Chapter 10: Future Trends in Health Education/Promotion

Aging

- Another demographic factor that will impact the practice of health education/promotion in the future is the aging population - One of the major reasons for the aging trend is that older Americans are living longer than ever before. - causative factors accentuating changes in age demographics are that married couples in the United States are having fewer children, and the oldest of the baby boomers (those born between 1946 and 1964) are now beginning to retire.

The Whole School, Whole Community, Whole Child model.

- CDC expanded the coordinated school health model to this - This new model "promotes greater alignment between health and education outcomes . . . creates a unified model that supports a systematic, integrated, and collaborative approach to health and learning" - Model components include (1) health education, (2) nutrition environment and services, (3) employee wellness, (4) social and emotional school climate, (5) physical environment, (6) health services, (7) counseling, psychological, and social services, (8) community involvement, (9) family engagement, and (10) physical education and physical activity

What does this rapid acceleration mean for health education specialists?

- Extending our traditional health education/promotion delivery systems by reaching out across time and space, as well as literacy and language ⦁⦁ Allowing both synchronous and asynchronous communications in pictures, sounds, movement, and virtual reality ⦁⦁ Individualizing and personalizing communication and instruction through tailored messages and interventions based on the variables we know are likely to influence interest, ability, readiness, and a host of other relevant variables ⦁⦁ Extending the way we internalize, understand, individualize, and use massive amounts of data through instant access to even the minutest detail in a large data repository ⦁⦁ Enhancing opportunities to provide new services and interventions by creating new practices and strategies (p. 46)

School Setting

- In 2015, Congress passed the Every Student Succeeds Act (ESSA), and for the first time health education has been included as a "core subject" - importance of school health education specialists: Providing high-quality health education in schools means more students will learn how to increase positive health behaviors and reduce negative ones. -

Work-Site Setting

- In particular, worksites have become an increasingly important set- ting for health education/promotion programs. Examples of programs offered include stress management, work-site safety, drug and alcohol abuse prevention, and tobacco cessation. - ACA signals the emphasis on work-its health promotion

Minority Population Changes

- In the 1800s and early to mid-1900s, the bulk of immigrants to the United States came from Western Europe. - worsening economic conditions in Mexico and Central America over the decade from 2000 to 2010 are largely responsible for the large number of immigrants from those areas. - war-ravaged regions of Asia, Africa, and Eastern Europe are presenting new challenges (and opportunities) for the public health community. This wave of new immigration, coupled with the fact that, regardless of country of origin, immigrants have higher rates of fertility than native-born peoples

medical care trends

- In the United States, medical care tends to concentrate on secondary and tertiary care and to ignore the value of primary prevention.

technology

- Many of the advances in communication, transportation, medicine, engineering, and ease of access to information have created an enhanced quality of life for people worldwide. - The increased availability and use of technology also creates myriad opportunities for the prospective health education specialist in the planning, design, implementation, and evaluation of programs and materials. - technological capabilities in the field of education have created a learning environment in which information is readily available and lessons can be easily structured - tech can change and alter behavior not just inform or change attitudes

I. Demographic Changes

- Over the past 30 years, the population growth rate in the United States has increased at about 1 percent per year

politics and health

- Some governmental officials and legislators worry that public health professionals infringe on personal autonomy by advocating for seat belt laws, tobacco laws, work-site wellness programs, helmet laws, air bags, environmental protection, healthier options in fast foods and public schools, gun control laws, and health insurance for all. - Others believe that legislation fostering a social climate that enhances the health of the population as a whole is worth the sacrifice of some personal choice and autonomy.

ACC

- The Affordable Care Act has increased the opportunities for health education specialists. Koh and Sebelius (2010) document that this law "promotes wellness in the workplace, pro- viding new health promotion opportunities for employers and employees" - the act strengthens the community role in promoting prevention and serves to enhance partnerships between state and local government and community groups and nonprofits

Public Health Setting

- The community setting (called the public health setting in this text) has a myriad of options for the practice of health education/promotion. - The purpose of community health organizations is to both monitor and improve the health of the public they serve. - collaboration with community organizations and with other professionals to address population health

credentialing

- The credentialing process as it now stands begins with the candidate's submitting a transcript of coursework in health education to the NCHEC. - candidate has completed coursework leading to a degree in health education and the course- work has focused on the responsibilities and competencies of an entry-level health education specialist > then can take the exam - questions based on 7 competencies and awarded CHES (Certified Health Education Specialist credential)

