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Learning Health Promotion: Many Journeys, Many Paths



I Introduction



Health Promotion was a child of the social reform, environmental, and human rights movements of the 60s and 70s and had its adolescence as an articulated concept and set of activities in the early 80s. And as health promotion practice matures and grows, practitioners continue to struggle with issues of identity, seek consensus around who we are and what we do, and debate the pros and cons of particular approaches and philosophies.



So how can we "learn" health promotion? What are the skills needed? Can anyone practice health promotion? Where do we learn how to become health promoters? The answers may be as diverse as the individuals that practice health promotion. The scope of this article is to define the current state of health promotion education and provide a list of opportunities and resources for those seeking to increase their knowledge of health promotion through formal and informal channels.



Is health promotion exclusively a professional activity? Certainly not. If health promotion is truly about empowering and involving individuals, a variety of formal and informal experts can and should contribute to health promotion, but there is a range of training and learning experiences that can help put them on such a path. In this article, our definition of education and training is very broad, forming a continuum of learning opportunities that encompasses informal and formal social encounters, self-learning, organizational membership, workshops, courses and institutes, accredited programs, diplomas, degrees and continuing education.



Since health promotion is an approach as well as a set of skills, a variety of educational experiences can enhance the practice. There are some key areas that need to be included in the practice in order to effectively demonstrate the approach or philosophy of health promotion. These areas include skills in advocacy, community development, social marketing, (see III). The path you choose depends on your destination and, more often than not, on the diversions you encounter along the way.



And this is as it should be, as health promotion enters young adulthood.

II Defining Health Promotion



To look at the scope and breadth of learning opportunities for the field, we first turn to the World Health Organization and their definition of health promotion: "the process of enabling people to increase control over and improve their health. This process is based on the understanding that social conditions and personal actions both determine health. Hence, health promotion activities move beyond disease prevention and health education to address social change, institutional change, and community change in addition to changes in personal behaviours." (WHO, 1986). More recently, health promotion has been described as a process that works within communities to "create the conditions for health." (CPHA, 2001)



Health promotion does indeed take place at the population or community level and, contrary to what the name implies, it is not exclusively a "promotional" activity, like, for example, public relations. To be effective, health promotion activities must *engage* communities and individuals in creating healthy public policy, building supportive environments, and reorienting the health system, as well as developing skills and educating on an individual level.



Health promotion practitioners are currently in demand and can be found working in a diverse range of settings including public health units, community health centres, provincial resource centres, community centres, charitable health organizations, and hospitals, not to mention working in larger public and private sector organizations where employee wellness is valued. In addition, some health promotion professionals work on a contract basis and are sought out for their skills in group facilitation, communication planning and campaign development, proposal development, and community development.



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III What is Needed?



What are the core competencies required by the health promotion practitioner? This has been the subject of some debate, but most would agree that the core skills required by health promotion practitioners include knowledge and experience in the areas of community development, social marketing, communication, advocacy, health education, project management, program planning, evaluation, media relations, and policy development.



Lefevbre describes the health promoter as health educator, social marketer, and politician combined: "the health educator must know how to change the behaviour of individuals, groups, organizations, and social systems. The social marketer needs to have excellent communication and marketing skills, along with a sensitivity to culture, race, gender, disabilities, and class issues. The politician in the health promoter will understand negotiation, strategy, policy, and organization. Common to these characteristics is the capacity for critical analysis and the ability to work with others." (Lefevbre, 1991)



The core competencies approach of health promotion has been used as the basis upon which to plan and develop courses and programs in health promotion (see, for instance, Promotion & Education, 2000, or the University of Toronto's Health Promotion Program's list at http://phs.med.utoronto.ca/mhsc_health_promotion_competencies.asp). Core competencies have also been used as indicators for job objectives and appraisal and evaluation of health promotion capacities. Some of the countering debate on using "core competencies" has centred on health promotion professionalization and accreditation, concern that exclusionary practices can arise, and the limiting of a multidisciplinary field that is constantly evolving (see, for example, the report from the Canadian Centres for Health Promotion Resarch and Canadian Association for Teachers of Community Health 2000 symposium referenced below).



