**5. Educating for health and health education pedagogy**

Education for health empowers people and communities and occurs on a global level. A constructivist and social justice approach using the socio-ecological model as a lens is a foundational core for framing education for health [48–50]. Learners build and co-construct knowledge in a social setting through engaging learning activities. Social constructivism considers that learners obtain knowledge through socialization, however; various cultures would result in different learning and produce very different narratives. The socio-ecological model (SEM) posits that factors shape an individual's health status, related behaviors, and choices at the intrapersonal, interpersonal, organizational, community, and policy levels [50]. Health education practice is best when learning is dynamic and interactive. Students learn in groups or with a partner, share prior knowledge, curiosities, and assets, and knowledge. Health education practice has historically examined health equity issues through needs assessment and learning experiences that foster voluntary health-related behavioral and social change.

A culturally responsive teaching approach where students make meaningful connections between learning, their cultures, and life experiences, increases students' ownership of learning [51, 52]. Educators use cultural responsiveness to guide and elevate their practice and help students build their own person agency, so they have a more direct influence over health promoting actions. Understanding the identities and challenges students experience, and that cultivating learners' cultural assets improves learning because students feel seen and heard [52]. Too often the power in the educator-learner bond is with the educator, and the experience, knowledge, and ideas of the learner are assumed or disregarded.

Health education supports engaged citizenry, which takes many forms including individual and group actions aimed at addressing problems that are of public interest and concern. Health literate people are focused not only on improving and maintaining their own health but also on the health of others. What does this mean? Incorporating social justice into health education provides opportunities for higher-order critical thinking skills as well as engaging pedagogical practices. Addressing social determinants of health in education allows for inclusion of underlying social justice issues that influence health such as racism, xenophobia, sexism, heterosexism, transphobia, ableism, ageism, and income and wealth disparities [53]. The National Academies of Medicine's call to action stresses the upstream, systems-level changes that strengthen the integration of both health literacy and school health education to improve the health of future generations [54]. For example, using school level data to advocate for policies, programs, and practices to create equitable environments. We know that students identifying as Lesbian, Gay, Bisexual, Transgender, Queer or Questioning (LGBTQQ )

experience bullying more than their heterosexual identifying peers. Students may recommend the development or strengthening of Gay, Straight Alliances or other groups that support understanding and acceptance of all students [55].

Health educators must also be adept working with adult learners. This group wants to know the "why," behind learning about a particular issue or topic, are more self-directed than younger groups, and learning should involve them in the planning and be relevant to their lives [56]. Pedagogical approaches or health education planning should ensure learning goals are linked to learners needs and interests and incorporate the learners' life experience and knowledge into the learning environment.

#### **5.1 Health education in schools**

What should school health education look like? When should children first start developing health literacy skills? An ecological approach to health literacy acknowledges that the development of these skills is influenced by factors that interact and affect health behavior and ultimately health status. For example, parents and guardians initiate this learning through indirect (modeling, establishing value systems and standards) and direct learning (intentional conversations) during their time together. These individual and social environmental factors, which include social networks, organizations, communities, and populations, should be targets for interventions aimed at improving health status [50]. Schools are one of the primary places for the delivery of current, engaging, well-planned health education lessons and curricula. Developing health literacy skills through school-based efforts should commence during the pre-school years and continue until high school graduation [37, 57]. Hu et al. [58] found that health education, focusing on nutrition, for both kindergarten children and their parents, significantly improved healthy eating behaviors. This evidence supports the role school-based health education efforts can have on student learning. Healthy students will engage in learning better and learning about how to stay healthy keeps students healthy. As individuals become more adept with these health literacy skills, confidence in accessing and navigating literate environments will increase along with self-efficacy [59].

As stated in a previous section, effective planning for school health education begins with this end in mind: Health Literacy. This approach emphasizes that students should learn about and practice healthy behaviors while at school [34]. As active participants in learning, students build critical thinking, communication, problemsolving, and other skills that support health.

There are many learning strategies or activities to consider when planning health education. In the US elementary schools, classroom teachers may serve as the health educator. Some health topics are easily integrated into other subject areas such as English Language Arts, Math, and Science. In others, health education is a standalone content area. We would suggest that the approach is secondary to the intentionality of implementation of one approach or a combination of approaches. First and foremost, is to ask yourself, what is the purpose of the health education lesson? What learning outcomes do I want my learners to achieve by the end of the lesson, unit, or program? What health education standards or skills are my learners working toward achieving? Once these questions are answered, the health educator can then explore the various learning strategies. Health education professional preparation and ongoing professional development need to be based on a meaningful approach to skills-based health education [40].

*Perspective Chapter: Strengthening and Empowering Professional Health Educators' Capacity… DOI: http://dx.doi.org/10.5772/intechopen.108980*

When the selection of learning strategies is based on learner engagement centered on the emergence of agency that builds on lived experiences, there is room for building trust between the educator and students, critical thinking, and student and community voice. In practice, the health educator should purposefully intent for students, along with themselves, to grow during the learning process. Learning should be interactive where students learn in groups or with a partner, share prior knowledge, curiosities, and assets, and knowledge is perceived as dynamic and changes with our experiences [51, 60, 61]. We recommend the following when selecting learning strategies:

