RHP&EO is the electronic journal of the International
Union for Health Promotion and Education
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My Favourite Five Signpost Publications in Health Education and Health PromotionBy Lawrence W. Green, Centers for Disease Control and Prevention Green LW. My Favourite Five Signpost Publications in Health Education and Health Promotion. Reviews of Health Promotion and Education Online, 2001. URL: reviews/2001/6/index.htm. This was hard work, picking my five favourite publications in health education and health promotion. I made a list, but it contained five times the allowable five. And that was after ruling out favourites that failed to meet the screening criteria I imposed, such as written by people in the field for people working in the field of health education and health promotion. That eliminated some classics in philosophy, history, biology, and research methods that have guided and sustained me in my work. It set aside (perhaps for another list in another place) the works that inspired and led me into public health, and thence into the social and behavioural aspects of public health. It axed some classics in research and evaluation, such as Campbell and Stanleys Experimental and Quasi-Experimental Designs for Research, and in the philosophy of science, such as Rene Dubos Mirage of Health. A second screen excluded works that were my favourites in each of the health issues or problems to which health education and health promotion have bent their research and application. It eliminated, for example, the research papers that I might have selected as the exemplary, or most rigorous, or most definitive, or most creative design to test a specific type of intervention on a type of health problem or population. It eliminated the many award-winning program descriptions and case studies that were notable for their creative and systematic application of theory and practice to one of the many specific problems successfully tackled by health education and health promotion. This criterion also sidesteps the debate that would ensue between those who would disqualify as health promotion anything that focused on a single outcome or problem, because they view health promotion as necessarily focused upstream on broader community or population determinants of multiple health or quality of life concerns. My apologies, then, to people like Lief Aaro, Joshua Adiniyi, John Allegrante, David Altman, Ronald Andersen, William Bailey, Kay Bartholomew, Ed Bartlett, Chuck Basch, Renaldo Battista, Lisa Berkman, Bob Bertera, Allan Best, Steve Blair, Bob Bolan, Ron Braithwaite, Lester Breslow, Bill Brieger, Sally Casswell, John Catford, George Cernada, Judith Chwalow, Noreen Clark, Sue Curry, Loren Daltroy, Mark Daniel, Mark Dignan, Terry Dwyer, Joan Eakin, JoAnn Earp, John Elder, Eugenia Eng, Michael Eriksen, Jack Farquhar, Jonathan Fielding, Andrew Fisher, Brian Flay, Brian Flynn, Andrea Gielen, Karen Glanz, Bob Goodman, Nell Gottlieb, Ralph Hingson, Donald Iverson, Howard Kalmer, Laura Kann, Snehendu Kar, Gerjo Kok, Kate Lorig, Maurice Mittelmark, Donald Morisky, Patricia Mullen, Donald Nutbeam, Rena Pasick, John Pierce, Pekka Puska, Barbara Rimer. These are people who have authored or co-authored a study or program evaluation that was the best in their niche. Their contributions are simply too specific to too many varied areas to compete on an equal footing for the most influential five overall. Another set of exclusions had to be some very admirable and exciting works of recent vintage that seem to have great potential to advance the field, but have not yet stood the test of time and notice. Whether they will have the impact I would predict for them remains to be seen, so I took the easy way out on these more speculative choices by omitting them. Ill give a similar hint of my biases with a similar nod to some of these authors: Johannas Brug, Margaret Cargo, Mark Daniel, Katherine Dean, David DeJoy, Hein DeVries, Anne George, Gaston Godin, Michele Kegler, Matthew Kreuter. Work on topics currently influencing health promotion, such as tailoring of communications and other computer applications, social capital, participatory research, remain to survive the ravages of changing social fads, professional ideological swings, and funding priorities. Before forcing my choices, I also had to eliminate the works emanating from the cognate social and behavioural sciences that have had applications in health education and health promotion almost incidental to their more generalized applications in other fields. The specific theoretical and empirical foundation works of psychologists Albert Bandura, Carlo DiClemente, Stephen Fawcett, Carl Hovland, Irving Janis, Jim Prochaska; Sociologists Lisa Berkman, Sol Levine, David Mechanic, Everett Rogers; economists Bob Evans, Morris Barer, Ken Warner and others have been powerful, each in its own way. But they are too numerous and too basic to enter the same competition for listing among health education and health promotion resources. I found it impossible to decide how to weight these theories because each makes a different kind of contribution to the thinking and application of the planner, policy maker or practitioner at different levels of application in an ecological approach to health promotion. And finally, my apologies to those who have had the dubious distinction of contributing some of their work to publications on which I imposed myself as a co-author. I have had to resist the temptation of putting into the mix any works that might rise to the final list on the strength of my pride in being associated with them. Such a conflict of interest would not be worthy of the precedent and standard Michel ONeill has set for this series. The