Health education in textbooks of 16 countries: emphasis on biomedical and health promotion approaches

Classically, Health Education has been based on the Biomedical Model (BM) of health, where the pathologic, curative and preventive conceptions are the main pillars. The more recent approach of Health Promotion (HP) looks for identification of healthy habits and for developing personal empowerment for healthy decision-making towards environmental challenges. The aim of the present study was to compare the emphases on either model (BM or HP) given by textbooks on the topic of Health Education of 16 countries. A total of 71 primary and secondary textbooks on the topic health education were analysed. A specific constructed grid was used for the textbook analysis. Text and image analysis of all countries textbooks allocated France, Malta and Italy to the BM pole whereas other countries such as Germany, Mozambique and Finland were preferentially linked to a HP approach. 1. Background, aims and framework Classically, Health Education has been based in the Biomedical model (BM) of Health. The pathologic (Pa), Curative (Cu) and Preventive (Pr) conceptions are the main pillars of the BM, therefore Health Education has been based in the information about the diseases, how to cure them and especially how to prevent them, by means of persuasion by educators and/or by health professionals (Leininger, 1984). The idea is to make children and young people to get informed about diseases – which are often shown in horrifying images – and persuade them to avoid or change unhealthy habits to prevent such diseases. Bury (1988: 106) expresses clearly this perspective: “Health Education motivates persons to obtain information and to do something to be in good health by avoiding the harmful actions and by creating favourable habits”. In the decade of the 80s of the 20 century the notion of Health Promotion (HP) emerges with a holistic perspective of health where the person is seen as a bio-psycho-social unit in permanent interaction within him/herself and his/her environment, including the other human beings. The HP approach does not dispense the medical practice but considers that the BM is only a little part of a much larger whole where upstream causes (socio-economic, housing, nutrition) are determinant to set off persons’ illness. The dynamic relationship of the person with the environment plays a major role in the HP approach where the person needs to create his/her own resources and acquire competencies to fight constantly against disturbing environmental agents (Antonovsky, 1987; 1993). In this view of Health Promotion, Health Education is seen as a life-long process, since birth until death, that helps persons to make informed choices towards healthy habits (Jones & Naidoo, 1997; Katz & Peberdy, 1998; Ewles & Simnett, 1999). In this context HP looks for: identification of Healthy (He) habits, develop personal and social empowerment (Ep) for healthy decision-making towards environmental (Ev) challenges. ∗ In Katz & Peberdy (1998) The aim of the present study was to compare the emphases on either model (Biomedical model or Health Promotion) given by primary and secondary textbooks on the topic of Health Education in 14 countries.