Gulay I am afraid I disagree with you, and see health education as being one small component of health promotion. Most health care professionals seem to believe that they are providing health education, when in reality all they are doing is providing health information. Particularly in clinical settings professional seem to think that by providing an individual with a pamphlet on a health topic that this is health promotion! In my view, health information is a minor aspect of health education, for many consumers it may be awareness raising, for a few it may be educational.

To really engage in health education, information needs to be accompanied with a change of perspective and insight into how actions or beliefs need to change. However for health education to result in health promotion, action on this information needs to occur.

Telling an obese person that they need to loose weight and giving them information of health consequences such as diabetes or heart disease is not health promotion. Health promotion occurs when you look beyond an individuals behaviours. While it might be necessary for the obese person to learn cooking skills to improve their diet, it may also be necessary that healthier food options are available for them to buy when they do their grocery shopping. These food options also need to be affordable. This individual may also need a safe neighbourhood to feel comfortable to walk to the shop to get this food, or to undertake the physical activity we all know needs to occur along with a healthy diet to maintain a healthy weight. A number of factors may impact on if actions are adopted to make a change in this individuals life, having a friend to walk with or a neighbourhood walking group, may make the difference between participating in physical activity or not, etc, etc. Health promotion involves working towards creating all of the supports which facilitate adopting or maintaining better health actions.

Sorry to be so long winded, this is a topic I am extremely passionate about :-)

Health promotion consists of general measures which will strengthen the individual/host and prevents the occurrence of disease by interrupting the interaction between agent, host and environment. However, health education is one of the measure of health promotion directed towards personal hygiene, nutrition, life style adopted by individual/ group of people by him self or themselves

Health Education: Any combination of learning experiences designed to facilitate voluntary action conducive to health

Health Promotion: A combination of educational and environmental supports for actions and condition of living conducive to health.

GREEN AND KRUETR (1991)

Good points Rajsinh and Eshetu - but I'm not convinced Rajsinh that what you have suggested differentiates between the two; they seem to be sating the same thing. Eshetu - your definitions seems somewhat broad and generic to me and, while Green and Krueter's seminal PRECEDE-PROCEED model variants are associated (mainly as a specific process for conducting health promotion/education programmes) - the 1991 variant seems particularly out-moded and out-dated against the context of the question i asked today.

I don't necessarily have an answer but I'm interested in how you make the distinction Dean (can you point to/link to one of your publications?) Do you make a distinction between health education in a clinical context (e.g. self-care/management education) vs education designed to prevent illness and promote health? And what do you see as the issues/problems to arise from the lack of definitional clarity?

Hi Rebecca,

Many thanks for the response and the interest. I could respond for hours on this topic - but will try to keep it short and sweet. Many of my publications (take your pick with quite a few of them) try to delineate the difference as essentially health education is usually (but part of the contextual complication is not always) mostly about 'imparting health-related information'. It might be part of health promotion (but not always) - but the essence of health promotion is about political process, policy and community empowerment. Most health professionals (especially clinically-based) do not actively or universally engage in the latter. The problem to me is that if a health practitioner cannot convey or understand this (and incorrectly call all their activity health promotion), then they do not appear very credible to those that do differentiate and practice very differently. To evolve in a discipline you have to first adopt, understand, and be seen to conversant in the language and practices of the current concepts and contexts of that discipline.

I agree that health education can be a powerful tool for health promotion as well as can be used for primary and secondary prevention of disease.

I agree that delineation between health education and health promotion is important.

There is always a danger of losing the meaning of terms if they are used too loosely. To me there is a vast difference between health education and health promotion (while I do agree that properly deployed health education can be a tool of health promotion).

Health education involves providing individuals with information in relation to health related topics. This may or may not result in an improvement in an individual's or community's health status. While health promotion embraces a broad range of activities (including health education) to empower individuals and/or communites to achieve improved health outcomes (outcomes that are meaningful to them). In this way health promotion is about building capability. I find Amartya Sen's writings are useful to explain this concept.

Hi Narelle,

Looks like you and I are on the same page - which is good to know. There is a 'vast difference' between the two in my opinion as well - and yet the terms are used interchangeably by so many people - including many health professionals.

You promote healthy living by educating people on health. Deeds done for a better health is health promotion which is more or less individualised, where as education is general, it may be accepted argued or rejected. A young man when he does not indulge in adverse activities promotes his health, and when he is advised what foofds can cause heart atttack may be considered as education.

I usually tell this to our clients since keeping a good face is to be motivated by oneself and one has to be proactive hence promote himself to a better platform. We educate him about the ills of scmoking and sunexposure.

Health promoting is an subtopic of health education. It is a structure to change people's behaviours. This structure can be developed by the way of health education.

Gulay I am afraid I disagree with you, and see health education as being one small component of health promotion. Most health care professionals seem to believe that they are providing health education, when in reality all they are doing is providing health information. Particularly in clinical settings professional seem to think that by providing an individual with a pamphlet on a health topic that this is health promotion! In my view, health information is a minor aspect of health education, for many consumers it may be awareness raising, for a few it may be educational.

To really engage in health education, information needs to be accompanied with a change of perspective and insight into how actions or beliefs need to change. However for health education to result in health promotion, action on this information needs to occur.

Telling an obese person that they need to loose weight and giving them information of health consequences such as diabetes or heart disease is not health promotion. Health promotion occurs when you look beyond an individuals behaviours. While it might be necessary for the obese person to learn cooking skills to improve their diet, it may also be necessary that healthier food options are available for them to buy when they do their grocery shopping. These food options also need to be affordable. This individual may also need a safe neighbourhood to feel comfortable to walk to the shop to get this food, or to undertake the physical activity we all know needs to occur along with a healthy diet to maintain a healthy weight. A number of factors may impact on if actions are adopted to make a change in this individuals life, having a friend to walk with or a neighbourhood walking group, may make the difference between participating in physical activity or not, etc, etc. Health promotion involves working towards creating all of the supports which facilitate adopting or maintaining better health actions.

Sorry to be so long winded, this is a topic I am extremely passionate about :-)

Rebecca, this feels like some shameless self promotion, but you may find a text book that I have been involved in publishing recently answers some of the questions you asked Dean...it is called 'An introduction to community and primary health care' and is published by Cambridge, (Guzys & Petrie). The PHC patchwork on page 36 may help differentiate between activities undertaken in clinical settings, which is usually secondary prevention and primary prevention which usually occurs in a community setting. Hope this helps.

