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Health promotion has its roots in America in health education (Chen,2001). In the United States, health education has been in existence for more than a century. The first academic programs trained health educators to work in schools, but the role of health educators working within communities did not become popular until the 1940s and 1950s.

Health education promotes a variety of learning experiences to facilitate voluntary actions conducive to health (Green et al., 1980). These educational experiences facilitate gaining new knowledge, adjusting attitudes, and acquiring and practicing new skills and behaviors that could alter individual (one-to-one) or group instruction through personal online or group communication. Mass communication strategies can stimulate behavior change through public service announcements, webinars, social marketing techniques, and other evolving communications vehicles such as text messaging to blogging.

Health promotion has been defined as the combination of two levels of action: (1) health education and (2) environmental actions to support the conditions for healthy living (Green & Kreuter, 1999). Environmental actions prioritize populations in organizations and the community. Such environmental strategies and interventions include political, economic, social, organizational, regulatory, and legislative changes that can improve the health groups of individuals (Table 1.2).

Table 1.2 Components of Health Promotion Programs

Health Education to Improve Individual Health	Environmental Actions to Promote Health
Health knowledge Health attitudes Health skills Social support Health behaviors Health indicators Health status	Advocacy Environmental change related to variables influencing health outcomes (e.g., education, transportation, housing, criminal justice reform) Legislation Policy mandates, regulations Financial investment in communities and other resource/community development Organizational development Criminal justice reforms

The priorities for health promotion programs identified by the World Health Organization (1998) are advocacy for health to create the essential conditions for health, enabling all people to achieve their full health potential and mediating between the different interests in society in the pursuit of health.

Health promotion uses complementary strategies at both personal and population levels. In the past, health education was used as a term to encompass the wider range of environmental actions. These methods are now encompassed in the term health promotion, and a narrower definition of health education is used to emphasize the distinction.

Health education as a discipline has a distinct body of knowledge, a code of ethics, a skill-based set of competencies that is scientifically updated every five years, a rigorous system of quality assurance, and a system for credentialing health education professionals (Knowlden et al., 2020). With the latest credentialing study, there are now eight competencies (areas of responsibilities for health education specialists) as the centerpiece of credentialing as well as the foundation for preparation programs (Table 1.3). Approximately 250 professional preparation programs offer degrees in health education at the baccalaureate, master’s, or doctoral levels (Alber et al., 2020).

Table 1.3 Eight Competencies: Areas of Responsibilities for Health Education Specialists (HESPA II 2020)

AREA I	Assessment of Needs and Capacity
AREA II	Planning
AREA III	Implementation
AREA IV	Evaluation and Research
AREA V	Advocacy
AREA VI	Communication
AREA VII	Leadership and Management
AREA VIII	Ethics and Professionalism
Source: HESPA II 2020, Responsibilities and Competencies for Health Education Specialists, NCHEC. © 2020, National Commission for Health Education Credentialing, Inc.

The distinct occupation of health educator is recognized and tracked by the U.S. Department of Labor, which estimated that there were 123,800 health educators in the workforce in 2018 (U.S. Department of Labor, Bureau of Labor Statistics, 2020a). According to the Bureau of Labor Statistics, the demand for health educators is expected to increase by more than 19 percent, almost twice as fast as all other occupations of 11 percent growth (U.S. Department of Labor, Bureau of Labor Statistics, 2020b). The growth is driven by efforts to improve health outcomes and to reduce healthcare costs by teaching people about healthy habits and behaviors and utilization of available healthcare services.