health education topic in community

Planning and Conducting Health Education for Community Members

Health education is any combination of learning experiences designed to help individuals and communities improve their environmental health literacy. The goals of health education are to increase awareness of local environmental conditions, potential exposures, and the impacts of exposures on individual and public health. Health education can also prepare community members to receive and better understand the findings of your public health work.

Some health education takes the form of shorter, one-on-one, or small group conversations with community members, state, territorial, local, and tribal (STLT) partners, and stakeholders. In the beginning of your public health work, you may need to constantly educate community members about exposure sources and exposure pathways –that is, how they may encounter harmful substances.

Later in your public health work, you may want to do a full community workshop or participate in existing community events to increase understanding about specific exposures related to the chemical of concern. Be sure to address how the harmful substance may be encountered, levels of exposure, and ways community members can prevent, reduce, or eliminate exposure. There may be other concerns that are not chemical-specific, such as environmental odors and community stress.

Health education is a professional discipline with unique graduate-level training and credentialing. Health educators are critical partners that advise in the development and implementation of health education programs. Public health work benefits from the skills that a health educator can provide. (See resource: What Is a Health Education Specialist? external icon ) If you don’t have this training, see what you can do to build your skills and improve your one-on-one and small group educational conversations. Health educators may also work with other public health professionals such as health communication specialists. Health communication specialists develop communication strategies to inform and influence individual and community decisions that enhance health.

• Assess individual and community needs for health education. (See activity: Developing a Community Profile )
• Ask community members about factors that directly or indirectly increase the degree of exposure to environmental contamination. Factors may include community members accessing a hazardous site or the presence of lead in house paint, soil, or water.
• Develop a health education plan.
• Listen for opportunities to provide health education throughout your community engagement work.

Despite nearby mines being shut down, a tribal nation continued to face risks of exposure to uranium and radon. To help the community better understand how to reduce the risk of exposure, a group of federal and tribal agencies developed a uranium education workshop. The agencies established a vision and a set of strategies to ensure the workshop was technically-sound and culturally appropriate.

The agencies ensured that they

• Offered the workshop in English and tribal languages,
• Developed materials at the average US reading level for broad accessibility,
• Invited all local tribal families to participate, and
• Piloted the workshop with three communities before finalizing the content.

Before the first pilot workshop, the agencies sought feedback on content, tone, and complexity from community health representatives from the tribe’s department of health. The community health representatives provided many suggestions to tailor the presentation for tribal community audiences.

The workshop content was further refined after each pilot presentation. Working with local professionals and offering workshops as pilot sessions enabled the agencies to tailor content to the needs, preferences, and beliefs of local community members.

CDC’s National Center for Environmental Health (NCEH) and ATSDR have many existing materials to help educate community members about specific chemicals. ATSDR’s Toxicological  Profiles and Tox FAQs provide a comprehensive summary and interpretation of available toxicological and epidemiological information on a substance. ATSDR’s Choose Safe Places for Early Care and Education Program  provides a framework and practices to make sure early care and education sites are located away from chemical hazards. Consider leveraging or adapting these resources, as well as the following chemical-specific websites and interventions, when developing health education activities for your community, such as

• NCEH’s Childhood Lead Poisoning Prevention Program Website
• ATSDR’s soilSHOP Toolkit —A toolkit to help people learn if their soil is contaminated with lead
• ATSDR’s Don’t Mess with Mercury  — Mercury spill prevention materials for schools

Per-and Polyfluoroalkyl Substances (PFAS):

• ATSDR’s PFAS Website

As noted above there may be other concerns that are not chemical-specific, such as environmental odors and community stress. Some helpful resources to address these concerns can be found here:

• ATSDR Environmental Odors
• ATSDR Community Stress Resource Center

Develop health education materials that are culturally appropriate, with community input.

Be aware that your health education messages may be received by the community differently than you intend. Consider testing your messages with community counterparts before you use them widely. Be aware of community beliefs about health and the environment, so that you can develop culturally appropriate health education materials. Your awareness will help you design, plan, and implement activities that are protective of health and respectful of community beliefs. (See callout box: Cultural Awareness )

Avoid stigmatizing (devaluing) communities living in “contaminated” areas [ ATSDR 2020 ].

• CDC Learning Connection  (CDC). A source for information about public health training.
• Characteristics of an Effective Health Education Curriculum  (CDC). A list of characteristics that you can use to develop an effective health education curriculum.
• Community Environmental Health Education Presentations  (ATSDR). A collection of presentations designed for health educators to use in face-to-face sessions with community members to increase environmental health literacy.
• Promoting Environmental Health in Communities (ATSDR). A guide that includes talking points, PowerPoint presentations, and covers the basic concepts of the environment, toxicology, and health.
• What is a Health Education Specialist? external icon (Society for Public Health Education – SOPHE): A description of a health education specialist including areas of responsibility and competency.

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Impact Lives

Empowering communities with health education.

  Public health officials are constantly working to inform, educate and empower communities about health issues to encourage a healthier way of life. Through educational programs, these professionals strive to inspire communities to make better health choices. There are many different strategies for effective health education in communities to promote interaction and raise awareness on the elements of health related issues. Through effective health education strategies, public health officials can make a considerable impact on the overall health and knowledge within communities.

What is Public Health?

Public Health is described as the science of protecting and improving the health of communities through education, promotion of healthy lifestyles and research for disease and injury prevention. Professionals in Public Health study health related concerns that are potentially affecting communities and work to find ways to educate individuals to avoid health risks.

This field deals with health issues impacting communities as whole. Compared to traditional medical professionals who work on an individual basis, public health officials treat communities as their patients, whether it is on a global scale or local neighborhood. Main duties of a public health official involve conducting research and sharing their findings by implementing educational programs to prevent problems from occurring.

Increasing Health Literacy 

Nearly nine out of 10 adults have difficulty using everyday health information that is routinely available in health care facilities. Defined as the ability to process and understand basic health information needed to make informed health decisions, health literacy requires skills to break down that information. This involves calculating numbers to determine things such as cholesterol and sugar levels, measuring medication and understanding nutrition labels. Poor literacy skills have been associated with higher health care expenses by affecting a patient’s capability to effectively use available information to implement health behaviors or respond to health warnings.

National Action Plan

In 2010, the U.S. Department of Health and Human Services developed the National Action Plan to Improve Health Literacy with the goal of creating a society that:

• Provides everyone access to accurate, actionable health information
• Delivers person-centered health information and services
• Supports life-long learning and skills to promote good health

The Action Plan is based on the idea that each individual has the right and need to access health information that will assist in making informed decisions as well as the need for health services to be provided in a way that can be easily understood by the average citizen and beneficial in encouraging health, longevity and quality of life. The seven goals in the plan include:

• Develop and disseminate health and safety information that is accurate, accessible and actionable.
• Promote changes in the health care delivery system that improve information, communication, informed decision-making and access to health services.
• Incorporate accurate and standards-based health and developmentally appropriate health and science information and curricula into child care and education through the university level.
• Support and expand local efforts to provide adult education, English-language Instruction, and culturally and linguistically appropriate health information services in the community.
• Build partnerships, develop guidance and change policies.
• Increase basic research and the development, implementation, and evaluation of practices and interventions to improve health literacy.
• Increase the dissemination and use of evidence-based health literacy practices and interventions.

Educational and Community-Based Programs

Health educators attempt to bridge the gap between distributed information and the public by developing effective educational programs for communities to prevent disease and injury, improve health and enhance the quality of life. These programs play a key role in reaching people outside of traditional health care settings such as schools, worksites and hospitals.

For a community to effectively improve its health, changes are often needed in physical, social, organizational and political environments in order to adjust factors that could be contributing to health problems. For example, communities may need to implement new programs or policies to change community norms in order to promote better health.

These programs work to educate communities on issues such as:

• Chronic diseases
• Mental illness/behavioral health
• Unintended pregnancies
• Nutrition and obesity prevention
• Substance abuse

Through successful education programs that use proper cultural communication methods, public health professionals are able to promote policy change and advocacy for better health education in communities. Health educators are constantly working to ensure that individuals have a clear understanding of how life choices affect health status. For those interested in being involved in the education of communities to promote health education, Benedictine University offers an online Master of Public Health ( MPH ) with a 35-year legacy as well as a specialized certificate in Health Education and Promotion .

Related Benedictine Programs

With the proper stress management, a health care career in nursing is one of the most rewarding careers available. Benedictine University offers an online accredited Master of Science in Nursing (MSN) degree for those looking to advance their nursing careers while juggling their busy work and personal schedules. To learn more click here or talk with one of our Program Advisors today.

Goal: Promote health and safety in community settings.

A person’s community can have a major impact on their health and well-being. Healthy People 2030 focuses on ways organizations, businesses, schools, and residents can help build healthier communities. 

Community organizations that provide preventive health care services can help improve health and well-being. Businesses can also help keep people safe and healthy — like by making sure employees use protective gear when needed and taking steps to make workplaces safer.  

Schools and community organizations can play an important role in helping children and adolescents stay healthy. For example, giving children and adolescents opportunities to play sports can help them get more physical activity. 

Objective Status

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Related Objectives

The following is a sample of objectives related to this topic. Some objectives may include population data.

Community — General

Emergency preparedness.

• Foodborne Illness

Heart Disease and Stroke

• Nutrition and Healthy Eating
• Physical Activity

Public Health Infrastructure

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The Importance of Community Health Education – and Where You Might Fit In

Community health education is an important part of our world today. In fact, if the year 2020 has taught us anything, it is that community health education is a vital part of our society. The outbreak of COVID-19 – a pandemic that has infected millions of people around the world — crippled the global economy and changed the way we live. However, there have also been great strides made in preventing the spread of the novel coronavirus, thanks to infectious disease experts and public health educators who work diligently to keep the public informed.

One of the few positive outcomes of this life-changing virus has been the acts of kindness — big and small. Doctors and nurses have been working 18-hour shifts in areas hit hardest by the outbreak, and healthcare workers in other areas have flown to major cities to volunteer their services. Manufacturers have been shifting focus toward producing personal protective equipment (PPE) and donating thousands of items to hospitals. Even amateur crafters have been hard at work making cloth masks to donate to their local nurses! These powerful signs of hope may have inspired you to take action. It may even inspire you to make a career change, or help you decide what you’d like to do with your life.

One of the most important roles in public health today is in community health education. Public health educators teach people about behaviors that promote wellness. Within this field, there is a variety of public health issues to address, such as disease prevention, environmental health, nutrition, safety and disaster preparedness, and more.

Public health educators typically work in public health divisions of states, counties, cities, and towns. They may also work in private sectors, such as health insurers or counseling programs. They often create and assess health education programs, write grants and find proposals, conduct research, and oversee health education programs within their communities.

Whether working with individual residents, organizations, or entire populations, public health educators make a real impact on society. But what exactly can you do within community health education? Where do these types of health professionals fit?

There are many different paths available in the public health education field. The job opportunity for aspiring public health professionals is bright. In fact, the U.S. Bureau of Labor Statistics (BLS) expects employment of community health educators to grow 11% over the next several years.

Professionals who specialize in this field may work in the following settings:

• Community Health
• Consumer Health
• Environmental Health
• Family Life
• Mental/Emotional Health
• Injury Prevention and Safety
• Personal Health
• Prevention and Control of Disease
• Substance Use or Abuse

But how does one break into the community health education field ? According to the BLS, health educators need a bachelor’s degree before teaching others about health and wellness. Depending on the area of focus, public health educators may also need to earn the Certified Health Education Specialist (CHES) credential before starting their careers. This also requires a bachelor’s degree, and is where an undergraduate public health program comes in handy.

A Bachelor’s in Public Health , such as the one at Goodwin University, can prepare you for a future of powerful impact. Classes at Goodwin are taught by industry professionals who understand the inner workings of the public health field. Their experience can prepare you better than any textbook ever could. The program at Goodwin is also one that offers flexibility to students. Courses are available days, nights, and even in a hybrid online/on-campus format. This offers the kind of flexibility needed to complete a degree without putting your life on hold.

You may dream of working for the Centers for Disease Control and Prevention (CDC) or the World Health Organization (WHO) to help tackle massive pandemics like COVID-19. Or perhaps you have a passion for health and wellness and want to make a positive impact on your own local community. Either way, the Career Services team at Goodwin can help you get there. This group of passionate professionals is available to Goodwin students and grads — for free — for life. The Career Services team does not stop until you are in a role that you love.

Are you ready to jumpstart your career in community health education? You will make a positive impact in your community — or around the world — within no time once you have completed your degree. Learn more about the Public Health program at Goodwin University by calling 1-800-889-3282, or visit us online to request more information.

Goodwin University is a nonprofit institution of higher education and is accredited by the New England Commission of Higher Education (NECHE), formerly known as the New England Association of Schools and Colleges (NEASC). Goodwin University was founded in 1999, with the goal of serving a diverse student population with career-focused degree programs that lead to strong employment outcomes.

What you need to know about education for health and well-being

Why focus on education for health and well-being.

Children and young people who receive a good quality education are more likely to be healthy, and likewise those who are healthy are better able to learn.

Globally, learners face a range of challenges that stand in the way of their education, their schooling and their futures. A few of these are related to their health and well-being. Estimates show that some 246 million learners experience violence in and around school every year and 73 million children live in extreme poverty, food insecurity and hunger. Pregnancy related complications are the leading cause of death among girls aged 15-19, and the COVID-19 pandemic has vividly highlighted the unmet needs of learners and their mental health.

UNESCO works to promote the physical and mental health and well-being of learners. By reducing health-related barriers to learning, such as gender inequality, HIV and other sexually transmitted infections (STIs), early and unintended pregnancy, violence and discrimination, and malnutrition, UNESCO, governments and school systems can pose serious threats to the well-being of learners, and to the completion of all learners’ education.

Why is health and well-being key for learners?

The link between education to health and well-being is clear. Education develops the skills, values and attitudes that enable learners to lead healthy and fulfilled lives, make informed decisions, and engage in positive relationships with everyone around them. Poor health can have a detrimental effect on school attendance and academic performance.  Health-promoting schools  that are safe and inclusive for all children and young people are essential for learning.

Statistics  show that higher levels of education among mothers improve children’s nutrition and vaccination rates, while reducing preventable child deaths, maternal mortality and HIV infections. Maternal deaths would be reduced by two thirds, saving 98,000 lives, if all girls completed primary education. There would be two‑thirds fewer child marriages, and an increase in modern contraceptive use, if all girls completed secondary education.

At UNESCO, education for health and well-being refers to resilient, health-promoting education systems that integrate school health and well-being as a fundamental part of their daily mission. Only then will our learners be prepared to thrive, to learn and to build healthy, peaceful and sustainable futures for all.

• The relevance and contributions of education for health and well-being to the advancement of human rights, sustainable development & peace: thematic paper , UNESCO, 2022

How is UNESCO advancing learners’ health and well-being for school and life?

UNESCO has a long-standing commitment to improve health and education outcomes for learners. Guided by the  UNESCO Strategy on Education for Health and Well-Being,  UNESCO envisions a world where learners thrive and works across three priority areas to ensure all learners are empowered through:

• school systems that promote their  physical and mental health  and well-being
• quality, gender-transformative  comprehensive sexuality education  that includes HIV, life skills, family and rights
• safe and inclusive learning environments  free from all forms of violence, bullying, stigma and discrimination

Through its unique expertise, wide network and a range of strategic partnerships, UNESCO supports tailored interventions in formal educational settings at regional and country levels, with a focus on adolescents. Key areas of actions include:  technical guidance  at global levels, and targeted and holistic action at national levels such as the Our Rights, Our Lives, Our Future (O3) programme; joint efforts through the  Global Partnership Forum for comprehensive sexuality education  and the  School-related gender-based violence working group ; guidance on school health and nutrition; advocacy around the  International Day against violence and bullying at school ; capacity-building and knowledge generation such as the  Health and education resource centre .

UNESCO aims to make health education appropriate and relevant for different age groups including young learners and adolescents, thus working closely with young people and youth networks. It identifies adolescence (ages 10-19) as ‘a critical window of opportunity to invest in education, skills and competencies; with benefits for well-being now, into future adult life, and for the next generation’ and a time when schools should impart healthy habits that will empower adolescents to become healthy citizens.  Young People Today  is an initiative aiming to improve the health and well-being of young people in the Eastern and Southern Africa region.

Why is comprehensive sexuality education key for learners’ health and well-being?

Comprehensive sexuality education (CSE) is  widely recognised as a key intervention  to advance gender equality, healthy relationships and sexual and reproductive health, all of which have been shown to positively improve education and health outcomes.

At UNESCO, CSE is a curriculum-based process of teaching and learning about the cognitive, emotional, physical and social aspects of sexuality. It offers life-saving knowledge and develops the values, skills and behaviours young people need to make informed choices for their health and well-being while promoting respect for human rights, gender equality and diversity. CSE empowers learners to realize their health, well-being and dignity, develop respectful relationships and understand their sexual and health rights throughout their lives. Effective CSE is delivered in an age-appropriate manner.

Without correct knowledge on sexual and reproductive health, learners face risks directly impacting their education and future. For example, early and unintended pregnancy increases the risk of absenteeism, poor academic attainment and early drop-out from school for girls, while also having educational implications for young fathers.

Through its O3 flagship programme, UNESCO contributes to the health and well-being of young people in Africa with a view to reducing new HIV infections, early and unintended pregnancy, gender-based violence, and child and early marriage. The O3 programme has benefitted over 28 million learners so far and has introduced ‘O3Plus’, focusing on actions in favour of young people in tertiary education.

UNESCO’s  Foundation for Life and Love campaign  (#CSEandMe) aims to highlight the benefits of good quality CSE for all young people. Because CSE is about relationships, gender, puberty, consent, and sexual and reproductive health, for all young people.

Why is UNESCO building back healthy and resilient schools?

As the education of 1.6 billion learners came to a halt as a result of the unprecedented COVID-19 global health pandemic, the world became witness to the crucial importance of schools as lifelines for learners’ health and well-being. Schools are a social safety net providing essential health education and services including meals,   identifying signs of mistreatment or violence, establishing links to health services, fostering social connections and promoting physical activity. And without this safety net, millions of learners were at risk.

For example, early and forced marriage and unintended adolescent pregnancy rose during the pandemic and lockdown periods. This resulted in more dropouts from school, leaving learners and girls in particular out of school. The pandemic vividly illustrated the interlinkages between education and health, and the urgent need to work across sectors to advance the interests of future generations,  building back resilient  education systems to prevent, prepare for and respond to health crises. It also highlighted learners’ unmet need for support around their mental health.

Learner mental health and well-being is an integral part of UNESCO’s work on health education and the promotion of safe and inclusive learning environments. UNESCO joined with UNICEF and the WHO to launch a  Technical Advisory Group  of experts to advise educational institutions on ensuring schools respond appropriately to crises like the COVID-19 pandemic.

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Reimagining BMCC

Monitoring and Reporting Positive Cases

• Health Education

Community Health Education (A.S.)

• Mission Statement

Programs Offered

• Community Health Education
• Gerontology
• School Health Education
• Public Health

BMCC Admissions

or learn more .

The Community Health Education program will teach you to positively influence the health behavior of individuals, groups and communities. You will also learn to address lifestyle factors (i.e., nutrition, physical activity, sexual behavior and drug use) and living conditions that influence health. Community Health Education is the study and improvement of health characteristics among specific populations. Community health is focused on promoting, protecting and improving the health of individuals, communities, and organizations.

