Public health is relating to refraining the spread of disease within a distinct society, this frequently through supplying water to assist people to keep themselves, their houses and animals clean. There are four main ancient origins of health education: the Egyptians, the Greeks, the Romans and the Medieval times. The Egyptians (4000 BC) were very concerned about cleanliness due to social and religious factors. The Egyptians wrote records of public health practice, refined systems for sewage disposal, provided surplus grain to feed the poor and printed pamphlets describing the dangers of drinking excessive amounts of alcohol. Since the Egyptian times, two approaches have carried on in today’s society: 1) Education stimulating healthy behaviours at the individual level and 2) The development of healthy public policies at the community level (BBC, 2014).
Due to lack of sewers and no provisions of running water, the Greeks were unable to have a thorough public health system. Despite this, a lot of rich Greeks obeyed a health programme which contained information about having a healthy diet, bathing themselves, teeth being cleaned and exercising. This health programme was connected to their theory of the four humours (blood, phlegm, yellow and black bile) and altered depending on the time of year. Further to the four humours, Greek doctors were guided by Pythagoras’s theory ‘Balance of opposites’ to support the idea of ‘everything in moderation’. Hippocrates acknowledged that regular people would be too poor or too engaged with work to adhere to a health programme, resulting in them not being as healthy as the rich. During the time that medicine was still being developed, the Greeks persisted with requests to the Gods for healing at the asklepion (a healing centre of the ancient Greeks). Over time, the asklepion evolved into health resorts with certain provisions, for example, baths and a gym (BBC, 2014).
The earliest system of public health was developed by the Romans. Three crucial points were considered together which resulted in the Romans developing a public health system: they had doubts about Greek doctors, soldiers in the army required clean surroundings and their capabilities in engineering. The Romans, in the same way as the Greeks saw the benefit of personal hygiene and health. Juvenal, a writer, came up with the phrase “a healthy mind in a healthy body”. The Roman writer Celsus suggested exercises before a meal, and bathing fragile parts of the body (duplicating Hippocrates’s ‘Programme for Health’). Galen recommended good health through gym exercises and breathing deeply (BBC, 2014).
Medieval people were not too clean but they appreciated the link between clean living and good health. Sometimes, medieval people would bathe themselves. Medieval people came up with a similar account of the Greek’s Programme for Health and the doctor Alderotti suggested people should extend their arms and legs, wash their face, brush their teeth and exercise (BBC, 2014).
Social hygiene was associated with one’s personal hygiene but also one’s traits and characteristics. The poor and working classes were described as uncultured and in need of example through demonstration and education by the civilised middle classes (La Berge 1992). There were efforts made to promote breastfeeding, to prepare healthier meals and to grasp better measures of hygiene within one’s house (Apple, 1987). Maternal ignorance and inadequate personal hygiene were often the factors thought to cause the death of babies. However, the topmost death rate was particularly found in the poorest areas. Between the late nineteenth and early twentieth centuries, the social hygiene movement was an effort to manage sexually transmitted diseases, prostitution and and to deliver sexual education through advertising and scientific research methods. Eugenic conceptions resulted in the development of what we would now see as reprehensible policies, for example, to impose sterilization of those who were thought to be unsuitable to have children, including individuals with alcohol addictions, disabilities and mental health issues (Dyhouse, 1978).
Health education became more established in the start of the twentieth century during the personal services era, the second part of public health development. ‘Prevention is better than cure’ was the new strategy in the personal services era. Health was improved through health education due to local authorities expanding services beyond the prevention of illnesses. For instance, mothers learnt hygiene, nourishment and home visiting enabled infant care within the home. Physicians were becoming more involved when public health was moving towards personal and preventative services. In the 1930’s and 1940’s, the Ministry of Information (WWII) came about but their public advertisements were seen as patronising and ungainly (Grant, 1994). Civil servants managed the Ministry of Information but they had limited insight and understanding of health education (Taylor, 1980). In the personal services era, various campaigns on health education came about including campaigns on immunisation (1940-1945), anti-smoking and alcohol campaigns (1950’s and 1960’s) and posters regarding washing of hands and keeping clean. The Institute of Health Promotion and Education was formed in 1962 for skilled employees to come together to discuss their passion in Health Education and Health Promotion, as well as their knowledge and understanding in the subject. The Cohen Committee arose due to lobbying from health teachers who wanted better national structure and arrangement. The Cohen Report Ministry of Health (1964) stated that health education was required for a more extensive spectrum of subjects, the aid of broadcasting and mass media needed to be predominant and that central funding of new HEC (1968) was suggested (Berridge, 1999).