In the literature of health promotion skills and competencies, common themes that emerge are some combination of theoretical and practical skills, exposure to the social sciences, organizational and administrative skills, facilitation, and communications. Competencies can be useful if they are broadly defined and thought of as guidelines for learning and practice.



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IV Where do we learn?



Tell me and I'll forget

Show me and I might remember

Involve me and I'll understand

(author unknown)



With the growth of health promotion as both a career choice and a strategy for community development, educational and professional development opportunities are abundant. The menu of options is diverse, from continuing education courses and distance learning to graduate studies and everything in between.



Within the sphere of health promotion, health education goes beyond didactic instruction to involve learners and applies Brazilian educator Paolo Freire's notion of empowerment, thereby "enabling people to increase control over and improve their health" (WHO, 1986; Labonte, 1994). By extension, education for health promotion practitioners should strive to do the same and incorporate the theoretical with the practical. Most experienced health promotion workers bring to their work a combination of formal education and practical experience in community work, social services, education or related disciplines



Still, many entry-level health promotion positions in the public sector require a baccalaureate or graduate degree in health promotion, health sciences, or social sciences from a recognized university. Specialized university programs in health promotion have emerged within the last 15 years, and a wide variety of educational opportunities are now available.



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V Learning Opportunities



Here is a quick overview of the types of education opportunities to draw on to create your own learning continuum.



Self-learning and informal learning opportunities

* online courses, such as the Health Promotion "101," forthcoming from the Ontario Health Promotion Resource System

* journals (THCU maintains a list of journals of interest to health promotion and health communication practitioners) http://www.thcu.ca/infoandresources/journals.htmlinks to HP journals)

* listservs (such as CLICK4HP, HPLink--OPC maintains a good list at http://www.opc.on.ca/english/our_programs/hlth_promo/resources/hlth_prom... c.htm)

* mentor programs and contacts



Workshops, forums, symposia, conferences

* workshops by provincial organizations such as The Health Communication Unit (http://www.thcu.ca), Program Training and Consultation Centre (http://www.ptcc.on.ca/), Canadian centres for health promotion (http://www.utoronto.ca/chp/chp/consort/), and universities (see OHPE 350.2 for more information)

* national and international conferences, chronic disease organization events, public health conferences nationally and provincially (there is no one central list, but listervs and bulletins are good sources for finding out about such opportunities; check the OPC page above for a good list)



Summer Schools, Institutes, Short Courses

* Ontario Health Promotion Summer School, Prairie Region summer school (see OHPE 350.2 for more information)



Certificates and Diplomas

* community colleges, short courses at universities (see OHPE 350.2 for more information)



University Degrees



* undergraduate (e.g., University of Waterloo, Ryerson, Dalhousie University, Brock University, University of Athabasca, see OHPE 350.2 for more information)

* graduate (e.g., University of Toronto, University of Ottawa, University of Waterloo, University of Alberta, Dalhousie University, University of Montreal, Laval University, Lakehead University, Athabasca University; see OHPE 350.2 for more information)

* post-graduate (e.g., University of Toronto, Saskatchewan Population Health and Evaluation Unit at the University of Saskatchewan, Laval, University of Alberta)



Section VI takes a closer look at two types of health promotion learning: continuing education and distance learning.



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VI Continuing Education



Looking for a refresher or to get an introduction or orientation to health promotion in general or to a specific part of the field? Then short-term, non-degree courses and programs of continuing education may be for you.



Summer institutes or health promotion summer schools often offer a condensed health promotion primer in addition to specialized sessions on a wide range of topics from capacity building to social marketing. The summer school format is geared to meet the needs of learners at many stages, from the relative newcomer to the skilled practitioner looking for a specific focus. Of course, networking is a valuable part of the experience, and the experience of spending time with other learners is valuable in itself.



