The Interplay Between Health Promotion, Health Education, and Instructional Design

Introduction

The interest in studying the interplay between disease, human behavior, and the environment dates to the 19^th century when the notion of public health began to emerge, instituting regulations and laws aimed at controlling the spread of disease and improving health conditions. However, the resistance to these laws and the persistence of unhealthy behavior gave rise to the need for health education (Palfrey, 2018) to “educate people of all ages about healthful living” (Willgoose, 1985/2010, p.18). Previously, the definition of health education comprised a wide range of activities such as advocacy and social mobilization, but it was later narrowed down to differentiate it from the broader scope of health promotion and to focus it on communicating information related to health risk factors and behaviors (World Health Organization, 1998).

As in many fields, a variety of terms are used in public health, sometimes meaning different things to different people. To facilitate communication between diverse health agencies, the World Health Organization (WHO) published a glossary of terms in 1986 that was later revised in 1998, entitled Health Promotion Glossary (Smith et al., 2006). For the interest of this chapter, the following definitions are highlighted:

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  Health is “a state of complete physical, social and mental well-being, and not merely the absence of disease or infirmity” (WHO,1998, p. 1). This definition is still the one most widely used in the literature (Sharma & Romas, 2011; Simons-Morton et al., 1995; Smith, 2010) and has not been amended since its formulation in 1946 (Word Health Organization, 2011). This is due to its emphasis on the positive aspect of well-being and the health dimensions beyond the physical ones (Simons-Morton et al., 1995; Stroebe, 2000).

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  Health Promotion is “the process of enabling people to increase control over, and to improve their health” (WHO, 1998, p.1).

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  Health Education “comprises 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” (p.4).

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  Health Behavior is “any activity undertaken by an individual, regardless of actual or perceived health status, for the purpose of promoting, protecting or maintaining health, whether or not such behaviour is objectively effective towards that end” (WHO, 1998, p.8).

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  Public Health is the science and art of promoting health, preventing disease, and prolonging life through the organized efforts of society (WHO,1998, p.3).

Lately, the 2020 Joint Committee on Health Education and Promotion Terminology undertook a similar effort and proposed similar definitions for health education, health behavior, and health promotion (Joint Committee on Health Education and Promotion Terminology, 2021). In this chapter, the terms health education will be used as defined above to underscore the educational component of interventions.

Theoretical Foundations Of Health Education

Multiple factors determine the health status of people. These are called determinants of health (Nutbeam, 1998). Some of these determinants are changeable while others are not. An example of a changeable determinant is a certain skill one needs to improve their health, such as planning a healthy meal, while an example of an unchangeable determinant is age. These determinants are also situated at different levels. Some are individual, some are societal and interpersonal, and others are structural and environmental (Cleland et al., 2010). The complexity of the interplay between these health determinants and health behavior led to the emergence of several theories and models that explain why people behave the way they do in health-related matters (Glanz et al., 2008).