Hi Diana - many thanks for the responses. It's encouraging that they come from a fellow colleague nurse as well - and are applied in the correct context. So many nurses (and worldwide they represent a huge number of health professionals) are quite 'vague' about using the terms health education and health promotion correctly. Satyaprasad and Gulay - I feel it is right to challenge your interpretations of the terms. How you view health promotion (as a sub-set of health education) is incorrect. It can only be the other way around. It's a common mistake - but one that exemplifies why I asked the question in the first place.

Just to add -and coming at this from an educational perspective - I would suggest that health education is less about 'imparting information' (' banking' model of education) and more about supporting people to learn about health-related issues, and to take action informed by this learning. Health promotion would help provide a broader supportive context for more fine focused educational activities to take place.

Thanks Dean for instigating this conversation. I agree with you and most of the above comments on this issue. It is important to regularly clarify the difference if we want health promotion to continue to improve its 'credibility'

Rather than repeat what others have said I will quote from an article we wrote on this several years ago which I believe is still valid.

Health promotion can be regarded as a combination of educational, organisational, economic and political actions designed with consumer participation, to enable individuals, groups and whole communities to increase control over, and to improve their health through knowledge, attitudinal, behavioural, social and environmental changes. (REF: Howat P, Cross D, Maycock B et al. Towards a more unified definition of health promotion. Health Promotion Journal of Australia. 14(2): 82-4. 2003). And some more recent articles with Dr David Sleet of CDC have modified this example applied to the prevention of alcohol related traffic crashes - to show that health education is part of broader health promotion.

Best wishes. Peter

A very interesting question Dean and I could not agree more with Narelle Patton on the various points stated. Health education and promotion are very loosely used not just by physicians but also many reseachers. From what I gather and my understanding of this topic 'education' is one of the pillars for any disease prevention and management. It could be simple information in the form of pamphlets and basic explanations or maybe a lecture or indepth counselling. Though the results may vary based on how 'detailed'this education is - the point is that education is a must especially in clinics and for raising general awareness. However, Health promotion may entail education but is more about bringing about a change using behaviourial strategies, mass media and other such sources and also involve more stakeholders. So, in essence 'Health Promotion' is more long term and requires massive effort than 'Health education' which may be more short term and requires some effort but not at the same scale as 'promotion' would.

Peter, Dean and anyone else who would care to comment, I find it harder to delineate between health promotion and critical health literacy, than between health promotion and health education. Primarily as the focus of health literacy goals are stated in an almost identical manner to those of health promotion. Your perspectives would be greatly appreciated.

Many thanks for the recent post everyone.

Ian - I'm not amiss to your suggestion on health education being potentially more than imparting information. There are different levels of health education though; the most limited being the 'medical model' giving information to those who are ill or at risk of being ill - and expecting individuals to act for the better on that information. Better forms of health education are, as you suggest, those that offer more than this unrealistic approach i.e. motivational interviewing etc. Health promotion, however, is not really about education - unless you consider it at the population level i.e. political influence of national school curriculum content on health-related matters.

Peter - a useful personal context and representation of health promotion. If you don't mind me saying - it seems to be almost replicating the 'nebulous' WHO definition of health promotion from the mid-1980s. An oft-cited definition - but one that is rarely used by those in the know. 'Catch-all' definitions, I find, are not that helpful and tend to contribute to the semantic confusion. I prefer specific delineations between concepts.

Ranjani - you are correct to agree with Narelle. Health promotion generally is so much more than health education - to the extent that a health promotion programme may contain little health education input. That said, expansive and well resourced longitudinal and multi-disciplinary health education programmes should always have a place within health promotion strategy. The difference is always between effective health education interventions - and limited ones.

Correct Diana - the essence of health literacy programmes (bar the limited health education ones that just rely on a pamphlet in a GP surgery, for instance) are often focused on community and population strategy and empowerment, emancipation, and collective empowerment; all that are at the heart of health promotion (or should be).

Hi Dean

I actually agree with your comment about the 'nebulous' WHO definition of health promotion from the mid-1980s - that is still being used by many people. It is far too loose and hard to interpret.

But I disagree that the definition I quote is nebulous. It was actually written in frustration with the WHO definition. It is very practical and in fact mostly based on the work of Professor Lawrence Green who is without peer for his contributions to the advancement of health promotion internationally.

This definition has been used many times in real life health promotion - not just as an 'academic exercise.'

Perhaps readers who doubt this may refer to the article I quoted and the simple example where the definition is applied.( see above)

Also refer to another very practical example applied to road safety. It shows clearly where health education is just one component of health promotion, albiet an important one ( I am happy to send a copy to anyone who cant access it) { Howat P, Sleet D, Elder R, Maycock B. Preventing alcohol related traffic injury: A health promotion approach. Traffic Injury Prevention (special issue). 5(3):208-219, 2004.}

Best wishes

Peter

Health Education should be a part of any educational system and included in the teaching programs of primary and secondary learning. It is the basis for the

ulterior building of efficient initiatives for health preservation and promotion. Therefore it should be properly prepared and dlivered like any other subject by the Educational System.

Health promotion could be emphasized in the last stage of this programe but

it is mainly the duty of Health Care Systems that face the individual patients and their families as well as the public and should initiate campains like disease prevention,

and disease managing,

So even if these are not always distinct specialities and may have tangent topics

the responsability to promote them should be clearly defined and further developed

and hopefully started soon.

I have had a request to add the reference I previously quoted that illustrates how health education is part of the broader health promotion (REF: Howat P, Cross D, Maycock B et al. Towards a more unified definition of health promotion. Health Promotion Journal of Australia. 14(2): 82-4. 2003).

best wishes

Peter

Dear Dean

thanks for raising this issue. I totally agree with you. Indeed many health professionals (and not only) use health education and health promotion interchangeably. Health promotion - the way i view it- is an 'ubmrella' term, that includes health education (hope it makes sense!).

Recently, in my country-Cyprus- we had an educational reform and one of the task was to introduce health education in the school curiculum shifting from just the idea and implementation of health education to health promotion. It has been difficult though for professionals to understand the impications and implementation of health promotion practice/ and/or activities rather than health education....but we are trying...

You may read also a related article on this- Ioannou S., Kouta C. & Charalambous N. (2012). Moving from health education to health promotion. Developing the health education curriculum in Cyprus. Health Education. 112 (2): 153-169

Thank you all for all your ideas and interest in this discussion.