The program focuses on career preparation and teaching individuals and groups how to better care for themselves. The Community Health Education degree is a general health degree that prepares you to work in hospitals, community-based organizations, wellness centers or the fitness industry. It provides a foundation for careers in health promotion, disease prevention, fitness, health education and healthcare administration. It is also an entry point for those interested in pursuing clinical degrees.

Transfer Options

You will have the option to transfer to CUNY colleges such as York, Hunter, Lehman and Brooklyn College or to private schools such as Long Island University Brooklyn and Hofstra to major in Community Health Education, Health Administration, Public Health, Gerontology, Physical Therapy, Exercise Science, or Nursing. BMCC has articulation agreements with several four year colleges to allow you to seamlessly continue your education studies there.

Explore Careers

BMCC is committed to  students’ long-term success and will help you explore professional opportunities. Undecided? No problem. The college offers  Career Coach for salary and employment information, job postings and a self-discovery assessment to help students find their academic and career paths. Visit Career Express to make an appointment with a career advisor, search for jobs or sign-up for professional development activities with the Center for Career Development. Students can also visit the Office of Internships and Experiential Learning to gain real world experience in preparation for a four-year degree and beyond. These opportunities are available to help BMCC students build a foundation for future success.

Professor Lisa Grace Program Coordinator [email protected]

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This program is offered in-person, online and in a hybrid format.

Requirements

Community health education academic program maps.

• Community Health Education Program 2 Year Plan
• Community Health Education Program 5 Semester Plan

Required Common Core

Flexible core 3, curriculum requirements, program electives (areas of study).

Choose 12 credits from 1 area of study below:

Health Education and Promotion

Food studies, exercise science, health services administration, health communication, health education electives.

Choose 1 course (3-4 credits) from:

Please note, these requirements are effective the 2021-2022 catalog year. Please check your DegreeWorks account for your specific degree requirements as when you began at BMCC will determine your program requirements.

• Consult with an advisor on which courses to take to satisfy these areas.
• These areas can be satisfied by taking a STEM variant.
• No more than two courses in any discipline or interdisciplinary field can be used to satisfy Flexible Core requirements.

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Community Health Education Strategies: Student Experiences

• June 23, 2021
• Health@Emory , Read

Editor’s Note: This summer, Exploring Health will feature posts from students within the Health 1,2,3,4 program’s Health 497 course — Community Health Education Strategies. This piece is an introduction to student blog posts about their experiences participating in the course.

Health 1,2,3,4 is an academic program housed within the Center for the Study of Human Health at Emory University. The four-course series aims to provide students with strategies and resources to play an active role in their own health, while also equipping them with the skills to promote the health of their peers.  In addition to growing their knowledge of the science of health and strategies for health promotion, students who complete courses within the Health 1,2,3,4 program walk away with tangible skills that prepare them for a wide range of careers or educational programs after graduation.

Recognizing the need for students to translate the skills and knowledge acquired in the Human Health courses, the Health 1,2,3,4 program introduced a new course for the 2020-2021 academic year: Health 497 — Community Health Education Strategies.  In this two-part course (Fall and Spring semesters), students apply their understanding of health education principles and strategies to develop and facilitate the delivery of health education with collaborative partners in the Atlanta and Emory communities. Students who participate in the course are provided with the opportunity to develop professional skills, including leadership, discussion facilitation, communication, and more.  This year, Health 497 offered two paths for the students to pursue: group coaching to support Healthy Emory’s Diabetes Prevention Program (DPP) and health education lessons for Martin Luther King Jr. Middle School .

Healthy Emory’s Diabetes Prevention Program (DPP) Group Coaching Path

Developed by the Centers for Disease Control and Prevention, Healthy Emory’s Diabetes Prevention Program (DPP) enables Emory employees with pre-diabetes to modify their behaviors to prevent the progression of the disease. Partnering with Healthy Emory, Health 497 provided optional, student-led group coaching sessions to support DPP participants in maintaining healthy behaviors and reaching their health goals. Students within the Health 497 DPP path trained to become student health coaches, developing and facilitating group coaching support sessions on four different topics: food logging, physical activity, embracing a problem-solving mindset, and overcoming social obstacles to healthful nutrition. By participating in the group coaching support sessions, DPP participants revisited key components of the DPP curriculum, discussed personal health barriers, and developed specific goals to promote well-being.

Martin Luther King Jr. Middle School Health Education Path

The Health 1,2,3,4 program maintains a collaborative partnership with Martin Luther King Jr. Middle School to provide health education to its 6 th -8 th grade student population. Students who pursued the Health 497 King Middle School path developed and facilitated lesson plans on several health-related topics, including nutrition, positive mental health, and time and energy management. The middle school students who participated in the health lessons expanded their understanding of health and health-promoting behaviors.

It is with great pleasure that we share the personal experiences and reflections of our Health 497 students within their specific paths to highlight the impact this course has had on their academic and professional growth. Stay tuned for the student pieces as they are posted in the Exploring Health blog this summer.

To learn more about the Health 1,2,3,4 program, visit the program webpage.   For more information about collaborative partnership opportunities, contact program director Lisa DuPree at [email protected] .

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Community Health Education Degree Online

Earn a Community Health Degree Online

• $330/credit (120 credits)
• Transfer up to 90 credits
• Provides education requirements for CHES exam
• Gain skills to help your community achieve wellness
• Learn about topics critical to preventing and treating illness and injury
• No application fee or SAT/ACT scores required

Community Health Education Degree Program Overview

With an online Bachelor of Science (BS) in Community Health Education degree, you can make a positive difference in the communities that need it most.

The online bachelor's program focuses on improving the health of individuals and their communities based on their needs and resources.

For student Jacqueline Graham , this program gave her so much more than what she learned in the classroom. Graham says, "it was truly life-changing," giving her the confidence to not only complete the program but go on to pursue her master's.

This program aligns with the educational requirements for the Certified Health Education Specialist (CHES) examination , offered through the National Commission for Health Education Credentialing. Successful student graduates will have fulfilled the educational requirements to be eligible to sit for the CHES examination.

What You'll Learn

• How to plan, develop, implement and evaluate community health programs
• Strategies for assessment and analysis of health programs
• Identification of health disparities
• Global, social and ethical responsibility
• Promotion of effective health communication campaigns
• Statistical constructs and epidemiological principles

How You'll Learn

At SNHU, you'll get support from day 1 to graduation and beyond. And with no set class times, 24/7 access to the online classroom, and helpful learning resources along the way, you'll have everything you need to reach your goals.

Career Outlook

With community health a concern throughout the United States and around the globe, the need for health educators and community health workers is on the rise.

Through 2032, employment is projected to grow 7% for health education specialist positions. Growth is driven by efforts to improve health outcomes and reduce healthcare costs through promotion of healthy behaviors. 1

In 2022, the BLS reported a median annual wage for health education specialists of $59,990 , with the highest 10% earning more than $106,210 . 1

Understanding the Numbers When reviewing job growth and salary information, it’s important to remember that actual numbers can vary due to many different factors — like years of experience in the role, industry of employment, geographic location, worker skill and economic conditions. Cited projections do not guarantee actual salary or job growth.

Health education specialists can work in a variety of settings. According to the BLS, here are the top 5 employers of community health workers and health educators: 1

• Hospitals – state, local and private
• Individual and family services
• Religious, grantmaking, civic, professional and similar organizations
• Outpatient care centers

The BLS notes that while health educators typically need at least a bachelor's degree, some organizations also require Certified Health Education Specialist (CHES) credentials. 2 The CHES credential is offered through the National Commission for Health Education Credentialing (NCHEC).

SNHU's online BS in Community Health Education program can help prepare you for a variety of roles within the high-growth public health education field, including:

Community Health Educator

Educate people about the availability of healthcare services in their area.

Wellness Manager

Develop health and wellness programs for a community or corporate organization.

Patient Educator

Coordinate treatment programs and address questions from patients and families.

Social and Community Service Manager

Coordinate and supervise programs and organizations that support public well-being.

"I thought to myself … imagine what I would learn from this degree program and what I could accomplish from there," Amato said.

The BS in Community Health Education program is designed to help you build a strong foundation from which you can use to launch the next chapter of your life. Whether you wish to go straight into the field or want to continue your education by earning a master's in public health online , this program can help you get there.

Start Your Journey Toward an Online Community Health Degree

Why snhu for your online health education degree flexible with no set class meeting times, you can learn on your schedule and access online course materials 24/7. affordable as part of our mission to make higher education more accessible, we’re committed to keeping our tuition rates low. in fact, we offer some of the lowest online tuition rates in the nation. prior coursework could also help you save time and money. snhu’s transfer policy  allows you to transfer up to 90 credits toward your bachelor's degree and 45 credits for an associate degree from your previous institutions—that means you could save up to 75% off the cost of tuition. you could also save time and money by getting college credit for previous work experience , or by taking advantage of military discounts and employer tuition assistance if available to you. respected founded in 1932 , southern new hampshire university is a private, nonprofit institution with over 160,000 graduates across the country. snhu is accredited by the new england commission of higher education (neche), a regional accreditor, which advocates for institutional improvement and public assurance of quality.  recently, snhu has been nationally recognized for leading the way toward more innovative, affordable and achievable education: u.s. news & world report named snhu the 2021 most innovative university in the north and one of the nation's "best regional universities" awarded the 21st century distance learning award for excellence in online technology by the united states distance learning association (usdla) a $1 million grant from google.org to explore soft skills assessments for high-need youth network at southern new hampshire university, you'll have access to a powerful network of more than 300,000 students, alumni and staff that can help support you long after graduation. our instructors offer relevant, real-world expertise to help you understand and navigate the field. plus, with our growing, nationwide alumni network, you'll have the potential to tap into a number of internship and career opportunities. 93.6% of online students would recommend snhu (according to a 2022 survey with 17,000+ respondents). discover why snhu may be right for you . admission requirements expanding access to quality higher education means removing the barriers that may stand between you and your degree. that’s why you can apply at any time and get a decision within days of submitting all required materials: completed free undergraduate application prior transcripts, which we can retrieve at no cost to you test scores are not required as part of your application acceptance decisions are made on a rolling basis throughout the year for our 6 (8-week) undergraduate terms . how to apply if you’re ready to apply, follow these simple steps to get the process going: complete a free undergraduate application submit any additional documents required work with an admission counselor  to explore financial options  and walk through the application process if you have questions or need help filling out your application, call 1.888.387.0861 or email [email protected] . if (typeof accordiongroup === "undefined") { window.accordiongroup = new accordion(); } accordiongroup.init(document.getelementbyid('5c8b67b0a0e44d91a4319aa7e0db6de5')); make a difference in your community.

"My capstone was my most loved and valued class. I was able to focus on my passion in helping a community that is poverty-stricken and provide the youth in that area a way to reverse some unfavorable behaviors."

Courses & Curriculum

When you earn your health education degree online at SNHU, you've completed a program that was designed to set you up for success in the health field – created by subject-matter experts who know the skills you need to have under your belt. The U.S. Bureau of Labor Statistics cites some of those important qualities 1 as:

• Analytical and problem-solving skills. Health education specialists collect and evaluate data to determine the needs of the people they serve. They may need to solve problems that arise in planning programs, such as budget constraints or resistance from the community they serve.
• Instructional skills. Health education specialists and community health workers lead programs, teach classes and facilitate discussion with clients and families.
• Interpersonal skills. Health education specialists and community health workers interact with people from a variety of backgrounds. They must be good listeners and be empathetic in responding to the needs of people they serve.
• Communication skills. Health education specialists and community health workers must be able to clearly convey information in health-related materials and in written proposals for programs and funding.

SNHU's bachelor's in community health education prepares you for the professional certification examination to become a Certified Health Education Specialist (CHES) offered through the National Commission for Health Education Credentialing (NCHEC). According to NCHEC, the CHES credential shows employers that you've mastered the Seven Areas of Responsibility for health education specialists, outlined in the Health Education Specialist Practice Analysis project. 2 Those areas are:

• Administer and manage health education/promotion
• Assess needs, resources and capacity for health education/promotion
• Communicate, promote and advocate for health, health education/promotion and the profession
• Conduct evaluation and research related to health education/promotion
• Implement health education/promotion
• Plan health education/promotion
• Serve as a health education/promotion resource person

The curriculum in the community health education degree provides you with 12 credits of electives within your program – meaning you get the opportunity to choose 4 courses in community health education, integrated health professions and public health education.

"I have learned so much in the years since I have been a student," said student Jacqueline Graham . "This major is wonderful, and the courses are interesting. There is so much to learn."

Plus, the community health degree program has plenty of free elective space overall. That's ideal for students with transfer credits, or even those who want to broaden their skill set and explore areas of interest.

Daniel Amato '21 was one student who brought a lot of credits into his program.

"I transferred credits to SNHU, which helped me complete my degree much faster," he said. "My credits ended up completing all my electives, so all I had to do for my community health education degree was my core classes. It was much quicker than I thought it would be."

Classes are taught by instructors who have experience in the field.

"The instructors at SNHU are so very helpful, and they all want their students to succeed," Graham said. "They are very accessible, so you will never feel alone or that you cannot have access to them because it is online."

Amato agreed.

"My instructors were knowledgeable and passionate about community health education," he said. "They allowed all of us to bring our own experiences into the classroom and use them within our studies. It made for a fun learning environment, because we got to read each other's stories and bounce ideas off each other."

Curriculum Requirements & Resources

General education.

All undergraduate students are required to take general education courses , which are part of SNHU's newly redesigned program, The Commons. The goal of The Commons' curriculum is to empower you with some of the most in-demand skills, so you can succeed not only in your academic career, but in your personal and professional life too.

Technology Resources

We provide cloud-based virtual environments in some courses to give you access to the technology you need for your degree – and your career. Learn more about our virtual environments .

Earn Math Credits

Save time and tuition with our Pathways to Math Success assessments. Depending on your scores, you could earn up to 12 math credits – the equivalent of 4 courses – toward your degree for less than $50 per assessment. For additional information, or to register for a Pathways to Math Success assessment, contact your admission counselor or academic advisor today.

Minimum Hardware Requirements Component Type   PC (Windows OS)   Apple (Mac OS)   Operating System  Currently supported operating system from Microsoft.   Currently supported operating system from Apple.  Memory (RAM)  8GB or higher  8GB or higher  Hard Drive  100GB or higher  100GB or higher  Antivirus Software  Required for campus students. Strongly recommended for online students.  Required for campus students. Strongly recommended for online students.  SNHU Purchase Programs  Visit Dell   Visit Apple   Internet/ Bandwidth  5 Mbps Download, 1 Mbps Upload and less than 100 ms Latency  5 Mbps Download, 1 Mbps Upload and less than 100 ms Latency  Notes:   Laptop or desktop?   Whichever you choose depends on your personal preference and work style, though laptops tend to offer more flexibility.  Note:   Chromebooks (Chrome OS) and iPads (iOS) do not meet the minimum requirements for coursework at SNHU. These offer limited functionality and do not work with some course technologies. They are not acceptable as the only device you use for coursework. While these devices are convenient and may be used for some course functions, they cannot be your primary device. SNHU does, however, have an affordable laptop option that it recommends: Dell Latitude 3301 with Windows 10.  Office 365 Pro Plus  is available free of charge to all SNHU students and faculty. The Office suite will remain free while you are a student at SNHU. Upon graduation you may convert to a paid subscription if you wish. Terms subject to change at Microsoft's discretion. Review system requirements for  Microsoft 365 plans  for business, education and government.  Antivirus software:  Check with your ISP as they may offer antivirus software free of charge to subscribers.  if (typeof accordionGroup === "undefined") { window.accordionGroup = new accordion(); } accordionGroup.init(document.getElementById('f756dce5bd874c61855f6f6e92d88470')); University Accreditation

Tuition & Fees

As a private, nonprofit university, we’re committed to making college more accessible by making it more affordable. That’s why we offer some of the lowest online tuition rates in the nation.

We also offer financial aid packages to those who qualify, plus a 30% tuition discount for U.S. service members, both full and part time, and the spouses of those on active duty.

Tuition Rates are subject to change and are reviewed annually. *Note: students receiving this rate are not eligible for additional discounts.

Additional Costs No Application Fee, Course Materials ($ varies by course)

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• Publications
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NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

Institute of Medicine (US); Stoto MA, Behrens R, Rosemont C, editors. Healthy People 2000: Citizens Chart the Course. Washington (DC): National Academies Press (US); 1990.

Healthy People 2000: Citizens Chart the Course.

• Hardcopy Version at National Academies Press

9. Health Promotion and Disease Prevention in Community Settings

Our world—and our neighborhoods—are instrumental in determining our health status. Education, access to services, family life, and work all play a role in shaping individual health and lifestyles. The kinds of health messages that people receive close to home, in their own ''world," also are among the most influential in determining their health behaviors. Many witnesses, therefore, argued that interventions in schools, the workplace, and the community at large can be powerful tools in implementing the Year 2000 Health Objectives.

Many testifiers accepted this premise and focused some, if not all, of their proposed objectives on interventions within the school, the workplace, and other community settings. They addressed common health problems faced by people in these settings, as well as programs that have been implemented to deal with them.

In schools, for instance, the major immediate concerns are substance abuse, AIDS, and teen pregnancy, but testimony was also directed at the health-enhancing possibilities for education programs on nutrition, physical fitness, mental health, and general lifestyle awareness and skills to enhance behavioral change. On the worksite, the primary concerns are screening for chronic diseases and programs to deal with smoking, nutrition, and stress. In the community, testifiers paid special attention to programs aimed at substance abuse and the prevention of chronic diseases, and on ways to make them culturally relevant to the community they serve.

In addition to the needs and proposals specific to these three settings, a number of implementation issues cross the three areas, including the content of health education programs, financing issues, and the coordination of services. These are addressed at the end of the chapter.

• Health Promotion and Education in Schools

Many witnesses see both a great potential and a great need for school-based health promotion endeavors. Thirty-four of them focus their remarks on health education in schools, and another 135 mention the need for school-based health education interventions either in the context of a specific issue or in terms of special interventions for children and adolescents.

The American School Health Association (ASHA) presents a detailed analysis of the needs and opportunities for school health programs. Problems encountered in school-aged children include unhealthy lifestyles, chronic and episodic illnesses, emotional and behavioral problems, visual and hearing deficits, eating disorders, nutrition problems, teenage pregnancy, sexually transmitted diseases, and dental problems.

In the face of these problems, "the school, as a social structure, provides an educational setting in which the total health of the child during the impressionable years is a priority concern." No other setting approximates the magnitude of the school in terms of the number of children that can be reached. Thus, many witnesses see the school as a focal point for health planning in the community. (#196)

Given this orientation, the ASHA proposes specific objectives regarding

• periodic screening for hearing, vision and dental disorders; scoliosis; high blood pressure; and fitness levels;
• care and health promotion programs for students with chronic illnesses or problems;
• professional preparation and availability of school nurses;
• provision of primary health care clinics in schools;
• school breakfast and lunch programs;
• health education curriculum, class time, and the professional preparation of teachers;
• physical education programs and testing that emphasize cardiovascular fitness and lifetime sports;
• mental health programs that include the development of prosocial behaviors, stress management skills, and control of stress and violence;
• provision of worksite health promotion programs for faculty and staff and a healthful school environment. (#196)

Implementation of School-Based Health Promotion

Testifiers feel that to meet many objectives, education must begin in the schools. However, school health programs need to be significantly improved if they are to serve this purpose. More comprehensive curricula are required, along with more hours spent on health education, better teacher training, and better availability of health professionals or health services to students. The involvement and support of parents are also viewed as critical to the success of many school-related activities.

Texas Commissioner of Education William Kirby writes:

The public schools of America bear much of the burden to educate children about the physical, emotional, social and economic dangers of such health issues as drug abuse, school-age pregnancy, AIDS and smoking. We accept this responsibility, yet we know that the task is too great for education systems to bear alone. We are grateful to the federal government for its support in such programs as the Drug-Free Schools and Communities Act, to the Surgeon General for his comprehensive report on AIDS, and for federal funding to assist in the education of disadvantaged and handicapped children. We appreciate the philosophical and economic support and look forward to continued cooperation and coordination of education and health efforts among federal, state, and local governmental entities. We share a common goal—ensuring bright futures and long, healthy lives for our children. (#305)

Many testifiers suggest ways to improve the health education system so that it deals more successfully with adolescent health problems, including such far-ranging suggestions as environmental health issues; training in how to be an active and responsible medical consumer (#105) ; issues of television exposure, "latchkey children,' and homelesshess (#198) ; suicide prevention programs (#500; #731) ; and art therapy and dance to deal with stress and to foster creativity (#477; #595) .

Underlying these specific programs is concern about the capability of elementary and secondary school faculty to teach health issues. Chet Bradley of the Wisconsin Department of Public Instruction writes:

I am convinced that unless a significant change in the professional preparation of elementary teachers in the area of health becomes a reality, the institutionalization of quality health instruction at the elementary level will never occur. I propose to you that the most meaningful and effective long-term approach toward successful school-based prevention and health promotion efforts for our young people is through an investment in outstanding teachers.

His testimony includes a proposal to train elementary school teachers to earn a three-year master's degree in elementary health education. (#593)

The American School Health Association supports Bradley's view and states that

most health education is conducted by poorly trained, non-specialists who devote much less than the minimum of 50 hours necessary for success, and who see health education at the best as secondary to their primary functions. These teachers also are working without the benefits of the other components of a comprehensive school health program. Thus, school health education is generally a failure. (#055)

Some witnesses called for more use of tested and effective behavioral teaching models. According to the National Education Association:

Attitudes and behavior are not changed by simple presentation of the facts—or by scare tactics. Regardless of race, creed, or socioeconomic status, young people believe in their own invulnerability—that "it" simply isn't going to happen to them. An effective preventive health curriculum must rationally counter this belief in invulnerability and build a youth culture that embraces healthful behavioral choices. (#059)

Similarly, Kenneth Kaminsky of the Wayne County Intermediate School District in Michigan writes that "the most successful programs today employ the social competency or 'life skills' model." This model emphasizes skill development in communication, assertiveness, resistance skills, peer selection, problem solving and decision making, critical thinking, making low-risk choices, self-improvement, and stress reduction skills. (#426) According to David Groves of Comerica Incorporated, "Social competency development programs emphasizing cognitive and social problem solving skills, perspective taking, and coping skills should be provided to all children as a part of their educational opportunities.'' (#075)

Williams argues that a comprehensive, preventive health curriculum in schools necessitates collaboration not only among "educators, parents, school boards, administrators, and communities," but also among teacher preparation institutions and the medical community. (#059) The effectiveness of a school health promotion and disease prevention program relies on the support of the entire community.

Community involvement is especially important when the more sensitive issues of AIDS education and school-based or school-linked reproductive health clinics for teenagers are addressed. Kirby emphasizes the need for local discretion in all health programming.

We believe that where school-based clinics exist, they must be coordinated with existing health services and should be established and maintained to meet the specific needs and philosophy of the local community. It is imperative that school-based clinics be under the direct supervision of the campus administrator and that considerable flexibility be allowed at the local community level. Programs not supported by and congruent with local standards are not likely to be successful. (#305)

One problem with focusing on school-based programs, however, is that not all adolescents stay in school long enough to benefit from them.

A large percentage of school age children are disenfranchised from the nation's schools. They are in jail, on the street, working, or on the run. Thus, the health objectives regarding school aged children are not realistic and lack sophistication. They have only focused on those children currently attending school or available to what is called "school site health education." (#055)

Specific Problems and Interventions

Much of the testimony on school health issues arose in the context of interventions in specific areas. Programs aimed at improving nutrition, physical fitness, and mental health, and also at preventing AIDS, teenage pregnancy, smoking, and other substance abuse were mentioned most frequently.

Testifiers proposed various nutrition objectives, many of which are designed to ensure both classroom education and cafeteria participation. Several witnesses also underlined the need for a nationwide monitoring system of school-age children's nutrition status; without this, setting objectives will be difficult. Many of those testifying about nutrition education referred to the Nutrition Education and Training (NET) Program, which came into being by an act of Congress in 1977. Its purpose is "to teach children the value of a nutritionally balanced diet through positive daily lunchroom experience and appropriate classroom reinforcement, to develop curricula and materials, and to train teachers and school food service personnel to implement nutrition education programs." (#161) Witnesses testified that this program should be supported and, in some cases, expanded.

Some testifiers, such as Carol Philipps representing the Midwest Region NET Program Coordinators, advocate "integrating nutrition concepts into other curricular areas as appropriate, for example biology, elementary language arts, mathematics, home economics, and social studies." (#590) Others place great emphasis on maintaining school lunch and breakfast programs and summer food programs in public and private schools. To actually maintain a nutritionally balanced diet, they argue, many children need school meals.

Physical Fitness

The discussion of physical fitness focuses on engaging children in vigorous health-fitness activity and on preparing children for healthy physical activity behaviors later in life. For instance, the American Alliance for Health, Physical Education, Recreation and Dance (AAHPERD) believes that thoroughly and appropriately integrating physical activity into one's life is possible only with a sound educational program as a starting point. (#596)

One of the current problems with physical education programs, according to Brian Sharkey of the University of Northern Colorado and others, is that physical fitness tests given to school children often dictate, at least in part, the content of the curriculum. Hence, it is important to select fitness tests that will lead to the desired behaviors. As an example, he cites the health-related fitness test developed by AAHPERD as being preferable to the athletic skills-related test of the President's Council on Physical Fitness and Sports (PCPFS). Unfortunately, he says, "well-meaning school teachers see the glitter and polish of the PCPFS award system" and forsake AAHPERD's fitness test. This, Sharkey feels, prevents the establishment of a unified health-fitness related program in U.S. schools. (#363)

Others discuss the need to integrate physical education with other health-related programs. Guy Parcel of the University of Texas Health Science Center at Houston, for example, discusses a program called Go For Health that was designed to reduce cardiovascular risk factors in elementary school children. This program makes an organizational-level change in the school lunch and physical education programs to "create an environment supporting healthful diet and physical activity practices," which is then supplemented with classroom instruction and theory "consistent with the school environment." 1 (#295)

Charles Kuntzleman of Fitness Finders makes the argument that increasing the amount and time of current physical education programs as they now exist may not solve the problem of the poor physical condition of today's children. According to Kuntzleman, 75 percent of the time in a typical physical education class is spent on record keeping, roll call, listening to instructions, waiting to take a turn, and general management; only 25 percent of the child's time is devoted to motor activity. (#121)

Mental Health

Many witnesses stressed the necessity of providing mental as well as physical health education to children. Such programs can address a wide variety of issues ranging from stress management to the prevention of adolescent suicide.

The American School Health Association accents the pivotal role a school can play in fostering the mental health of a child and building skills for later life. The ASHA believes that stress management is an important part of a school health education curriculum. (#196)

Gaffney speaks of suicide and the potential of a teacher for identifying a suicidal child. She argues that "teachers are the children's first line of defense because they see behaviors before even parents do on occasion." (#731)

The school is also an important setting for dealing with problematic personality characteristics. Bruce Dohrenwend of Columbia University School of Public Health says that because problematic dispositions can be "laid down early in life," the school is a good place to provide "training and orientation toward mastery and control." (#729)

Family Planning and Reproductive Health

Many testifiers endorse the provision of family planning programs within the general school health curricula. They also agree that reproductive health or sex education should begin early in the school years. Testifiers acknowledge the sensitivity of these issues and recognize parental concerns, but most feel that ignorance of pregnancy and AIDS outweighs the concerns about sex education.

High teenage pregnancy rates indicate a failure of educational and service provision efforts, according to Deborah Bastien of Galveston, Texas. She underlines the disparity of adolescent pregnancy and abortion rates in the United States and in other industrialized countries, and concludes that the higher rates of both pregnancy and abortion here are due not to greater sexual activity but to lesser availability of contraceptive services and sex education. Despite this, "U.S. public policy still focuses on preventing sexual activity among teens." (#236) Sylvia Hacker of the University of Michigan supports this position: "Recognizing that adolescents are risk takers, espousing abstinence as the only choice will not work." Instead, she says, sex education could help adolescents realize that choices are possible in expressing one's sexuality, and intercourse is only one of them. (#406)

Jackie Rose of the Clackamas County Department of Human Services in Oregon suggests social motivations for teenage pregnancy: "We see teens for whom making a baby is one thing they can succeed in." To change these attitudes, she argues:

We need comprehensive, coordinated teen-parent programs and teen pregnancy prevention programs to help them realize other options. We need to devise strategies to keep teens in school, for example, teaching teens and their families techniques for success and making available health services that minimize barriers to those services; that is make services available where the teens are—chool-based health clinics. We need a goal to decrease the rate of repeat pregnancies during the teenage years. (#343)

When and how family planning education should begin, argues Susan Addiss of the Quinnipiack Valley Health District in Connecticut, are important questions. Even though "there is controversy about the content and timing of such education in communities around the country," Addiss urges "most strongly that an objective be developed with respect to some desired percentage of the nation's school systems having comprehensive family life education curricula in place by the year 2000." (#460)

The National Parents and Teachers Association also supports school-based sex education and says that because few parents actually discuss sex education, "schools and other public agencies and organizations must undertake this education." (#578) Similarly, Cathy Trostmann, a community school nurse in Texas, feels that sexuality education should begin in the first year of school and be presented at a level and in a manner that relates to the level of the child's development. She argues, however, that provisions be made for parents "to give their own instructions in the home with guidance provided by the school system," if they so desire. (#302)

The American School Health Association calls for school-based intervention programs to reduce not only teen pregnancy, but teen alcohol and substance abuse as well. According to ASHA, these programs must encompass more than just classroom education. The best way to decrease adolescent pregnancy and the incidence of sexually transmitted diseases among adolescents is to provide multiple channels: health and educational professionals, parents, and peers. The utilization of school-based clinics, school-linked clinics, and school-and community-based education programs is an example of an intervention that complements instruction and has been shown to be effective in reducing adolescent pregnancy. (#232)

Clinical services are a critical part of successful intervention programs for teenage reproductive health. As ASHA notes, in preliminary evaluation a few programs have shown dramatic efficacy in combatting teenage pregnancy. 2 It also cites studies that show widespread support for school-based clinics; the number of clinics across the United States has risen from 1 in 1970 to 120 in 1988. 3 (#232)

AIDS Education

Although the ideal content of AIDS education programs is controversial, most witnesses who address this issue call for aggressive school education. Wayne Teague of the Alabama Department of Education writes that when he was asked whether parents or the school system should decide the content of an AIDS education program, "I took the position that we do not give people an option for their children to commit suicide." (#675) However, although AIDS education is now mandatory in Alabama state schools, across the nation—according to Ralph DiClemente of the University of California, San Francisco—few school systems currently provide AIDS education as part of a formal curriculum, and even fewer have evaluated program effectiveness. (#273)

DiClemente believes that AIDS prevention programs should "encourage health-promoting behaviors and eliminate or reduce high-risk sexual and drug behaviors. Adolescents cannot be coerced into changing behavior patterns." (#273)

AIDS education, however, is hampered by the lack of information on the epidemiology of behavior among at-risk groups. Lew Gilchrist of the University of Washington says that baseline information is lacking on the actual use of condoms among specific populations, including adolescents. To offer effective education, these programs must be grounded in an understanding of actual behaviors and attitudes in at-risk populations. (#691)

Smoking, Alcohol, and Substance Abuse

Some testifiers argue for early, school-based prevention activities for smoking, alcohol, and substance abuse. For example, according to the National Association of State Boards of Education:

There should be a specific focus on alcohol and drugs beginning in the fourth grade and continuing until graduation. Providing accurate information is essential for a substance abuse prevention program. This includes knowledge about physiology, high-risk populations, high-risk situations, the actual prevalence of drug and alcohol use, family influence, peer pressure, stress, the role of the media, and cultural norms. (#573)

Kaminsky argues that students now view schools as the leading source of antidrug information. For this reason, schools must provide a program that can give adolescents information and influence healthy lifestyle behaviors. He outlines a program for substance abuse and lists as its components a grade-specific curriculum, in-service teacher training, counseling services for children, parent education programs, peer leadership and liaison work with community service providers, parent groups, and the media. (#426) Many of Kaminsky's components are reiterated by other testifiers, especially peer leadership and community-wide efforts.

• Health Promotion in the Workplace

As the American Occupational Medical Association (AOMA) points out, virtually all the 1990 Objectives can be addressed effectively and efficiently in the workplace. Health problems having to do with "reproduction, child-rearing, immunization, mental health, substance abuse, hazard exposure, risk-taking, and self-destructive habits" are all appropriate and pertinent material for workplace health education and health promotion programs. (#071) Many other witnesses agree.

Business Roundtable spokesperson Paul Entmacher offers a sample list of health promotion programs to be found in businesses today which "amply demonstrates the extent that business health promotion activities are part of the nation's total effort." These include

• smoking cessation, general tobacco use abstention;
• coronary heart disease prevention, including nutrition education;
• stroke prevention and hypertension control;
• seat belt usage and auto crash injury prevention;
• diabetes screening and education;
• early identification and treatment of alcohol abuse;
• cocaine, heroin, and marijuana education and counseling;
• occupational safety standards and matching education;
• occupational toxicity education and control;
• weight control;
• physical fitness and exercise;
• cancer detection (cervical smears, mammography); and
• AIDS public education and worker counseling. (#465)

A survey of 48 companies by the Washington Business Group on Health identified the five priorities (and some reasons for them) among workplace health issues in the 1990s:

Detection of, and intervention against, chronic diseases , including cancer and heart disease (32 responses): because chronic diseases account for the bulk of health care expenditures and for considerable absenteeism and productivity losses. Although solutions require addressing multiple risks, chronic diseases are amenable to large-scale detection and prevention programs.

Reduction of alcohol and drug abuse (21 responses): because alcohol and drug abuse are a major source of health costs, absenteeism, and lost productivity; because abuse increases legal and security costs; and because abuse reduces the morale of coworkers.

Improvement of mental health (19 responses): because mental health costs continue to grow. Stress-related illnesses are becoming more prevalent and contribute to overall health costs; employee assistance programs at the worksite can be effective.

Control of HIV infections and AIDS (15 responses).

Prevention and control of tobacco use (14 responses): because no other single factor accounts for as much cost and loss of productivity.

Smaller numbers of respondents identified physical fitness (11 responses), maternal and infant health (8), occupational safety and health (8), maintaining health and quality of life in older people (8), nutrition (6), and other topics. (#355)

Many of those who addressed the question of worksite-based programs spoke of generic issues such as the need for comprehensive policies, the role of health professionals, and the special difficulties faced by small businesses. Others addressed specific activities, policies, and programs to deal primarily with smoking, nutrition, stress reduction, substance abuse, and physical fitness and exercise.

Implementation of Workplace-Based Programs

Marilyn Rothert of Michigan State University targets three factors for developing a successful worksite health promotion program: (1) involvement of employees and management in the identification and development of all phases of the program; (2) expectation that successful programs will be sustained; and (3) working across populations and risk areas, and using multiple strategies. (#394)

Margo Gorchow of the Health Development Network at Botsford General Hospital in Michigan describes the problems encountered in a worksite risk reduction program at a General Motors plant.

To put up a poster announcing a smoking cessation program will not necessarily fill your classroom with eager, expectant students willing to give up smoking and pay money to do it. Offering free introductory sessions so groups can learn what the program is about does not necessarily make people want to give up a habit of eating potato chips, chocolate chip cookies, et cetera . Aggressive outreach and engagement strategies need to be developed and implemented, to reach out to the individuals, to raise their level of health awareness, and engage them in a program to support their own interests, rather than what we think is a good idea for their health, to make a lifestyle change. (#386)

Gorchow maintains that her program's success comes from keeping

a high profile of visibility, with our professional staff (R. N. s and R.D.s) periodically on the factory floor talking to employees and signing them up for risk reduction classes. This approach is working to engage the employees into a program as well as to provide follow up to assess their progress or relapse. There are on-site wellness coordinators at the plant as well. This proves to be an expensive, labor intensive approach. Still, in the first year of this study we were able to attract approximately 10 percent of the work force into behavior change programs. (#386)

A number of testifiers called for a comprehensive set of policies, interventions, and activities for work-site wellness. According to Rothert and others, these programs share three components: (1) employee education, (2) a knowledgeable and available health professional, and (3) incentives for sustained participation. (#153; #394)

For example, the Adolph Coors Company provides fairly complete wellness services to its employees, retirees, and their dependents. These include preventive dental coverage, smoking cessation programs, exercise programs, stress prevention programs, screening for high blood pressure, causes and solutions for low back pain, good nutrition, weight management, healthy pregnancy/prenatal awareness and education programs, and mammography screening for the company and the community. A cost benefit analysis of Coors' programs shows that for each dollar invested, the company can expect a return of $1.24 to $8.33. Max Morton, manager of the Coors Wellness Center, claims a high level of participation and success for the various programs. Morton underlines the need to reach production staff as well as management staff: "Our studies suggest a difference in where production and nonproduction workers get their health information. Production workers reported that the majority of their information comes from television, radios, and newspapers, in contrast to nonproduction workers information sources, which were their M.D.'s and our Wellness Center." (#153)

A similarly comprehensive health promotion program is being undertaken at Michigan State University. Rothert explains that its purpose is to "establish an institutional process to sustain health promotion as a broad-based commitment and component of the mission of Michigan State University and to develop a model of this process that can be deployed to other organizations." She adds, "Health habits can be contagious, and we are attempting to create a broad-based environment supportive of individual health promoting decisions." (#394)

Many testifiers who have or are developing work-site health promotion programs concluded that a knowledgeable health professional at the worksite is a necessity for success. For example, Pat Joseph, representing the American Association of Occupational Health Nurses, argues that workplace health education is most successful through occupational health nurses. "Approximately 75 percent of all occupational health nurses are the sole health care provider in the workplace," she says, and for this reason, they are "among the 'movers and shakers' in the activity to eliminate preventable disease and to promote optimum health in the workplace." (#385)

However, although a program under the direction of a health professional might be the ideal, it may be too expensive for most small businesses to staff and draft comprehensive workplace wellness programs. To overcome this difficulty, there are now a host of local business groups on health, community organizations, and coalitions that can aid small businesses. Companies, such as insurance providers, make programs available, and resources can be found that help provide at least some wellness information or services, according to witnesses.

Jack West, President of the Puro Corporation of America, illustrates what can be done. With 47 employees of his own, he argues that small businesses "can pick the low-hanging fruit" of employee health promotion programs. These are cheap interventions such as employee self-assessment questionnaires (at $12 per person), lunchtime cancer self-screening seminars, complimentary flu shots, a company newsletter on health and fitness, a company subscription to a local fitness club, and providing his company's product—bottled water—to pregnant employees or spouses. (#734)

The New York Business Group on Health, a not-for-profit coalition of nearly 300 organizations of which the Pure Corporation is a member, tries to help businesses obtain health information appropriate to the workplace. Its director, Leon Warshaw, says, "We have published a two-volume directory of available resources for health education/promotion and every issue of our bimonthly newsletter is replete with articles describing innovative and successful programs and capsule reviews of publications and educational materials suitable for use in the workplace." (#448)

Warshaw also talks about providing help and direction in the adaptability of projects.