During the 1960’s and 1970’s, physicians had control over patients and were accountable for diagnosis and medical care of a patient. Patients were not accustomed to engage in diagnosis treatment and were considered to conform to guidance and treatment given by physicians. Patients who did not follow the guidance and treatment given were thought to be abnormal. Lalonde (1974) proposed the ‘Health Field Concept’ which consisted of four factors contributing to one’s health: human biology, environment, lifestyle and Health Care Organisation. The report is thought to have guided the growth and expansion of health promotion, acknowledging that people are accountable for alterations in their behaviours to make better their own health, and in addition to, the assistance of fit and well communities and surroundings to health (Tones and Green, 2004).
After the increase of health promotion in the 1980’s, the Eclipse of Health Education was born. The WHO (World Health Organisation) arranged the Ottawa Charter for Health Promotion first held in Ottawa in 1986, followed by a further eight conferences, each held in a different city in countries around the world. There were five outcomes of the charter:
To form public procedures.
To devise encouraging and helpful environments.
To enhance community deeds.
To expand one’s individual skills.
To reorganise health management services regarding the stoppage of disease and bad health, and the promotion of physical and mental wellness.
During the 1980’s, Health Education became connected with the medical model and victim blaming. Victim blaming is portrayed by a perspective which highlights how one lives their life and disregards the social and political circumstances in which certain problems arise. Health education becomes eclipsed by health promotion. Health education is frequently attributed to as ‘traditional health education’ in a dismissive manner. Health education models and categorizations are moved to health promotion, although health promotion would often follow the rules of the medical model (Green, 2008). In the 1990’s, patients had the power to select their treatment if they wish and were instructed to oversee their own illnesses. Patients and professionals had a better relationship in which they would discuss outcomes to be reached. Doctors were less patronising and they acknowledged that patients need their family and friends around them. The Internet became more advanced therefore enabling information to be exchanged on a considerable scale to many people. (WHO, 2018).
The Jakarta Declaration was the fourth global conference held in Jakarta in 1997. It proposed an aim for health promotion into the 21st century, with members of the conference dedicated to coming up with the most extensive spectrum of resources to deal with health determinants. The main concerns for health promotion in the 21st Century are to:
Promote social responsibility for health.
Expand on investments for health development.
Make firm associations for health.
Develop abilities of communities and empowerment of people.
Make stable foundations for health promotion.
Health promotion should be supported by states or nations having the right permissible, social, educational and economic surroundings (WHO, 2018).
New Health Education started in the 21st century. There was now a central point to empower people, to ask individuals to participate in forming whole actions and to build health promoting establishments. Tones and Tilford’s model of health promotion shows correlation between the two major methods to achieve health improvement, these two being the growth and putting into effect of Healthy Public Policy and Health Education where individuals are enabled to take charge of their lives. Tones and Tilford suggest that the idea of Health Promotion can be put into an equation:
Health Promotion = Health Education x Healthy Public Policy
This equation implies that Health Promotion is the result of both Health Education and Healthy Public Policy. The multiplication sign ‘x’ means to add a given total many times. In this instance, the given total is Health Education (HE) which is added as many times over as Healthy Public Policy (HPP). So, when HE and HPP are multiplied, they generate a larger impact than just the total of the two. HE and HPP will result in an impact that is larger than the exclusive parts, if carried out together. This equation shows how central both Health Education and policy are to one’s goals reached, community and national health ranking and how interdependent the relationship is amongst Health Education and the wider activity of Health Promotion.