The field of health promotion and education is at a turning point as it steps up to address the interconnected challenges of health, equity and sustainable development. Professionals and policy makers recognize the need for an integrative thinking and practice approach to foster comprehensive and coherent action in each of these complex areas.

1. “Health Education as Paradigm in
Controlling Infection Disease in Timor-
Leste"
Dili,08/august/2023
dr. Filipe de Neri Machado, MPH

2. Outline
INTRODUCTION OF PUBLIC HEALTH
ESSENTIAL PUBLIC HEALTH SERVICES (EPHS)
EVIDENCE OF EDUCATION AND HEALTHY
BEHAVIOR
MIS INFORMATION AND PROPAGANDA
KEY POINTS ON HEALTH EDUCATION
TIMOR-LESTE H.E PARADIGM
LEVELS/APPROACH OF HEALTH EDUCATION
IN TIMOR-LESTE

4. PUBLIC HEALTH IS THE SCIENCE AND THE ART OF:
PROCESS OBJECTIVES/INTERMEDIATE RESULT GOAL
ORGANIZING COMMUNITY
EFFORT AWARD:
• Manager
• Innovator
• Researcher
• Apprentice
• Communitarian
• Leader
• Educator
1. A sanitary environment;
2. Control of community
infections;
3. Education of the individual
in principles of personal
hygiene;
4. Organization of medical and
nursing services for the
early diagnosis and treatment
of disease;
5. Development of the social
machinery
To attain:
1. Preventing
Disease
2. Prolonging
life
3. Promoting
physical
health and
mental
Health
4. And
efficiency
To ensure every individual in the community has a standard of
living adequate for the maintenance of health, so organizing these
benefits “TO ENABLE EVERY CITIZEN TO REALIZE HIS BIRTHRIGHT OF
HEALTH AND LONGEVITY”
CEA Winslow
1920
PUBLIC HEALTH DEFINITION
A foundation of people’s welfare (the Health of
the nation)

5. EPHS, CDC 1994
EPHS, CDC 2020
ESSENTIAL PUBLIC HEALTH
SERVICES (EPHS)

6. Evidence of Education and
Healthy Behavior
A study published in The Lancet
Public Health stated that*”
• Education is strongly
associated with life
expectancy, morbidity,
and health behaviors, and
educational attainment
plays an essential role
in health by shaping
opportunities,
employment, and income
A Mendelian randomization study
found that.
• Higher education is associated
with better health behaviors
• highly educated smoke less and
pay more attention to healthy
habits.
*The Lancet Public, H. (2020). Education: a neglected social determinant of health. The Lancet Public Health, 5(7), e361. doi:10.1016/S2468-2667(20)30144-4
** Viinikainen, J., Bryson, A., Böckerman, P., Kari, J. T., Lehtimäki, T., Raitakari, O., . . . Pehkonen, J. (2022). Does better education mitigate risky health behavior? A mendelian
randomization study. Economics & Human Biology, 46, 101134. doi:https://doi.org/10.1016/j.ehb.2022.101134

7. HEALTH EDUCATION IS A CRUCIAL PARADIGM IN
CONTROLLING INFECTIOUS DISEASES IN TIMOR-
LESTE
It plays a vital role in promoting
preventive measures and
raising awareness about the
diseases' transmission,
symptoms, and management.
Is a young nation with limited healthcare
resources and infrastructure

8. Timor Leste Demographic Health
Survey 2016 summarized that
•22% percent of women and 19% percent of men
have no education
• Which reported that “Rural teenagers and those
with no education end to start childbearing
earlier than other teenagers”
• Women with no education (22 %) are less likely to
use a family planning method than women with
education (26 percent to 30 percent).
• A skilled provider assisted 33% of births to
mothers with no education, and 26 % were delivered
in a health facility, as compared with 95 percent
and 91 percent of births to mothers with more than
a secondary education

9. TIMOR-LESTE TO BE AN UPPER-MIDDLE INCOME COUNTRY WITH
AN EDUCATED AND HEALTHY POPULATION IN 2030.

10. HEALTH SERVICE DELIVERY MoH TIMOR LESTE

12. Fuentes : Diagram adapted from Chen 1994
MIS INFORMATION AND PROPAGANDA

13. Behavioral and social drivers of
vaccination (Example)
Source: The Behavioural and Social Drivers (BeSD) Framework. Source: The BeSD working group. Based on Brewer et al. Psychol Sci Public Interest. (2017)
https://apps.who.int/iris/handle/10665/354459