One should remember that the work force is not a uniform population. Specific cohorts can be identified on the basis of age, sex, educational and ethnic backgrounds, health status, and disease predilections so that they can be targeted for specific programs. The economies of scale, ease of access, and the enhancing effects of peer pressure serve to increase the effectiveness of these programs. (#448)

As with school-based health promotion programs, many of those who testified on workplace wellness singled out specific health needs and programs that should be addressed effectively by employers. The most commonly mentioned programs involved screening for chronic diseases, smoking, stress reduction, and nutrition.

Screening for Chronic Diseases.

Worksite screening for heart disease and cancer can be invaluable in identifying individuals at risk of developing either of these chronic diseases. Heart disease and cancer remain the two top killers in the United States despite the fact that, to a great extent, both can be prevented. As speaker Thomas Washam of the Aluminum Company of America (Alcoa) points out, worksite screening can save lives. For example, at Alcoa there are blood pressure monitoring programs and chronic health condition monitoring programs. These programs have found individuals who were in need of medical or surgical intervention, as well as individuals for whom better compliance with recommended medication was imperative. (#307)

The AOMA suggests as an objective that "90 percent of the Fortune 500 companies and 75 percent of all employers with more than 100 employees should provide for on-site blood pressure screening and follow-up." Voluntary organizations, health care providers, and other organizations will have to assist employers that do not have their own assessment resources, AOMA adds. (#071)

Leslie VanDermeer, an occupational health nurse, says that "screening of total cholesterol levels should be made available to all employees who work in a company that has an on-site medical unit or nursing department." She argues that since the fingerstick method of measuring total serum cholesterol is "low cost, accurate and easily accessible," it would be "a scientifically sound and attainable goal for the year 2000 to have 100 percent of the worksites that contain employee health services offer this service." (#217)

Angelo Fosco, General President of the Laborers' International Union of North America, calls for making preventive services available through company-provided health plans. He suggests that these plans give particular emphasis to occupational diseases and work-related disorders, and that they be made available to retired workers as well. (#586)

Worksite screening for chronic conditions also can be useful in encouraging individual responsibility and coordinating other components of a worksite wellness program. Screening for cholesterol, high blood pressure, and breast cancer, for example, can help individuals to monitor their own health conditions. It also enhances the connection with other wellness programs for nutritional awareness, smoking cessation, physical fitness, and stress management. The Adolph Coors Company, in addition to blood pressure screening, cholesterol screening, and a cardiac rehabilitation program, provides a significant mammography screening program. The company has encouraged employees and their spouses to "spread the word" to the community that many breast cancer deaths can be avoided if detected early. Coors offers mammograms for $15 to all staff and dependents, and is now coordinating screening for the nearby community. (#153)

Nonsmoking programs are the most frequently cited worksite interventions. Many large businesses in the United States are actively and effectively reducing smoking in the workplace. According to Alice Murtaugh of New York City, 36 percent of U.S. companies with 50 or more employees have smoking control activities. 4 (#159)

Charles Arnold, representing the Health Insurance Association of America (HIAA), exhibited a step-by-step implementation plan as an example of what can be done for employers who want to reduce smoking among their employees. The manual entitled Non-smoking in the Workplace: A Guide for Insurance Companies is put out by HIAA and the American Council of Life Insurers, who have "resolved to make the provision of worksite smoking cessation programs a top priority for the employees of our industry." (#440)

Some in the business community are not content to limit their activities to the private sector, and address participation by the government, both as a regulator/lawmaker and as an employer. "More laws to ban smoking in the workplace must be enacted," says Murtaugh. (#159) However, Robert Rosner of the Smoking Policy Institute of Seattle adds, "Before the government can advise any other organization on the issue of smoking policy and cessation programs, it must get its own house in order." Although the government has made progress, Rosner says it still lacks consistent and comprehensive policies for its own employees and worksites. (#349)

Because of the link between nutrition and chronic disease, a number of testifiers described nutrition goals that would be appropriate for the workplace. Providing information about sodium, cholesterol, fats, and sugar in foods, and including cafeteria and other food providers in worksite nutrition programs were viewed as good policy. However, according to Marilyn Guthrie of the Virginia Mason Clinic in Seattle, "although there exists both professional and public awareness of nutrition's role in health, more concrete data on the cost versus benefit of initiating changes in eating patterns are needed to provide the impetus for more structured programs." (#077)

Loring Wood of NYNEX suggests combining nutrition and physical fitness objectives into a single objective to bolster the effect of education in the workplace. Specifically, he says that overweight, hypercholesterolemia, and exercise are closely related to each other and to cardiovascular risk. Thus, workplace initiatives that foster good nutritional guidelines in the cafeteria and at the same time actively encourage employees to exercise regularly either off site or in subsidized programs are likely to increase productivity, lower absenteeism, and help retain satisfied employees. Wood proposes that "by 2000, 25 percent of companies and institutions with more than 500 employees should actively encourage their employees to exercise regularly through subsidized programs or on their own time, and their cafeteria managers to be aware of and actively promote U.S. Department of Agriculture and Department of Health and Human Services dietary guidelines." (#736)

Stress Management.

Stress management is also a common element in specific interventions suggested for the workplace. Because of its toll on productivity and the absenteeism stress produces, stress management has become a compelling health issue for the business community. James Henderson of Pacific Bell reiterates this: "Our fastest growing health care cost item is the price of stress and depression in Southern California." (#761) Harriette Zal of the Southern California Association of Occupational Health Nurses remarks, "It is predicted that 'stress' will be the occupational health disease of the 1990s." (#230)

As described in testimony, employer-sponsored programs for stress management can range from lunchtime classes to long-term education and relaxation classes. James Quick from the University of Texas at Arlington, representing the American Psychological Association, outlines how individual and organizational stress can be dealt with without causing "distress." He cites four basic components of a stress management program:

knowledge of what stress is, what causes it, and what constitutes the stress response;

knowledge of costs—"both individually and collectively"—of mismanaged stress;

familiarity with how to diagnose stress and its effects; and

knowledge of responsible individual and organizational prevention strategies that are beneficial in the management of stress. (#176)

Employee assistance programs (EAPs), which provide counseling services and resources for employees, are another work-based method of handling stress. The benefit of EAPs for employees is that it recognizes their total environment—in and out of work—as appropriate for interventions. As the AOMA says:

Such broad-based programs should provide the expertise to counsel on finances, parenting, interpersonal relations, marital discord, dislocation support, bereavement, AIDS, substance abuse, violent crime victimization, rape, etc. It is unlikely that many small businesses will have all counseling resources within their organization. Rather, the EAP counselor (whether contracted or employed, on-or off-site) should serve as an advisor and should guide employees to appropriate resources. (#071)

• Community-Level Interventions

More than 100 testifiers argue that behavior-related health problems—for individuals or entire populations—can be addressed most effectively through at least some degree of community-level intervention. Linda Randolph of the New York State Department of Health says that the increasing appreciation of "the role that communities play in supporting the individual" makes it necessary not only to empower individuals in the health arena, but to empower "communities as aggregates of individuals" as well. (#177)

As an organization with the resources necessary to provide support for community health plans, the New York State Department of Health has devised a five-step process that allows it to help communities "determine for themselves the means they will employ to realize optimal health" and to establish prevention interventions: (1) identify health problems, (2) determine the relative public health threat, (3) devise strategies to solve the problems, (4) implement strategies, and (5) evaluate the effectiveness of the strategies. (#177)

Other testifiers who outline community intervention strategies reiterate these five steps, perhaps using different terminology. Many argue that a key element of both devising and implementing prevention interventions is the realization that customs, mores, and socioeconomic status affect the health of individuals and communities. Effective programs, they say, must take these components into account.

Frank Bright of the Ohio Department of Health observes that "populations whose needs are being addressed should be brought into the planning process." Forcing an intervention upon a community from without or establishing an isolated intervention within an unsupportive community will not bring the same change in health status to that community as community-owned goals will. Bright says that community ownership of health objectives offers the potential of bringing necessary services into existing structures and making them acceptable to the population. (#470)

Most of those who testified about community interventions spoke about specific programs, but some addressed the opportunities that community-level programs offer to racial and ethnic minorities. Still others stressed the need to link community-level programs with wider efforts in society.

Witnesses mentioned a number of specific areas where community-level interventions are especially valuable. These areas include adolescent suicide and substance abuse, other adolescent issues, alcoholism, and the prevention of cardiovascular disease.

Problems of Adolescents.

Robert Tonsberg, Director of the Wind River Health Promotion Program, reports that a community coalition to reduce adolescent suicide was developed when a series of suicides took place in the Wind River Indian Reservation in Washington State. In looking at the histories of the victims, it was found that there was a high incidence of substance abuse and depression among them. The Wind River Health Promotion Program approached this by developing stress-coping skills among young people and education programs for children and youth. The planners also decided to use the "Tupperware approach"—instead of having participants coming to them, they brought the services to the community. The program relies on community-based networking and on collaboration and coordination with community groups; schools; churches; and local, state, and federal organizations. It focuses on multiple targets for change and multiple strategies for intervention and evaluation. (#711)

In Seattle, a citywide program to provide education and services to urban children was developed with the aid of a survey distributed to adolescents in the city. Robert Aldrich of the University of Washington says that one of the most startling discoveries of this survey was "some very major differences between what kids thought and what the adults thought the kids thought." To deal with this, says Aldrich, "we put in place a kids' board, 30 teenagers who report to the mayor and who, with the officials of the city and the private sectors began to deal with each of the issues that have been brought up by the kids, and some we thought of ourselves." Aldrich also points out that this Kids' Place program is not a medical intervention program. Instead, it is "more socially driven so that the primary things that are being dealt with are things like housing, and facilitating a day-care system." Aldrich urges others who might be interested in organizing similar programs to conduct a citywide survey and then plan strategies around the results. (#689)

Alcohol-Related Problems.

Al Wright of the Los Angeles County Department of Health Services describes a county-level alcohol intervention program that supports ''the prevention of, intervention in, and recovery from alcohol-related problems that occur at the individual, family, and community levels as a result of the relationship between alcohol, drinkers, and the environment." Among the strategies for primary, secondary, and tertiary interventions, Wright includes an "environmental approach to community-level prevention of alcohol problems," that is a counterattack on the social components of drinking. He lists price, product, place, and promotion as four areas in which there are industrial and societal pressures to drink. Los Angeles County's intervention program has developed four countermeasures: taxes, alternative beverages, planning/zoning, and norms/ policies. Wright's testimony illustrates that through coordinated activities, social habits can be changed. (#229)

Cardiovascular Problems.

Adrian Ostfeld of Yale University describes a statewide hypertension control program that was implemented with good results in Connecticut. After the organizers carried out a statewide survey of both health consumers and health providers in 1978, they decided to focus their efforts on controlling high blood pressure and reducing lifestyle-related risk factors, especially in younger men whose problems were more severe. They sought and received the cooperation of physicians, other health professionals, and provider agencies such as neighborhood health centers, public and private nursing agencies, the Red Cross, and family planning agencies. After four years, noticeable changes occurred in two areas. First, physicians and other health professionals became more active in screening for hypertension and helping their clients control it. Second, many residents of Connecticut reduced their behavioral risk factors for heart disease, including smoking and the consumption of salt and fat. (#459)

For Raymond Bahr of St. Agnes Hospital in Baltimore, Maryland, active participation of the community hospital is essential in a community program to prevent heart attacks. To enhance the link between early cardiac care and the community, Bahr says, "it is going to become important for each community hospital to have a coronary care system that moves into the community with educational programs focusing on chest pain and providing an early cardiac care center in the hospital." Bahr emphasizes the hospital's responsibility in this program.

Coronary care is a community problem because a significant number of sudden deaths and myocardial infarctions take place in this environment. Before entering the hospital coronary care system, the public must interact with the emergency care delivery system as well as with the hospital emergency room. The ultimate fate of the community depends on the quality and effort available in these areas. (#511)

Bahr's plan also includes strategies for informing the community at large. He argues that people must be instructed in cardiopulmonary resuscitation and must recognize the early warning signs of a heart attack. "But what is more important," he argues, "is developing the concept of having an 'executive person' in each family to deal with the chest pain patient who is experiencing procrastination and denial of the heart attack." Bahr also targets high school education as an appropriate vehicle for teaching that late entry into care causes sudden cardiac deaths. (#511)

Racial and Ethnic Minorities

Because of the importance of culturally related health knowledge and attitudes, as described in Chapter 6 , community-level intervention is thought to be an especially effective way to implement health promotion and disease prevention programs.

The Hispanic Agenda in Colorado, described by Rita Barreras of the Colorado Department of Social Services, is one such program that aims to develop community health objectives and programs for the Hispanic community. Its premise is that the responsibility "to insure that there is a coordinated, integrated and systematic approach to positive change" lies with the Hispanic community itself. (#243)

The steering committee for the Hispanic Agenda acted as impetus for the community-wide goal-setting process. It first identified eight component areas: education, higher education, labor and employment, economic development, housing and neighborhood, health and human services, political participation and leadership, and media. Next, experts were invited to submit papers and to draft goals for these eight component areas. Finally, criteria were developed to help planners identify and assess issues and strategies. (#243)

Margaret Hargreaves and her colleagues at Meharry Medical College's Cancer Control Research Unit describe several cancer prevention strategies being undertaken by Meharry, Morehouse, and Drew universities for the Black community. Their awareness program

aims to improve cancer knowledge of Blacks in the three consortium cities by developing a program to ensure the diffusion of cancer information throughout the community. The strategy will employ community organization, mass media, and personal contacts. The program will be provided through churches, worksites, and the community-at-large. (#615)

Hargreaves stresses the need to develop strategies that are culturally specific to the Black community.

Blacks have been reported to exhibit a particular pattern in availing themselves of health care, delaying in utilization of the traditional health care system, and relying upon family, friends, and even spiritualists and healers during critical stresses in their lives. Such delays are compounded by medical care expenses that they are unprepared to meet. With their unique value systems and problems of access, it is apparent that different health promotion strategies should be used to reach Blacks. (#615)

Mario Orlandi of the American Health Foundation emphasizes the importance of designing substance abuse community intervention programs that are "culturally relevant and that address specific sociocultural barriers to effective cross-cultural program dissemination." He also notes, however, the need for more data and research studies in these communities. In an evaluation of two community intervention approaches and their applicability to minority cultures, Orlandi found difficulties and gaps in assessing the substance abuse intervention needs of Blacks, Mexican-Americans, Asian Americans, and Native Americans. For all four of these groups, he rites a lack of basic research or intervention development research projects. For Blacks, compared to other groups, although there have been a number of research studies on substance abuse, Orlandi argues that "despite this accumulated body of research, the relevant understanding of Black substance abuse is lacking," and especially absent are ''the appropriate information and insight necessary to design effective preventive interventions for this population. The lack of systematic, longitudinal, multivariate studies, and the failure to employ ethnographic and other culturally-sensitive data collection procedures also has impeded progress." Orlandi concludes that the problem is not that preventive innovations are not available for planners trying to develop programs for minority populations, but rather that "programs are not available that fulfill both criteria: demonstrated efficacy and cultural relevance for particular minority or ethnic groups." (#167)

Linking Community-level Programs with Larger Efforts

A number of testifiers argue the necessity of linking community intervention programs with wider state, regional, and national health goals. The importance of networks, linkages, broad-based support, and above all, mass communication should not be ignored.

Woodrow Myers of the Indiana State Board of Health says that state health departments have a role to play in helping communities link themselves "to statewide solutions that affect other communities' problems and ultimately to national solutions, whether private or public, to address those needs." Myers describes several injury prevention programs that Indiana has undertaken, which involve both government and community components. Two examples are the Hoosiers for Safety Belts program and the Indiana Poison Control Center. The first is a statewide nonprofit coalition of private citizens, professional groups, service clubs, corporations, public agencies, and trade associations. The second program is a regional center dedicated to the prevention and treatment of poisoning. The center maintains a 24 hour, toll-free poison information line to inform citizens about household products, chemicals, pharmaceuticals, and live plants that may be poisonous. In both these interventions, the communities and the state share common goals to increase the use of safety belts and to provide statewide poison control services. (#405)

In some cases, the resources for health promotion and disease prevention programs are already available, but poorly coordinated. For example, writing about adolescent health problems, Claire Brindis and Phillip Lee of the Institute for Health Policy Studies at the University of California, San Francisco note that "categorical programs that have followed traditional patterns and focused on a single aspect of an issue—family planning, drug abuse, counseling—have had limited success.' Only a small portion of the adolescent population has responded to this categorical, medical-model approach. ''Communities need to work toward comprehensive and coordinated services," according to Brindis and Lee. This means making health education, social services, and job-related services available in the same place, with combined funding from public and private sources, and conducting rigorous evaluation to document success or failure and to move away from policies and programs that are not effective. "This comprehensive approach increases the efficiency of currently available community resources; facilitates the formation of linkages among a variety of concerned groups, such as parents, religious organizations, service clubs, clinics and social service agencies; and spreads funding responsibilities among several concerned parties." (#027)

Karil Klingbeil of the University of Washington recognizes that community-level education, counseling, and services are very important for reducing violence but calls for national-level activity, as well. Klingbeil recommends six secondary prevention steps that would be national in scope:

implementation of a national family violence prevention week;

"major media campaigns utilizing billboards, newspapers, radios, buses and other public vehicles, that can be used by public and private agencies";

development and implementation of legislation on all forms of abuse;

mandated "training and education on all aspects of family violence in all professional schools and cross-training in substance abuse and alcohol";

"innovative approaches to interviewing and interrogating child as well as adult victims";

"establishment of cross-agency committees or boards whose sole purpose it is to alleviate system barriers for victims as well as the offender groups." (#697)

The array of lifestyle choices offered to individuals in today's society and the conflicting information available in the media about what constitutes healthy behavior lead some testifiers to target communication channels in their intervention programs.

The National Council on Alcoholism, for instance, discusses the need to look at alcohol problems as social, as well as individual, problems. Thus, there should be process objectives for each objective on "public and community education based on the principles of sound educational theory and mass media communication." According to the council, "The alcohol and beverage industry spends two billion dollars a year on alcohol marketing that encourages and glamorizes drinking and associates alcohol use with maturity, success, sexuality, and high-risk activities." To counter this, it recommends that broadcasters ''grant equivalent air time for health and safety messages about alcohol." (#467)

Ruth Roemer of the UCLA School of Public Health states that the most effective legislative measures to reduce smoking are "(1) banning all advertising and promotion of tobacco products, and (2) raising the taxes on and prices of tobacco products very substantially."

Government has an obligation to protect the health of the people, and a ban on advertising would promote the social norm of a nonsmoking society. It would counter the negative consequences of advertising, which are especially pernicious in influencing young people to smoke. (#184)

The American Medical Association calls for responsibility in the media. The AMA believes that the media can be of "inestimable value" in attaining objectives, but that to do a responsible job, the medical community and the federal agencies must provide them with factual data. The AMA notes that the media have made a "cooperative effort at banning or otherwise censoring counterproductive advertising and promotional practices that are harmful to the public's health." (#095)

• Crosscutting Implementation Issues

Michael Eriksen, representing the Society for Public Health Education, writes:

As part of the effort to assure quality of health promotion interventions, it is important to remember that not all interventions should concentrate solely on the individual. In fact, often the most effective health promotion interventions are those directed at the changes in the behaviors of providers, environments, and systems. Organizational change is inherent in the definition of health promotion and should be considered an integral component. (#309)

A number of implementation issues are common to interventions proposed for schools, workplaces, and communities. Suggestions were made about the content of health promotion and education programs, their financing, and the coordination of available services.

