Interrogating Global Health Promotion Education

By Bob Karch

As an educator, I have spent the last twenty-two years of my thirty-three years as a college professor focused on the educational preparation and training of health promotion professionals.  In so doing, I have always viewed education as both a process and a product. More specifically, as a process I see education as the sequence of events, activities, experiences and progressive operations designed to impart predetermined information to individuals.  Most often institutions of higher education organize these activities in a formal structure commonly known as a curriculum.  In contrast, however, when I think of education as a product, my thoughts focus on the results left by learning or, more descriptively, the residuum of any experience. Clearly, individuals do not retain all that they were exposed to in the process side of education, but what they do retain and, with that, what they take into the world at large, becomes the product of that experience.

For institutions of higher education and more specifically, those institutions that are now or want to be involved in the future education of health promotion professionals, it would be advisable that due consideration be given to both process and product. For example, do we as educators operating within our respective ivory towers believe that we know best what any well-educated health promotion professional needs to know in order to be successful in their career and, as such, do we then prescribe the "process" one needs to follow?  Or do we, as progressive educators, recognize that there is a real world outside our towers that is constantly changing and that we thus need to continually monitor the external environment to ascertain the "product" needed to best meet the health challenges in the world in which we all live?

The challenge that confronts any curriculum developer in this discipline is how to strike a balance between the two: process and product. Moreover, finding such a balance is even more challenging when we consider the many issues associated with the preparation of health promotion professionals for work within the international community. Perhaps that is why so few institutions have undertaken such a task. Some have taken up this responsibility however, and this issue of Global Perspectives highlights a few of those programs. But before you turn to read about those programs, let me share with you a few process and product "guiding" questions that you may chose to consider when developing a curriculum for the health promotion professional who desires to work in the international community.

1. What are the health needs, problems and interests of the individuals that seem to transcend national and geographical boundaries?
2. What are the country or regional specific health problems faced by contemporary societies?
3. What are the global social, economic, political and environmental trends that will impact the future of health?
4. Has consideration been given to the basic beliefs, philosophies and the societal presuppositions and principles that have guided educational programs in years past?
5. Has care been taken to assure that the most appropriate instructional strategies are utilized?
6. Has the appropriate information technology been utilized to facilitate both teaching and learning and can that technology be transferred and adopted both geographically and culturally?
7. Has there been the appropriate mix of both cultural awareness and sensitivity in the instructional plan and curriculum?
8. Is there a common body of knowledge that, with respect to health promotion, transcends the countries of the world and if so is that knowledge the foundation of the curriculum?
9. Is there a common language or, at least, agreed upon terminology that has universal application and if so has that been incorporated into the educational process?
10. Is there a process in place to continually monitor the health promotion "product" needs of the world at large?

These are but a few of the many questions that need to be addressed if we truly want to be responsible and responsive educators in this rapidly changing world of health promotion.  I would welcome your additions to this list.

As well, this issue of GP introduces a brand new feature on page 7. Global Innovations presents new and creative projects, programs and methods in the promotion of global health, and it presents this information in clear summary form, complete with essential contacts and addresses for the featured programs. This issue presents the German Bonus Project, and future issues will take you to innovative health promotion concepts and activities around the world. If you have suggestions for programs and projects to be included in the Innovations section in forthcoming issues, do let us know by emailing Vivian Blaxell at vivianuccia@earthlink.net.

The Study Program in Health Promotion and Health Management at University of Magdeburg – Stendal, Germany

by Dr. Kerstin Baumgarten

 The Mission

The course of studies in Health Promotion and Management at the University of Magdeburg was established as a project founded by the federal government in 1993. Apart from postgraduate studies in Public Health, the Magdeburg program is unique in Germany.

Government policies, the increase in life expectancy, and rapid developments in medical engineering pose new challenges to the system of health insurance, to prevention, and to health promotion. The reorganisation of German health care services, changes in the spectrum of diseases, globalisation and related changes in work call for a new ideal in the area of health protection and environmental protection. As Germany is bound to international standards (Ottawa Charta, Agenda 21, Health 21), skilled workers with the appropriate knowledge and abilities of health  and environmental protection and promotion are needed. The Magdeburg program fulfills the current quality standards in branches of the public health service and leads to professional competence of health promotion specialists. Health promotion constitutes a social process which has to be organised in all sectors of human life, in work, in the educational system and in leisure activities as well. Because of its global activities and partnerships, the program opens students to international fields of work. 

