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Asia-Pacific Journal of Health, Sport

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Critical health literacy: shifting

textualsocial practices in the health
classroom
Kerry Renwick

College of Education, Victoria University, Melbourne, Australia

Published online: 17 Sep 2014.

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To cite this article: Kerry Renwick (2014) Critical health literacy: shifting textualsocial practices
in the health classroom, Asia-Pacific Journal of Health, Sport and Physical Education, 5:3, 201-216,
DOI: 10.1080/18377122.2014.940808
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Asia-Pacific Journal of Health, Sport and Physical Education, 2014

Vol. 5, No. 3, 201216, http://dx.doi.org/10.1080/18377122.2014.940808

Critical health literacy: shifting textualsocial practices in the health

classroom
Kerry Renwick*

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College of Education, Victoria University, Melbourne, Australia

This paper will consider ways in which students are constructed as aliens in health
classrooms. Creating the classroom as a setting for health promotion requires
closer attention to those who make use of such space. If classrooms are places
where diversity exists and is recognised, then health educators are challenged to
consider how students are positioned. Too often, students have been positioned as
the other and therefore subjected to accommodation and assimilation to
dominant discourses of health. In what ways do students as aliens in the
classroom get the opportunity to develop health literacy as a way to speak for, to
or from their other/own space? Developing critical health literacy can help
inform classroom practice in new, engaging directions. This leads, as this paper
argues, to health education praxis combining reflection and action for
transformative purposes, for both teachers and students. Praxis offers both a
philosophical starting point and a set of practical guidelines for how health
teachers view and work with the aliens inhabiting the classroom.
Keywords: critical health literacy; praxis

Introduction
The development of Health and Physical Education (HPE) within the new
Australian National Curriculum introduces health literacy as one of five underpinning propositions (ACARA, 2012). The recognition of health literacy as a resource
for health is derived from a range of health promotion literature including the
Jakarta Declaration (World Health Organisation [WHO] 1997) that argues for
participation and engagement in activity that supports health. This is not about
preventing or managing disease per se or targeted behaviour change interventions;
rather it is about people taking action in their communities in ways that offers
hopeful possibilities for a more just society where everyones health is valued
(Marmot, 2011).
However, such recognition poses a challenge to educators, since HPE classrooms
have traditionally not been a site for discussing meanings of health, or this new term
health literacy. There is reference to Nutbeams model of health literacy that is
informed by the framing of health literacy as an asset that can be built through
patient education (Nutbeam, 2008, p. 2077). The focus is still on the management of
communication between health care providers and the patient while navigating the
health system. Thus, the development of health literacy has value for treatment
*Email: Kerry.Renwick@vu.edu.au
2014 Australian Council for Health, Physical Education and Recreation

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K. Renwick

(secondary level) or maintenance (tertiary level) health promotion. However, the

focus of health promotion and education in schools is for prevention (or primary
level), and thus, the development of health literacy is both a different focus and
outcome.
In this paper, I marshal resources to develop an approach to understanding
literacy and health literacy in ways that complement pedagogical practices and
proactive versions of health education. My argument rests in part on the notion that,
without a broad and critical view of literacy, it is not possible to develop an
educationally defensible broad view of health and health promotion in schools.
These arguments are particularly important to those groups in a society for whom illhealth may well be a major marker of marginalisation, often associated with poverty,
regionality, indigeneity and gender, among other dimensions of identity.
The paper proceeds from wider discussion of approaches to health promotion
and suggests implications for school health literacy. Different debates about literacy
are then explored, in order to facilitate engagement with a proactive and important
capability of navigating a healthy life. Greens (1999) three dimensions of literacy are
presented as a framework for a more transformative health literacy, which includes
critical, cultural and operational dimensions of literacy, in a rich and critical health
literacy. The paper concludes with a discussion of praxis: the processes of bringing
together theory and practice in critical health literacies for the school classroom.
Primary health promotion taking it to school
The development of health promotion has been encapsulated within the Ottawa
Charter (1986); it aligns with Antonovskys (1996) consideration of what actually
creates health. His salutogenic view of health focuses on developing health from
any position on a health-ease/dis-ease continuum, to emphasise those features that
are useful, constructive and productive for health. That is, looking to salutary factors
rather than risk factors (Antonovsky, 1996). The approach enabled a shift in
paradigm from individualistic understandings of lifestyle and behaviour change or
mere treatment of symptoms to deliberation about the determinants of heath and
attention to health actions within particular contexts and meaning. Health, as an
outcome of living, is thus not the result of chance (Eriksson and Lindstrm, 2008)
but the interaction between people and their social and natural environment. This
positioning of health requires an emphasis in education as health promotion rather
than disease control, with a value set of equity, empowerment and participation
(WHO, 1986) and invites practice based on reflection and action for transformative
purposes and growth as human beings (Freire, 1972).
In Australia, health promotion organisations make substantial reference to
epidemiology and are therefore predicated on improving population health outcomes
by targeting chronic disease by focusing on particular biological markers (Marmot
and Wilkinson, 2005). As a result we know that long-term smokers are at a higher
risk of developing cancer, lung disease and heart disease compared to those who
smoke less or those who dont smoke at all (QUIT, 2014). However, there is also a
social gradient of health (Marmot, 2003) that shows how some population groups
are more likely to experience ill-health and chronic disease compared to others.
Poverty in every form or manifestation shows negative effect for health, and
therefore, those living in low socio-economic circumstances experience illness and

