EDITORIAL

This is my valedictory editorial and, hopefully, I will be forgiven for offering a brief historical perspective on the development of the journal - and indulge in a little reminiscing. I have, after all, been intimately connected with the Journal for 20 years! In fact, our Founding Editor, Douglas Leathar, involved me in the planning phase together with John K. Davies - our veteran News and Reviews Editor [John is still in post and is therefore now the longest serving member of the editorial team!]. In addition I would like to explore a number of important challenges that I consider the Journal will need to address.

A brief history

The seminal contribution of douglas leathar

My initial contribution to the Journal was a paper on the ‘use and abuse of mass media in health promotion’, which was one of three articles in a Pilot Issue produced in 1985 to test market readiness for a new journal. Douglas Leathar's comments in the introduction to the Pilot Issue established the philosophy that the new journal would espouse. In short, it was based on assertions that,

‘…current health education research is, to say the least, of variable quality…[and does not reach] the high academic standards of related disciplines in the social sciences.’ The new journal would, hopefully, ‘…resolve these weaknesses and help raise the standard of health education research to the level it deserves.’

In addition to having a sound academic and theoretical basis the Journal's orientation should be practical. As Leathar put it,

‘…the overriding criterion of publication…is quite straightforward: will practicing health educators gain any real understanding of the processes, rationale or philosophy underlying the health education activities in which they are currently engaged?’

In policy terms, ‘…the journal will always look to the future, and only to the past if lessons can be learned from it.’

These are admirable statements of intent to which I personally have been committed. I trust that they will continue to serve as a guide for the Journal in future.

The launch of the journal

The response to the Pilot Issue must presumably have been satisfactory since IRL Press [a company subsequently purchased by Oxford University Press] published the first issue of the new journal in April, 1986. That first issue established the American connection and Dr Ken Beck, from the University of Maryland was invited to act as an Associate Editor. I myself was delighted to receive an invitation to serve as a member of the Editorial Board. However, Douglas' vision was tragically interrupted by his death at the age of 41 and Ken Beck subsequently had the unenviable task of announcing this in the November 1988 edition of the Journal. John B. Davies, a health psychologist from the University of Strathclyde and an Editorial Board member agreed to act in a caretaker capacity and played a sterling role with Ken in maintaining the Journal's impetus. In March, 1989 I was invited to act as the UK-based editor and Ken Beck and I subsequently worked in tandem as the new Executive Editors. I was immensely grateful for Ken's support in those early days: he visited us in UK and we discussed the future direction of the Journal. We continued to enjoy a harmonious and productive relationship until his retirement from the US editorship – although he continued to work with us as a valued reviewer.

Shortly after I assumed the editorial role, in 1990, the journal became a fully fledged part of Oxford University Press.

Key challenges

There have been a number of significant and often controversial issues that Health Education has faced over recent years – and which have had implications for the Journal.

Two of these merit some further comment:There has also been a third issue of particular interest for the Journal: the importance of adopting a global focus for authors and readers.

• the relationship between Health Education and Health Promotion;

• the implication of Health Promotion ideology for Health Education research methodology.

The relationship with health promotion

Readers are doubtless well aware of criticisms of Health Education's so-called ‘victim-blaming tendency’. Health Education was accused - and even vilified – for adopting a narrow individualistic focus on health and its promotion. It was excessively concerned – it was argued – with adopting a medical model and using educational strategies to prevent those diseases accorded epidemiological priority at primary, secondary or tertiary levels. This critique was to a greater or lesser extent integral to the Health Promotion Movement which emerged in the 1980s with the enthusiastic support of WHO. Although there was an element of Humpty Dumpty in its definition, Health Promotion emphasized the environmental and social determinants of health and illness. Accordingly, its recommendations for action centred on creating what the Ottawa Charter described as healthy public policy and fostering political action of a more or less subversive nature. Health Education appeared to have been relegated to a marginal role.

My own view has been that Health Promotion is best viewed as a synergistic interaction between Health Education and ‘healthy public policy’. An extended discussion is, of course, beyond the scope of this editorial. I will merely assert that, not only is education a key feature of Health Promotion, it is its most important feature! Without education, it is highly unlikely that important and typically problematic policies will be implemented. Consequently, if we regard Health Promotion as the militant wing of public health, the most important contribution of Health Education should also be radical and political!