Hello Arthur, I believe you have raised another dimension to the health education discussion. I agree that Heath should be part of the school curriculum, and at one time I trained to be a secondary school teacher so that I could teach health, as in Australia this is usually taught by physical education teachers, who tend to focus on human biology! The sociology of health and health literacy is often absent in formal health classes. In the end I became a secondary school nurse, where my primary function was health promotion not clinical care. I was invited in to Heath classes so was able to provide the type of health education that is frequently superficially discussed, such as sexual health and substance use. To a limited extent I was able to undertake health promotion activities, which I would not have been able to achieve if employed as a teacher. These activities involved more than the provision of health information, rather focusing on changing school processes and policies to support healthier behaviours and minimise health risk. I was also able to work with students to develop peer support networks focused particularly on mental health and sexual health. From my perspective, you may be able to teach health promotion theory to students in the later years of their education, but they have limited opportunities to be involved in health promotion activities apart from in limited and superficial ways. I left my role as a secondary school nurse after 5 years because of my frustration that students were viewed as the 'product' of the school system, while parents and the government were the employer/consumer. The students themselves had very little power to effect change, even healthy change, unless this was sanctioned by other.

Peter - good article you have attached. it very much resonates with much of my work to attempt to clarify the theoretical and practical boundaries of health education and health promotion - and other related individual and population-based concepts. You are correct in highlighting that anything that is endorse by the likes of Lawrence Green (and Marshall Kreuter) is seminal and stands out as a better attempt than the WHO for trying to clarify and delineate concepts. PRECEDE-PROCEED is a classic framework (and one of the best) for encapsulating many aspect of health promotion (and expansive health education as well).

Arthur - useful commentary that essentially further highlights the need for conceptual clarity. I'm not sure that health promotion should be 'taught' in schools. Instead, it should be one of the main policy drivers that ensures schools are politically health-promoting - rather the taught content. Health 'education' should be what is taught.

Christiana - no problem on raising the issue. I think that it is a very important one to raise - and Peter (like myself and yourself) agrees that it is more than a semantic debate. The credibility and success of health promotion to wider stakeholders is at stake. I've published in Health Education and know that it is a good journal - so look forward to accessing your suggested article. Your interpretation of health promotion as an umbrella term is commonly used. It's emerged out of the well-accepted works of the likes of Ewles & Simnett and Whitehead & Dahlgren etc. It's true - but I think that this concept can be 'over-whelming' for some. When they see the umbrella - it often comes back to the WHO default that 'health promotion includes everything to do with health'. It either renders the term overwhelming or, to some, 'meaningless. It's the continuing semantic battle that health promotion has 'continued to enjoy' for a few decades now. Thst's why 'new' positions and interpretations that are more specific are probably more useful for today's context.

Christiana,

It's a small world - hey. I was just looking through your profile and note that I wrote a chapter for your edited book a few years ago. Scriven A, Kouta C, Papadopoulos I (2010) : Health Promotion for Health Practitioners (In Greek). Paschalides Medical Books, Athens.ISBN 978-960-399-988-1 (298 pages)

I was dealing directly with Angela Scriven - so you and didn't get to correspond between us. My chapter was translated to Greek - so I hope that translation ended up reading well.

Hi Diana,

Looks like our posts 'crossed' in this recent discussion. As ever - spot on. You've eloquently highlighted to Arthur my exact point. Glad that we are, as ever, on the same page. A primary role of school teachers and/or school nurses is supposed to be 'health promotion' - but the conceptual quagmire is just as evident in this environment as it is anywhere else. That said, as visible as health education can be throughout the school years of children the better - even in the absence of health promoting policy formation. It's well researched that the better the health education impact in early years, the higher the likelihood that this will continue on into adult life. If their is 'some' health promotion - to the degree that you identify you were involved in - even better!!

Dean

you are probably right that more specific solutions/suggestions are needed.

However, i think that health professionals need to understand the extend and the meaning of health promotion as well as the implication of health education in their everyday practice. Probably may be a 'contemporary' practical guide is needed, with examples and sucessful health education activities and health promotion practices.

Dear Dean, allow me to thank you- even late- but now i got the chance- for contributing to this book. Actually, is the only book in greek language that is originally written for health promotion and not a translation of another english wrtitten book. Probably it is time for revising it!

Hi Christiana,

Practical guides are always needed - as long as, to me, they are conceptually and contextually correct - and identify poor forms of health education and health promotion - as well as excellent forms of health education and health promotion. That way, health professionals can differentiate as to whether their practice does make a difference - or not.

There is always that ever-present realisation that perhaps a new edition of a book is about due. I'm happy to assist/contribute with the next edition if you feel that is appropriate.

Thanks a lot Dean for the willingness to help in a new and/or revised book. Your contribution is very much appreciated and valued.

In simple terms health promotion is enabling an individual to take care of their health by educating them to make better choices for health.

and Health education is a tool to promote health.

Thanks

also health promotion is also policy (Marmot report). health education is more individual oriented and quite often is based on specific risks. maybe criteria for health promotion research could help you to find out the difference. http://heapro.oxfordjournals.org/content/20/3/306.full

Mr Dean, it was a nice oppertunity to learn about health promotion and education. WHO gudelines and definition must be read and understood about the importance of both the entieties.

Thank you for this opportunity to engage in this discussion. I accept words/terms can have different meaning for different people and cannot be separated from context. As from the discussion here, it is important to know what meaning of health education / health promotion directs your thinking and the implications of this way of thinking on your practices/comments. As we know there are numerous definitions for health so too health education/health promotion. The challenge is to make clear the meaning imposed and expose whose interests are being served in the different ways of thinking. For me health education/health promotion can be constructed as structures and processes. How I think about these terms means I would like to insert health literacy into this discussion. Which again raises recognizing that there are different ways of giving health literacy meaning. Different ways of thinking about health education/health promotion can create and at the same time limit opportunities to promote health literacy.

Thanks for the recent posts all. The debate continues and that is a good thing. It's something that i have been 'championing' for some years now - and I'm still not sure that we are that close to a universal consensus. Yes Kay - health itself is a 'nebulous' concept that is hard to pin down, hard to measure and often a very individual thing - that's part of the problem that the discipline and science of health education and health promotion faces - and then we can add into the 'rich mix' other concepts such as health literacy. I asked a question on RG a few months ago which centered on 'health communication'; it's another term that adds to the dilemma - but one that definitely includes health literacy within its processes.

Hello Dean..thank you for posting a question that has generated such a healthy debate..

I agree with what you and many others alike have said about the health promotion. I think Jakarta declaration has comprehensively summarized the concept of health promotion (can be found here: http://www.who.int/healthpromotion/conferences/previous/jakarta/declaration/en/index1.html).

My only disagreement (a smaller one may be) is that health education is not just limited to the transfer of information to patients/individuals; rather it embraces the idea of pursuing people and motivating them to adopt healthful/healthy behaviors/practices.

