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Abstract  In his comment on Victor Fuch's essay, the late Alvan Feinstein raised the question of whether government‐sponsored programs of "health promotion" are always good for well‐being.

Purpose and Scope. This article reviews the health and social science research relevant to both the role of powerlessness as a risk factor for disease, and the role of empowerment as a health-enhancing strategy. The research literature surveyed includes studies that address these key concepts from the fields of social epidemiology, occupational health, stress research, social psychology, community psychology, social support and networks, community competence and community organizing. Definitions are provided to operationalize these sometimes loosely-applied terms. Important Findings. Powerlessness, or lack of control over destiny, emerges as a broad-based risk factor for disease. Empowerment, though more difficult to evaluate, can also be demonstrated as an important promoter of health. Major Conclusions. Given the importance and currency of these concepts of powerlessness and empowerment, a model of empowerment education is proposed for health-promotion practitioners. Measurement of empowerment raises issues for researchers on how to test the multiple personal and community changes that may result from an empowering education intervention.

Providing health services to the public under any government-sponsored program, such as the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), involves an opportunity cost. Public funds devoted to a particular intervention are no longer available to fund other activities. Maximizing the benefit from limited resources requires decision makers to identify the most efficient strategies to provide effective services (e.g., cancer screening) to maximize population health. Such decisions may benefit from collection and analysis of valid, accurate and reliable economic cost and effectiveness data related to program activities. The results may help decision makers identify and select best practices to improve program operations and performance. In this paper, we provide a brief description of the economic evaluation methods used in estimating the costs and benefits of public health programs, and discuss the application of these methods to the NBCCEDP.

A significant portion of the deaths in the United States could have been prevented or postponed using known interventions. One reason this did not occur is because medical science and medical education are disease, not health, oriented. Since physicians are at the center of the health care delivery system, their disease orientation pervades the industry. Historically, there have been calls for physicians to focus more on disease prevention; however, medical education does not teach disease prevention/health promotion. There are several reasons for this: 1) medical school faculty conceptual discordance between "certainty" of curative disease vs. the "probability" of risk factor reduction; 2) gaps in the knowledge of effective interventions; 3) the concept that health promotion/disease prevention are outside the province of physicians; 4) the significant role of biomedical research grants on medical school funding; 5) the close association of medical education and the acute care hospital; and 6) the use of rote memory/lecture based teaching methods of traditional medicine vs. the problem-based learning necessary to teach disease prevention/health promotion. Some medical schools have begun to use problem based learning and to introduce health promotion concepts. Widespread and long-lasting change requires support of the leadership in medical schools and the preventive medicine/public health community, and grant funding from state and federal sources to support research on medical education research and change.

Key steps in the research process / Crosby, DiClemente & Salazar -- Philosophy of science / Salazar, DiClemente & Crosby -- Ethical issues in health promotion research / John Santelli -- Choosing a research design / Salazar, Crosby & DiClemente -- Conducting observational research / Crosby, Salazar & DiClemente -- Designing randomized controlled trials in health promotion research / DiClemente, Salazar & Crosby -- Qualitative research strategies and methods for health promotion / Salazar, Crosby & DiClemente -- Program evaluation / Nancy Thompson, Michelle Kegler & David Holtgrave -- Measurement in health promotion / Richard R. Clayton -- Improving validity of self-reports for sensitive behaviors / Zimmerman, Atwood & Cupp -- Principles of sampling / Crosby, Salazar & DiClemente -- Analytic techniques for observational research / Crosby, DiClemente & Salazar -- Analytic techniques for experimental research / DiClemente, Salazar & Crosby -- Introduction to scientific writing / Crosby, DiClemente & Salazar -- Crafting a successful research proposal / DiClemente, Salazar & Crosby.