Structure of the Program

The course lasts eight semesters on a full–time basis and is separated into foundational and an advanced phase. Contents of the foundation core are as follows:

• Introduction to health sciences and health promotion;
• Introduction to human biology;
• Introduction to psychology, education and sociology;
• Health management and basics of law;
• Methods of health promotion;
• Public communication and internet work;
• Statistics and research planning.

The advanced phase includes the following areas:

• Project management;
• Health education;
• Health ecology;
• Organisational development;
• Health communication;
• Methods of investigation and planning;
• Professional competence development;
• Electives: use and application of media, languages, health practice.

During the advanced phase of studies, students elect a field of specialization from the following areas:

• Public health promotion;
• Organisational development and occupational health;
• Personal psychosocial health promotion;
• Health communication.

Characteristic of the course of studies is the emphasis on the close connection between theory and practice that is produced through project work as well as internships in the field. Methodical and didactic construction promote the communicational, creative and problem solving skills of the students. Because of its global activities and partnerships, the program opens students to international fields of work. Upon successful completion of the program students will be awarded a Diploma in Health Promotion and Management.

Main fields of practice for graduates

The program works successfully. Ninety percent of the graduates got jobs in the field of health promotion and management. They work in the following fields of health care:

• Insurance companies;
• Rehabilitation centers  and clinics;
• Enterprises (occupational health);
• Educational institutions;
• Community public health services.

Their main areas of activities in these fields are:

• Research and publication of health reports and health advisement;
• Public action, lobbying of decision makers and participation in the education of the public;
• Continuing education in health issues such as nutrition, exercise of strategies for overcoming diseases;
• Organisational development and creation of infrastructures for health;

In practice Magdeburg-educated health promotion specialists influence the quality of health promotion interventions. Main factors for these quality improvements are a generalistic qualification, a holistic health view and the adjustment of the qualification to conform with the strategies of the Ottawa Charta. Beside professionals in the behaviour area (like specialists in physical education and nutrition or psychologists) Magdeburg graduates are able to manage an intersectoral, cooperative approach in Health Promotion, so the study program contributes to establishment of a broad alliance for health in Germany and delivers qualified professionals to implement the German Health Reform 2000.

A Graduate Diploma in Indigenous Health Promotion in Sydney, Australia

The course and its aims

The course is a postgraduate program in indigenous health promotion. It is offered by the Department of Public Health and Community Medicine at The University of Sydney. The Graduate Diploma was developed in close consultation with Aboriginal health professionals through the Australian Indigenous Health Promotion Network  and the Indigenous Studies Unit, Koori Centre at the University  of Sydney.

The course offers Aboriginal and Torres Strait Islander Health Workers/Practitioners the opportunity to add knowledge and skills in promoting health to their clinical and community knowledge and skills. The course has been designed to ensure that students’ learning is connected with their day-to-day work in their communities, and reaffirms the importance of community participation and community development. The course is based on national and international best practice in Indigenous health promotion.

As a result of completing the course students will be able to:

• Communicate effectively with individuals and with all members of communities;
• Identify community needs in relation to health promotion using a variety of sources of information and ensuring community participation;
• Select priorities for health promotion in consultation with the community;
• Develop plans of action based on principles of effective health promotion practice;
• Develop plans for evaluating health promotion programs that will ensure that there is evidence of the outcome achieved;
• Manage and implement health promotion projects effectively; and
• Ensure that their health promotion practice is culturally-effective and is based on the principle of community participation.

Structure

The course is aimed at working health professionals, so studying part-time, students can complete the course with one year’s full time study. However, some students may wish to re-enroll on a part-time basis for at least part of a second year to complete a final project. The course consists of one two-week block and five one-week blocks of full-time study. The first three blocks are core units and must be completed by all the students. The students then select three electives from a range of options to complete the course. The blocks are taught on campus at the University of Sydney. Following each block students return to their community/workplace and complete a project that is based on the learning achieved in the block course.

The final part of the course requires students to complete a project that brings together all the different parts of the course. This is to consolidate their learning with particular emphasis on demonstrating the inclusion and importance of community participation and community development.