Three documents that provide information about competencies health education specialists must possess into the future

- The first document features the deliberations by members of the Committee on Educating Public Health Professionals for the 21st Century. They identify eight new content areas that should be added to the curricula of individuals studying to practice public health: informatics, genomics, communication, community-based participatory research, global health, health policy, health law, and public health ethics. Shows the expanded and needed knowledge to interact with other professionals. - The second document is the Web site for the National Commission for Health Education Credentialing (NCHEC) (2016), which features the results of a study titled "2015 Health Edu- cation Specialist Practice Analysis (HESPA)". - The third document, a cogent paper written by McKenzie (2004), cautions that those in charge of health education preparation programs must not assume that it is possible or even advisable to prepare "generic" health education specialists. T

Clinical or Healthcare Setting

- The shift in practice norms by most clinical healthcare professionals requires trained per- sonnel to ensure that education in the healthcare setting meets the needs of both the patient and the provider and motivates the patient to adopt a healthier lifestyle and comply with any treatment regimen.

III. Profession Preparation and Credentialing profession preparation

- The social changes previously discussed in this chapter are the challenges driving health education specialists of the future to be proactive in meeting the demands placed on them.

family structure

- The traditional family (two parents and their children) is becoming less and less common be- cause of factors such as high rates of divorce, smaller families, postponed marriage and childbearing, teenage and non-marital childbearing, stepfamilies, homosexual couples, and dual-earner marriages - new methods of reaching individuals, families, and communities will need to be created to improve the health of all family members in accor- dance with their needs.

Standalone Baccalaureate Programs (SBP)

- This allows for health education programs not associated with schools of public health to go through a nationally recognized accreditation process. The former approval process offered by SOPHE/AAHE Baccalaureate Program Approval Committee (SABPAC) ended in 2015

Alternative Settings

- first alternative is to teach health education/promotion in a postsecondary institution - Students who are interested in combining the fields of health education/promotion and journalism can find positions in both the print - health education specialist positions will continue to be available in foreign countries - Medical supply companies, pharmaceutical companies, sports equipment manufacturers, health topic curriculum developers or companies, health food stores, and textbook publishers often employ health education specialists in sales positions - health education specialists in long-term care institutions and retirement communities is escalating - in entrepreneurial and consultant roles.

Important consequence of CHES credential

- is that of eligibility for reimbursement for services rendered.

political climate

- many political issues that impact health of the population

Medical care establishment & the Affordable Care Act (ACC)

- provisions in the plan are set to be enacted from 2014 to 2020 - cost of care continues to escalate, and the system seems stuck in an unsustainable model of reimbursement for procedures (fee-for-service) instead of a capitate reimbursement structure for helping people stay well - enhancing the quality of life not just longevity

National certification

- this certification pro- gram does establish a national standard for individual health education specialists. - Having a national certification better ensures that health education specialists in every state or setting have the same training and academic requirements.

IV. Implications of Practice Settings

- worksite - school - health/clinical care - public health * same because they all try to create a climate that makes the improvement of health status for every member of the population served by each entity

competencies represent a baseline for the future practice of health education/promotion in work-site settings:

1. Become familiar with the culture inherent in a business setting. 2. Use up-to-date technology to market programs to work-site supervisors, employees, and their families through newsletters, brochures, Internet chat groups, and social media. 3. Plan and manage a budget. 4. Acquire grant writing skills. 5. Implement programs in a manner consistent with management philosophy. 6. Coordinate needs assessments of work-site populace and conduct evaluations of program components. 7. Design and employ evaluation strategies that are outcome-based to assess program effectiveness. 8. Conduct fitness assessments and participate in health screenings. 9. Function as a resource person for health information for employees and their families. 10. Identify and work with aspects of the corporate organizational climate that facilitate or impede participation. 11. Recognize the importance of cultural and demographic influences on individual and group health behavioral choices. 12. Attain a working knowledge of epidemiological and statistical principles and applications. 13. Acquire sound oral and written communication techniques. 14. Gain a thorough understanding of current, relevant literature and well-designed research studies that influence health promotion practice in the work-site setting. 15. Work both independently and as a member of a team. 16. Teach and promote the enhancement of strategies to increase health literacy among the population served to reduce health disparities (Hasnain-Wynia & Wolf, 2010). 17. Prepare and conduct prevention presentations to work-site subgroups. 18. Coordinate employee coalitions and steering committees to maximize employee input into program components. 19. Be able to apply behavior-change strategies and what is known about environmental influences on behavior to the work-site setting.