What you have pointed out about clinicians is right that many of them are not doing health promotion, not even health education. It is merely the transfer of information.

Health education is about convincing people to adopt healthy behaviors and thereby contributing to health promotion (health education is part of health promotion)

Thanks Dean for providing us all with this opportunity to share our thoughts on this topic. I enjoy a good debate, and your most recent post gives me the opportunity to finally challenge your perspective. While you state that health literacy is a process of health communication, I consider the reverse to be true. Similar to the health education and health promotion delineation, I believe that health communication is a component of health literacy rather than the other way around.

I need to clarify that when I conceptualise health literacy, I view it as what Don Nutbeam described as critical health literacy, rather than functional health literacy. Critical health literacy relates to the decisions and actions we take in regard to our personal, family and communities health interests. If health literacy is percieved to be what Nutbeam described as functional health literacy, then I agree it with considering it as a process that contributes to health communication.

Thanks again Imran and Diana. Good posts - as ever.

Imran - yes - I fully agree that there are different levels and forms of health education that are more than merely imparting health information. I'm mainly referring to the 'default' of medicalised health education - especially with health professional clinicians. Wider, empowerment-based health promotion interventions are at the other end of the spectrum of health education. However, they are the least common manifestations of it and then, where they exist, there is the 'blurring' of the lines between are they health education or health promotion?

Diana - hhhmmm - I think that we are in agreement but, again, it boils down to getting it exact. I don't disagree with your position per se. Nutbeam is a seminal author on the subject. It's the 'interchangeability' issue again - and I'm not sure that either health communication or health literacy is established enough yet to make that delineation-call. If it goes the way of health education/health promotion - the debate will reign for some time.

Thanks for the discussion .the two areas health promotion and health education are regularly abused by health workers and community workers because they are not understood on how to evaluate the work done so we need to have some indicators for evaluation which are not base on outcome like mortality and morbidity because this could be the results of many inventions. Other wise health education is a major component of health promotion. it is because health education was born before health promotion and some old literature especially from USA has been using the two interchangeably. Health promotion is a specialization in public health.

it is very important to do make a conceptual difference between Health promotion and education. I agree with others that health education is a major component of health promotion, and the health promotion approaches focus on encouraging and empowering people to change their behavior and adopt healthy lifestyle and may focus on efforts to change the health determinants. health education focuses on activities that designed to facilitate health related learning and ultimately, lifestyle or behavior change for people.see Precede (adopted for health education programmes) -proceed model (adapted for health promotion .

I like to be with Patton (while I do agree that properly deployed health education can be a tool of health promotion).

Useful recent posts and many thanks. Yes - health education is often a major component of health promotion - but only when it is done well, is well resourced, long-term etc. When it is merely medical risk-related information-giving - it rarely contributes to health promotion as a whole.

Lenet - the point that you make about health promotion as a specilaisation of public health adds to the conceptual confusion. Related terms to health promotion, such as public health (and other related terms i.e. community health, population health, primary health care, etc) often confuse even more. Public health approaches, for many countries, often implies a medicalised approach to population health (especially say in the US) - and not necessarily correctly termed as health promotion.

Hi Dean:

With reference to this discussion, I have read this article:

A Lee, C Tsang, S Lee and C To.

A comprehensive "Healthy Schools Programme" to promote School Health: The Hong Kong experience in joining the efforts of health and education sectors.

J Epidemiol Community Health 2033; 57: 174- 177.

The "Healthy Schools Programme" in Hong Kong gives a good example of close partnership between the health and education sectors, and moves towards a multidisciplinary approach and active learning towars Health Promotion.

Best wishes.

Diana.

From Perú.

Dean,

Imran Abbasi sent a link that is important for all health providers to be aware of. The WHO defined Health Promotion in global terms that is inclusive of multi-faceted approaches to health within all communities. Part of this is encouraging political infrastructures that support the acquisition of food security, housing, and employment that offers quality working conditions. It is noted that in 1st world countries it is common for the health agencies in these countries to merge the terms "health promotion" and "health education" to become interchangeable, since health policies are frequently in place and improved upon.

So, health education is a component of health promotion, although, it is important not to lose sight of the roots of the broader meaning of health promotion set out by WHO. We tend to view these labels in an insular fashion when we are not faced with food insecurities and poor working conditions that are still rampant in many countries.

Having said that, it is imperative that here, at least, in the U.S. we recognize not only the economic importance of promoting policies to support those in need, but also how people are affected by thee insecurities, and continue to battle those political powers that threaten to tear down the fragile health infrastructure that is currently in place.

Excellent discussion topic, Dean!

Darshel - a very good response. What you posit is very much the higher-end global health aspect of health promotion - particularly with reference to issues such as political infrastructure - and very useful to use examples such as food insecurity. Such issues are highly complex and require international efforts to resolve which is why, if it comes under the health promotion umbrella, many will feel uncomfortable dealing with such issues and refer back to the default of health promotion as merely 'encouraging people to be healthy' - whether they have a personal/political choice in that or not.

Thanks for an interesting topic of discussion Dean. I've enjoyed reading the responses so far.

I would agree that health promotion and health education are two separate terms and we would not be doing justice by using them interchangeably. Although I see the arguments for their similarity they still mean two very different things.

Health promotion is a much broader term that encompasses efforts to improve health and prevent disease and injury. I see health education as a strategy for health promotion. So although health education can be considered an aspect of health promotion, health promotion is much more than health education.

Many thanks Jacqueline - a considered and measured response that encapsulates the essence of this thread.

I agree, the Health Education (EPS) is a tool or procedure to empower patients to participate actively in the management of their own health and improve through a healthy lifestyle that prevents them from more pravelentes disease and associated lifestyle.

In my opinion the EPS is essential for improving individual health (individual strategy) and collective (population strategy or mass) element.

Finally, the EPS is framed in the field of health promotion when your goal is to improve the health and in the field of disease prevention when your goal is to reduce the incidence of disease.

Best regards from Salamanca (Spain)

The difference between health promotion and health education is that; health education teaches about health to the people while health promotion is involves advertisement of health services and creating a know how about the existence of these services.

What is the difference between Health Promotion and Health Education?

• Though the aims and objectives of health education and health promotion overlap, health education takes the shape of a field of study whereas health promotion takes the shape of advertisement.

• Health education is increasingly being introduced as a subject in schools to impress upon students the importance of healthy behaviors and attitudes. This is believed to have a cascading effect on all people in the society to develop health awareness and wellness.

• Health promotion tries to shift the focus of responsibility from governments and health professionals to organizations and people by raising the levels of awareness about diseases and prevention of diseases through healthy behaviors and attitudes.