Content of Health Promotion and Education Programs

Recognizing the importance of health promotion activities in nonmedical settings, many witnesses had suggestions about defining the scope and content of such programs. Sunny Chiu of the Michigan Department of Public Health, for instance, calls for (1) clearly defined policies, priorities, and strategies for health promotion; (2) scientific data and the opportunities to apply them through program planning and implementation; (3) the tools and resources for practitioners and the community; and (4) the information, educational processes, and a combination of motivational and supporting forces for behavioral change—both individual and collective—lined at reducing preventable morbidity and mortality. (#395)

The National Education Association suggests that health education focus on "life-enhancing" behaviors. According to Williams, "Our nation's schools must put into place health education programs that engage students, ensure that they understand the scientific and medical facts, and motivate them to choose appropriate behavior." Education must motivate young people to adopt healthful, life-saving behavior. (#059)

According to the American School Health Association:

The health education curriculum needs to be comprehensive and not content-specific or narrowly targeted. It should work to motivate health maintenance and promote wellness and not merely to prevent physical illness. In order to do this, it must possess the following characteristics: its activities should develop effective decision-making skills; it must be well-planned, sequential, and based upon the student's health needs and interests as they relate to national and local community health priorities; it must focus on health attitudes and feelings, as well as behaviors and practices; it must integrate all dimensions of human health and not focus only on the physical; it needs specific goals and objectives in addition to effective formative and summative evaluation procedures; it requires effective management and sufficient resources. (#055)

Igoe writes that "despite increasing pressure to participate in the management of their own health, consumers of all ages are often unable or unwilling to do so." Research shows, she says, that those people who strive for mastery over their own health needs and who are prepared to deal assertively with health professionals usually obtain the best health care. To overcome consumer passivity and conversational barriers between the health professional and the consumer, Igoe stresses self-responsibility and autonomy. Consumers must learn to approach health care as a "problem-solving endeavor that requires an active coping effort, rather than as a situation calling for passivity and submission." She suggests objectives to integrate "consumer activism'' education into all school curricula, including medical schools; to make it a responsibility of state health implementation programs to provide public service materials for consumer activism; and to do more research and survey work on outcomes of consumer activism. (#105)

Charles Lange of Loyola University says that one of the greatest obstacles to improving health is the lack of understanding by the general public of science, its methods, and its accomplishments. Unless the general public becomes more conversant with science, Lange feels, the achievement of the health objectives will be impossible. (#707)

Financing Health Promotion and Health Education

Health promotion and health education programs often fall outside of the common fee-for-service medical system and, therefore, are especially difficult to finance. Witnesses addressed this issue in the context of schools, worksites, insurance companies, and the media.

William Kirby, the Texas Commissioner of Education, says that "health services and health education are critical components of the public school program." However,

no education funds are specifically earmarked in the state budget for health services. Competition is steep for the funds that are provided in the form of general state aid to school districts, which must use those limited funds to meet the costly mandates of salaries, instructional provisions, and special programs as well as require-merits for health services. With the exception of drug abuse education, no additional funding has been allotted to local school districts to help them meet these responsibilities. Those in the legislative and health arenas must understand that education cannot continue to be expected to provide services and health-related instruction without some financial support. (#305)

Gorchow feels that financial support for health promotion must be sought from the private as well as the public sector. The insurance model in the United States has always been based on providing illness coverage rather than wellness coverage. With worksite-based intervention and education about prevention and management of chronic problems, it is possible to reduce the burden of illness on the individual as well as on the reimbursement systems. (#386)

Individuals should be encouraged to take responsibility for adopting and maintaining healthy lifestyles, says Jeannette Merijanian of the University of Montevallo. To do this, they need motivation to change their lifestyles, information on what and how to change, and support. Thus, "national resources and knowledge" should be linked together "with local organizations to promote, educate, and support citizens who want to improve their own health status." This will require insurance reimbursements for lifestyle changes and funding for health education programs, she says. Insurance reimbursements could be made either on self-reporting data or on quantifiable health changes, such as lower blood cholesterol and cessation or absence of smoking. (#644)

Kenneth Warner of the University of Michigan addresses the question of financing advertising efforts.

Television has aired one shocking documentary after another on drugs, while magazines have repeatedly featured the grim and stark imagery of crack and smack on their covers. Their front covers, that is; the back covers feature attractive, glossy ads for cigarettes and alcoholic beverages. The effect of this media hype is that teenagers believe that illegal drugs are the principal source of premature death in our society, while in fact cigarettes kill as many Americans in a single day as cocaine does in a year. We need a professionally designed paid broadcast media advertising campaign against tobacco use and alcohol misuse.

According to Warner, the hundreds of millions of dollars required for such an effort could not be raised voluntarily. One solution is to increase the excise taxes on cigarettes and alcohol to pay for the campaign. As little as one cent per pack of cigarettes would raise $300 million, he says, and the tax itself would reduce the demand for tobacco, especially among younger people. 5 (#429)

• Testifiers Cited In Chapter 9

027 Brindis, Claire and Lee, Phillip; University of California, San Francisco

055 Eberst, Richard; Adelphi University (Long Island)

059 Williams, James; National Education Association, Health Information Network

071 Givens, Austin; American Occupational Medical Association

075 Groves, David; Comerica Incorporated (Detroit)

077 Guthrie, Marilyn; Virginia Mason Clinic (Seattle)

095 Hendee, William; American Medical Association

105 Igoe, Judith; University of Colorado Health Sciences Center

121 Kuntzleman, Charles; Fitness Finders (Spring Arbor, Michigan)

153 Morton, Max; Adolph Coors Company

159 Murtaugh, Alice; New York

161 Neill, Carol; Alum Rock Union Elementary School District (California)

167 Orlandi, Mario; American Health Foundation

176 Quick, James; University of Texas at Arlington

177 Randolph, Linda; New York State Department of Health

184 Roemer, Ruth; University of California, Los Angeles

196 Seffrin, John, Allensworth, Diane, Eberst, Richard, et al.; American School Health Association

198 Sheps, Cecil; American Public Health Association

217 VanDermeer, Leslie; Hunter College (New York)

229 Wright, Al; County of Los Angeles Department of Health Services

230 Zal, Harriette; Southern California Association of Occupational Health Nurses

232 Allensworth, Diane; American School Health Association

236 Bastien, Deborah; Galveston, Texas

243 Barreras, Rita; Colorado Department of Social Services

273 DiClemente, Ralph; University of California, San Francisco

295 Parcel, Guy; University of Texas Health Science Center at Houston

302 Trostmann, Cathy; Houston, Texas

305 Kirby, William; Texas Commission on Education

307 Washam, W. Thomas; Aluminum Company of America

309 Eriksen, Michael; University of Texas Health Science Center at Houston

343 Rose, Jackie; Clackamas County Department of Human Services (Oregon)

349 Rosner, Robert; Smoking Policy Institute (Seattle)

355 Jacobson, Miriam; Washington Business Group on Health

363 Sharkey, Brian; University of Northern Colorado

385 Joseph, Pat; United States Air Force, Lowry Air Force Base, Denver

386 Gorchow, Margo; Botsford General Hospital (Farmington Hills, Michigan)

394 Rothert, Marilyn; Michigan State University

395 Chiu, Sunny; Michigan Department of Public Health

405 Myers, Jr., Woodrow; Indiana State Board of Health

406 Hacker, Sylvia; University of Michigan

426 Kaminsky, Kenneth; Wayne County Intermediate School District (Michigan)

429 Warner, Kenneth; University of Michigan

440 Arnold, Charles; Metropolitan Life Insurance Company

448 Warshaw, Leon; New York Business Group on Health

459 Ostfeld, Adrian; Yale University

460 Addiss, Susan; Quinnipiack Valley Health District (Connecticut)

465 Entmacher, Paul; Metropolitan Life Insurance Company

467 Aguirre-Molina, Marilyn and Lubinski, Christine; National Council on Alcoholism

470 Bright, Frank; Ohio Department of Health

477 Speert, Ellen; American Art Therapy Association

500 Medrano, Martha; University of Texas Health Science Center at San Antonio

511 Bahr, Raymond; St. Agnes Hospital (Baltimore)

573 Wilhoit, Gene; National Association of State Boards of Education

578 McGuire, Judi and Crowder, Aletha; The National PTA

586 Fosco, Angelo; Laborers' International Union of North America

590 Philipps, Carol; Wisconsin Department of Public Instruction

593 Bradley, Chet; Wisconsin Department of Public Instruction

595 Leventhal, Marcia; New York University and BrooksSchmitz, Nancy; Columbia University

596 Perry, Jean; American Alliance for Health, Physical Education, Recreation and Dance

615 Hargreaves, Margaret, et al.; Meharry Medical College

644 Merijanian, Jeanette; University of Montevallo (Montevallo, Alabama)

675 Teague, Wayne; Alabama Department of Education

689 Aldrich, Robert; University of Washington

691 Gilchrist, Lew; University of Washington

697 Klingbeil, Karil; University of Washington

707 Lange, Charles; Loyola University (Chicago)

711 Tonsberg, Robert; Indian Health Service/Wind River Indian Reservation (Fort Washakie, Wyoming)

729 Dohrenwend, Bruce; Columbia University

731 Gaffney, Donna; Columbia University

734 West, Jack; Puro Corporation of America (Maspeth, New York)

736 Wood, Loring; NYNEX Corporation

761 Henderson, James; Pacific Bell

• Cite this Page Institute of Medicine (US); Stoto MA, Behrens R, Rosemont C, editors. Healthy People 2000: Citizens Chart the Course. Washington (DC): National Academies Press (US); 1990. 9., Health Promotion and Disease Prevention in Community Settings.
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Health Education

(15 reviews)

College of the Canyons

Copyright Year: 2018

Publisher: College of the Canyons

Language: English

Formats Available

Conditions of use.

Learn more about reviews.

Reviewed by Uma Hingorani, Affiliate Professor, Metropolitan State University of Denver on 10/12/23

There is a Table of Contents, but an index and glossary of terms would both be helpful to find information quickly. read more

Comprehensiveness rating: 4 see less

There is a Table of Contents, but an index and glossary of terms would both be helpful to find information quickly.

Content Accuracy rating: 4

The information is well organized and accurate. Some updates are needed, such as reference to latest edition of The Diagnostic and Statistical Manual of Mental Disorders (DSM), including online tools to track menstrual cycle and Roe vs. Wade overturned stance on abortion in U.S., using more current CDC Fact sheets, including psychodelic mushrooms under drugs of abuse and impacet of legalization of marijuana on abuse potention, and including e-cigarettes, JUUL, and other modern cigarette types. Some minor typographical and spelling errors were noted ('spermacides').

Relevance/Longevity rating: 4

Updating sections to include modern aspects would be helpful.

Clarity rating: 5

The language is clear and conducive to an undergraduate level college audience.

Consistency rating: 5

The book flows well and uses consistent terminology throughout the chapters.

Modularity rating: 5

The text is divided into subsections, making it manageable to read and understand.

Organization/Structure/Flow rating: 4

The book is well organized and flows well.

Interface rating: 4

Use of more diagrams would be helpful. The diagrams and charts used emphasize the textbook reading.

Grammatical Errors rating: 4

Some minor typographical (bullets points not aligned in e-copy) and spelling errors were noted ('spermacides').

Cultural Relevance rating: 4

Culturally and racially sensitive.

This is a well-written, well-organized textbook which provides a good overview of health. Including the WHO definition of health and wellness would be beneficial as well as using more references to college-age students to engage this audience. In addition, updating sections to modern times would be helpful. Nonetheless, it is a straightforward and helpful textbook to use for a general health class elective.

Reviewed by Anna Smyth, Adjunct Faculty, Salt Lake Community College on 4/18/21

Health is a broad subject, and this book has done a nice job of categorizing and explaining some of the most important aspects. The book does not have a glossary or index but provides references at the end of each chapter for further exploration. read more

Health is a broad subject, and this book has done a nice job of categorizing and explaining some of the most important aspects. The book does not have a glossary or index but provides references at the end of each chapter for further exploration.

The data and information presented in the book appears to be accurate but some statistics are over 10 years old. Students would benefit from an updated edition. The information about sensitive topics such as violence in relationships, sexual health, etc. are handled skillfully without bias.

The text is written in a way that it would be relatively easy to update. Some of the topics, legal marriage for example, are changing due to legislation across the country, but the book speaks generally enough about these topics to capture this reality. The reader can pursue the references included at the end of each chapter to find more specific time-sensitive data around such topics.

Clarity rating: 4

The book is very clear in its use of language. This is a particularly appealing element if you have students whose native language isn't English. A moderate proficiency in English will make this book accessible--easy to read and understand. One missing piece of context noted: Section 5.6 seems to refer to a chart, ie "in the lower left corner" but no chart is included.

Consistency rating: 4

The text is consistent in the way the framework has been structured and the terminology is relatively consistent throughout, however there are some occasional verb tense inconsistencies, for example in Chapters 6 and 8 the voice alternates between speaking directly to the reader (you) and in third-person.

Modularity rating: 4

It would be as easy to pull a few excerpts from the book as assigned reading as it would be to review the entire text throughout a semester. There could be more of a contextual introduction to each chapter that may help provide a useful modular framework.

As the text is a presentation of a variety of interrelated topics rather than information that must be presented in a particular sequence for full and proper understanding, the organization seemed appropriate and sufficient. As Maslow's heirarchy is presented, there is an argument for using the order from that framework or the order of the six dimensions of health presented in Chapter 1, but the content therein, aside from Chapter 1, is not determined by the sequence so the current organization is sufficient.

I saw no significant interface issues, however the text could benefit from more illustrative images throughout to support learning and such images could help with minimizing any confusion as well as retention of the information presented. An example of such is Figures 14 and 15 on page 152 and Figure 4 in Chapter 9.

In my review, I noticed very few grammatical or spelling errors.

Cultural Relevance rating: 3

Some of the sections could be updated with more inclusive language, such as the section on fertility and conception. Language such as "pregnant people" rather than "pregnant women" or "birthing person" rather than "pregnant mother" is more inclusive of the transgender community. The text generally tends to reference nationwide statistics without detail or context regarding specific demographics. This could be a valuable addition as illustrated in Chapter 1 that health can be substantially influenced by things such as race and ethnicity, culturally sensitive healthcare, sexual identity and orientation, etc. which are topics included later in the text. Expounding upon some of these critical aspects of health and determinants of health would add value and represent a more comprehensive perspective of health in the US.

This book is a solid resource with lots of useful information to use in health-related course curricula.

Reviewed by Garvita Thareja, Assistant Professor, Metropolitan State University of Denver on 3/16/21, updated 4/22/21

It had covered most of the major topics in health and wellness. However, there are some foundational topics like dimensions or health (they touched these, but need more depth), theories for behavior change that should be added , being foundational... read more

It had covered most of the major topics in health and wellness. However, there are some foundational topics like dimensions or health (they touched these, but need more depth), theories for behavior change that should be added , being foundational in nature. Then again, some concepts are just added there and may not be needed at this level as it adds to confusion than contribution. We don't need that deeper biology part as its a health topic and not anatomy/physiology.

Content Accuracy rating: 5

Its very accurate book. I would re structure some aspects and add some examples at few places, but overall, its up the mark with accuracy.

Relevance/Longevity rating: 3

Content needs an update. For example if its a weight management, then we need to add information about various apps and calorie tracking resources. If its a drug and abuse, I would add an activity that really engages students about how taking shots can affect their cognition and possibly put them in DUI. This text has too much theoretical concepts but less of applied part or case studies.

The information is clear and use simple languages. Not big jargons or difficult terms.

Yes, its consistent with the topics and headings and sub headings. Its just too much information actually VS field work, examples and real applications.

yes, its divided into various parts and sub parts. Easy to navigate and clear layout. I would just add that piece where if we click on a sub topic from table of contents, it takes us to that page automatically instead of scrolling around.

Organization/Structure/Flow rating: 5

Yes, very clear and logical flow.

Interface rating: 5

Its easy to navigate. I would add a little more images as it gets monotonous reading it. WIth a topic like health, lot more colors and contrasts and images can be added.

Grammatical Errors rating: 5

I did not find one.

Cultural Relevance rating: 5

Not offensive. But I would actually add more of culture and diversity when it comes to health. Why are some cultures "Healthy"? or "why is disparity between genders with access to healthcare across the globe/developing nations"?

It is an interesting book. I liked reading it and refreshing some of the topics. I would just add some case studies and activities to make it more interactive instead of passive reading. May be we can have a supplemental lab with it? Its not a perfect book as it covers upper and lower division topics. But definitely, some components can be used as they are well written.

Reviewed by Sara Pappa, Assistant Professor, Marymount University on 2/24/21

The textbook is a comprehensive compilation of personal (individual) health topics, which are clearly defined and described. It would be appropriate for a Personal Health or Introduction to Health/Health Behavior course. It has a table of... read more

The textbook is a comprehensive compilation of personal (individual) health topics, which are clearly defined and described. It would be appropriate for a Personal Health or Introduction to Health/Health Behavior course. It has a table of contents, but not an index or glossary. It does not highlight key terms. There is a reference list at the end of each chapter--this could be expanded to include helpful links. Chapters do not have introductions or summaries.

The content is accurate and relatively unbiased. It includes current public health topics such as the leading causes of death, social determinants of health and health disparities. I might suggest changing the name of Chapter 12 to Chronic Diseases.

Each chapter is made up of many sections, or short descriptions of the topics. This helps with the organization of the content. There are not a lot of case studies, examples, graphics or anecdotal information to enhance the learning process. The material is somewhat dry the way it is presented (not very engaging).

The textbook is written in clear language and at an appropriate reading level for college students.

The chapters are organized in a consistent manner.

The textbook could easily be broken down into smaller units or sections as well as followed in a different order as indicated by a course or instructor. The short sections, as well as the chapter and section/sub-section numbering systems, make it easy to follow.

The textbook is organized in a clear manner, with chapter and section titles that make it easy to follow.

The textbook is easy to read and navigate.

The textbook is well written with few grammatical errors.

The textbook does include some references to culturally competent content. It would be improved with the addition of specific examples, including data and research, about cultural differences and how these affect health.

Reviewed by Sarah Maness, Assistant Professor, Public Health, College of Charleston on 1/27/21

Covers a wide variety of health promotion topics, primarily at the individual level. Lacks a section on social relationships and health. Only covers romantic relationships and in ways that are culturally dated (section on Married and Non-Marrieds). read more

Comprehensiveness rating: 3 see less

Covers a wide variety of health promotion topics, primarily at the individual level. Lacks a section on social relationships and health. Only covers romantic relationships and in ways that are culturally dated (section on Married and Non-Marrieds).