Skills and abilities must you possess if schools are to incorporate a coordinated health education/ promotion program to address the health needs of children and adolescents, both now and in the future?

1. Create a logical scope and sequence to health content units that incorporate age- appropriate information. 2. Prepare and deliver lessons that are participatory in nature, stress skill development, and foster attitudes necessary for problem solving and informed decision making 3. Use technology and social media to assist in both updating your own skills and delivering health education/promotion messages to your school and community. 4. Acquire sound oral and written communication techniques. 5. Apply behavior-change strategies and what is known about environmental influences on behavior to the classroom setting. 6. Teach and promote the enhancement of strategies to increase health literacy among the population served to reduce health disparities (Hasnain-Wynia & Wolf, 2010). 7. Use both qualitative and quantitative strategies to evaluate your lessons, your units, and the district health education/promotion program. 8. Assess the health needs of the students, faculty, and staff. 9. Ensure that health and counseling services are provided for students. 10. Read and interpret the findings of health research on effective health programs and practices. 11. Learn about the influence of culture on health, cultivate sensitivity toward it, and instill an awareness of it in your teaching. 12. Assist teachers at all grade levels in obtaining age-appropriate health education materials and help coordinate a classroom scope and sequence for all grade levels in your district. 13. Work both independently and as a member of a team. 14. Collaborate with health education specialists practicing in the community, work- site, or healthcare setting to coordinate the delivery of disease prevention and health promotion messages and programs. 15. Create or coordinate a parent/community health education/promotion advisory council. 16. Actively participate in local, state, regional, and national professional organizations. 17. Serve as resource person and liaison between the school health setting and other settings in which health education might occur.

What skills, competencies, and attributes will be absolutely necessary for the health education specialist of the future who seeks employment in a healthcare setting?

1. Learn to perform basic health screening techniques like blood pressure monitoring and pulse and respiration measurements. 2. Obtain a working knowledge of epidemiological and statistical principles and applications. 3. Maintain competence in the use of technology to access and deliver health-related information. 4. Acquire sound oral and written communication techniques. 5. Become familiar with the clinical disease process. 6. Learn a second language. 7. Obtain a working knowledge of the role of informatics in assisting in prevention at all vulnerable points in the causal chains leading to disease, injury, or disability (Davies, Smith, & Gustafson, 2001). 8. Recognize the importance of cultural and demographic influences on individual and group health behavioral choices. Health education specialists should be culturally competent. 9. Be able to apply behavior-change strategies and what is known about environmental influences on behavior to the healthcare setting. 10. Coordinate interdisciplinary teams or steering committees to maximize input into program components. 11. Teach and promote the enhancement of strategies to increase health literacy among the population served to reduce health disparities (Hasnain-Wynia & Wolf, 2010). 12. Provide training in health education/promotion theory to other members of the healthcare team. 13. Become familiar with technological innovations to provide better outreach to patients, employees, and their families through a variety of electronic and hard copy newsletters, brochures, Internet chat groups, Web sites, and social media. 14. Advocate policies that enhance the role of prevention and provide for universal access to health services when needed. 15. Work independently and as a member of a team. 16. Prepare and deliver lessons that are participatory in nature and research-based, that stress skill development and foster attitudes necessary for problem solving and informed decision making. 17. Learn to be flexible, as the job probably will involve changing and varied responsibilities. 18. Serve as a liaison between the healthcare setting and other settings in which health education might occur. 19. Function as a resource person for health information for patients and their families.

Given to members of the AAHE, describes four actions for present and future health education specialist that still ring true today:

1. Look at ourselves as major players in keeping Americans healthy; to that end, work with policy makers to affect legislation that truly promotes health. 2. Collaborate with other health professionals in both the for-profit and the not-for-profit sectors. 3. Strive to exhibit greater professional solidarity; be an advocate for the profession of health education/promotion and the role that trained health education specialists can play as part of the healthcare team. 4. Advocate for those who do not have a voice; be a spokesperson in the political arena and work to ensure that health services and health education/promotion are available for all.

