella
(also called German measles)
•Promotion of Traditional Medicine- Herbal Medicine
•Yosi Ka diri
•Araw ng Sangkap Pinoy- aimed to prevent Vitamin A, Iron
and Iodine deficiency
•Voluntary Blood Donation Program
•Kung Sila’y Mahal Mo Magplano- Family Planning
Program
•Doctors to the Barrio
 Laws:
•EO39-which created the Philippines National AIDS
Council as a national policy and advisory body in the
prevention and control of HIV-AIDS
•RA7719-the National Blood Services Act of 1994, this to
promote voluntary blood donation
•RA8172-Salt Iodization Nationwide (ASIN), providing
salt iodization nationwide approved in 1996 and renamed
FIDEL (Fortified for Iodine Elimination)
Lessons from Global & National History of
Health Education/Promotion

• Pre-historic Era
• Industrial Revolution
• Post-Civilized Stage
 Pre-Historic Era
Characteristics of Health Education in the earlier
periods
• Firstly, it was based on Authority and tradition. Its
sources were the classical, medical authors, empirical
knowledge and folklore.
• Secondly, it was closely linked to the literacy of the
people. As more people learned to read, more health
literature was produced for them.
Characteristics of Health Education in the earlier
periods
• Thirdly, the audience for health literature was
affected by the rise of new social and political
orders.
• Finally Health education was directed to the
individual and was not concerned with the
community except when the need arises in times
of epidemics.
INDUSTRIAL REVOLUTION
• The 18th century endeavored to project hygiene from a
personal to a public plane.
• John Howard showed that people are galvanized into
action when facts about social disease are made
available to them and that an aroused and informed
public opinion could be a lever of social reform.
• The 19th century illustrated how health education has
included the concept of arousing public opinion in
support of legislative action for improved public health.
INDUSTRIAL REVOLUTION
• The 18th century endeavored to project hygiene from a
personal to a public plane.
• John Howard showed that people are galvanized into
action when facts about social disease are made
available to them and that an aroused and informed
public opinion could be a lever of social reform.
• The 19th century illustrated how health education has
included the concept of arousing public opinion in
support of legislative action for improved public health.
 INDUSTRIAL REVOLUTION
19th Century advanced 3 requirements for Health
Education
Purpose to drive it forward powered by self-
interest.
Knowledge to make it effective. It leaped forward
from the darkness of the middle ages to the
scientific outlook of the modern world.
Means to get it across. Means to educate that the
most striking change was to take place.
 INDUSTRIAL REVOLUTION

Health Education has turned to social

sciences for a better understanding of how
to work with people individually or in
groups.
Objectives of Health Education has
changed. Simply presenting information is
not enough. What counts is whether and
how this knowledge is applied.
HEALTH EDUCATION IN POST-CIVILIZED STAGE

• It reflects the changing patterns of health and a

growing understanding of the social, biological,
and physical environment that influence health.
• It has adopted the principle that Health
Education is working “with” rather than “for”
the people.
• It has marked the shift in emphasis to
Health Promotion
ISSUES AND TRENDS IN HEALTH EDUCATION

• Drugs, Alcohol and Tobacco

• Teenage Pregnancy
• Abortion
• Sexually Transmitted Diseases
• Hypertension
• Diabetes Mellitus
• Chronic kidney disease
• Breast Cancer
• Rabies
THEORIES OF HEALTH
EDUCATION
 LEARNING THEORIES RELATED TO HEALTH
CARE PRACTICE
Biopsychosocial Model George Engel

• A psychiatrist at the University of Rochester

• Introduced the Biopsychosocial model or BPS in 1977
• He advocates the new medical model to explain health and
disease.
• Guided the research on health behavior models like the
social cognitive models of Bandura’s Self efficacy and health
Belief model.
Biopsychosocial Model

• Is an approach that states that human

experience of health or illness is greatly
affected or determined by the interplay or
interrelatedness.
Factors in Biopsychosocial Model
1. Biological
• Concerned with the functioning of the different organ
systems of the body and its coping or adapting
mechanisms like immunity level, genetic susceptibility, or
predisposition

• Seeks to explain the cause of illness or disease

because of the breakdown in the physical or
environmental functioning of the body
Factors in Biopsychosocial Model
2. Psychological

• Deals with how the individual perceives the health

threat and the state of emotional control, discipline, and
motivation to stay healthy
 Factors in Biopsychosocial Model
3. Social factors

• Concerned with the individual’s perception of his/her ability to deal

with the health threat or health problems and the barriers posed by
the society or the environment towards the attainment of health and
healthy lifestyle.

• Shows a direct link between the mind and the body and an
indirect link with the intervening social or environmental factors to
explain disease causation.
 Theories/models in health education
• In planning health education content, approaches,
strategies and activities, there are models or theories
which explain human behavior in relation to health
education.