Several community colleges offer health promotion courses, some as part of other programs such as nursing, and others as specialized programs, such as workplace health promotion. Some colleges offer post-graduate certificate or diploma programs in health promotion, for example Canadore College in North Bay.



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VII Distance Learning



A distance learning course is one you take without meeting a teacher in a classroom. You can study from home or at work and whenever you like. These courses can be semester based with specific start and end dates or can be set on a personal timeline. One or more media may be used to deliver a course, including texts, manuals, and study guides, CD-ROMs, web pages, and video or audio.



While the distance learning approach can be a convenient way to take courses, it is not suited to everyone's learning needs. At Humber College, the prospective student interested in distance learning is asked to do self-assessment through an online the Readiness Checklist, courtesy of Monroe Community College, at http://www.monroecc.edu/depts/distlearn/minicrs/OnlineForm.htm.



Another good overview of online courses and the aptitude, ability, and resources to find and participate in online courses can be found at Ontario's Volunteer's Online five-part E-Learning Module: http://www.volunteersonline.ca/modules.php?name=Content&pa=showpage&pid=167.



Canadian Virtual University (r) (CVU) is a partnership of 11 universities across Canada committed to delivering university-level programs that can be completed from anywhere in the country or beyond. Students can enrol in online courses from several Canadian universities from one web site: http://www.cvu-uvc.ca/.



The Distance Studies website, http://www.distancestudies.com/index.cfm, lists courses in Canada and the US.



Here are some examples of distance learning in health and health promotion at a Master's level:

* Athabasca University, Master of Health Studies, http://www.athabascau.ca/calendar/03/grad/health_02.html

* Lakehead University, Master of Public Health http://www.lakeheadu.ca/mph/ (thesis)

* University of Alberta, Master of Science, http://www.chps.ualberta.ca/grad_prog/distance_students.htm (courses)



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VIII Conclusion



Where you enter the continuum of learning depends on many factors, including your work and educational background, time and flexibility, location, and, of course, money! Your career and personal goals are also important. For guidance, talk to someone you know who is working in the field or better yet, find yourself a mentor.



Ideally, a mentor is someone who has an understanding of the field you want to develop in and/or has a similar workstyle that you can learn from and apply to your field. Another good feature in a mentor is someone who is a good coach and generous with constructive advice. It may not be as difficult as you think. Mentorship is a two-way street. A good mentor may provide you with a sounding board, perhaps steer you in the right direction, or offer helpful suggestions, but remember the work is up to you. If you can contribute to the work that your mentor is engaged in, you'll learn while you help each other meet different goals. One of the most rewarding aspects of lifelong learning is that, unlike most formal education, you often have a chance to actually apply your studies to your work.



There are many paths to health promotion, and you will gain valuable knowledge no matter which way you go. Whatever path you choose, do so knowing that your journey may take some unforeseen turns or stops along the way. You may find that family, career or volunteer work may take priority, but every experience is beneficial to health promotion. As long as you're moving towards your goals, you'll get there someday. So enjoy the journey, it's half the fun!

Canadian Public Health Association. (2001). Action Statement on Health Promotion. Ottawa, Canada.



Canadian Consortium of Health Promotion Research Centres.(2000). Symposium for Teachers of Health Promotion and Community Health. Report available from http://www.utoronto.ca/chp/chp/consort/teacherssymposiumreport.doc.



Hills, M., and O'Neill, M. "Editorial." (2000) Promotion & Education. Special Issue on Education & Training. IUHPE..



Labonte, R. (1994). "Death of program, birth of metaphor: The development of health promotion in Canada." In A. Pederson, M. O'Neill and I. Rootman (Eds.). Health Promotion in Canada. (pp.72-90). Toronto: W.B. Saunders.



Ontario Prevention Clearinghouse. (1994). "Health Promotion: Sources for Training and Support." Toronto. Out of Print.



World Health Organization. (1986) Ottawa Charter on Health Promotion. Ottawa and Geneva: WHO.