Improving the Health of a Field that Preserves It | Teachers College Columbia University

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Improving the Health of a Field that Preserves It

What should health promotion workers on the front lines know and be able to do? To TC's John Allegrante, that's the question
In 2008, while earning her master’s degree in health education at Teachers College, Ashley Gleitman spent two months in a village in the West African nation of Togo, teaching local residents how to become peer educators in preventing HIV/AIDS.
The education process worked both ways. To succeed in training 43 villagers, Gleitman (now a doctoral student in the same program) had to learn and adapt to local cultural practices, navigate village and regional politics and pick up French on the fly.
In the 21st century, where an infectious disease can become a pandemic by leaping continents with the flight of a plane, ever more frequent natural and human disasters can create instant disease-prone populations, and vast, uneducated numbers of people are living with chronic diseases such as heart disease and diabetes, there is a clear-cut need for a new breed of multi-skilled, resourceful professionals on the front lines. Yet high-caliber people like Ashley Gleitman are not always the norm. One major reason why is that the health education profession lacks both a unified system of accreditation and an internationally agreed upon core set of competencies that students should have upon leaving school, whether they have received their professional preparation at Teachers College in New York or a university in Cape Town.
“The challenges we face in global health are not someone else’s problem—they affect all of us,” says John Allegrante, Professor of Health Education and Deputy Provost at Teachers College. “And unless we can demonstrate to the public that the professionals who are in charge of safe-keeping the public health are capable, prepared and competent, we won’t get the cooperation that we need from people to support public health measures and the kinds of legislation that help to protect the health of the people.”
Recently, thanks to Allegrante’s own leadership, the outlook for the field has been improving. Three years ago, Allegrante met Margaret Barry, Professor of Health Promotion and Public Health and Director of the Health Promotion Research Centre at the National University of Ireland, Galway, when the two were serving on the same panel on standards and competencies in health promotion at a conference in Vancouver. Both Allegrante and Barry were discussing standardization efforts in their respective countries. If both Ireland and the United States were concerned about preparing the next generation of health education professionals, Allegrante surmised, perhaps their peers in other countries were as well. Could the time be right to move beyond national standards—to go global?
“After the session,” Allegrante recalls, “I went to Margaret and said ‘Why don’t we convene a global consensus conference?’” Barry agreed and the two began a collaboration in which they would ultimately co-chair what is now known as the Galway Consensus Conference: a groundbreaking effort to reach an agreement on the kinds of knowledge required of health education and health promotion professionals worldwide.
The work began in the fall of 2007, as Allegrante and Barry organized a working group of more than two dozen of the field’s leading academic figures from around the world, who set about researching standards in place in various countries in order to pull together rough drafts of working papers for Galway.
It was clear they faced some serious obstacles. Within the United States, universities themselves have trouble classifying health promotion programs. Some programs are in schools of public health, while others are housed in colleges of education or other units. Some stand alone as departments, while others are tucked into overarching undergraduate or graduate programs.
Another issue: the field cuts quite a wide swath. For example, even as Gleitman was working on HIV/AIDS management in West Africa, a team of her TC colleagues and students from Columbia’s Mailman School of Public Health was creating the Harlem Fruit Project, an award-winning social marketing campaign to increase fruit and vegetable consumption among adolescents in Harlem neighborhoods.
There also was an obvious need for a more cohesive national system of program accreditation. Currently, graduates of health education programs, whether accredited or not, are eligible to take the national certification exam, which in the United States leads to the title Certified Health Education Specialist.
On the international level, there isn’t even a consensus on what the field should be called. In the United States, it’s generally referred to as health education, while in Europe and other parts of the world it’s known as health promotion. The two names refer to much the same thing: helping people lead healthier lives by creating the social circumstances that promote health and by doing everything from improving nutritional practices to preventing the spread of infectious diseases.
The Galway conference organized by Allegrante and Barry took place during three days in June of 2008 and was attended by leading scholars and practitioners from professional health education associations from the United States and Europe. Allegrante took the lead, drafting versions of a document declaring the competencies deep into the night and sending the drafts out by e-mail in time for conferees to read and discuss them the following morning. “There was one moment when I realized, ‘My gosh, I’ve really got myself into a bind here,’” Allegrante says. “I felt like my back was to the wall because I realized that everything was riding on my ability to pull everything together around the writing of the statement.”
By day three, however, consensus had emerged: a document detailing eight domains of core competencies, from the ability to “catalyze” change by empowering people and communities, to the capacity to use leadership skills to mobilize and manage resources, to the ability to assess the needs of various communities and effectively plan, implement and evaluate health promotion projects.
The Galway Consensus Statement was a genuine breakthrough. The June 2009 issues of the field’s two most prominent journals, Health Education & Behavior and Global Health Promotion, were devoted to the Galway Consensus. Allegrante and Barry were the invited co-editors, and Allegrante wrote or co-wrote five of the 10 articles on the subject that appeared in the two publications.
“It really was a first,” says Alyson Taub, Professor Emerita of Health Education at New York University, who was a member of the original working group. “It marks the first global initiative on competencies and accreditation in health education and health promotion. It’s true that there are various pieces to this. One is the extent to which we can come to a broad agreement about the core competencies, and then how we use those core competencies in academic programs at colleges and universities; and, as a third piece, whether there will there be mechanisms for measuring and ensuring quality, which might be certification or an accreditation process. Those processes will differ in various countries based on a whole range of factors, but identifying the domains of core competencies was the first important step in the process.”
Allegrante, too, sees Galway as a first step. It will take time, he concedes, for the domains of core competencies hammered out in Galway to gain traction around the world. What is needed now is for others in the field to weigh in, offering refinements. Indeed, Allegrante and Barry are already planning a second conference, in 2010, which will seek to draw even wider input from practitioners and scholars, especially from developing countries.
Allegrante points out that in professions like nursing and medicine, there is general international agreement on requirements in addition to rigorous accreditation and licensing systems. “The world is getting smaller with respect to common standards,” Allegrante says, “so I think it’s coming for health education.”
Not long after the Health Education & Behavior and Global Health Promotion articles were published, Allegrante got a call from the Soros Foundation’s Open Society Institute, asking if he would take on the job of helping Kazakhstan develop standards and curriculum along the lines of the Galway document. To Allegrante, it was a hopeful sign that a movement toward global standards may at last be taking root. To others, it was also testimony to Allegrante’s own unique skills and accomplishments.
“Since first meeting John in Vancouver, I’ve been impressed by his ability to network and to reach across cultures and communicate,” Barry says.
Which sounds a lot like what a good health education professional should be able to do.

Published Friday, Dec. 4, 2009