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disease disproportionately to the wealthy. Ill-health becomes increasingly evident at

every step down the social hierarchy (Marmot and Wilkinson, 2005, p. 21), but it is
not a gradual decline from the highest to the lowest socio-economic circumstances.
Rather there is a substantial difference between the health of those in high compared
to middle socio-economic circumstances so that the middle has more in common
with the lowest socio-economic circumstances. Health promotion and education
approaches that use an epidemiological orientation and biological explanation are
simply not adequate to clarify why some population groups within the same nation
state have shortened lives.
The provision of health promotion and education in schools is a contested space.
Within a biomedical perspective, the considerations are about improving health via
reducing disease and infirmity (Becker, Glascoff, & Felts, 2010), and while there is
considerable effort to shift from this model, the dichotomy between health and
disease prevails and the social basis of health is largely ignored and underdeveloped
(Eriksson and Lindstrm, 2008). For health promotion to embody the values of
equity, participation and empowerment, work for social justice (WHO, 1986, 2009)
requires promotion of health (Antonovsky, 1996). More attention to social
perspectives of health (Antonovsky, 1996; Eriksson and Lindstrm, 2008) and
thinking about the causes and precursors to physical, mental, and social well-being
(Becker et al., 2010, p. 32) is warranted especially for healthy young people and in
schools as a context for education.
There is need for a quite different approach to locating responsibility for health
as a private and individual act. Schools, particularly primary schools, are located in
neighbourhoods or regions where people have little choice over the conditions that
contribute to determining levels of health in terms of both quality and length of life.
Australian indigenous people, for example, the majority of whom do live in cities,
have life expectancy of at least 10 years less than other Australians, at 2.5% of the
population (Australian Bureau of Statistics, 2012). People with low access to income
usually have restricted access to other forms of healthy infrastructure in their lives
including adequate transportation and housing, access to healthier foods and
resources for leisure and exercise and reliable and sufficient income. Neither of
these examples can be adequately explained as a biological predisposition, or as
Marmot (2011) posits, linking neighbourhood deprivation to disability-free life
expectancy could all be due to a remarkable ability of people to choose places to live
depending on their level of health ill health leads to neighbourhood income
(p. 291).
So what might health education look like if it is positioned to maximise health
and well-being and limit, perhaps even prevent, the onset of illness and disease?
Within this primary level of health promotion, the focus on settings or particular
contexts highlights how personal and social resources can be marshalled towards
maximising health. This, according to Eriksson and Lindstrm (2008), is a
humanistic approach that needs to pay attention to human rights. To engage in
such health promotion requires the development of a particular way of viewing the
work and having skills not only to think about that positioning but also to be able to
act what Freire (1972) calls conscientisation. This will be discussed in detail in the
later section on Praxis, but at this point I want to explore schools as sites for primary
health promotion and their inherent potential for this to be enacted within the

