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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.

      Settings for Health Promotion Programs

      Earlier in this chapter, we discussed the impact of the Jakarta Declaration in giving prominence to the concept of the health setting as the place or social context in which people engage in daily activities and in which environmental, organizational, and personal factors interact to affect health and well-being. Health is promoted through interactions with people who work in various settings, through people’s use of settings to gain access to health services, and through the interaction of different settings.

       Schools

      Schools are pivotal to the growth and development of healthy children and adolescents. School settings include childcare; preschool; kindergarten; elementary, middle, and high schools; and vocational-technical programs. The model for promoting and protecting the health of children and adolescents in schools is to place students in the center of the entire school community to promote their cognitive, physical, social, and emotional development with coordinated health policies, processes, and practices that promote learning and health. In schools, health promotion happens in ten areas: (1) Health Education, (2) Physical Education and Physical Activity, (3) Nutrition Environment and Services, (4) Health Services, (5) Counseling, Psychological, and Social Services, (6) Social and Emotional Climate, (7) Physical Environment, (8) Employee Wellness, (9) Family Engagement, and (10) Community Involvement (ASCD®, 2021). Health promotion in schools is done in the context of the community. Recognizing that schools are part of and an extension of the larger community within which it operates and serves its students (ASCD®, 2021).

       Colleges and Universities

Colleges and universities—including 2-year college (community college), certificate programs, advanced vocational training, 4-year college (bachelor programs), graduate programs, and professional programs—place a prominent role in promoting the health of young adults as well as non-traditional students (for example, adults seeking a career change or retired individuals seeking enrichment). Boosting educational attainment beyond high school has been more prominent in recent years. Given the future of work and the increasing role of technology, education beyond high school becomes even more relevant for workers to compete in the labor market. These sites have extensive programming and structures to provide healthcare and promote healthy lifestyles. Initiatives such as Healthy Campus 2020 (American College Health Association, 2020) empower schools to improve health and well-being by creating a culture where social and physical environments promote health. Health promotion initiatives at colleges and universities need to be part of how the sites assertively address persistent racial/ethnic gaps in educational attainment. Even as we see higher rates of attainment among the younger working-age population, gaps among particular components of that group are also larger in spite of so many efforts to close them (Prescott, 2019).

       Healthcare Organizations

      Healthcare organizations provide services and treatment to reduce the impact and burden of illness, injury, and disability and to improve the health and functioning of individuals. Healthcare practitioners work with individuals in community hospitals, specialty hospitals, community health centers, physician offices, clinics, rehabilitation centers, skilled nursing and long-term care facilities, and home health and other health-related entities. Traditionally, these sites are thought of as being part of the healthcare industry, which is one of the largest industries in the United States and provides 18 million jobs. The U.S. Department of Labor, Bureau of Labor Statistics (2020b) reports the healthcare and social assistance sector is expected to make up 40 percent, or 3.4 million, of the overall increase in employment from 2018 to 2028. Six of the 10 fastest-growing occupations from 2018 to 2028 are expected to be healthcare. The roughly 595,000 establishments that make up the healthcare industry vary greatly in size, staffing patterns, and organizational structures. About 76 percent of healthcare establishments are offices of physicians, dentists, or other health practitioners. Although hospitals constitute only 1 percent of all healthcare establishments, they employ 35 percent of all healthcare workers (OER, 2020). While health promotion programs might seem out of place in a treatment facility, in fact, much work is done in such facilities to reduce the negative consequences associated with disease.

       Communities

Communities are usually defined as places where people live—for example, neighborhoods, towns, villages, cities, and suburbs. However, communities are more than physical settings. They are also groups of people who come together for a common purpose. The people do not need to live near each other. People are members of many different communities at the same time (families, cultural and racial groups, faith organizations, sports team fans, hobby enthusiasts, motorcycle riders, hunger awareness groups, environmental organizations, animal rights groups, and so on). These community groups often have their own physical locations (for example, community recreation centers, golf, swimming, and tennis clubs; temples, churches, and mosques; or parks). These affinity groups all exist within communities, as part of communities, and at the same time, they are their own community. Health promotion programs frequently seek out people both in the physical environment of the neighborhood where they live and within the affinity groups that they form and call their community.

      Within a community, the local health department and community health organizations work to improve health, prolong life, and improve the quality of life among all populations within the community. Local and state health departments are part of the government’s efforts to support healthy lifestyles and create supportive environments for health by addressing such issues as sanitation, disease surveillance, environmental risks (for example, lead or asbestos poisoning) and ecological risks (for example, destruction of the ozone layer or air and water pollution). The staff at a local health department includes a wide variety of professionals who are responsible for promoting health in the community: public health physicians, nurses, public health educators, community health workers, epidemiologists, sanitarians, and biostatisticians.

      Community

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