Content Accuracy rating: 1

I would not feel comfortable using this text in my class based on issues with accuracy. Section 1.7 about Determinants of Health mentions Healthy People 2020 however does not describe the Healthy People Social Determinants of Health Framework when talking about Social Determinants of Health and includes different factors. Citations are very dated, 2008 or earlier when this edition came out in 2018. Healthy People 2030 is now out so next version should update to that as well. Bias encountered in the chapter about relationships and communication. Only covers romantic relationships and is written with from a heteronomative perspective that also centers marriage and is stigmatizing to those who are not married. ("Marriage is very popular..because it does offer many rewards that unmarried people don't enjoy." "There are known benefits to being married an in a long-term relationship rather than being single, divorced or cohabiting). Also refers to attempts to legalize same sex marriage in this chapter, which has been legal for years now. References are not formatted in AMA or APA style which is standard for the field. Wikipedia is used as a reference in Chapter 2. Chapter 6 discusses "options" for unplanned pregnancy (including taking care of yourself, talking to a counselor, quitting smoking) and does not mention abortion as an option. HPV vaccination recommendations need to be updated.

Relevance/Longevity rating: 2

All topics are relevant but the supporting statistics are outdated by more than a decade in many places. Years are not included in many statistics, nor in the citation at the end of the chapter.

Clarity rating: 3

The sections read as rather disjointed. Chapters could be more aligned and have improved flow for the reader to understand how concepts are related. For example, going right into theoretical models of behavior change in Chapter 1 is early and advanced for an introductory text.

Consistency rating: 2

In the Introduction it states the book is about health, health education, and health promotion. Since health promotion is broader than health education, and fits the topics of the book, it is not clear why this is not the title instead. This book could be useful for an introduction to health promotion class but instructors may overlook it because of the name. Some chapters contain no in text citations despite stating facts, while others contain many. Reference lists and in text citations are formatted differently in different chapters.

Almost too modular, not clear how some sections relate and there is not a lot of detail in many subsections.

Organization/Structure/Flow rating: 3

The sections within each chapter often seem disjointed and do not include enough detail in each section.

Interface rating: 3

In many chapters, only weblinks are provided as citations. If the link is broken, there is no title, author, journal or year for reference. Figures included without citations (ex: Social Readjustment Rating Scale).

Grammatical Errors rating: 3

Did not notice overt grammatical errors.

Includes examples and text of people of multiple races and ethnicities. Is not inclusive based on sexual orientation and in terms of the way it discusses marriage and relationships.

The cover does not appropriately capture what the book includes. It could be more representative of health than just a sports field/physical activity. Health is multi-dimensional and includes in addition to physical - mental, emotional, spiritual, occupational aspects, which the book acknowledges in the text. Hair and clothing style of people on cover also look outdated.

Reviewed by Corrie Whitmore, Assistant Professor, University of Alaska Anchorage on 11/11/20, updated 1/10/21

This book was developed for a Health 100 class. It covers a wide variety of personally relevant health topics, with segments defining health, discussing "your bodies response to stress," describing threats to environmental health, and offering a... read more

Comprehensiveness rating: 5 see less

This book was developed for a Health 100 class. It covers a wide variety of personally relevant health topics, with segments defining health, discussing "your bodies response to stress," describing threats to environmental health, and offering a guide to "understanding your health care choices," which includes both nationally relevant and California-specific information. The index is detailed and specific. There is no glossary.

This textbook would be appropriate for a lower division personal health course. Some components would be useful in an introductory public health course, such as the "Introduction to Health," "Infectious Diseases and Sexually Transmitted Infections," and "Health Care Choices" secgments.

The text is not appropriate for a "Fundamentals of Health Education" or "Health Promotion" course aimed at future Health Educators.

Book provides accurate information with clear references to unbiased sources (such as the CDC for rates of diseases).

Content is releveant and timely.

The book is appropriately accessible for lower division students, with clear definitions of relevant vocabulary.

Good internal consistency.

The segmentation of the book into 14 topical sections, each with subsections, makes it easy to assign appropriate chunks of reading and/or draw pieces from this text for use in other courses, such as an introductory public health course.

Well-organized.

Easy to navigate.

Easy to read.

Good discussion of health disparities, acknowledges cultural components in health. Is not insensitive or offensive.

Reviewed by Audrey McCrary-Quarles, Associate Professor, South Carolina State University on 8/17/20

The Health Education book covered all the components usually found in other basic health books. It can be utilized as an Open Textbook for students taking the introduction to health or the basic health course, such as HED 151 - Personal and... read more

The Health Education book covered all the components usually found in other basic health books. It can be utilized as an Open Textbook for students taking the introduction to health or the basic health course, such as HED 151 - Personal and Community Health.

The author could use a picture that exhibits diversity on the cover.

Some of the data is just a little outdated but can be updated very easily with an article or current chart.

Clarity is okay.

Consistency is good!

Should be an easy read for students.

Organization and flow are great!

Text can use some more pictures and charts, especially in Chapter 1.

Did not notice any grammar errors in scanning over the book.

The cover should be a picture that depicts diversity as well as showing more diversity throughout the book.

Overall, the book serves its purpose. It is good!

Reviewed by Vanessa Newman, Adjunct Faculty, Rogue Community College on 7/22/20

The textbook successfully covers a wide array of health education topics. The chapters on "Relationships & Love" and "Health Care Choices" were excellent additions to what you find in many health books. Overall, I would have liked to have seen... read more

The textbook successfully covers a wide array of health education topics. The chapters on "Relationships & Love" and "Health Care Choices" were excellent additions to what you find in many health books. Overall, I would have liked to have seen more case studies, illustrations, examples, and quick quizzes to reinforce the content presented and to reach students with different learning styles. Many of the sub-topics could be even more robust with the addition of information on auto-immune disorders for example or a section on health education professionals like personal trainers and health coaches or information on what to do if you suspect a food-borne illness and how to access help.

The contributors have done a great job of presenting accurate information but it is now outdated in many sections and chapters which is what happens in textbooks generally. The language and presentation of material appears unbiased. The addition of more graphics and examples that cross demographics, cultures, and races would be a welcome addition. I found no factual errors but did question the notion that gluten-free diets can assist with anemia and wondered if research about the resilience gene in children might be referenced.

The research presented is all 2015 or before with an emphasis on 2008 information. Sections about marijuana and cannabis, infertility, social disorder, and smoking need refreshing. It would be helpful to have information about genetic testing (23 and me and Live Wello) added, functional fitness addressed, and infectious disease content brought up to date. So much has happened affecting people's health has transpired since 2015 that it is time for updating. Also, more information in sections like how baby birth weight can predict chronic disease development and mindfulness as a practice for improved quality of life.

Content is presented in clear, concise and appropriate language. Every once in a while there is a sentence structure issue or a word ordering that is clarified by a re-read. There is not an emphasis on jargon or overuse of idioms in my opinion. All terminology was defined or given reference as to where to locate additional information. Again the use of diagrams, illustrations, more examples would also improve clarity and accessibility for some. I did not recall seeing information on how many calories are in a gram of protein, carbohydrate and fat presented. And relevance affects clarity. For example, including language about portal of entry and exit in the infectious disease section.

Having a quick quiz at the end of every chapter would have added consistency. Also standardized formatting for charts and graphics would improve the textbook overall as well. The chapters, sections and headings all appear consistently presented. There was nothing presented that was jarring or appeared out of context. References looked similar and were all summarized at the end of each chapter.

Modularity was this textbook's strength. Large chunks of information were broken down into manageable sections and sub-sections and the white space was appreciated. Because of this, the information did not seem overwhelming or "too much too fast." Students can take breaks and not lose track of where they were or forget critical information. Again, more examples, quizzes or case studies could also improve modularity and add an interest factor. The table of contents was thorough.

Time was taken to decide which chapters and topics should be presented in which order. The flow was organic, natural and later sections built on previous information. The structure of the textbook made sense and usually my questions about a topic or subject were answered within the same page. I had no complaints about organization and could find sections easily based on the table of contents.

No interface issues for me, but I was reading on a personal computer and perhaps on a tablet or phone there would be.

The paragraph spacing was not what I would have chosen. There were some inconsistencies. There are contractions like isn't which I prefer not to see in textbooks because it is too casual a style for me. Many instances of punctuation coming after quotations, but this may have been a style choice. The font seemed appropriate but more bolding or color would keep the reader's attention. There are spelling errors on the food chart on p. 236. Some issues with singular vs. plural. For example on P. 64 "nightmares" needs to be plural. A few places where punctuation is missing.

The text is not culturally insensitive, but without additional examples, graphics, and diverse charts it becomes a bit bland. The reference to a handgun on p. 56 was uncomfortable for me. Under weight management, there could be more information presented on how different cultures appreciate varying body types and have different food rituals and discussion on how not to "fat shame" others. Some examples of cultural influences could be presented in the infectious disease section like how practices for burying the dead can lead to disease and how food preparation affects disease management.

I thought it was comprehensive and well organized. If it were not for relevance issues, I would choose to use this book in our general health class.

Reviewed by Robert West, EMS Program Director, North Shore Community College on 6/7/20

Health education is an enormous subject area but this text does an excellent job covering the most important topics. The comprehensive nature of it topic coverage does come at the cost of not being comprehensive within any single topic- this book... read more

Health education is an enormous subject area but this text does an excellent job covering the most important topics. The comprehensive nature of it topic coverage does come at the cost of not being comprehensive within any single topic- this book is an overview that provides an excellent framework for further study and exploration.

Topics within Health Education are inherently subject to bias- religious, cultural and generational perspectives often influence the scientific and open-minded exploration of issues in topics like sexuality, nutrition, and relationships. This book clearly strives to support perspectives with research and did not shy away from topics like abortion and gender roles.

The greatest weakness of this text is that it often feels outdated. Health information is dynamic and no text can always be current, but there are sections that are clearly too old to be considered useful unto themselves. Examples: The narcotic abuse epidemic is absent. This is a major issue in substance abuse and the text primarily looks at heroin abuse without examining the larger issue of prescription narcotic gateways to abuse, or even other narcotics of abuse. The use of PrEP for reducing HIV transmission has been available since 2012 but is not mentioned. The section covering sexual orientation and gender identity cites the 1993 Janus Report for its source of statistics. There is no publication date listed in the text- the latest citation that I noticed was 2015 but most come well before 2010, making the text a decade old in a field that changes rapidly.

The text is well-written and easy to comprehend.

Consistency rating: 3

The Acknowledgements page at the front of the book states that it was "compiled by..." and this speaks to the way the text appears. There is no consistency is the writing of the book. Some chapters are broken down into Sections, brief (often only a paragraph long) collections of sentences that seem to address a behavioral objective that we do not see. Other chapters are written like a standard text and then some appear in a question-and-answer format. None of these are inherently problematic, but the changing style may trouble some readers.

Chapters and chapter sections are clearly delineated.

Chapters are well organized- there is no logical order into which one must teach the various issues of health. The readings of this text could easily be sequenced as desired by the instructor.

The interface is clean and simple. There are few images/illustrations- they would be a welcome addition.

The text is well-written and contains no grammatical/spelling errors that I noticed.

Overall the text seems fair and cites studies to provide evidence of its claims, though some sections simply feel less than open-minded. In the discussion of marriage vs. cohabitation (does anyone use that word anymore?), the text lists advantages of being married that include less likely to commit crimes and less addiction. Statistically, perhaps, but is there a causal relationship? A single paragraph addressing "spiritual health" states: The spiritual dimension plays a great role in motivating people’s achievement in all aspects of life. Some people, yes, but it's not a global truth. Race is never addressed as a topic within the text, though it is commonly listed when a risk factor of disease, health care disparity, etc.

If updated, this would be a superb book. As it stands, it provides an excellent framework for a college course in General Health from which the instructor, or students, could be directed to contemporary writings on these issues. An instructor could readily assign chapter readings and then short research projects that would that could be shared with the class as a whole to assure present day relevance.

Reviewed by Kathy Garganta, Adjunct Professor, Bristol Community College on 5/26/20

The textbook covers a variety of topics in a choppy sequence jumping from three chapters on sexuality and sexual health to substance abuse then onto nutrition. The book was limited in depth and many areas needed additional explanation. There are... read more

The textbook covers a variety of topics in a choppy sequence jumping from three chapters on sexuality and sexual health to substance abuse then onto nutrition. The book was limited in depth and many areas needed additional explanation. There are many lists that did not have the background explanations to support the lists. Several areas were lacking details and were not at college level.

Content Accuracy rating: 3

The text was generally accurate, but lacked backup documentations. Several phrases or statements appeared subjective without the supportive documentation that could lead to misinterpretation. For example, page 107, Section 6.6, Sexual Frequency is covered in one paragraph. In it a statement, “although satisfaction is lower in women,” is delivered with no backup explanation. On page 149, section 7.11, Sexually Transmitted Infections begins with a list of twenty different infections without clarity of an opening explanation.

Relevance/Longevity rating: 5

The textbook was written in 2018 and is still current today. Because of the changing nature of health, it will need updating.

The text was basic and often used lists without additional explanations. Many sections were too brief leaving the reader confused. Page 210 contained an example of a diet list. The list for 4 healthy diet approaches was followed by confusing numbering.

The structural set up of headings and subheadings were consistent, but occasionally spacing was off.

The use of headings and subheadings were helpful. The table of contents clear and easy to follow. Often the sub headings were very short and needed additional information to validate their statements. As an OER text, sections could be assigned as resources to courses outside of health.

The topics were arranged with an unusual flow. Having three chapters on sexuality before nutrition changed the flow and weight of importance.

The text is free of significant interface issues. The chapter headings in the table of contents allows for easy navigation. The use of charts, color displays, photos would have assisted in explaining the topics. The chapter’s would benefit with a more engaging approach. Introspective questions or activities would help to relate material to students lives.

The text contains no significant grammatical errors. However, spacing and formatting needed consistency. For example, on page 86, five definitions all begin with the same exact phrase, throwing off the reader’s flow. On pages 285-86 the formatting/spacing is off.

The text should make greater use of photos/drawings that are reflective of a variety of gender, races, and backgrounds.

Grateful to the author for contributing to OER resources.

Reviewed by Sonia Tinsley, Assistant Professor/Division Chair, Allied Health, Louisiana College on 4/28/20

Covers a variety of health topics that are typical to a personal and community health course. However, the information is very brief. read more

Covers a variety of health topics that are typical to a personal and community health course. However, the information is very brief.

Content is accurate. However, some chapters tend to be limited with reference information.

Some chapters include a limited number of statistics and references but could be updated.

Information is basic and easy to follow.

Terminology used is consistent throughout the text.

The information can be divided into modules to use throughout the course.

Topics are organized and easy to follow.

There were not any features in the text that seemed to be distracting or confusing.

There were no glaring grammatical errors.

The text was very basic and seemed to be written for a variety of races, ethnicities, and backgrounds.

Would have been helpful to have more self-appraisals for readers to complete and make information personable.

Reviewed by Jeannie Mayjor, Part-time faculty in the Health and Human Performance Dept., Linn-Benton Community College on 1/15/20

I think this book does a great job of making the material presented easy to understand. Many similar textbooks are more advanced due to more challenging word/term choices, but this book would work well for anyone taking an intro level class in... read more

I think this book does a great job of making the material presented easy to understand. Many similar textbooks are more advanced due to more challenging word/term choices, but this book would work well for anyone taking an intro level class in health.

The book doesn't cover any of the topics in an in-depth manner. Since it's an intro-level textbook, there aren't many complicated ideas to present where accuracy could be a problem. I think some areas, like nutrition, are missing more up to date info, but that could be remedied by incorporating more recent articles and info from various health journals.

Since this text provides an easy to understand overview of health, it would be easy to update. There are no cutting edge or controversial views expressed in the book, so it does have longevity, but again, there will be a need to present more up to date info to supplement the general understanding that the students will have after reading this text. I like the section on sexual health/identity/orientation in the Sexuality chapter. One more chapter that I appreciate is the chapter on psychology: the most common mental health disorders that college-aged students encounter is important and the section on resilience in both the psychology chapter and the stress management chapter are greatly needed.

The book is very clear and understandable. After having taught a health class every term for the past twenty years, I think the way this book is written would appeal to most students.

I did not catch any inconsistencies in this text. Topics discussed in early chapters might come up in later chapters at times, but the info presented the second time around is consistent with earlier explanations of ideas and terms.

Larger type on chapter headings would help improve the ability to divide the book into smaller reading sections, it's easy to miss the start of a new chapter when scrolling through the text. Once you are in a chapter, the subheadings are helpful in dividing the chapter into smaller reading sections. I wish the chapter on cardiovascular diseases (coronary heart disease and stroke) was limited to those two diseases, without including a section on cancer. I think the topic of cancer deserves its own chapter.

The text is well organized and chapters flow into each other in logical ways. There are enough chapters to spread this out over a ten or 15 week term/semester. The chapters are short enough that you could easily assign one and a half chapters or two chapters for one week's worth of classes.

I would have liked to see more photos, although there are plenty of graphs, and I enjoyed the interactive quiz called The Big 5 Personality Test, I would have liked to see more. Some of the links listed in resources are no longer working, and one link in the Fitness chapter is not working, (Adding Physical Activity to Your Life) and I had been looking forward to exploring the topic in more depth. The MyPlate.gov website has been significantly changed, around the time that this book was published, so some of the links to that site no longer work.

I usually notice grammatical and spelling errors, as well as missing words, but I did not encounter anything obviously wrong in my reading.

The text could use more cultural references. I would have liked to see more acknowledgement of cultural differences and references to the health of people from other cultures, especially as it relates to changes they may encounter once a person from another country moves here.

Great overview of the various topics covered in a 100 or 200 level college health class. I will use sections of this book to help simplify some of the topics that my students find challenging, for instance, the fitness and heart health chapters/sections. Due to the inclusion of many of the mental health disorders that our students encounter, I will fit in some of the sections in the psychology chapter. I look forward to implementing some of the material in this text into my health classes.

Reviewed by Jessica Coughlin, Assistant Professor , Eastern Oregon University on 1/6/20

This textbook includes very similar topics to most of the college level health education books that are available today. While the book includes many of the main points related to each topic, it does not go into too much depth. However, this... read more

This textbook includes very similar topics to most of the college level health education books that are available today. While the book includes many of the main points related to each topic, it does not go into too much depth. However, this limitation can be solved by supplementing the book with scholarly articles. Based on the number of chapters and the amount of information, I think this book would be beneficial for a 10 week or 16 week term.

The book cites quality sources, however it would be helpful to include in-text citations since the references are only at the end of the chapters and it is difficult to know where the information is coming from. This is especially important for time sensitive information such as statistics. Also, some information seems to be directly from the sources, but it is not cited.

The information is mostly up to date, however as stated before, including in-text citations would help readers have a better idea of the relevance of the material. Also, there are limited references for each chapter.

The material is delivered in a clear and concise way. Adequate context is provided for terms and concepts.

The format of the text-book is consistent as is the type of delivery for the information.

The text includes a good amount of headings and sub-headings, which makes it easy to break the information down into smaller reading sections.

The book has a good flow to it. Each section within the chapters is well-organized and provides a logical progression.

The book is free of any significant interface issues, however there are some small issues such as spacing and formatting errors. Additionally, some small changes such as larger title pages for each chapter would be helpful as well as more graphics and pictures.

I did not notice a significant number of grammatical errors.

The text is not culturally insensitive or offensive. Like most textbooks, it could provide more examples that navigate the relationship between health and different backgrounds.

I would use this textbook, along with other supplemental materials for my course. It reviews the main topics I currently cover in my course and has less limitations than many overly-priced books.

Reviewed by Kathleen Smyth, Professor of Kinesiology and Health, College of Marin on 4/17/19

This textbook covers the myriad of required topics for an Introductory Health Course. The table of contents includes all of the topics I cover in my classes. No textbook is perfect and this book is no different but one should not rely on textbooks... read more

This textbook covers the myriad of required topics for an Introductory Health Course. The table of contents includes all of the topics I cover in my classes. No textbook is perfect and this book is no different but one should not rely on textbooks only anyway. This free textbook is an excellent launching point for any contemporary health education course.