In practice, health education seeks to broaden health literacy, effectively at an individual level and often in clinical settings

In practice, health promotion seeks to mobilise activism and collective agency to address underlying social, economic etc determinants of health, often within community settings

Alan - a good response. Succinct, yet effective. It does appear that health literacy and health communication are the 'new' health education - and far more likely to be part of a concerted health promotion strategy than simple information-giving.

The difference I can identify is that with health promotion, there is an element of proactiveness, you are not waiting for the problem. In health education, you have already assessed and seen the educational needs. So, there is a problem already and you are educating to address the problem.

It all depends on what school you went to and/or what school of thought you ascribe to. When I studied health education, it was much along the lines of what many above are calling health promotion. I would suggest that it matters less about what you call it than what strategies you're implementing, and all of them listed above are necessary.

But the exact language is less important. I have personally railed against the dumbing down (or, if you will, the broadening) of the concept of "structural interventions" which has gone from meaning changing the context in which people live ( the mission of public health) to distributing condoms or putting a checkbox on a form to support one kind of screening or another. But here it's not so much the words that bother me, but the fact that so many in public health (and social work), including funders, have a harder time (for all the oft-cited reasons) of addressing social conditions and taking themselves out of the provider role for all health improvement efforts, and rely heavily on services. Remember: John Snow did not conduct small group workshops, motivational interviewing, case management, or counseling to people getting their water. To answer your question: what are the strategies you want, and why, and how will you distribute the scarce resources you have among them?

Edward - it's a useful way of viewing it. Akin, to me, of the 'upstream-downstream' analogy.

Dan - I agree that the debate is easily viewed as semantics and for those, like you and I, who 'grew up' in an educational world where the term health promotion did not exists - then I think that it is fine to use it. I do, however, feel that more recent practitioners (especially health professionals) should be getting the terms and language correct. It's more than semantics if you do not appear credible to your fellow colleagues who have taken the time and effort to learn what constitutes health education and health promotion and that there are clear delineations. As you point out, there are scare resources out there for preventative health etc - so I would argue that the funders/budget-holders would be more confident in apportioning those resources more to those who can describe their practices correctly.

They are related but essentially different. They are two different processes in the area of health and therefore I agree that they should be separated and not be used interchangeably.

Both should be separated because they both have different definition both should not be use interchangeable. Health education means educating people about their health making them aware of their their health expanding their knowledge and health promotion means promoting health in terms of promoting healthy lifestyle so that people can make healthy choices to better or improve their health this way they are not been force in making any decision about their health.

Agreed Nicolette.

Racheal - you seem to be saying the same thing about both health education and health promotion - except that one is about being told to adjust lifestyle and the other allows the individual to have choice. I'm not sure that this is an accurate representation of what they are.

In short health education is one of the main component of Health promotion. For health promotion program health education is the main startegy to follow. Health promotion is broader concept in which health education strategy is required.

The theoritical part of health education and promotion has been well discussed. Can a practical method of implementing education or promotion be possoble to understand them bettter.

Hi Nighat,

Hhhhhmm - i both agree and disagree. Often health promotion programmes incorporate health education strategies - but not always. Often, policy-driven HP interventions do not, nor preventative screening programmes, nor social necessarily social media campaigns - but then some of those may come under the 'new' health communication agenda.

Thank you Dean It has broaden my concept of health promtion. I have not thought about this way. You are very right.

Cigarrete smoking has lead to heart attacks strokes, COPD, and lung cancers, alcohol has caused more road accidents ruining families, and causing deaths more than in war. What is the use of health education and promotion if it could not stop these.

Dear Satyaprasad

It seems like the difference between "what to do" and "how to do " with even a "how to prove it is efficient. " .... Each one of these is rooted in health education and health promotion. Success is not 100% achievement in 100% of places. There is definitely

a substatial achievement in comparison with what was 50 -yars ago in maters of public health ,You may see what happens with the incresing life expectancy !

It is a long treck to go and progress toward what is called full TRANSLATION . We ought to march it armed with rationally delivered health education and health promotion.

Very good point Arthur. It's when the semantics between health education and health promotion can be seen to be 'less than relevant' (although it is very relevant) - and that is when all health-related approaches (regardless of what we call them) impact on individuals and communities and evolve and grow. If people benefit - it is a plus. I like your analogy though that not 100% of people benefit 100% of the time. That is the reality of health-related practice - and any progress we make adds to the 'pot' - so that we live and learn from our practices.

Rich indeed Chinedu!!

Thinking of the two terms as part of a Venn Diagram, health promotion is the larger of the two circles and encompasses a significant part of health education, but not all. First to health promotion. Building healthy communities where good options are available for work, exercise and eating are all part of effective health promotion that require very little health education at the individual level. Adding a health education component may also be integral to the builder's plan. As to health education, some campaigns have taken on a proselytizing or coercive tone that tries to move the education into action (health promotion). Such approaches are problematic and might not be viewed as health promotion, but disease avoidance.

From my point of view, Health education is broader in scope and centers on the overview of health as it relates to we'll being. On the other hand, Health Promotion targets a particular exercise that could help to fighting against any pending health problem.

Eric - a perceptive response. I like your interpretation - and your addition of the commonly termed 'victim-blaming' approaches to risk-related behavioural-health programmes.

Chibuike - personally, I would contend that the reverse is true of what you propose. Health education is generally narrower in scope and health promotion is broader.

Satyaprasad's concern about the effectiveness of health promotion in controlling cigarette smoking is timely. Too often, there is criticism of the effectiveness of health promotion.

Cigarettes are an excellent example of how health promotion has been responsible for dramatic reductions in use particularly in developed countries such as the USA, Sweden, New Zealand and Australia.

In Australia for example, daily tobacco use by adults has declined from 37% in 1977 to 16% in 2011. In Western Australia it is now, even lower due to 35 years of comprehensive health promotion. Health education has always been one part of the mix ( eg school programs along with community programs) ( with high media use - TV, radio, newspapers etc ) supported by policy ( eg non-smoking in public places, bars/pubs, recreation areas, universities; plain packaging; bans on tobacco promotions etc) and economic changes ( increased taxation ) etc.

Tobacco remains one of health promotion's most visible areas of success.

Dear Peter, I dont agreee with your views. Look at what you are seeing. Smoking banned in public places, trains, theaters, colleges etc. Dont yoy think that this is artificial or forced rather than voluntary. I would call health promotion or education succesful only when the society gives up cigarettes even when the ban is liffted.. Can you tell how far are we from achieving it.