One of the strengths of education is that it has a long established ideological, philosophical and technical basis – unlike the theory and practice of policy development! In the last analysis, education is about providing the conditions necessary for efficient learning. Accordingly an educational needs assessment should be made prior to initiating action [something which may happen only rarely!]. The nature of the relevant health learning task is typically complex. It is, of course, a truism to say that education should not be only about providing knowledge but should also be concerned to provide the conditions for other kinds of learning – e.g. the development of beliefs and attitudes; the clarification of and instillation of values; the provision of skills – psycho motor and social.

Of course, we must not ignore Health Education's critically important function in contributing directly and specifically to the prevention and management of disease; patient education, for example, must be an essential feature – and has demonstrated its effectiveness over many years. However, to meet the radical imperatives associated with Health Promotion's overriding goal of achieving equity and related radical goals, the kinds of sophisticated theoretical and practical needs assessment that have characterized high quality patient education must be applied to a new radical and ‘political action’ agenda.

Ideology and research methodology

One of the most interesting developments in recent time has been the vigorous discussion, debate about the content and form of the research methodology that should be employed by Health Promotion and Education. Many have argued forcefully that there needs to be a paradigm shift from traditional, ‘positivist’ research ideology and methods. Only the briefest observations can be provided here about this important issue, however we can provide a flavour of the debate and argument integral to this major challenge for Health Promotion in general and, particularly, for the Journal. We might do this by recalling that the ‘gold standard’ of the ‘traditional school’ of evaluation research has been enshrined in the litany of the randomized controlled trial. The nature of the radical ‘theological’ challenge is conveniently provided in the following extract from the WHO European Working Group on Health Promotion Evaluation [WHO (1998)]:

Conclusion 4. The use of randomized controlled trials to evaluate health promotion initiatives is in most cases inappropriate, misleading and unnecessarily expensive. For a better understanding of the impact of health promotion initiatives, evaluators need to use a wide range of qualitative and quantitative methods that extend beyond the narrow parameters of randomized controlled trials.

In short, if we are serious about Health Education's commitment to equity and empowerment, only those research methods that involve the participation of those individuals and communities which would previously have been viewed as experimental ‘subjects’. Moreover, the research methods should not be detached and neutral but rather should actively contribute to such goals as the achievement of healthy public policy. Accordingly action research should be a major feature of the researcher's armamentarium.

The Journal will hopefully be heavily involved, in future, in critical discussion of this new paradigm research and will encourage submissions that incorporate the ideology and methodology – while, of course, still providing evidence of genuine validity – albeit in a somewhat different novel form!

Encouraging global contributions

One of our Founding Editor's fervent wishes was that the Journal would provide a global service: neither authors nor readers should be limited to UK, Europe and the USA. This has not proved to be easy – but I am pleased to say sound progress has been made.

In the early days contributions from the Americas tended to outnumber contributions from the ‘rest-of-the-world’. By way of illustration, in volume I, there were 19 contributions from the Americas and 13 from the ‘Rest-of-the-World’; when I took over editorship in 1990, Volume 5 included 34 papers from the US [and Canada] and 13 from ‘rest-of-world’.

Of course use of the term ‘rest-of-the-world’ incorporates an inappropriate hegemonic connotation [and I would recommend it is not used in future]. We should also note that the use of the term ‘Americas’ is misleading since the only papers that have had a South American origin came from collaboration between European university departments and South American public health workers [a paper on aspects of the health of Street Children of Brazil comes to mind].

Why has there been this imbalance? Several reasons. In part we must remember that the US has been a pioneer in the development of theory and research in Health Education. In part there have been language problems which advantage native English speakers. In part there have been political and cultural factors - such as the dominance of curative medicine in some cultures. And of course there has been limited university provision and funding in developing countries.

