History of Health Promotion at Dalhousie University

Marc Lalonde

Until the early 1900s the documented history of both medicine and health education was shared (Cottrell et al Girvan & McKenzie.,1999; McDermott, 1999). At the dawning of the 20th century, public health and health education diverged from other branches of medicine. Both were concerned with sanitation, however health education focussed on improving personal hygiene of school children while public health had as its domain prevention of disease and illness at a larger, institutional level. In 1920 the term health education was substituted for hygiene in the school curricula. In 1925 the first school health education text entitled Health & Safety in the New Curriculum was introduced to US schools (McDermott, 1999), no text was consistently used in across Canadian schools. This has been partly attributed to the jurisdictional nature of education in Canada, it is a provincial rather than federal responsibility therefore there are no national educational programs..

1986 Ottawa Charter

Emphasis on school health education fluctuated throughout the next three decades until the early 1960s when the Samuel Bronfman Foundation (in the US) sponsored the first national study on School Health Education (SHES, 1965 as cited in Brown, 1999). From the time of this seminal report until the present, health education has claimed its own body of knowledge asserting, as its domain, health issues potentially amenable to behavioural intervention (rather than issues of public hygiene or medical treatment). The results of the SHES also greatly influenced the development of health education in Canada becoming the main framework for establishing curricula both in the public education system and for the basis of post-secondary development (Beazley, 1974). Concurrently, in both the US and Canada, social concerns related to adolescent sexual behaviours and drug use emphasized the need for specialized knowledge for those in the health education field (Association for the Advancement of School Health Education, AHE;1994; Doyle & Ward, 2001; LeDain Commission of Inquiry, 19721). The Lalonde Report (1974) A New Perspective on the Health of Canadians, further shaped the Canadian agenda paving the way for reframing health non-medically (Green & Kreuter, 1999) and ensuring that the social components of healthy living were included in their models. This background influenced the developed on Health Education and Health Promotion programs at Dalhousie.

Undergraduate Health Promotion program:

Dalhousie introduced health education courses into its physical education degree (BPE) program at its inception in 1966. Following the seminal work of Lalonde (1974), Dalhousie began a BSc (Health Education) in 1976 graduating its first student in 1977. Although several other Canadian

Population Health Promotion Model

programs focused on Health Sciences, Dalhousie’s was the only undergraduate program in Health Education in Canada. From 1976-1980 the BSc (Health Education) at Dalhousie emphasized school health education. Students received a teaching license allowing them to teach in the public schools. In 1980 Dalhousie introduced a Community Health stream to the BSc program noting that intervening on health issues in the public schools was only one route to affecting health status. This shift in focus arose from the Canadian public debate about the “distal determinants of health such as social conditions and politics beyond the immediate risk factors (Green & Kreuter, 1999, p. xxvii.)”. Our shift in focus was well reflected the 1986 Ottawa Charter for Health Promotion (World Health Organization, 1986), and the Epp (1986) report: Achieving Health for all: A framework for health promotion. In 1986 we further refined the Community Health emphasis to include two streams, Community Health Education and Lifestyles. In response to the 19944 Canadian Strategies for Population HealthPopulation Health Report – Investing in the Health of Canadians Health Canada(Federal, Provincial and Territorial Advisory Committee on Population Health) further changes were made to the Community Health BSc degree.

In 1995 as a result of teacher preparation revisions in Nova Scotia, the School Health program was discontinued and the BSc. program focused entirely on Community Health Education, amalgamating its two previous streams into one comprehensive program. As faculty retired over the next several years, new faculty brought with them an interest and expertise in broader health promotion research and policy issues. In 2003 we completed extensive revisions of the program to include a new Research and Policy Stream and an Honours option. In keeping with the directions we had undertaken since 1994 we also changed the undergraduate degree name to Health Promotion, Students entering the program since 2004 receive a BSc (Health Promotion) degree upon graduation.

Graduate Health Promotion Program:

In the early 1970s Dalhousie began its graduate degree in Physical Education. Over the early years several students focused on broader aspects of health, in their MSc research. In 1974 the first student graduated with an MSc specializing in health education. Twelve years later, as a result of the Epp report (1986) and the Ottawa Charter (WHO, 1986) the graduate program reconsidered its emphases. In 1988 we changed its focus to include general social health research as well as a specific emphasis in program evaluation. The degree designation was then changed to an MA.

During the intervening years the topics of investigation by graduate students covered a broad range of health issues, not all in program evaluation. By 2005-2006 policy discussions in Canadian health care and the social sciences had adopted the more common terminology of Health Promotion rather than Health Education as reflective of Canadian social determinants of health approaches to health research. In 2006 Dalhousie changed the name of its graduate degree to an MA (Health Promotion). The MA (Health Promotion ) was first awarded at the May 2007 convocation.

References

Association for the Advancement of Health Education (AAHE) (1994). Code of ethics for health educators. Journal of Health Education 25 (4), 197-200.

Beazley, R. (1974). A health education curriculum guide for the junior high schools in Nova Scotia -- 1971 [c1974]. Unpublished Masters thesis. Halifax, NS: Dalhousie University.

Brown, K. M. (1999). Significant developments in health education history [On-line]. Available: http://hsc.usf.edu/~kmbrown/hed_history.htm

Cottrell, R. R., Girvan, J. T., & McKenzie, J. F. (1999). Principles & foundations of health promotion and education. Toronto: Allyn and Bacon

Doyle E., & Ward, S. (2001). The process of community health education and promotion. Toronto: Mayfield.

Epp, J. (1986). Achieving health for all: A framework for health promotion. Ottawa: Health and Welfare Canada.

Federal, Provincial and Territorial Advisory Committee on Population Health. (1994). Strategies for population health: Investing in the health of Canadians. A report prepared for a meeting of the Ministers of Health, Halifax, NS September 14-15, 1994. Available: http://www.phac-aspc.gc.ca/ph-sp/phdd/pdf/e_strateg.pdf

Greene, L. W., & Kreuter, L. W. (1999). Health promotion planning: An educational and ecological approach (3rd ed.). Toronto: Mayfield

Lalonde, M. (1974). A new perspective on the health of Canadians: A working document. Ottawa: Ministry of National Health and Welfare.

LeDain Commission. (1972). The non-medical use of drugs: Interim report of the Canadian Government Commission of Inquiry. Available: http://www.druglibrary.org/Schaffer/LIBRARY/studies/ledain/NONMED1.HTM

McDermott, R. J. (1999). Historiographic timeline of health education events [On-line]. Available: http://hsc.usf.edu/~kmbrown/RJM_History.htm

World Health Organization.(1986). The Ottawa charter for health promotion. Geneva: Author.