One of the greatest challenges in teaching health is to be unbiased given so many factors affect our health like politics, economics, zip code etc. The textbook does a fine job of explaining the role of government. For example: generic drugs and the abortion debate. Any areas in question can be used by the instructor to create a discussion with the students for better/different alternatives or ideas.

Health is very dynamic so the textbook will need to be updated on a regular basis.

This is an easy to read text. The majority of college students will have no issues with the terminology.

For a textbook that is not professionally published I found the terminology and framework sufficient for my needs. Anything missing can easily be added by the instructor and used as a discussion or research assignment for the students.

Maybe the best feature of the text is the modularity. Each section of the table of contents is hyperlinked so one could easily pick and choose the topics assigned to the students.

The organization follows the same logical fashion as all of the top rated professionally published Health Education textbooks.

There are a couple formatting issues but nothing that affects clarity in my opinion. I think because this is free I have lower expectations vs a professionally published textbook and I am ok with this.

I did not notice any obvious grammatical errors.

The text is not culturally insensitive or offensive but it could include in-depth analysis of health status in relation to one's race, culture and zip code. As I mentioned previously this is a topic that can easily be supplemented by the professor.

This free textbook meets all the requirements for an introductory health course. It leaves room for me to do my job to engage my students in more detail by discussing controversial topics while giving them the opportunity to be critical thinkers. I appreciate all of your efforts on this project.

Reviewed by Amanda Blaisdell, Assistant Professor, Longwood University on 4/11/19

It gives a lot of information, but it isn't very "in-depth." Admittedly, it would be a challenge to be very in-depth with one book that covers so many topics. This book certainly lacks sufficient images/pictures. The amount of information varies... read more

It gives a lot of information, but it isn't very "in-depth." Admittedly, it would be a challenge to be very in-depth with one book that covers so many topics. This book certainly lacks sufficient images/pictures. The amount of information varies by topic. For some reason, some topics (that don't seem as important in relation to other priority issues) have much more text and information, while other topics lack in comprehensive quality to a large extent. Types of intimate partner violence is incredibly insufficient. There are LOTS of ways that people are abusive, those 5 bullets are not enough. There are lots of incomplete sections. It seems like most sub-topics are hand-selected.

There are biases in the information. For example, mental health is described with an emphasis on college-aged students. Why? Mental health issues affect everyone. This makes it seem like a college student problem. Another example, on page. 57 a strategy to cope with stress is to "give in once in a while." What are we promoting here? I have taught health education and stress management for years. There is a better way to phrase the point they are getting to.

It seems like it is up-to-date as of right now, but health facts are only good for five years.

Sometimes more jargon is necessary. Too much relying on cultural metaphor.

Not all facts have footnotes so that the reader can find the source of the information. Why do some have a reference footnote but other facts do not? How can we dig deeper and fact-check? The reference sections are hyperlinks, which come and go. Why are the references lacking any actual APA, MLA, or other format? APA would be appropriate. Students emulate what they find in textbooks. Some seem to be in some formal form, but others are not and the formatting is not correct.

Yes, very much so.

Some topics fit in multiple categories, so there should be some in-document link to information.

Some sections have a space between paragraphs... some do not.. it is not consistent or visually appealing (Example, p. 23). Figure 1 on page 51 seems to have highlighting and blurriness on the image. Look on p. 122, what is that symbol before the "Copper IUD"? WHy does it say it twice? Is there a heading that wasn't bold? What is going on?

I don't know if you call this "grammar" per-se, but formatting is not consistent. For example, on p. 55 there is no consistency in capitalization of first words in bullet points. That just seems sloppy and unprofessional.

Don't refer to sexual arousal as being "turned on," as that is a cultural metaphor. Some language needs to be technical because this book is supposed to provide information. There is lots of evidence of attempts at cultural competence, but it doesn't provide enough of that. There are lots of lifestyles that are OK even if they don't fit our Western model.

To be honest, it seems like portions of this book are plagiarized. Is this a rough draft?

Table of Contents

• Chapter 1: Introduction to Health
• Chapter 2: Psychological Health
• Chapter 3: Stress Management
• Chapter 4: Relationships and Communication
• Chapter 5: Gender and Sexuality
• Chapter 6: Sexual Health
• Chapter 7: Infectious diseases and Sexually Transmitted Infections (STI's)
• Chapter 8: Substance Use and Abuse
• Chapter 9: Basic Nutrition and Healthy Eating
• Chapter 10: Weight Management
• Chapter 11: Physical Fitness
• Chapter 12: Cardiovascular Disease, Diabetes, and Cancer
• Chapter 13: Environmental Health
• Chapter 14: Health Care Choices

Ancillary Material

About the book.

Readers will learn about the nature of health, health education, health promotion and related concepts. This will help to understand the social, psychological and physical components of health.

About the Contributors

Contribute to this page.

National Minority Health Month: Understanding Culture, Community, and Connections to Advance Health Equity

April marks National Minority Health Month! This year’s theme (“Be the Source for Better Health”) focuses on improving health outcomes through our culture, community, and connections. These elements that make us each unique are also critical to reducing health disparities. Recognizing and honoring the strengths and traditions within diverse communities can help improve health outcomes and advance health equity. Together, we can collectively advance health equity by valuing cultural diversity, supporting communities that have been marginalized, and fostering inclusive environments. We must all work together to #BetheSourceforBetterHealth .

The Need for Community Engagement to Advance Health Equity

The COVID-19 pandemic further exposed existing longstanding inequities that systematically undermined the physical, social, economic, and mental health of racial and ethnic minority and American Indian/Alaska Native (AI/AN) populations. It also revealed the limitations of available data to monitor public health issues on factors that impact community health. To address these inequities, we in public health continue working to address and understand the social determinants of health (SDOH) that shape individual and community health, especially the structural and systemic drivers of inequities. Understanding SDOH local to communities as well as the fundamental conditions communities need to thrive (or “vital conditions” – Figure 1) is key to successful public health work. However, we also need to approach public health differently to collect the necessary data to drive evidence-informed action. We cannot understand a community’s issues and solutions without talking to the community.

Figure 1: The Vital Conditions for Health and Well-Being framework, indicating the seven necessary conditions for community resilience.  See https://www.communitycommons.org for more info.

Improving Health Outcomes Through Community Data Collection 

CDC’s Office of Health Equity (OHE) is engaging communities through collaborative efforts to power local action and advance health equity. In partnership with CDC Foundation, OHE is supporting several initiatives to improve community data collection for evidence-based action to reduce health inequities.  Two examples include:

• Project REFOCUS (Racial Ethnic Framing of Community-Informed and Unifying Surveillance): Project REFOCUS works to shift traditional public health emergency response so that communities – as experts in culturally responsive efforts – are continuously involved in public health, not just during disease outbreaks. Project REFOCUS funds community partners to establish data collection systems and social listening protocols that effectively monitor, in real time, the impacts of social stigma and racism on racial and ethnic minority populations as they affect public health crises mitigation and prevention practices. Recommendations for action are not only informed by community voices but further amplified by citizen journalists and ethnic media. Collectively, these efforts bring the framework of social movements to public health to ensure that emergency response efforts remain locally informed, responsive to cultural needs, and that public health institutions remain accountable to the communities they serve.

The Project REFOCUS team is working closely with six communities to operationalize the Crisis Stigma Monitoring and Response System (CMRS) framework: Wake County, NC; Lincoln, AR; San Antonio, TX; Detroit, MI; Albany, GA; and New York, NY.

• Communities in Context (CiC) is a community-engaged approach to gathering local data that is useful to communities’ health improvement goals. CiC centers community members’ voices, experiences, and perspectives as key data. CiC considers the broader factors that influence health – from the social determinants like housing and education to the underlying structures and systems, like economic policies and racism. The goals of Communities in Context are to:
• Collect and combine local information with guidance from community, including information on how power and influence operate in the community, existing and needed resources, stories of people’s experiences, state and local health data, and key policies at the state and local levels;
• Work with community members to use local information to define shared priorities for action that can be used by state and local public health and community leaders to improve public health decision-making;
• Create publicly-available and user-friendly resources that communities can use to support informed action.

OHE, Wayne State University, University of Michigan, and the Institute for People, Place, and Possibility (IP3) are partnering to lead CiC in Greater Detroit, Michigan. Other community partners include state and local public health departments, health systems, and community organizations.

OHE’s Communities in Context Conceptual Model.  The eight gears listed below indicate key components of the project, working together to power evidence-based action using ongoing community input.

• Identifying key data and policies
• Engaging local communities
• Convening multisectoral partners
• Building trust
• Connecting local issues to larger systems
• Mapping power and assets
• Building local capacity
• Creating public data and resources

Being the Source for Better Health

OHE collects and shares important information on how unique communities, cultures, and connections support local capacity to promote change among racial and ethnic minority and AI/AN populations. OHE is committed to working with communities and partners from various sectors to improve health outcomes and #BetheSourceforBetterHealth .

How are you focusing on culture, community, and connections to improve health outcomes and #BetheSourceforBetterHealth ?

Learn more about health equity and how you can play a role in reducing health disparities and developing policies that can help address public health problems in your community.

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• Open access
• Published: 23 February 2024

The effect of service-based learning on health education competencies of students in community health nursing internships

• Maryamsadat Emrani 1 ,
• Zohreh Khoshnood 3 ,
• Jamileh Farokhzadian 2 &
• Mohammad Sadeghi 4  

BMC Nursing volume  23 , Article number:  138 ( 2024 ) Cite this article

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This study investigated the impact of service-based learning on the health education competencies of students in community health nursing internships. community health nursing internship is one of the areas where students acquire health education competencies. Studies have shown that some students have poor health education competencies, and new educational interventions, such as service-based learning, can help improve their competencies.

This quasi-experimental study was conducted in 2021–2022. The participants were final-year nursing students affiliated to Kerman University of Medical Sciences. All participants ( n  = 72) were selected via the census method and randomly divided into intervention and control groups (36 participants in each group). The students in the intervention group attended a service-based learning program for 20 days. The data were collected before and one month after intervention using a 48-item health education qualification questionnaire. The collected data were analyzed using SPSS22 software.

The results showed that the mean health education competencies scores were lower before intervention in the intervention and control group (165.75 ± 23.09) (170.16 ± 28.58)( p  > 0.05). There was no significant difference between the two groups in terms of their mean scores on health education competencies( p  > 0.05). The health education competencies score increased significantly for the participants in the intervention group (191.58 ± 28.35) compared to the control group (165.97 ± 28.11) after intervention.

Nursing administrators and professors need to take effective steps to empower nursing students as much as possible and incorporate service-based learning techniques in clinical education programs for nursing students.

Peer Review reports

Introduction

Nursing is a unique profession because nurses assume many simultaneous roles, such as providing direct care, making clinical decisions, supporting clients and families, teaching, and acquiring necessary skills in clinical education [ 1 ]. Clinical education is a distinctive process because it allows for practical application of knowledge in real-life situations. Additionally, acquiring professional competencies, particularly health education competencies, is not possible through theoretical courses alone [ 2 ]. Health education competencies refer to a set of knowledge, attitudes, and skills required for success in health education and encompass competencies such as clinical, educational, technical, and social skills [ 3 ]. Apart from practical skills and knowledge, nurses should possess effective problem-solving, decision-making, and communication skills, as well as the ability to make sound judgments in different situations [ 4 ].

Currently, new teaching methods receive much attention in theoretical and clinical education programs, as traditional teaching methods alone are less effective in training students to acquire necessary competencies. One of these modern methods is service-based learning. Service-based or outcome-based learning has gained importance in professional health curricula, including nursing, aiming to educate students about social responsibility and train individuals who can respond to the community’s expectations [ 5 ]. Service-based learning is both an educational program and philosophy. In the educational program, learners provide meaningful services to their community while involving community members, and in the educational philosophy, they learn about social responsibility [ 6 ]. This type of learning involves students in experiential activities that contribute to their growth, expose them to clients from different cultures, and enable them to provide effective services for people in diverse cultures [ 7 ]. The goals of service-based learning include promoting learning through university educational programs and instilling moral values and professional commitments in students as they engage in providing services and meeting real community needs [ 8 ].

The essential elements of service-based learning include obligation, critical thinking, being two-sided, leadership development, and meaningful service experience. In service-based learning programs, students commit to carrying out planned service, critically analyze it, and identify real public problems to develop citizenship commitment skills, effective planning, and appropriate leadership skills [ 9 ]. The seven steps of implementing service-based learning include meeting the community’s known needs, achieving curriculum goals through a new service-oriented learning approach, fully reflecting the service-oriented learning experience, developing and promoting students’ responsibility, establishing and enhancing community participation, planning, and finally equipping students with knowledge and skills [ 10 ]. The components of service-based learning include establishing a partnership between the community and the faculty, expressing and clarifying the outcomes and competencies obtained from the service-based learning process, selecting textbooks and other learning resources, providing educational programs, designing evaluations, designing infrastructures, and maintaining and updating course lessons and required activities [ 11 ].

If service-based learning is provided effectively, it offers several advantages and benefits to learners, the community, and educational institutions. Learners address the real needs of the community and gain positive, meaningful, and authentic experiences. Moreover, they develop skills in group work, responsibility, mutual dependence, altruism, emotional outcomes, a sense of usefulness and efficiency, as well as cognitive, emotional, and social learning. Service-based learning empowers learners to face social problems and handle complex situations. Thus, the benefits of service-based learning can be categorized into three main categories: personal development, social responsibility, and educational benefits, including improved problem-solving skills, enhanced speaking and reading abilities, higher academic achievement, and increased concentration and sense of academic achievement. Community-related benefits include attention to and addressing community needs, additional human resources, active citizenship, empowerment, and improved community properties. Educational institutions benefit from service-based learning by training motivated learners, fostering a cooperative learning environment, and producing employees with rational thinking [ 12 ].

A review of the literature suggests that many students lack theoretical knowledge, practical skills, and effective communication abilities before entering the clinical setting or are not familiar with the clinical setting before starting the internship program [ 13 ].

Another study reported that most teachers and students had a relatively poor assessment of internship programs in terms of helping students acquire a social perspective and gain nursing skills for patient care. Additionally, students and teachers faced problems such as limited access to welfare and educational facilities, non-cooperation of healthcare teams, dispersion of internships across clinical departments during the program, and they believed that changes should be made to the organization and execution of internship courses [ 14 ].

Dadgaran et al. (2013) highlighted the need for early prevention and simultaneous evaluation of the service-based learning method in nursing students and showed that this method helped people gain a deep understanding of differences and strengthen their knowledge, skills, and communication abilities [ 15 ]. Khorrami Rad et al. (2011) examined the impact of the service-based learning method and found that it increases students’ awareness and changes their attitudes toward usual methods [ 16 ]. Hwang et al. (2020) also stated that service-based learning significantly increased the critical thinking ability of all students [ 17 ]. Dombrowsky et al. (2019) found that Service-learning fosters student creativity and independence and is more focused on client or agency need. Also provides a broader perspective of health care and an increased sense of agency and self-confidence [ 18 ]. Furthermore, Read et al. (2018) showed that implementing service-based learning in schools using recommended strategies and curriculum content leads to coherent, integrated learning and a successful experience for students [ 19 ]. Hwang et al. (2014) also showed that service-based learning, when implemented with sufficient training, facilitates students’ learning [ 20 ].

In general, previous studies have shown that service-based learning is an integral element of nursing education. Despite the advantages of service-based learning, the studies have highlighted some obstacles and challenges faced by students, medical colleges, and schools, including limited opportunities and time, the unpredictability of the real world, mismatch with students’ learning styles, heavy workload, limited infrastructure and support, lack of financial and human resources, and coordination and planning problems. Specific challenges faced by students include procrastination, fear of unpreparedness, severe anxiety in dealing with challenging clients, and feelings of depression and despair in learning environments. These challenges require further studies on the effectiveness of service-based learning [ 21 , 22 ].

Thus, based on the literature, one of the goals of health internship programs is to train community-oriented nurses and provide effective nursing services to community members. Additionally, there is a need for training creative and skilled students, improving their competencies in health internships, and enhancing their knowledge, attitudes, and social skills in the nursing profession. To this end, the present study aimed to investigate the effect of service-based learning on the health education competencies of students in community health nursing internships.

This quasi-experimental study was conducted during the first and second semesters of the academic year 2021–2022. The participants were selected from last-year nursing students at Razi School of Nursing and Midwifery, which is affiliated with Kerman University of Medical Sciences in southeast Iran. The students were selected using the census method and were then randomly divided into intervention and control groups, with 36 students in each group. The research setting consisted of two health centers where the students completed their community health nursing internships.

Initially, all last-year nursing students ( N  = 72) were selected using the census method. Then, they were randomly divided into two groups, control and intervention, by drawing lots (36 students in each group). After explaining the study process to students, researcher obtained their informed consent. The criteria for enrollment in the study were willingness to participate, completion of a nursing undergraduate program, and successful completion of the health internship in healthcare centers. The exclusion criteria included unwillingness to continue participating in the study, lack of active participation in the internship course, and being an exchange student.

As part of the academic program, the students completed their internships every month in groups of 4 people at two comprehensive health centers. Each theoretical training session lasted for 45 min. The students in the intervention group then participated in the community nursing internship program for a total of 20 days spread across eight sessions. During their time at the health centers, the students first identified community and public needs in a specific area through discussions and exchange of opinions. Subsequently, they developed the necessary planning after setting the goals. The students also received theoretical training on community problems. Following this, the students attempted to solve the identified problems and provide services while engaging with the respective area. Finally, the services provided by the students were assessed.

On the other hand, the students in the control group received usual training, while the participants in the intervention group attended the service-based learning program and put the instructions into practice within the community. In the second semester, the control group enrolled in the study with the same number and grouping as the intervention group. The difference between the control and intervention groups was that the students in the control group were taught only theoretically and were not looking for a solution to meet the needs of the society. the intervention program was adapted based on the number of internship days. A summary of the instructions and content of the intervention program was presented in the last session. Table  1 provides an overview of the instructions provided in the service-based program.

The data in this study were collected using a demographic information questionnaire and the health education competencies questionnaire. The demographic information questionnaire contained items that assessed the participants’ personal and occupational characteristics, such as age, gender, marital status, place of residence, province of residence, completion of service-based learning courses in the past, its impact on their future career, and the extent to which they were interested in nursing work.

The health education competencies questionnaire contained 48 items and 5 subscales: skills (10 items), knowledge (19 items), community presence (6 items), attitudes (6 items), and professional preparation (6 items). A respondent’s score ranged from 48 to 240. The items were scored using a 5-point Likert scale ranging from very poor to very good (1 = very poor, 2 = poor, 3 = moderate, 4 = good, and 5 = very good). The content validity of the Persian version of the questionnaire was assessed by 10 professors at the nursing school of Kerman University of Medical Sciences. They rated the items in terms of simplicity, clarity (qualitatively), and relevance (quantitatively). The content validity index (CVI) was equal to 0.84, and the reliability of the tool was estimated using the internal correlation method and Cronbach’s alpha coefficient (α = 0.75) by administering the questionnaire to 30 participants before the intervention. The results confirmed the reliability and validity of the instrument [ 3 ].