State of global health / Richard Skolnik -- Global health promotion : the state of the science / David V. McQueen -- Global health promotion and the social determinants of health / Kumanan Rasanathan and Alyssa Sharkey -- Models of health behavior change : international applications / Rick S. Zimmerman, Zhiwen Xiao, Purnima Mehrotra, and Charles Roy -- Two health communication approaches : COMBI and entertainment education / Everold Hosein, May G. Kennedy, and Sandra De Castro Buffington -- Global health promotion (GHP) in the context of human rights / Elvira Beracochea, MD. MPH. and Lubna Ahmed, MPH -- Ehealth and global health promotion / Sheana S. Bull, PhD, MPH; Gretchen Domek, MD, MPhil; and Deborah Thomas, PhD -- Reducing maternal and infant mortality : meeting a global challenge / Padmini Murthy -- Malaria prevention and control / Fouzia Farooq and Elke S. Bergman-Leitner -- Global immunization initiatives from a health promotion perspective / Marilyn Rice, Jon Andrus, Virginia Swezy, and Rick S. Zimmerman -- The evolving global HIV pandemic : epidemiology, prevention, and future priorities / Ralph DiClemente, Puja Seth, and Purnima Mehrotra -- Community-based risk communication in epidemics and emerging disease settings / Renata Schiavo, Karen M. Hilyard, and Ewart C. Skinner -- Non-communicable diseases (NCDs) : moving toward health promotion / C. James Hospedales, Andre Pascale Kengene, Branka Legetic, and Adriana Blanco -- Women's cancers / Silvana Luciani and Irene Agurto -- Health promotion in families and communities : an integrated approach from Latin America and the Caribbean / Fernando Zacarías, Adrián Díaz, Manuel Peña, Adela Páez Jiménez, Leticia Martínez, Gina Tambini -- Oral health promotion / Margaret Scarlett, DMD, and Gary Kreps, PhD -- Implementation of public health innovations in developing countries / Bonita Stanton, Xiaoming Li, and Linda Kaljee -- Health promotion in the global setting : the role of international organizations and governments / John Bryant and F. Curtiss Swezy -- The future of global health promotion / Rick S. Zimmerman, Jon Andrus and James Hospedales

This is the second ebook featuring the processes and outcomes of school health promotion. The members of the Schools for Health in Europe Research Group were invited to submit their work addressing processes and outcomes in school health promotion to this ebook of Health Education. Additionally, an open call for papers was published on the Health Education website. Following the traditional double blinded peer review process, a number of submissions were accepted for publication. Five papers were published in the previous volume and the remaining six are featured in this volume of the Journal

HIA and EA are approaches and processes that support better, healthier, and more sustainable policy development and decisionmaking. When undertaken well, and when valued and applied, they can also help to support better, more informed, transparent and democratic policy development and decision- making processes. However, they are not a panacea; rather, they constitute one important piece of the policy development and decision- making puzzle. Public health practitioners need to increase their knowledge and understanding of EA and HIA. They should improve their links with EA and HIA specialists. They also need to proactively and consistently undertake and commission assessments of health either within EA or as stand alone HIAs. Public health practitioners would also do well to oversee and scrutinize the scope of work for, and the findings of, EAs and HIAs that are commissioned and undertaken by others in the localities in which they work. By doing so, public health practitioners can help to advance the agenda of improving health for all by acting on the upstream determinants of health and bringing together key actors across society.

Sect. I. The health promotion concept: The health effects of health promotion / Jeffrey S. Harris and Jim Fries. Employer's financial perspective on workplace health promotion / Michael P. O'Donnell -- Sect. II. Program management: Design of workplace health promotion programs / Michael P. O'Donnell, with comments by Tim McDonald and John Harris. Program management of workplace health promotion programs / William B. Baun. Program evaluation / Ron Z. Goetzel and Ronald J. Ozminkowski -- Sect. III. Strategies: Awareness strategies / Larry S. Chapman. Theoretically-based strategies for health behavior change / Kenneth A. Wallston and Colin Armstong. Building supportive cultural environments / Judd Robert Allen -- Sect. IV. Interventions: Health assessment / David R. Anderson, Seth Serxner, and Paul E. Terry. Physical activity in the workplace / Mark G. Wilson, C. Shannon Griffin-Blake, and David M. DeJoy. Worksite nutrition programs / Karen Glanz and Alan R. Kristal. Worksite weight management / Gordon D. Kaplan, Valerie Brinkman-Kaplan, and Edward M. Framer. Tobacco control and cessation / Nell H. Gottlieb. Medical self-care / Paul E. Terry. Stress management / Lawrence R. Murphy. Employee assistance programs / R. Paul Maiden and Donald B. Levitt. Social health in the workplace / Kenneth R. McLeroy, Nell H. Gottlieb, and Catherine A. Heaney -- Sect. IV. Perspectives: Workplace health promotion in small business / Daniel Stokols, Shari McMahan, and Kimari Phillips. Aging and workplace health promotion / David Gobble. Global perspectives in workplace health promotion / Wolf Kirsten. Connecting the workplace to the community / Paul Terry and Michelle Nunn. The future of workplace health promotion / Don R. Powell and Elaine Frank