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K. Renwick

context of schools, with young people together with recognition for current and
mitigating factors.
There are times when schooling connects too well with the lives of students.
When health education has a biomedical orientation, there is a focus on what is
missing or deficient in the person or their environment resulting in risk
management programs and behaviour change as an outcome (Deschesnes, Martin, &
Hill, 2003). This orientation can reinforce students understandings about why
illness develops in a physical sense but without any or very limited understandings of
how illness is experienced in inequitable ways. When students have no agency or
possibility to change illness-causing circumstances, when they perceive no opportunity for hope, then why would students take up the prescribed actions
promulgated in behaviour change interventions? (Sleeter, Torres, & Peggy Laughlin,
2004).
What if having heart disease or lung cancer is just part of the way that it is in
the lived world of these young people? And while health is important, it isnt because
it is a tool of trade of human capital and a signifier of productivity. As Marmot
(2011) asks, why do we not consider how social circumstances determine a persons
health? In describing the purpose of schooling, Breunig (2005, p. 112) argues that
Schools provide the norms and principles of conduct that are learned through
students varied experiences in schools and in the larger society and thus they filter
and sort students. Equally, how might health education classrooms reinforce how
social health inequities are perceived as inevitable, especially when the health
messages and learning are most closely aligned to those higher on the social health
gradient and provide limited or no possibilities for transformative action for those
lower on the social health gradient?
The alien-nation in the classroom
According to Freire (1970, 1972, 2008), education should provide students with the
capacity to have a critical understanding of their own reality and engagement in
transformative action. Critical understanding focuses on how social order is both
created and imposed with the result being differential access to socio-economic
resources and opportunities. Having uncovered or what Freire (1972) referred to as
decoding the social order and circumstance, individuals (in this case students) focus
on questioning why they or others experience oppressive conditions and to act to
stop and transform, creating opportunities for liberation (Sleeter et al., 2004).
Classrooms that provide possibility for transformative action require quite
different texts and an expanded teacher knowledge base. Most traditional health
education, including public health, has been single-issue focused (e.g. sun-smart,
dental health, safe sex, skip rope for heart), focused on major disease risk categories
(e.g. heart health, cancer, drug and alcohol education) or fitness and engagement in
sport. This is biomedical health education that is largely focused on bodies derived
from a view of a biological machine. Thus, the prevailing use of schooling as a
change agent for population health is based on a nineteenth-century machine image
of bodies actively pushing and pulling as seen through various health behaviours.
Teachers focus on specific health concerns that are either derived from their own
health-ease/dis-ease continuum or what they perceive as that which their students
need to know because of the students particular stage of life or because of a critical

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incident. Green and Bigum (1993) have considered a differential between teachers
and students that they describe as a form of alienation and challenge the perceived
usefulness of what is covered in classroom. They argue that changing social contexts
that are increasingly life-stage differentiated make it difficult in the classroom to find
shared spaces for learning. Students are increasingly being positioned as the other
since it is who teachers are the adults in the space.
There are three elements that Green and Bigum (1993) identify that elucidate
how students are cast as an alien nation. These elements inform how health
promotion and education is positioned from an adult and risk management
perspective. Firstly, there is a locus of moral panic about young people and their
perceived deficiencies. Young people are seen as not yet being complete or adequate
(in adult terms), and therefore, there is a sense of pathology and apocalypse
expressed through a sense of excess, that is obesity, drug taking, binge drinking, and
disenfranchisement. Second, there is an obvious tension between youth culture as
global and future orientated versus the gerontocratic cultures of the West. It is here
that epidemiology and risk management are positioned so that in health promotion
and education the focus is on the risk of developing preventable diseases, risk factors
and risk behaviours that are clustered as complex patterns of behaviour and called
lifestyle. And thirdly, the development of media culture, computerisation and
techno-cultures are inevitability creating experiences that adults are less likely to be
able to claim as a shared experience. There is an underwriting of global media
culture by military as evidenced by first shooter computer games and financing of
war/conflict films for a particular perspective or propaganda even if it means
rewriting history (Der Derian, 2009; Nieborg, 2010). And there is a predominance of
messages being distorted from context as evidenced by the use of short news grabs or
the Internet where there is sharing of local stories globally but without the backstory
or circumstance (Davies, 2011). These elements offer interesting options for critical
health literacy; however, there are current circumstances that limit or prevent any
possibilities for critical pedagogy that are more likely to ignore local experience and
cast students as the other in the health classroom.
Descriptions of how schools reproduce social relations (Ball, 2006; Bourdieu and
Passeron, 1977; Freire, 1985; McLaren, 1998) is important in limiting possibilities for
a life well lived. Narratives of how students are sorted and sifted in deterministic
ways as they pass through a schooling (rather than an educative) process have also
existed for some time (Apple, 2013; Connell, Ashenden, Kessler, & Dowsett, 1982;
Willis, 1997). The relatively new but significant shift to high-stakes testing is making
the league table of schooling for success more explicit (Au, 2007; Hursh, 2005) and
highlights the need for more rather than less critical pedagogy in the classroom.
Thompson (2002) describes how alienated students have teachers who try to
motivate them, to engage with a curriculum that is geared towards high-stakes
testing, with a reward of future employment and job security. One issue is that for an
increasing number of students, their lived experience suggests that the curriculum for
testing reinforces what they cannot do and getting any job will be increasingly
unlikely. According to Hooley (2008): Under current economic arrangements,
schools merely reproduce the relations of power and privilege, the advantages and
disadvantages that exist, in spite of the efforts of many progressive educators to
change to more equitable systems for all children (p. 39). As already discussed,
social circumstances determine an inequitable experience of health so if health

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K. Renwick

promotion and education in schools is to avoid compounding and reinforcing why

particular groups will continue to experience particular chronic and preventable
disease, it needs to be enacted both intellectually and purposefully.