Student Perceptions of the Diploma Course

Graduates of the 1998 class appeared to have positive reactions to the course. One remarked: "I have learned to read about and think about Indigenous health promotion and to listen to other people’s ideas.…" Another student commented: "I have developed my skills in program development and in critically reviewing articles. I have developed my knowledge and skills in evaluation…." Most 1998 graduates felt that their knowledge of and insight into health promotion generally had been revitalized and strengthened by the course, and the mix of  "Learning on the job and studying at the same time has been useful."

Studying for a Masters Degree in Exercise and Nutrition Science in the Historic City of Chester, UK

by Kevin Sykes

 The Centre for Exercise and Nutrition Science (CENS) is an international specialist centre for postgraduate teaching and research based at one of UK’s leading institutes of higher education, Chester College. The College, which has over 6,500 full and part-time students is a part of the University of Liverpool. CENS is located in the School of Science and Health and is supported by the Departments of Sports Science and Biological Sciences. It has strong links with local hospitals, health authorities and corporate organisations, with UK Fire Brigades, Police Forces and the government Home Office and has an international reputation for its work in occupational and community health and fitness. CENS is a member of the International Institute for Health Promotion and attracts students from worldwide onto its very popular MSc  in Exercise & Nutrition Science.

A wide range and flexibility

There are currently 330 students from 24 nationalities on this Taught Modular Masters programme, which runs as a 1-year full-time or 2-year part-time course in the UK, and is also taught on location in Hong Kong and in Singapore. The course attracts students from a wide range of backgrounds and professions including medicine, physiotherapy, nursing, dietetics, nutrition, food science, exercise and sports science, human biology, pharmacology, ergonomics, dentists, health promotion, firefighters, police officers, lecturers, teachers, fitness leaders and sports coaches. The programme is highly flexible allowing students to mix full-time and part-time modes of study according to their needs and work commitments. Many students opt to study for a part of their programme overseas and this interchange helps foster the atmosphere of a truly international centre both in teaching and in collaborative research projects.

CENS in the UK

In the UK, the annual intake is around 40 students and modules are taught by a series of 6-week, one-morning per week classroom, laboratory and/or seminar sessions. There are also three Easter School modules delivered as short, intensive 4-day modules followed by 7 weeks of home-based learning. Each module requires the submission of  a 4,000-word written assignment or its equivalent (e.g. poster presentation). Students select 8 modules, and on successful completion, progress to the Masters Research Project which culminates in a 16,000-word Thesis.

CENS Abroad

In Hong Kong and Singapore, the part-time course is run in collaboration with the British Council and is delivered by visiting UK academics who teach the 20-hour modules over an intensive weekend and two evenings. Students then have resource packs and support from local tutors to help them to prepare their 4,000-word written assignments. Taught modules occur every 8 weeks and while most students opt to keep up this pace, many opt to study more slowly and may take a maximum of 6 years. Laboratory and library resources are available locally and the programme recruits around 20-25 students annually in each country.

There are many examples of collaborative research programmes with local and national institutions and in addition to providing research publications and conference presentations, job opportunities often arise and the proportion of students moving into related careers is very high.

CENS is now one of the largest specialist academic centres of its type in Europe with MSc, MPhil and PhD students with a mission statement of promoting health through exercise and nutrition. With over 120 graduates and a strong commitment to excellence, the course is well subscribed with many coming from worldwide to study on the recommendation of former students. Another attraction is the attractive campus of Chester College, founded by the Church in 1839, in the historic Roman city of Chester.

Country Profile:  Education and Curriculum in Public Health and Health Promotion in Latvia

By Ineta Pirktina

The Republic of Latvia is situated on the eastern coast of the Baltic Sea. It has an area of about 25,000 square miles and a population of 2.5 million inhabitants. Latvia is firmly on track to complete a successful transition to a market economy and is working toward membership of the European Union in the course of the next decade. After high inflation and sharp declines in income and social indicators in the initial years after independence in 1990, the economy has stabilized and growth has resumed. Latvia is implementing the policies needed to meet the challenges presented by EU accession requirements and maintaining economic growth.

Health trends in Latvia

Recent data for all indicators used for evaluating human health, have shown unfavorable trends in Latvia: the birth rate is low and continues to fall; the death rate is high and continues to rise; infant mortality is high, and life expectancy at birth remains one of the shortest in Europe.

