Health education is NOT health promotion!

There exists a panoply of pretentious academic definitions of “health education” and “health promotion” as a vehicle for intellectual debate imbued with only a scant semblance of real-world applicability.  The parameters of any cogent discussion of these nomenclatures comprises a deeply personal reflection of whether we, as academicians, believe that our efforts are promoting change or educating people on how to change, if indeed they are in the mood to change!  In the spirit of this thought experiment, I have chosen in this post to convey an anecdotal viewpoint of this duality and let the reader decide where they stand on the issue.  Having been employed as a Clinical Nutritionist working in a Functional Medicine physician’s office a few years ago, I have had the luxury of exploring firsthand the nuances that differentiate health education from health promotion, both in the direct counseling of patients, as well as interacting with groups of individuals within the context of community outreach health promotion programs that were innovated by myself and my former physician-employer.

Although the mechanistic nuances of health education and health motivation are somewhat overlapping and interrelated, one distinct difference that emerges between the two is that health education is exactly that, i.e. education, and may not necessarily provide a compelling motivation for an individual or population group to implement actual changes in diet and lifestyle that will result in positive health outcomes.  Some may argue that effective health education is by its nature a vehicle for eliciting an intrinsic motivation to change, but such a presumption conflicts directly with the perspective of an individual for whom social and cultural factors are a far more powerful influence on their behavior than the practical considerations of maintaining or optimizing their health.  In a clinical setting, working day-to-day with patients who were referred to me by my physician-employer, I encountered an alarming number of people (age, gender and ethnicity irrelevant) who considered unhealthful social activities with friends and family, including the routine consumption of traditional unhealthful foods, and sometimes even American junk food, as indispensable components of their cultural identity.  These same patients often considered any type of health education as a personal attack on their culture and way of life, sometimes exclaiming that “If I have to give up ‘this or that’, my life would not be worth living”.  This was exactly the point at which I had to transition my modus operandi from that of health educator to health motivator, usually by trying to convince the person sitting across from me that giving up a particular food that was harming their health was in fact an act of love and sacrifice made for their children, grandchildren, and loved ones, all of whom want them to be healthy and around for as long as possible to contribute to the family dynamic and pass their wisdom on to younger generations.

In my role as a Clinical Nutritionist, I often found myself confronted with two distinct challenges in health education and health promotion.  My first challenge, as a health educator, was to overcome the deluge of misinformation on what constitutes “healthy eating” as disseminated by popular media, in an effort to convince patients that my advice on health and nutrition was more scientifically valid than the myths they had heard on their favorite daytime talk shows or had read on Facebook.  The second challenge, as a health promoter, was to get to know them as individuals and customize a motivational plan for each of them that was most likely to illicit positive lifestyle changes directed at achieving quantifiable improvements in health outcomes, as measured through lab tests ordered by their doctor.

My closing thought on all this is simply to delineate that the fundamental difference between “health education” and “health promotion” is analogous to two sides of the same coin, i.e. one must educate at the same time as promote.  In other words, in the same breath in which we dole out advice to someone on what to eat, we should also provide a why which is more compelling than the why of why they had been eating as they had in the first place, choices that had compromised their health.  The truest definition of an effective health educator and promoter, in my opinion, is a well-informed nutrition professional who educates compellingly, provides actionable information to their target audience, motivates individuals and population groups to pursue health as a core value, and does so with an emphasis on sensitivity toward cultural differences and individual proclivities.

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