Look at AIDS control, Condom use has reduced transmission but not activity. Today the possibility of transmission of HIV is high but the barrier is effective, similarly cigarette consumption is low because of barrier not because of health education. I mean the chnage must be voluntary rather than forced.

Satyaprasad, I think the success story about cigarrete smoking in Australia which Peter alluded to is not entirely based in banning smoking in public areas. I haven't known of anyone who has quit smoking because they can't smoke in public areas. So I think the reduction in smoking can be attributed to other health promotion activities that have been happening in Australia.

Thanks for the recent posts guys. I've made no secret of the fact that, while smoking cessation/prevention programmes are commendable in their own right, I can't understand the obsession with them - particularly in my own profession. It's almost as if 'if we stop people smoking - then we solved all the worlds health problems'. Yes - it would reduce a lot of healthcare dollar expenditure that could be directed elsewhere but, at the end of the day, most smoking cessation programmes (especially at the behavioural level) are expensive, limited - and rarely successful in the long run. I especially don't buy into the utalitarian perspective that if you can get one person to stop smoking - then it's worth it. The only way that any measurable impact occurs is at the political level. Banning branding, off-putting pictures on cigarette packets, raising taxation etc have some impact - but they are often politically unpopular measures. If individuals 'want' to smoke - 'nothing is going to stop them' - bar personal experiences i.e. awareness of mortality, illness etc - and health professionals cannot dictate or influence those events.

Paret of the debate here, for me, is what are the main health priorities and what works and doesn't - both from a health education and health promotion perspective. It's not to say 'don't try' - it's more about what is realistic and realising that 'health' isn't always peoples top priority - no matter how preventable ill-health is.

Dr Dean, please do not think that we are deviating from your topic. The impact of health education and health promotion is visible in two distinct entities. ONE AIDS, the OTHER Cigarette smoking.

Practical result to a known and common entity would arouse the interest of many like Edward and Peter who have contributded with thier results.

I do agree that the discussion should be in the positive direction but cigarettes was the path braker.

Thank tyou Dean for Raising an important issue.

hi dear friend.

From my understanding, the difference between the two are based upon the assumptions. Where OLS only assumes that the expected value of the error term is zero and the variance of the error term is sigma squared, in MLE, you also need to know the distribution of your sample in order to use it. However, this makes MLE preferable over OLS because you can use it in nonlinear models as opposed to OLS which can only be used in linear situations. Other than that, they're both seem like very similar estimators to me and do about the same thing.

Are these the main differences or have I got them all muddled?

Thanks in Advance!

Education: Transmitting existing knowledge?

Promotion: Claiming that some existing knowledge is more important than other existing knowledge?

There must be a theoretical (e.g. telling people something) versus practical approach (showing or assisting people something) both for education and promotion

Dean, I agree that we must, as health professionals, use exact language to be "seen to be credible with the wider health promotion community", as you aptly put it. However, health promotion goes beyond merely educating our patient population; it involves more of a clinical 'take'. We administer pneumonia and influenza immunizations to our elderly patients at the time of their exam, believing this to be in line with current health promotion in this aggregate. Health education would involve disseminating information about the aggregate for which we provide care. Ex: 'Ways for the elderly to remain healthy during pneumonia and Flu season, teaching about healthy diet and exercise, good sleep hygiene, avoiding temperature extremes, avoiding people who are ill, advising to get immunized against influenza/pneumonia.' You do make a good point.

As ever, thanks for the recent posts all,

Mehdi - I would like to respond - but your post seems very 'cryptic' to me. The terms you are using are very unfamiliar in the health promotion/health education context - although I can relate to it on a statistical level.

Marcel - you are right that both theoretical and practical constructs should underpin both approaches.

Teresa - thanks for agreeing that they are good points to make - and providing a good clinical context case. Immunization interventions can be useful to use - but they can also add more confusion to the issue. For instance, the political determination of which vaccines and when that are used, as well as the distribution of them to the relevant target population, may well lie at the 'health promotion' level - but the clinical administration and 'coal-face' giving of the vaccines is often at the preventative, medicalised health education intervention. The intervention, itself, only varies to the extent that information/health education is offered - or not.

Vaccines is more of a preventive rather than education or promotion.

health deucation usually highlights dangers of foolowing bad practises. Eg Hand washing. which when practised in a proper way eliminates disease,

Hospitals, TV and schools are promoting this in a big way.

The world learns and listens to afew selected individuals and WHO is one of them.

If the goal is to reach people then the best way to propogate education is to let them hear from whom they like.

I agree that the over-emphasis on smoking and health gets very irritating. However, I have to concede smoking is still one of the main preventable causes of death. In China alone, of the 350 million smokers, 1.2 million die from tobacco-related deaths annually. Comprehensive health promotion is now touted as essential to curb this epidemic in China.

I stand by my claim that successful tobacco control in Australia provides us with one of our best examples of health promotion particularly in preventing young people from taking up cigarette smoking. Sadly, health education alone encouraging people to take voluntary actions has limited effect. Without the supportive environment provided by smoking bans, advertising bans, price increases through tobacco taxes, and plain packaging, etc along with the health education that are all part of health promotion, the smoking rates of our young people would still be very high.

A recent news item also supports policy changes as part of the health promotion approach where voluntary’ actions through health education alone are just not sufficiently effective. “Smoking bans help kids breathe easier: Paris, smoking bans in public and the workplace have led to 10 % drop in premature births and emergency asthma treatment for children”.

Best wishes

Peter Howat

Hi Peter,

Articulate response. You and I are in complete agreement. I suppose that, for me, it's about 'sharing the resources around' using the type of multi-method approach that you advocate. Smoking is important - but so is obesity and many other preventable issues - so I tend to have reservations about a focus on one over another.

Thank you Dr Peter for the wholesome nformation on cigarette smoking.

Rural areas have a high incidence of tobacco consumption, which makes health education a very important tool to give up smoking. This could be the practical part of Heat education and promotion. I would be glad if Dean could help us in making rural ares free of tobacco.

Satyaprasad - yes, health education as an important tool for smoking cessation in rural areas (particularly where concerted interventions occur i.e. motivational interviewing etc). The health promotion component is equally important in terms of preventative, rather than 'curative' interventions - particularly when aimed at school curricula etc.

Health promotion is rather a broad term where health education could be an step toward health promotion. In any chronic disease management life style modification is an important and continuous challenge where weight control, activity, smoking cessation all come in together for many patient.