envelope, please! The winners of my personal favourite works marking or documenting turning points in the modern history of health education and health promotion are: 5. Godfrey Hochbaums (1956) formulation of the Health Belief Model in work that emanated from the U.S. Public Health Service in the 1950s. This model has, indeed, stood the test of time, with applications in dozens of areas of both adult and child behaviour. Though frequently criticized for its narrow focus on the belief structures and values of individuals, it continues to serve health educators in their construction of health messages. In any broader ecological approach to health promotion, a building block includes effective communication with individuals, either through mass media or more individualized channels, in relation to their own belief and value expectancy structures. Even if the strategy is policy change, rather than individual change, the strategy usually must take into consideration ways to communicate the value of the policy change to individuals whose opinions in the aggregate will count in the political process in any democracy. I was impressed as a student by the elegance of the study design and analysis, the use of theory advancing from the more narrowly conceived fear-arousal theories of health behaviour and communications, and the immediate applicability of the model in a wide range of health communications. 4. William Griffiths and Andy Knutsons (1960) article in the American Journal of Public Health that first called into question the unbridled and simplistic enthusiasm during that era for the use of mass media in public health. Health officers were demanding of their health educators that they back off the labour intensity of their community organization efforts and concentrate on getting their messages onto television. Griffiths and Knutson argued that the people who most needed to be reached did not have television sets (at that time). The two-step flow of communication that had been demonstrated so well in earlier communication research would require community organization efforts to facilitate the secondary diffusion and application of health messages. Their arguments were partially lost in the subsequent rise in the proportion of households in developed countries that had television, but they helped set the stage with this influential caveat for the return to community approaches that were more robust than mass media alone. Griffiths chaired the public health education program at Berkeley through a period when it trained hundreds of health educators from developing countries, especially in Asia. His faculty carried out more than a decade of research applying his mixed media and community organization approach in Navajo, Bengali, Pakistani, Nepalese, and Thai communities. 3. Guy W. Stuerts (1965) writing on planned social change and the professional preparation of health educators. Though not the first professor of health education to apply this approach, Stuert was influential because he brought his concepts from South Africa to UCLA, and from the west coast to the east when he became chair of health education at the University of North Carolina at Chapel Hill. UNC had the largest MPH program in the U.S. at the time, and soon had an influential doctoral program. He continued after his retirement from the chair at UNC to work on the export of health educators to developing countries, particularly Africa. Much of Africas capacity today in health education is derivative of Africans trained in Chapel Hill or exports from this UNC program. 2. Lowell Levins work on self-care (Levin, Katz, & Holst, 1978). Levin was professor of public health at Yale University and had considerable influence on the field of health education during the Griffiths and Steurt era when it was trying to break away from old dogmas and to apply greater scientific rigor to the evaluation of its efforts. Although he did not publish much original research, Levin held the keys to the premier journal at the time, Health Education Monographs, as its editor, and brought his self-care philosophy to a more receptive European audience with his consultations to WHO and the European Regional Office. He invited Guy Steuart and me (then developing the health education program at Johns Hopkins University) to his home for a weekend retreat in the mid-1970s for the three of us to think about the professional preparation of health educators and the future of the field. We could hardly have foreseen the shape of health promotion to come, but Lowells self-care orientation combined with Steurts community and social change orientation might well have defined it. 1. Pederson, ONeill & Rootmans (1994) Health Promotion in Canada. This book provides a compilation of the best efforts of the country that hosted the First International Conference on Health Promotion in 1986, and the first country to articulate its own programs in line with the Ottawa Charter. This makes it a more useful resource than the Charter itself, for it contains the elements of the Charter and the experience of a country trying to live up to it in the subsequent eight years. These are listed in chronological order, with no intended ranking or weighting as to their relative importance. Each made what I consider a major contribution to signalling or documenting turns in the development of health education and health promotion in its time, and reflects an advance toward the next era. Much of what has been written since the 1994 book has not had time yet to demonstrate its comparable importance as a statement for our time, but I am confident that much of what has happened since 1994 reflects a vibrant and vigorously developing field. References
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