With employment opportunities for health education specialists in the public setting on the rise, what skills will the public health education specialists of the future need to function effectively?

1. Recognize the importance of cultural and demographic influences on individual and group health behavioral choices. 2. Maintain competence in the use of technology and social media to access and deliver health-related information. 3. Learn to be flexible because the job probably will involve changing and varied responsibilities. 4. Learn another language. 5. Learn and use strategies to seek information, guidance, and support from community members regarding their health needs. 6. Assess strengths of communities in building a plan to assist them in meeting their health needs. 7. Design and employ evaluation strategies that are outcomes based to assess program effectiveness. 8. Gain a thorough understanding of current, relevant literature and well-designed research studies that influence practice in the community setting (i.e., community-based participatory research). 9. Apply behavior-change strategies and what is known about environmental influences on behavior to the public health setting. 10. Learn and practice research-based, coalition-building strategies. 11. Actively participate in local, state, regional, and national professional organizations. 12. Work independently and as a member of a team. 13. Advocate policies that enhance the role of prevention and provide for universal access to health services when needed. 14. Foster the ability to work in a multidisciplinary and a multicultural environment. 15. Teach and promote the enhancement of strategies to increase health literacy among the population served to reduce health disparities 16. Study and apply the fundamentals of obtaining extramural funding. 17. Use a variety of marketing strategies to reach diverse community constituencies. 18. Attain a working knowledge of epidemiological and statistical principles and applications. 19. Acquire excellent oral and written communication techniques.

What tasks will a health education specialist need to be able to perform to be effective in the decades ahead?

1. The mission will be less providing factual information and more helping people become more analytical thinkers . . . 2. There will be . . . stronger partnerships with the medical establishment. . . . 3. Health education specialists will need . . . Long-term, not short-term, thinking . . . 4. A greater emphasis will be placed on values clarification. . . . 5. . . . Education at the community level will be the focus of most health interventions. 6. There will be an enhanced need for quality research . . . 7. Health education specialists must . . . use technology to help people learn. 8. . . . The gap between school and community services will close. 9. Environmental activism will continue to emerge . . . 10. . . . people will judge the success of health education/promotion by whether or not their quality of life has improved.

II. Societal Trends

All of these factors play a big role in shaping the structure of society in the future. ex. technology

Why CHES?

Having a national certification better ensures that health education specialists in every state or setting have the same training and academic requirements.

ethic minorities in the class

In 2012, approximately 49 percent of the children in public schools in the United States were minorities as reported by the National Center for Education Statistics (2015).

Under the ACA,

In 2014, the first year people were required to purchase insurance under the ACA, 89.6 percent of people had health insur- ance coverage for part or all of the year (Smith & Medalia, 2015). Currently, there are 19 states that have chosen not to expand Medicaid so there are still millions of people without health insurance who typically work in service-oriented positions that often pay minimum wage and are a major source of employment for many low-skilled workers - 32 percent percent of children under 18 in the United States are living in poverty.

postsecondary institution

defined as an institution that educates people after they graduate from high school. There will continue to be a need for qualified instructors. Minimum standards for obtaining one of these positions is usually a master's degree in health education and two to five years of experience for a community college or vocational school position, and a doctorate and two to five years of experience for a college or university position.

country's population growth

grew 3.3 percent since 2010.

macrolevel

health education specialists move from a position of assisting behavior change one person at a time to community-based inter- ventions.

conservative

one who generally distrusts governmental regulations and tax-supported programs for addressing social or economic problems

liberal

one who generally supports government programs to attack social and economic problems,

moderate

one who usually acts in a more situationally specific manner in regard to using tax-supported programs to solve societal problems

health education specialists

practice in a variety of settings (e.g., school, worksite, community, and health care), they may work with different populations (e.g., adults, the aged, children, and minorities), they may be process specialists (e.g., program planners, program implementers, and program evaluators), or they may be content specialists (e.g., HIV/AIDS, cancer prevention, injury or violence prevention, and nutrition).

2010 census on US minority population

table 10.1 on 310

demographic profile

the breakdown of the U.S. popula- tion by age group, sex, race, and ethnicity - greater percentage of minority residents and ever aging population.

Clark's thoughts

there is an ever-growing need to facilitate health education/promotion interventions at the community level (as opposed to the individual level, or microlevel).