The Journal has been actively involved in addressing many of these inequalities [and inequities!]. One particularly valuable development has been the establishment of close links with the International Union of Health Promotion and Education [IUHPE] – links that have been embodied in a formal agreement which has been of mutual benefit to members of HER and IUHPE. One feature of this agreement has been the designation of HER as the official research journal of IUHPE [subsequently extended to HER's sister journal, Health Promotion International]. Oxford University Press has also made an important contribution in its provision of free access to its publications for ‘deserving’ nations. Accordingly, I would like to acknowledge the central role of Professor Maurice Mittelmark of Bergen University in this inspirational initiative. One of the important features of this collaboration has been the ‘Equity Project’, which has emphasized and contributed to addressing the difficulties experienced in certain parts of the world in submitting good quality papers to the Journal.

Clearly there will continue to be limits to equality of opportunity so long as potential contributors from developing countries lack knowledge, training and support in relation to the intricate and esoteric world of research. I would, therefore, at this point like to thank our Associate Editor, Bill Brieger [of Nigeria and Johns Hopkins!] for his unstinting support for authors from developing countries in effectively providing a tutorial and advisory service for such authors. The result has been interesting articles that would not otherwise have been published.

Although we still have a good way to go, some changes have been apparent in recent time. For example, we have noticed what possibly amounts to a sea-change in the shift of balance between contributions from US and submissions from other parts of the world. Some indication of this is provided in the most recent complete volume of HER. In this, papers from US and Canada numbered 16 while papers from other parts of the world accounted for 50.

Thanks!

I believe that Douglas Leathar would have been more than satisfied by developments in the Journal he pioneered. Submissions have increased dramatically - to the extent that Oxford University Press responded positively to our recommendation for an increase from four to six in the number of issues per volume. We have, incidentally, experienced no difficulty at all in filling these issues! – to the extent that we found ourselves with an increasing backlog of accepted papers and, at one point, a delay of some 15 months between acceptance of manuscripts and their ultimate publication. Consequently, we felt obliged to restrict the word length of new papers – which had an appropriate effect. Undoubtedly though, the introduction of the electronic Advance Access system, which diminished the significance of delays in publishing in traditional had copy form, has been dramatically effective in handling authors' impatience by ensuring that their papers reached the public after only a few weeks!

Furthermore, inspection of measures traditionally used to assess the popularity and influence of journals - such as impact factors - has been very encouraging: at a time of general expansion in the market, more people are reading, quoting and using the journal.

Finally, I offer my warm thanks to the many people who have helped me over the years - and generally eased many editorial burdens! Thanks, then to the original US associate editor, Ken Beck; to his successor Ken McLeroy [with whom I had many enlightening late night telephone conversations about journal business!]; and to Jim Sorenson with whom I had a very enjoyable and productive collaboration. Regrettably, my contacts with the current US editor, Michael Eriksen, have inevitably been limited; but Michael has been most helpful in the convoluted and somewhat daunting process of transferring various editorial responsibilities at a time of expansion and considerable technical change.

My thanks also to the ‘veteran’ John K. Davies – who has unfailingly and efficiently carried out his important role as News and Reviews Editor.

Thanks also to the many OUP staff who have helped the Journal run smoothly over 20 years – for instance ‘managers’ such as Amanda Horsfall, Jackie Fox and Claire Saxby. More particularly, I would like to express my appreciation to Sue Bell, long-standing and ever helpful, Production Editor and her equally irreplaceable, Kate Welsby. Both have been unfailingly helpful, knowledgeable and efficient.

Finally thanks must go to the many Editorial Board members over the years – and of course to reviewers. I have often placed unreasonable demands on both of these but, quite obviously, they have made a major contribution to the Journal's success.

Clearly, we are dependent on our authors – who have [usually] responded to critiques of their submissions in a most positive – and even grateful fashion! And, clearly, the Journal could not have survived without the band of committed and expert reviewers whose suggestions even the authors have admitted have resulted in superior papers. Actually, one of the pleasures of this job has been to enjoy and benefit from my interaction with Editorial Board Members, Reviewers and Authors. This ‘role set’ really has constituted a genuine research community.

Since journal readers are the ultimate arbiters of the value of a Journal – and its financial viability, we are, of course, grateful to them too!

References