The validity of this questionnaire was assessed by Creswell (2007). The instrument was the Arabic and English version of the questionnaire, which was assessed by a group of 10 managers and senior Saudi nursing experts at the University of Salford and academic staff at the University of Dammam. The reliability of the instrument was assessed using Cronbach’s alpha and a 50-item Likert scale. The value of Cronbach’s alpha for each component was higher than 0.70, confirming the internal consistency of the instrument [ 3 ].

The data were collected from the students in the intervention group before and one month after the intervention, and from the participants in the control group before and one month after completing the internship program. The collected data were analyzed using SPSS22 software, employing the chi-square test, paired samples t-test, and independent samples t-test. The Kolmogorov-Smirnov test was used to check the normality of the data.

One of the limitations of this study was students unwilling to participate, so the researcher considered one session off from the internship for the students who participated in the study. Another limitation was the information exchange between the control and intervention groups, so the students in the intervention group asked to prevent the spread of information to the control group.

The participants were 72 nursing students, divided into two groups: the intervention group and the control group, each consisting of 36 students. The data from the chi-square test and independent samples t-test indicated that the students in both the intervention and control groups were homogeneous in terms of the demographic variables and showed no significant differences (Table  2 ).

The mean health education competencies score for the students in the intervention group before the intervention (165.7 ± 23.09) was lower than mean score of the students in the control group in the post-test (170.16 ± 28.58). However, the data from the independent samples t-test indicated no significant difference between the two groups in the mean scores of health education competencies and the scores on the related subscales.

In contrast, the mean health education competencies score for the students in the intervention group after the intervention (191.58 ± 28.35) was higher than mean score of the students in the control group in the post-test (165.97 ± 28.11). Additionally, the independent samples t-test showed significant differences between the two groups in the mean scores of health education competencies and the scores on the related subscales (Table  3 ).Analysis of covariance was performed to control for the effects of the pre-test on the post-test scores of health education competencies. The results indicated that the significant increase in the health education competencies of the intervention group was attributed to the service-based learning method. These findings corroborate the results presented in Table  3 (Table  4 ).

This study examined the effect of service-based learning on the health education competencies of students in the community health nursing internship program. The results showed that service-based learning positively affects the health education competencies of the nursing students in the intervention group. Similarly, Dadgaran et al. (2013) stated that the service- based learning method helps students work in different settings such as social health institutions. Thus, they deal with special populations such as older adults. The students can also develop a deep understanding of differences and cultural issues among older adults and promote their knowledge, abilities, and communication skills [ 15 ].

Avazeh et al. (2014) also found out service-based learning will increase nurses’ efficiency and quality of care [ 23 ]. Khorrami Rad et al. (2011) reported that the scores of knowledges and attitudes of the students in the intervention group after using the service-based learning method were significantly higher than the mean scores for the same variables in the control group. Moreover, the mean scores of knowledges for the students in the intervention group showed a significant difference before and after the intervention [ 16 ]. Valizadeh et al. (2010) showed that outcome-based education is effective in improving students’ cognitive and behavioral skills [ 24 ]. Hwang et al. (2020) also reported that the global health competencies, self-assessed global leadership, and critical thinking ability of all students increased significantly after training. Thus, nursing educators and global health experts can use discussion and exchange of opinions for educating students and solving their problems [ 17 ]. Rosen et al. (2019) also confirmed the positive effects of service-based learning such as interdisciplinary training and effective communication [ 25 ]. Dombrowsky et al. (2019) also suggested that the development of skills, teamwork, and leadership and the application of theory in practice with the service-based learning method increased the creativity and independence of health students and made them focus on clients and understand them better [ 18 ]. Read et al. (2018) found that implementing service-based learning in schools using the recommended strategies along with the curriculum content of the students will lead to coherent, integrated learning and a successful experience for them [ 19 ]. Hayward et al. (2017) showed that planning, implementation, and evaluation are highly efficient to maximize the benefits of service-based learning [ 26 ].

Knecht et al. (2015) also emphasized that listening to the voices of students who attend service-based learning courses enables teachers to gain a deeper perspective of their experiences and ultimately leads to a deeper understanding of service-based learning programs [ 27 ]. Hwang et al. (2014) showed that the perceived care was significantly different between the students and paired residents in the intervention group and the control group and the knowledge and attitude scores of nursing students increased significantly. The results of this research project confirmed that students can learn more effectively with adequate training and the effective use of service-based learning [ 20 ]. Furthermore, Long et al. (2014) showed that service-based learning effectively increased the self-efficacy, self-confidence, skills, knowledge, attitude, and self-awareness of students in working with Spanish culture and developed their cultural competence [ 28 ].

The present study confirmed the effectiveness of service-based learning on the health education competencies of students in the community health nursing internship program. Thus, following the results of the present study and similar studies in the literature, the outcome-based learning method improves nursing students’ competencies compared to traditional methods. Furthermore, since nursing students are interested in participating in service-oriented activities, it is necessary to provide them with the opportunity to learn theoretical and practical concepts together and to shift learning from passive and traditional learning to active and modern learning. In other words, the effective application of service-based learning in nursing universities can contribute to recognizing students’ educational problems. Furthermore, a focus on nursing education goals and incorporating them into curricula can be an effective step in educating people in the community. Thus, nursing professors and teachers can use the service-oriented learning model in practical and clinical courses offered for nursing students. Future studies can also address the effect of service-based learning on students’ knowledge, attitudes, performance, and educational competencies in different fields of medical sciences.

Data availability

All data generated or analyzed during this study will be available if necessary.

Henderson V. The nature of nursing. The American journal of nursing. 1964:62– 8.

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Acknowledgements

This article was derived from a master’s thesis completed in the Kerman School of Nursing and Midwifery. The authors appreciate all the professors and students who participated in this research project.

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Maryamsadat Emrani

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Jamileh Farokhzadian

Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran

Zohreh Khoshnood

Education development center, Sirjan school of medical sciences, Sirjan, Iran

Mohammad Sadeghi

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The research team in this article consisted of 4 people, two people with Ph.D. in nursing, and two persons with a master’s degree in nursing: 1. Dr. Zohra Khoshnoud, first guide. 2. Dr. Jamila Farokhzadian, second guide. 3. Senior nursing expert, Maryamsadat Emrani was responsible for preparing the article. 4. Senior nursing expert, Mohammad Sadeghi was responsible for submitting the article and editing.

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Emrani, M., Khoshnood, Z., Farokhzadian, J. et al. The effect of service-based learning on health education competencies of students in community health nursing internships. BMC Nurs 23 , 138 (2024). https://doi.org/10.1186/s12912-024-01799-y

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Educate to Empower aims to break down barriers to breast cancer screenings

With the president’s engagement prize, fourth-years simran rajpal and gauthami moorkanat plan to deliver education and resources directly to community centers in philadelphia, tackling medical mistrust, health literacy, and more..

Black women are 40% more likely to die from breast cancer than white women. Understanding this gap and its relationship to the historical and ongoing treatment of Black and Brown women in medicine has been the focus of Penn fourth-years Simran Rajpal and Gauthami Moorkanat.

Those stark statistics have driven their work toward breaking down the barriers to breast cancer screenings in marginalized communities in Philadelphia and led to their creation of Educate to Empower. Their focus is on using culturally-tailored messaging to overcome mistrust and fear of the medical establishment, as well as improving access and overcoming social, financial, and logistical barriers to evidence-based care.

Educate to Empower is one of two projects chosen this year to receive the President’s Engagement Prize , which awards $100,000 to fund each project and a $50,000 living stipend for each student. The Prize is meant to empower Penn seniors to design and undertake post-graduation projects that make a positive, lasting difference in the world.

Educate to Empower aims to deliver education and resources directly to community centers in Philadelphia. While working to address medical mistrust and health literacy, the program is positioned to influence early screening and detection in populations that may not be adequately reached by existing interventions.

“Simran Rajpal and Gauthami Moorkanat are inspiring student leaders who have spent their four years at Penn engaged deeply in service to local and global communities,” says Interim President J. Larry Jameson . “It’s fitting that their dedication and care for others has led to the thoughtful initiative Educate to Empower, which, through meaningful partnerships, will work to mitigate, and hopefully eliminate, health inequities in our city. I look forward to seeing this project flourish and evolve.”

Rajpal, a health and societies and biology double major from Chester Springs, Pennsylvania, and Moorkanat, a biochemistry major from Stirling, New Jersey, met each other in their second year in Penn Thillana, Penn’s classical Indian dance team. They both became captains of the team at the end of their second year, and after working so closely, realized they had similar interests in public health and women’s health. 

“It’s not one of the reasons we became friends but it’s one thing we did bond over, and we started talking about creating a project together that could help the Philly community,” Rajpal says.

The summer before her third year at Penn, Rajpal’s mother was diagnosed with Stage I breast cancer, and has now completed treatment and is doing well. “The diagnostic process really struck a chord in me because I realized how little I knew about my own breast health, or my own health in general. And if I knew so little about my own reproductive or breast health, and I want to go into women’s health and community health as a career, I can almost guarantee that a lot of other people don't know their risk of disease,” she says. 

She and Moorkanat then decided to focus on community health education and breast cancer.

“In Philadelphia, in particular West Philly, there’s a lot of communities that don’t have the access to health care that they need, even though Penn is right here,” Moorkanat says. “Our thinking behind this was that if we can deliver the resources to them, instead of making them come to Penn, maybe we can start to bridge that gap.”

Here’s how it will work: Cycles of four, one-hour workshops will operate during mealtimes at various community centers across Philadelphia. Each cycle cohort will be made up of 12 participants and 2 facilitators to cultivate small-group conversation and support. Sessions will cover self-examinations, screening guidelines, personal breast cancer risk assessment, and modifiable risk factors. All facilitators will undergo training to ensure competencies in the curriculum, cultural relativity training, and leadership skills. 

After completion of the program, participants interested in screening will be assisted in enrolling in Penn Medicine’s Breast Health Initiative to schedule their first free mammogram. Additionally, in collaboration with an advisory board composed of community partners, past participants, and experts, Educate to Empower will continue refining its curriculum and delivery to better address the needs of Philadelphia residents.

“Our ultimate goal is to use our four weeks in these community centers to not only alleviate medical mistrust and work to combat a lot of these access disparities, but to also provide our participants with enough confidence and reassurance that even if they have to enter the medical system, they’ll be OK and there are ways to support them,” Rajpal says.

Both agree that their time at Penn opened their eyes to the various ways they can address health inequities, both across the globe and down the street.

Moorkanat has been conducting global health research since her first year at Penn, initially looking at cervical cancer in Botswana.

“Cervical cancer is a very preventable disease if there’s proper public health measures, like HPV vaccination and routine screening, but sitting thousands of miles away, it’s really difficult to do something about that,” Moorkanat says. “The classes and all the different opportunities I’ve had here at Penn have shown me that just outside of our campus, there’s so much you can do to help our communities around us.”

For Rajpal, one of Penn’s biggest assets is its location in Philadelphia. “I’ve done such a random assortment of things across the city. I've worked for the Department of Public Health; I've volunteered at a free health clinic in South Philly; I work with the Netter Center and deliver programming to four schools a semester; it's a lot of very seemingly random things,” she says. “But at the end of the day, every single thing I do revolves around, ‘how can I bring resources to Philly neighborhoods and help reduce disparities?’ And if anything, taking classes in health and societies, working on research in a few different fields of study, and collaborating with faculty and staff on all of the various, lovely, random things that Penn has brought me has only increased my commitment to continuously pursuing that work and effort even beyond Penn.”

The team is mentored by Leisha Elmore , an assistant professor of surgery at the University of Pennsylvania Perelman School of Medicine and Chief of Breast Surgery at Penn Presbyterian Medical Center .

“The project was very advanced for their level of training. It was insightful, well-designed, and well- thought through, and what stood out to me very early was ‘wow, they are truly the future,’” Elmore says. “They are so bright, and it makes me optimistic about advancing health equity in future generations.”

Many programs trying to tackle similar issues are “one in, one out” programs, and while Elmore thinks those can play a role and have an impact, to truly make change, one needs to establish a footprint in the community.

“Educate to Empower is unique in that it’s designed to both create an educational component and impact on the community. But it also facilitates graduates of the program to join their efforts to continue increasing awareness around screening and overcoming barriers.”

Early detection truly saves lives, Elmore says. “One study that can be done very quickly can be the difference between someone with a curable disease who has a long lifespan beyond treatment of cancer versus those who we have a limited capacity to help.” 

“Simran and Gauthami are one-of-a-kind mentees who are truly motivated to make an impact and it's my honor to be their mentor,” Elmore says.

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DEEL Sustains Commitment to Reduce Health and Educational Disparities Among Infants, Toddlers and Their Families with New Cohorts of Multi-Year Community Grants

Apply by May 9 for up to $298,000 in support of community-informed proposals providing families access to critical resources and services, supporting healthy and equitable births, increasing parental health and wellbeing, and strengthening caregiver-child relationships.   

SEATTLE (April 22) – The Department of Education and Early Learning (DEEL), in partnership with the Office of Sustainability and the Environment and the Sweetened Beverage Tax (SBT) Community Advisory Board, is proud to announce the availability of $1.49 million in investments to improve health and educational outcomes for individuals in the prenatal-to-three years period.  

The Prenatal to Three (PN-3) Community Grant will fund community-informed programs that promote improved outcomes for pregnant individuals, infants and toddlers, and their families and reduce disparities that disproportionately impact communities of color, immigrants, refugees, heritage language speakers, and low-income families.   

This year’s PN-3 Request for Proposals (RFP) reflects DEEL’s ongoing commitment to reducing health and educational disparities in the early learning period, as the fourth year in which applicants have been invited to seek this SBT-funded award. Grantees are prioritized based on their commitment to advancing racial equity, alongside a mission to serve expecting parents, caregivers and/or guardians of children aged birth to three within the City of Seattle with a particular interest in reaching priority populations as named above. 

To learn more and apply by the May 9 submission deadline, please visit: https://www.seattle.gov/education/for-providers/funding-opportunities/2024-prenatal-to-three-community-grants .  

The 2024 RFP deepens the footprint of the investment strategy by providing a new cohort of awardees the opportunity to build on frameworks and practices with demonstrated success. In 2023, five organizations were awarded $280,000 over two years to sustain programming that helps reduce disparate perinatal and maternal health outcomes in communities most impacted by inequities. Eligible organizations proposed community-informed strategies to reduce inequities in one or more of the following areas: healthy births, parental health and emotional wellbeing, nurturing and responsive caregiving, and early childhood health and development. This investment strategy contributes to DEEL’s goal of kindergarten readiness for all Seattle children.  

Last year DEEL received 25 applications requesting more than $3.4 million in funding. Proposals were reviewed by community members and representatives from Public Health Seattle & King County and the Washington State Department of Children, Youth and Families. Each awardee is receiving $280,000 over two years, from 2023-2025, to support their efforts in community. Services are primarily directed and provided by women of color-led organizations and offered throughout the city, with an emphasis on serving communities in the southeast and central areas of Seattle.    

2023 PN-3 Community Grant award recipients include:   

• Families of Color Seattle – Offering Parent Groups, gatherings that increase parenting skills and provide a space for parents to discuss identity, race, culture, and belonging at no cost to participants. 
• Global Perinatal Services * – Providing culturally specific, doula services to Black, Immigrant and Refugee families, prioritizing those with low income. 
• Hummingbird Indigenous Family Services – Providing culturally specific, full spectrum doula support for Indigenous families.  
• Inter-Cultural Children & Family Services * – Providing parent education focusing in building strong parent-child relationships meeting cultural, logistical, and individual needs of African American pregnant individuals and families.  
• Voices of Tomorrow – Supporting the Mind, Body, Culture (MBC) home visiting program that offers culturally and linguistically responsive case management, peer-based education, and social-emotional supports.  

* First-time award recipient of DEEL funding    

Culturally-responsive services to be provided by awardees include prenatal and postnatal doula care, lactation support, home-visitation and in-home mental health counseling, and parental support groups focused on parenting skills and healing trauma related to identify, race, culture, and belonging.   

Since 2021, the PN-3 Community Grant has invested more than $4 million in community and supported over 1,200 caregivers with the first two groups of grant awardees. Research shows that culturally congruent perinatal support and family advocacy contribute to parent and child wellness, as well as improved academic outcomes.   

The City of Seattle Department of Education and Early Learning’s mission is to transform the lives of Seattle children, youth, and families through strategic investments in education. www.seattle.gov/education    

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NH community health workers push for certification, Medicaid reimbursement

Community health workers are sometimes called the “boots on the ground” of public health: doing outreach and education, connecting people with services and addressing barriers to getting care.

A measure aiming to strengthen that workforce is up for a vote in the New Hampshire House Thursday.

The legislation – part of a broader package meant to address ongoing workforce shortages in health care – would create a voluntary certification program for community health workers. It would also allow their services to be reimbursed by Medicaid.

Public health leaders say that would make funding more sustainable. Currently, many community health worker programs in New Hampshire are funded by short-term grants.

“A program may lose funding and regain it a year later – but they're starting from the ground up again,” said Amber Culver, the co-chair of the New Hampshire Community Health Worker Coalition.

Culver said that uncertainty also drives some community health workers out of the workforce.

Community health workers don’t provide clinical care, but serve as liaisons between the health system and their communities. That could include connecting people with insurance, helping them understand medical information, making sure they have transportation to appointments and following up with patients who have no fixed address.

The proposal, Senate Bill 403, passed the state Senate in March. The House Health, Human Services and Elderly Affairs Committee failed to reach a recommendation on it, splitting mostly along party lines.

At a hearing last week, Republican Rep. Jim Kofalt said the bill does not define community health workers’ duties clearly enough, and puts taxpayers on the hook.

“This bill creates a reimbursement mechanism in which we would be paying for people whose responsibilities, I believe, are extraordinarily vaguely defined [and] open to expansion,” he said.

Rep. Erica Layon, a Derry Republican, said she’s sympathetic to the idea that community health workers do a lot of good. But she expressed concern that certification could create a false impression that they can perform services they’re not qualified to provide.

“I just want to make sure that we’re not putting out false hope to our vulnerable people,” she said.

Democratic Rep. Trinidad Tellez of Manchester, a medical doctor who previously led the state’s Office of Health Equity, pushed back on those concerns.

“They do not pretend to be clinical providers,” she said. “What they do is they connect people to resources, they help people identify where to go for help.”

At a summit for community health workers in Concord this week, several workers said they fill an important gap, noting that economic, social and other nonmedical issues can have a large impact on people’s health.

Luis Porres has been a community health worker for the city of Nashua for 18 years. He said he likes being involved in the city where he lives.

“You don't see the impact until a lot of time goes by,” he said. “But I know that little things, or little efforts that we do, are going to make an impact in the long run.”

Magna Krieger, who directs community health services at Harbor Care in Nashua, said the work is especially important for reaching vulnerable populations.

“We work with the homeless community,” she said. “We also work with folks that are uninsured or barely insured. And we also are able to provide language access. My team, two of the community health workers speak Portuguese and Spanish.”

Krieger said they also have a “mobile access unit” staffed with community health workers, which can park in different areas. Patients who can’t get to the health center in person can step into the mobile unit to have telehealth appointments with medical providers.

Culver, who’s also a community health worker program manager for the North Country Health Consortium, likes to tell a story about a woman whose doctors were mystified as to why her medication wasn’t working.

“I think it was one or two visits and just conversation and getting her to trust me, we realized she just couldn't take the cap off of her pill bottle,” she said. “And so it was simply a phone call to the pharmacy to talk to them about, you know, an arthritis-friendly pill bottle cap.”

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