14. Behavioral and social drivers of
vaccination
Source: The Behavioural and Social Drivers (BeSD) Framework. Source: The BeSD working group.
Based on Brewer et al. Psychol Sci Public Interest. (2017)
https://apps.who.int/iris/handle/10665/354459
“I worry the vaccines are not safe”
“I don’t need vaccines; I’m healthy”
“I’m not sure this vaccine really works;
natural immunity is better”
Taking several vaccines is bad for you

15. Behavioral and social drivers of
vaccination
Source: The Behavioural and Social Drivers (BeSD) Framework. Source: The BeSD working group.
Based on Brewer et al. Psychol Sci Public Interest. (2017)
https://apps.who.int/iris/handle/10665/354459
A health worker hasn’t recommended
vaccination for me / my child
I have to ask my husband permission to
take the children for their vaccination
My village chief is against vaccination

16. Behavioral and social drivers of
vaccination
Source: The Behavioural and Social Drivers (BeSD) Framework. Source: The BeSD working group.
Based on Brewer et al. Psychol Sci Public Interest. (2017)
https://apps.who.int/iris/handle/10665/354459
“I’m not sure about
getting vaccinated I
don’t want to get
vaccinated”

17. Behavioral and social drivers of
vaccination
Source: The Behavioural and Social Drivers (BeSD) Framework. Source: The BeSD working group.
Based on Brewer et al. Psychol Sci Public Interest. (2017)
https://apps.who.int/iris/handle/10665/354459
“Vaccination sessions times are not convenient”
“Vaccination services are far away”
“To take the bus to the clinic is expensive”
“I got yelled at because I forgot my vaccination card”
“I waited 3 hours for vaccination”
“They ran out of vaccine, and I / my child couldn’t get
vaccinated”

18. KEY POINTS ON HOW HEALTH EDUCATION CAN BE
EFFECTIVE IN CONTROLLING INFECTIOUS DISEASES
IN TIMOR-LESTE:
Raising Awareness
Promoting Hygiene Practices
Encouraging Vaccination
Strengthening Healthcare Seeking Behavior
Community Engagement
School-Based Health Education
Addressing Stigma
Collaboration with Healthcare Providers
Using Various Communication Channels
Monitoring and Evaluation
By empowering individuals and
communities with knowledge,
promoting healthy behaviors, and
addressing misconceptions, health
education can significantly reduce
the burden of infectious diseases
and improve public health.

19. Community
Protection
Infodemic
Management
Science and
Knowledge
Translation
Public Health
and Social
Measures
Community
Engagement
Risk
Communication

20. Health Education: Health education provides
individuals and communities with information,
knowledge, and skills to make informed
decisions about their health and well-being. It
promotes positive health behaviors, prevents
diseases, and improves overall health
outcomes. Health education can cover various
topics, including nutrition, physical activity,
mental health, sexual health, disease
prevention, hygiene.
Community Beliefs in Culture and Attitudes:
Community beliefs in culture and attitudes refer to
the collective beliefs, values, customs, and
behaviors shared by a particular community or
society. Cultural norms, traditions, historical
experiences, and social interactions shape these
beliefs and attitudes. They influence how individuals
perceive health and well-being, their healthcare-
seeking behaviors, and their attitudes toward health-
related issues.
VS
Combining Health Education and Community Beliefs: When
designing health education programs, it's crucial to consider
the target audience's cultural context and community beliefs.
An awareness of cultural norms and attitudes towards health
can help tailor health education messages and interventions
to be more relevant and acceptable to the community.
Incorporating cultural competence into health education
initiatives increases the chances of successfully promoting
positive health behaviors and achieving health-related goals.
TIMOR-LESTE H.E
PARADIGM

21. Community Beliefs in Culture and
Attitudes

22. LEVELS/APPROACH OF HEALTH EDUCATION
IN TIMOR-LESTE
INDIVIDUAL LEVEL
(Approach)
Group Level
(Approach)
Community Level
(Approach)
• Personal
Contact
• Home Visit
• Personal
Letters
• Lectures
• Demonstration
• Discussion
Methods
- Group
Discussion
- Pannel
Discussion
-
Symposium
- Workshop
-
Conference
- Role
Play
- Debate
- Brain
Storming
• Television
• Radio
• Newspaper
• Printed
Material
• Posters
• Health
Exhibitions
• Internet

23. Drugs alone will not solve health
problems. Without health
education, a person may fall
sick again and again from the
same disease. Educating the
people about the prevention
and control of locally endemic
diseases is the first of the
eight essential activities in
primary health care.
DISEASE PREVENTION AND
CONTROL