Sounds like most are in agreement that health promotion is the umbrella term with health education being one of many methods used to promote health :-) I also agree with this concept and have cited Dean's definitions and research for my students and in my own research. Most of my own students (nurses and public health) find a relief in knowing they don't have to have all the answers and can evoke ideas from their clients... In fact in most industrialized nations (and more frequently in all countries) the health information is easily accessible- we simply need to sort out the fact vs fiction.

I would like to add to the discussion the concepts of social determinants and health behavior theory as underpinnings for health promotion focus vs health education only. When you break down most of the health behavioral theories, they look at the multiple ideas/attitudes, supports, barriers/resources, etc to changing a barrier. Education alone does not address these ideas. The social determinants of health fold into this same idea as representative of the multitude of issues impacting health choices or any health related behavior. Too often health care providers forget about these issues and create unreasonable expectations of their clients toward change.

A final thought is related to Motivational Interviewing as a conversation for exploring the internal knowledge, skills, and motivation toward change with a client. It is such a powerful idea and practice. This type of conversation embraces the engagement portion of health promotion in a way that moves (quite effectively) beyond health education :-) Wonderful conversation all!

Hi Kathlynn,

Always good to hear from a like-minded colleague. You and I have much in common. I fully agree that is a great thing that we do our best to ensure that health professionals are as fully informed as possible - and in a correct manner. Like you say - it takes pressure off practitioners to know what they can and cannot do through clearly articulating what their professional boundaries and competencies are, what is reasonable and what is not in terms of influencing and assisting clients and, clearly, motivational interviewing is one useful mechanism to assist.

Health education and promotion has been ongoing since centuries. New ideas and concepts have been developed, the effect seen has been phenomenal that it has eradicated plague, smallpox, put under control cholera, and many other infective diseases which are communicable and capable of mass deaths.

The modern diseases such as cardiac, obesity, arthritis, collagen vascular diseases, genodermatosis, renal diseases, gastro intestinal diseases, cancers, and least but not the last which really needs a major boost is to understand mental health and healthy living to avoid alziehemers disease.

The stumbling blocks to promote have been social stigma, taboos, resistance to learn newer techniques.

Health education impact may be more by inducing people to interact, and work together rather than compete with each other.

I like your reasoned comments Kathlynn.

It is good you have reminded us about the relevance of health behavioural theories, and social determinants as underpinnings of health promotion practice.

We too have found the incorporation of Motivational Interviewing into our health promotion interventions to be very desirable, especially when used in conjunction with Self Determination Theory. Ken Resnicow from Michigan has championed the combined use of these.

Yes Peter, Ken is awesome ;-) I have found use of Stages of Change (naturally), Integrated Behavioral Theory, Implementation Intentions Model help nurses and other health care providers to understand the process of behavior change. When they go through some dyad work with each other (in a workshop or a class situation), they shift from blame to a sense of understanding that there are other reasons for not following through on a behavior. it is such a joy when folks move from the blaming/non-compliant statements to understanding and acceptance. I also use the adopter's model and a couple of other ideas for shifting their thinking. in my work i tend to use these models and activities to explore Motivational Interviewing Spirit and the compassion piece.

As Dean has explored in his work - one of the biggest hurdles I run into in this discussion is with acute care nurses/providers. too often folks don't believe there is time in their practice for health promotion or MI related conversations. i have enough nurses who have shared stories on trying this that i believe there are ways to fit it in, but the current focus on maximizing tasks in a hospital means several nursing supervisors are actually teaching nurses to stay out of the patient's room as much as possible. Sad...

the good news is with the changes in medicare reimbursement in the US and with some of the Affordable Care Act changes, hospitals are being moved to provide case management, improved discharged instructions and options for improving patient satisfaction during the hospital stay. the hope is this will open the door for more health promotion as part of this conversation :-) Slowly, we can move away from all discharge instructions focused only on health ed...

Hi Peter and Kathlynn,

Yes - MI certainly has its place; done well that is as part of concerted, well resourced, multi-disciplinary approaches. Of course, such interventions take time, not just to implement - but to plan and evaluate etc. As Kathlynn points out, health professionals (and especially nurses) will argue that they haven't the time or resources to implement such programmes. However, I think that this is, at least in part, a ruse and a smokescreen. I actually think that a large part of the problem is a lack of knowledge, training, confidence, and skills in these areas - which brings me back full circle to the original question. I think that part of that lack of knowledge is not being able to define or differentiate between varying degrees and levels of health education and health promotion theory, practice and policy. For many health professional practitioners, the giving of a health pamphlet to a client, for them, constitutes health promotion. When more informed practitioners (and clients) witness this - it doesn't bode well for professional credibility.

Kathlynn - I also admire your faith that ACA will potentially change practice. However, the healthcare systems that i am familiar with all work under the auspices of clinical governance legislation (putting the patient at the centre) - which you think would have a profound affect as well - but those 'health' pamphlets still keep being handed out.

Well, health education is part of health promotion, precisely is what looks for "health literacy" in your group of interest.

Dean- too funny :-) I agree training/education is crucial and not always well done. Therapeutic Communication is seen as the primary and then other communication tools are added to this. MI may get 3 hours (if I'm lucky) in an undergraduate nursing program. Similarly, workshops are great and those interested will attend and often bring others-but the need to keep up those skills can be tricky when the health care system doesn't want to pay for this service/time. The shift in Spirit and compassion I see in training goes a long way to moving nurses in the direction you are suggesting Dean. However, support from the health care place is essential. I just read an article in Journal of Nursing Scholarship ( Zolnierek, C. D. (2014) An intergrative review of knowing the patient, 46:1, 3-10). sounds like there is more support for the need to releases nurses for "time to care" using a variety of models to increase both nurse and patient satisfaction. What we need is documentation of cost savings through reduced recidivism, increased follow-through on behaviors, etc...

On the one hand, I agree with your thoughts on smokescreen of how nurses spend their time and one article reviewed also mentioned that during "down time" nurses still didn't go to the bedside. Similarly, it was important to teach nurses communication skills to build this patient/nurse relationship- not sure if MI was mentioned as a skill in any of the articles. On the other hand, I can see how often nurses are involved in a relationship with their computers, pagers, and other tech tools vs the humans around them :-)

The ACA is creating some change as Medicare refuses to pay for return to hospital within 30 days - regardless of reason.... Case management is coming back (again- just a different name) to support effective discharge. Transitional care models are doing the same thing. Yet none of these alternatives are using/exploring behavior change issues to make more of an impact. Health care folks still tend to think that as long as they have told the patient to change diet, exercise, take meds, etc, this should happen accurately and within the next week :-) I'm not sure they understand or have been taught the rest of the story as embraced in the larger health promotion picture. For me this was brought home when I went out on a home visit with Physical Therapy on referral. No nursing care had been ordered. We found the patient on a matress on the floor, with a 10 inch stapled hip incision, 2 small children, no pain meds (but had the prescription) and no one to get these needs met at home (husband is a truck driver). Whoever discharged the patient- was not working under the larger concepts of health promotion, social determinants, skilled communication or awareness, but I believe there were written discharge instructions :(

I

Kathlynn,

Great repost. It sure is a 'can of worms' - hey. Pandora's Box never saw this one coming. Yes - at the end of the day - the bio-techno-medico model (including high tech machines that go 'ping' - but do little else other than line the pockets of the companies shareholders) are a powerful draw for many healthcare practitioners. The ironic thing is that, after the initial financial and resource pain, health promotion (particularly upstream population health) programmes are far more cost-effective than developing the machines that go ping. It sure is a topsy-turvy world - where a 'leap of faith or two' would go a long way to effective change. Here, in New Zealand, over the last 5-years or more, the government has invested over $2.5 billion in its Primary Health Care Strategy. If you ask me - we've now got a lot more machines that go ping - but the divide between those that have and have not (in terms of access to health services) remains the same.

We will get it right one day though - hey!!

I would like to add to this stimulating discussion from the perspective of Health Promoting Hospitals (HPH) which is my field of research. I definitely agree on the need to clearly define what is meant by health promotion, and what by health education or health information. In line with what colleagues have said, HPH would understand health promotion as the umbrella and health education as one method to promote health. And, following the settings approach in health promotion, HPH would have a number of other strategies and interventions in place to support the health of hospital patients, staff, and community. These would a.o. include staff training in cooperation with professional associations, universities etc., thus networking far beyond the walls of the hospital, because, as this discussion also shows, change towards health promotion requires a changed self-understanding of health professionals which cannot be achieved within single hospitals alone. For the same reason, HPH also promotes the adoption of health promotion amongst an organization's management goals, including a change of data used for monitoring and controlling - because permanent change needs to be supported by the evidence of data and figures.

Hi Christina,

Great to hear from you. Sounds like we have a great deal in common and, from your site, impressive to see that you work with the likes of Jurgen Pelikan. Not sure if you have ever seen my site - but settings-based health promotion is a big interest area of mine - and HPH is a main one for me considering my clinical background. Yes - it's a complex environment. HPH's areas are a popular WHO-movement setting - but there is also long-standing criticism (which I have contributed to as well) - which can be linked to the health promotion/health education debate and divide. The parameters for what constitutes a HPH have been quite loose, and the evaluative evidence not always convincing - added to the fact that the movement is mostly European-based. What you suggest as what should be in place for a concerted HPH strategy is commendable - especially the linking of programmes to incorporate public health, population health and community-focused interventions involving a multi-agency approach (as acute-based clinical health services and health professions are often the most resistant to such approaches). However, the reality for many reported HPH 'successes' often relates to quite singular, bottom-down, policy edicts - such as 'an anti-smoking' policy (which is difficult to govern anyway). However, there are more emerging instances of wider reform (albeit scant) - and having the likes of Oliver Groene, Mark Dooris etc championing the cause can only assist. If you refer to one or two of my publications in Health Promotion International - it helps to expand this view from the 'good, the bad, and the ugly' perspective.

There are several hundred programs around the US and other nations as well now, and many offer multiple degree levels in "Health Education" as a terminal degree. Few are offered or the same for Health Promotion as an area of study. Health Promotion is but a but one small component of the larger concept of study in the area of health education.

I offer that Health Education is the far broader concept especially in formal degree programs in higher education.

Hi Gary,

That is true, or at least the part about 'health education' degrees in the US. They tend to be quite popular because of the social learning theory and socio-cognitive theory connections related to risk-related, preventative, and behavioural interventions i.e. motivational interviewing etc. They appeal to those interested in health psychology - and health professionals who are interested in medically-orientated approaches to healthcare i.e. smoking cessation programmes. Health promotion degrees may appear less popular but, unlike the term health education (bar some recent terms - such as health communication) - there are many health promotion degrees that use terms other than health promotion - such as public health, community health, population health, primary health care, health policy etc.

My last point helps to illustrate the same 'trap' that you have fallen into that i have highlighted on this thread several times before. You state that health education is the broader concept or discipline and health promotion the sub-set of it - whereas the 'exact opposite' is the case.

I am surprised that Universities are still offering ‘Health Education’ degrees.

In Australia, most of the universities offering degrees in Health Education changed to the broader Health Promotion starting in the early-1980’s. I understand Curtin University was one of the first such universities to offer degrees from bachelor level, to masters in Health Promotion, and a PhD ( see https://healthsciences.curtin.edu.au/.../soph_health_promotion.cfm This was in recognition of the relatively narrow scope of Health Education and the limited employment opportunities specifically in that area.

Some of the Australian Health Promotion degrees included a comprehensive offering of studies across the Health Promotion competencies identified as required for employment in a large number of Health Promotion positions that evolved in Australia from the 1980’s to the present day. Health Education was just one component of those courses. (Australia was also one of the first countries in the world to develop a national set of Health Promotion competencies of which Health Education was just one component)

Today, the term ‘Health Education’ seems to be rarely used compared to Health Promotion. I am aware that even primary schools that have good quality ‘Health Education’ programs, usually have it as part of a broader Health Promotion ‘program’ that incorporates a supportive environment (e.g. sun protection environment, healthy school canteens, and policies that support sun protection, anti-bullying, safety , anti-smoking and alcohol use, and promote physical activity).

Correct Peter ,

However, I think that Gary's take on it is more or less US-centric. If you consider all the recent debates around Obamacare etc, the debate is often around (apart from the corporate insurance debacle) health promotion in the US as representing a highly medicalised public health model that more closely fits health education than it does health promotion and that's got to change I.e. those that have least at a community level should have more equal access regardless of their social status.

I also agree that health education, as a term, is becoming less visible. Either the term is 'replaced' and used interchangeably as health promotion instead by the uninitiated - or new vogue terms, such as 'health communication' are replacing 'what was health education'.

Yes - related to schools, an overall programme that is policy and curriculum-led and incorporates a multi-agency approach, which incorporates many supportive aspects of health, is health promotion. However, many schools adopt a singular, preventative , preachy, and punitive approach that I would call 'limited' health education - but they would call health promotion.

As an economist I would like to suggest that health promotion is tied to preferences - that of individuals and societies. I agree that in order to appropriately achieve health promotion, full information is necessary - which means not only providing information - but converting it to knowledge - ie education. Information and knowledge is always good before one can get to the normative issue of health promotion.