Policies for decentralization and development of health education.

This article reviews relevant US health education actions which are pertinent to understanding the possibilities for enhancing health education in Brazil, and discusses the interconnections between theory, policy, practice, and evaluation. One common assumption underlying most health education policy and practice is that participation of the population will increase involvement in programs. Economic theories of socialism and capitalism are implicit in short term policies, while long term policies imply understanding of cultural ideologies. The cycle: theory affects training and policy, policy affects training and practice, and practice affects evaluation which in turn affects theory and training. For instance, in the US the theory of life style's influence on health led to policy to change lifestyle. Ineffective health education led to more complex theories which changed health programs. Drunk drivers were penalized and smokers were restricted. Professional training programs increased to meet the demand. Policy had the most significant impact, and where it is absent, health education practice can become diffused and have an insignificant impact. The US cycle of underfunded policy for health education (professional poverty) began to change with the following initiatives: 1) improvement in research, 2) evaluation, 3) involvement of disciplines such as psychology and sociology in the study of health education problems, 4) significant policy analyses in the 1970's with the President's Committee on Health Education, and 5) new policy initiatives in the 1980's with the creation of the Office of Disease Prevention and Health Promotion in conjunction with the Center for Disease Control under the Public Health Service. Training in central in affecting practice and being affected by evaluation, theory, and policy.