Although it is recognized that strengthening the nation’s health requires action through policy, infrastructure and competency development, and through incentives to promote health at national and local levels, there is not a single academic or professional certificate or degree program offering majors in Health Promotion in Latvia’s 26 tertiary educational institutions today. However, several high school study programs do include health promotion and health education modules, even whole courses, but the volume differs noticeably from what would be possible at the tertiary level. In short, in order to combat Latvia’s health problems effectively, educated Health Promotion professionals are essential.

Public Health Education in Latvia

In the absence of health promotion curricula and programs in Latvia, public health education somewhat fills the gap and is divided into two different parts: public health education of the general populace and professional education in public health, including postgraduate education and continuing vocational training following medical and nursing education. Additionally, there are two levels of educational programs for health care administrators: undergraduate and postgraduate.

Since 1992, special study programs in public health and in epidemiology have been developed for all Medical Academy faculties at Latvian universities. Within these study programs, 5 hours are set aside for health promotion and disease prevention issues. Students get insight on health promotion models and various prevention strategies, their advantages and drawbacks.

Studies in national health and epidemiology is also included in the programs of faculties other than the Medical Academy. For example, the Faculty of Pharmacy offers 51 lectures, the Faculty of Rehabilitation offers 25 lectures, while the Faculty of Nursing offers 36 lectures. Social work, the evaluation of national health, and the organization of prophylactic activities are taught in the Faculty of Nursing. The Faculty of Pharmacy teaches pharmo-epidemiology and the design of investigations, while the Faculty of Rehabilitation  teaches data collection and research in national health information and their uses.

A Public Health Faculty was founded in 1999 and students in these public health programs are specially prepared for prophylactic activities. The length of studies is four years in the Public Health Faculty. During this time, the students acquire theoretical knowledge in anatomy, biology, physiology, biochemistry, physics, etc. Students also study epidemiology, social medicine, health promotion, prophylaxis and organization of health services and its financing. Courses on informatics and bio-statistics train students in data analysis and interpretation. Also, basic knowledge of philosophy, ethics, sociology, pedagogy, law and physiology is required.

In their fourth year of the study in the Public Health Faculty,  students can choose one of the following foci in their studies:

• Environmental health;
• Health promotion and education;
• Organization of health services.

Other opportunities to study Health Promotion in Latvia

In 1996 a Masters degree in national health studies was begun in the LAM School of Public Health. Its aim is to prepare specialists in the planning and management of health services for Latvia. The two-year program consists of four compulsory basic courses:  Introduction to National Health, Part I and Part II and Politics, Planning, and Management of Health, Part I and Part II.

Students also take two additional optional courses, one of which concentrates on health promotion.

The Centre of Professional Medical Education offers graduate training in national health nursing. The program here includes issues of national health, possible environmental risk factors, health promotion and prophylaxis.

Furthermore, health education specialists are trained at both the graduate and undergraduate levels in some Latvian universities. About 200 health educators are prepared each year in Latvia, and there is no doubt that they could give qualitative teaching about health issues to youth in the schools and often do. There is one problem however: health teaching is not a compulsory or even an optional course in many schools. So, health education specialists are too often not used effectively to promote health.

Developments and challenges

Despite a lack of focused training for health promotion professionals, there have been some important contextual developments promoting heath in Latvia, including health legislation, such as, the tobacco law, the active work of several Inter-Ministerial Commissions on tobacco control and narcotics control Commissions, and a newly formed Task Force on substance abuse prevention among youth, and a rapid growth of NGOs active in Latvian health promotion. Additionally, an Inter-Ministerial Board on Public Health issues has been set up, lead by the Ministry of Welfare, where different documents and projects concerning public health issues are discussed and approved.

Obstacles remain, however. Public health efforts lack adequate central co-ordination, there is no Board of Nutrition and thus no development of standards of nutrition; research in public health is limited; and public health, health education, and health promotion initiative are plagued by a lack of resources, particularly at the municipal level.

Therefore, though there has been some development of health promotion studies and activities in Latvia, the shift of emphasis from disease to health continues to present Latvians with many challenges. In order to implement health promotion at the national and regional levels, it will not be enough to have well-educated health promotion professionals. It is also necessary to create supportive environment and legislation in the nation. Multi-sectoral cooperation between all levels of national government, local government, community and NGO’s is a key element in the promotion of health and the forming of health promoting policy. This co-operation is an integral part of ensuring that health and the consequences of policy on health, becomes an accepted part of the national planning process.

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