Leonard Dawson

Community Health Development: An Overview of the Works of Guy W. Steuart.

Health education is a relatively young professional field; it was not until the mid 1940s that health education was included as a separate discipline in the curricula of U.S. schools of public health. Furthermore, it was not until 1950 that the national health education professional association (the Society for Public Health Education, SOPHE) was formed in the United States. Like public health and medical care, health education has changed dramatically in the past 45 years. Significant changes that have affected health education include the morbidity and mortality shift from communicable to chronic diseases, the change in method of payment for health services from individuals to government and third party payers, the explosion in the cost of health care, the AIDS epidemic, widespread environmental problems, and the new emphasis on health promotion and lifestyle change. Health education has also been affected by the continuing development of psychological, social, economic, and political theories. These developments have made important contributions to theoretical explanations of why people act as they do related to health, and have enriched research and practice. Over the years there have been recurrent calls and some efforts to create more community-based approaches to public health. Recently several major publications have emphasized this need. The Institute of Medicine in its report, The Future of Public Health, recommended that schools of public health develop closer relationships with practitioners, and that both the schools of public health and health departments integrate community-based approaches in the teaching and practice of public health. In the publications Healthy People 20002 and Healthy Communities 2000: Model Standards, emphasis is placed on communitybased strategies in addressing major public health problems, especially those health problems for which a discrepancy exists in health status based on differ-

The Role of Health Education in Public Policy Development

Health educators should view policy development as a unit of professional practice analogous to the individual, the small group, the community, and the organization. The impact of policy on other units of practice and on people served by health educators is too great and the competition for scarce resources for health and human services is too keen to be disregarded. An increasingly active role in the policy process is, therefore, vital to the profession. Unfortunately, many health educators find an active role strange and lack guidelines for effective policy intervention. This paper attempts to mediate that situation. First a conceptual framework is offered. Operational definitions of important terms are given, including policy, public policy, social policy, health policy, and health education policy. A model of the policy development process is presented, detailing the purpose and dynamics of several steps: establishing problem awareness, setting goals and objectives, selecting a course of action, designing alternative courses of action, analyzing policy, assigning implementation responsibility, implementing, and evaluating. Then five categories of intervention strategies encompassing 16 individual suggested roles ranging from indirect influence to direct political involvement are presented. The categories are: acting as a source of policy information, providing technical assistance, organizing, influencing policymakers, and taking direct political action.

Insider/outsider dilemmas in the development of an Appalachian self-care health education program.

This case study examines the process whereby a community based self-care health education program was developed and implemented in a poverty-struck coal mining region of southern Appalachia. One of the principle dynamics explored here in depth is the tension between “insiders” (persons who know the area but may not be well versed in program planning, implementation or evaluation) and “outsiders”; persons who may be professionally prepared for mounting programs but are hampered in their ability to adjust to or handle the vicissitudes of an unfamiliar social or cultural situation. Suggestions are advanced as to how this tension might be better managed.

Growth in Conversion Foundations: Implications for Health Education

Abstract A dramatic trend in health care today is the sale of nonprofit service delivery organizations to for-profit businesses. The monies from these sales are frequently used to create nonprofit foundations whose goal is to benefit the communitys quality of life. The rapid growth in the number of these “conversion” foundations, their ties to the local communities, and their interest in broadly addressing the underlying determinants of health have great implications for health educators and present specific challenges for the discipline of health education. Health educators can offer valuable skills to these foundations, including the ability to make community assessments more valid and comprehensive; ensure that funded activities are community driven; assist with planning; foster a vision of foundation practice that promotes collaboration and coalition building; and aid with evaluation of work of both the foundation and its grantees. The challenges for the discipline of health education include fosteri...

Assessment of Community Perceptions of Quality of Life to Inform the Grant-Making of a Conversion Foundation: A Case Study

The mission of the rapidly increasing number of conversion foundations in the United States is to enhance quality of life of their service community, usually via grant-making. Community assessments that are guided by known best practices appear to be ideal mechanisms for informing funding decisions. This case study illustrates how we attempted this with one conversion foundation. One component of the assessment—investigation of community perceptions—was deemed most important by foundation directors. This component and the implications of the overall process for other nonprofit organizations, community practitioners, and researchers are discussed.