• Theories can be classified on the basis of being directed

at the level of:
a. Individual (intrapersonal)
b. Interpersonal
c. Community
 4 most used health theories are:
1. Pender’s health promotion theory- Nola J. Pender

2. Bandura’s self-efficacy theory- Albert Bandura

3. Becker’s health Belief Model-

4. Green’s PRECEDE-PROCEED Model

 Health Promotion Theory
➢ Developed in 1987 and revised by Pender in
1996 to increase the utility of its predictions and
interventions.
➢ Widely used in the field of Public Health nursing
➢ Emphasizes actualizing health potential and increasing
the level of well-being using approach behaviors rather
than avoidance of disease.
 Health Promotion Theory
a) Individual characteristics and experiences
• Prior related behavior
• Personal factors
b) Behavior specific cognition and effect
• Perceived benefits and action
• Perceived barriers to action
• Perceived self- efficacy
• Activity related effect
• Interpersonal influences
• Situational influences
 Health Promotion Theory
c) Behavioral outcome
• Commitment to plan of action
• Immediate competing demands and preferences
• Health promoting behavior

d) Activity related affect

e) Commitment to a plan of action

➢ In a study, results showed that the modifying factors of age,
income, education and selected biological characteristic of body mass
had indirect effects on health promoting lifestyles as proposed by the
model.
 Bandura’s Self-Efficacy Theory
➢ Social learning theory is the result of separate research by Rotter and
Bandura.
➢ Bandura renamed the theory as Social Cognitive Theory to
emphasize the cognitive aspect of learning which explains human
behavior by citing three factors which are in continuous interaction
resulting in a process or reciprocal determinism or triadic reciprocal
causality namely:
a) Personal factors in the form of cognition, affect, and biologic events
b) Behavior
c) Environmental influences.
Social Cognitive theory
➢ Emphasizes that cognition plays a
critical role in people’s capability to
construct reality self-regulate,
encode information, and perform
behaviors.
Self-efficacy
➢ Is the single most important aspect of th
sense of self that determines one’s effort to
change behavior according to Bandura.
➢ Equated with self confidence in one’s
ability to successfully perform a specific type
of action
A person can increase self- efficacy through:
a) Personal mastery of a task
b) Observing the performance of others (vicarious
experience)
c) Verbal persuasion such as receiving suggestions from
others
d) Arousal of her/his emotional state.
• In the construct of emotional coping responses, a person
must be able to deal with any sources of anxiety
surrounding that behavior in order to learn.
Constructs in Social learning theory
➢ Help to explain learning

Value expectancy theory

• Reinforcement = learning but

• Reinforcement + an individual’s expectations of the

consequence of behavior = behavior
 3 ways in reinforcement according to Social
learning theory
a) Direct reinforcement
• supplied directly to the person

b) Vicarious
• Participant observes someone else being reinforced for behaving in an appropriate or
inappropriate manner
• Also called social modeling or observational learning

c) Self-management
• Involves record keeping to the participant of her/his behavior
• When the behavior is performed correctly, the person would reinforce or reward
herself/himself
• Construct of self-control is applied
• Reflects the idea that individuals may gain control of their own behavior by monitoring it.
 Health Belief Model (Rosenstock, Becker, Kirscht,
et al.)
• One of the 1st models originally introduced by a group of
psychologists in 1950’s to find out why people refused to use
available preventive services such as chest x- rays for
tuberculosis screening and immunization for influenza.
• Researchers assumed that people feared diseases and that the
health actions of people were motivated by the degree of fear
(perceived threat) and the expected fear reduction of actions, as
long as that possible reduction outweighed practical and
psychological barriers to taking actions ( net benefits).
4 Contructs in Health Belief Model

1. Perceived susceptibility
• Person’s opinion of the chances of getting a
certain condition
• People will not change their health behaviors
unless they believe that they are at risk.
4 Contructs in Health Belief Model
2. Perceived severity

• Person’s opinion of how serious the condition is.

• The probability that a person will change his/her health
behaviors to avoid a consequence depends on how
serious he or she considers the consequence to be.
 4 Contructs in Health Belief Model
3. Perceived benefits

• Person’s opinion of the effectiveness of some advised action to

reduce the risk of seriousness of the impact.

• It is difficult to convince people to change a behavior if there

isn’t something in it for them.
4 Contructs in Health Belief Model
4. Perceived barriers

• Person’s opinion of the concrete

and psychological cost of this advised
action
PRECEDE-PROCEED Model (Bastable)

➢ Based on the epidemiological

perspective on health promotion
to combat the leading causes of
death.
 The core of the model is the definition of health education as any combination of learning
experiences designed to facilitate voluntary actions conducive to health.
• Health education is aimed primarily at planning experiences that are designed to
predispose, enable and reinforce voluntary behavior conducive to the health of
individuals, groups or communities.
• The phases in the PRECEDE component identify priorities and objectives
• Phases in the PROCEED address criteria for policy, implementation and evaluation as
influenced by the diagnoses in the PRECEDE phases.
• The strength of the model lies in its inclusion of interventions from a population needs
perspective; has predictive value in predicting changes in health behavior.
• Relevant or useful to community health nurses since the model notes that the
community is the center of gravity.
8 Phases of the PRECEDE-PROCEED model:
1. Social diagnosis- begins with population self-study/assessment
relative to the quality of life.
2. Epidemiologic diagnosis
3. Behavior and environmental diagnosis
4. Educational and organizational diagnosis- addresses issues dealing
with education Administrative and policy diagnosis – addresses
issues dealing with education
5. Implementation
6. Process evaluation
7. Impact evaluation
8. Outcome evaluation
Thank you for Listening!!!