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Health literacy as a developing term

Health literacy is a term used commonly in national and international health policy.
It is a term that is not yet well understood, even in policy circles (Nutbeam, 2000),
and there is an apparent failure in health promotion and education to grasp the
potential for political action, both undermining the potential of public health
campaigns and health promotion more generally. WHO defined health as being a
state of complete physical, social and mental well-being, and not merely the absence
of disease or infirmity and was provided in the WHOs constitution as long ago in
1948. Further, Nutbeam (1998) describes health as a resource for everyday life, not
the object of living. It is a positive concept emphasising social and personal resources
as well as physical capabilities (p. 351). Health promotion draws on the interplay
between reflection and action to work towards something better. The challenge for
health education in schools is how the reading of health texts works with or against
young peoples aspirations.
Health literacy literature increasingly focuses on its value as a personal skill.
Health professionals working with patients in the treatment and management of
illness and disease are also becoming aware of the impact of health literacy on the
efficacy of care. Particular consideration is on how health literacy influences
compliance with health-prescribed regimes and how patients are able to navigate
the health care system. Speros (2005) contends that health literacy is perceived as a
stronger predictor of health status compared to socio-economic status, age and
ethnic background. Nevertheless, as Marmot (2011) warns us, if we are to make
inferences about causation, then we need to be aware of reverse causation that is,
health status is a predictor of socio-economic status, age and ethnic background.
And therefore might it be possible to argue that a persons engagement in health
literacy might also be a predictor of socio-economic status, age and ethnic
background?
Health literacy is not immune from the simplistic interpretation of functionality
and much of what has been written about health literacy is positioned as reading
pamphlets and medical instructions (Renwick, 2013a; Ryan, Rossi, Lisa, Macdonald, & McCuaig, 2012). There is an assumption that the ability to read health texts
facilitates treatment and maintenance of illness and disease. But what might health
literacy look like if it is oriented towards prevention of ill-ease and maintenance of
health? What if it is seen as a personal and community skill for how it can facilitate
democratic engagement (Renwick, 2013a)?
There is a focus on literacy that is about its multimodality, where writtenlinguistic codes are co-presented with visual, audio and spatial modes to create texts
with meaning across a wide range of communications (Kalantasis and Cope, 2008).
Cope and Kalantzis (2009) argue that this is a growing phenomenon where the
making of meaning is increasingly one of negotiating different discourses, often
simultaneously. Following this logic, health literacy as a specific content of text, is
inevitably multimodal.

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Critical health literacy

In writing about critical literacy, Mulcahy (2008) argues that it is not a repertoire of
teaching skills and strategies per se, rather an ontological positioning that talks
about the lived world in particular ways (Kincheloe, 2003). Beavis and Green (2012,
p. 192) argue that critical literacy is a reflective practice, (that) deepens insights,
develops an orientation towards questioning and evaluation, and increases understanding and power, or capacity. Critical pedagogy is used for literacy to develop
and explicitly explore the connections between language, knowledge, power and
ideology and to recognise the existence of inequities and injustices with the intent to
seek transformative action for social justice (Mulcahy, 2008). This parallels with the
definition of health literacy as the cognitive and social skills which determine the
motivation and ability of individuals to gain access to, understand and use
information in ways which promote and maintain good health provided by the
WHO (2009, n.p.). Health literacy is therefore not simply a matter of reading
medical literature to change behaviour, rather it promulgates the development and
exercising of those skills that enable participation in society and control over daily
occurrences, especially those that influence health (Nutbeam, 2000, 2008, 2009;
Kickbusch, 2001, 2009). This provides an important orientation for health literacy in
schools with young people who are, by and large, not ill and therefore the focus of
health literacy needs to be on the generation of health in sociocultural contexts
(Ryan et al., 2012).
Critical health literacy classrooms use pedagogical approaches that have selfreflection at the core (Wallowitz, 2008). Teachers are self-reflecting about their own
contextual practices; they work with their students to interrogate texts in ways that
elicit active responses (Giroux, 2011) that are meaningful in their everyday lives and
that challenge imposed perceptions about the universality of the lived experience
(Park, 2012). Engaging in critical health literacies within their classrooms, teachers
provide opportunity for students to grapple with their understandings about social
justice and equity as prerequisites for health (WHO, 1986). The focus of the classroom
is about working together to acknowledge power differentials and exploring how
health knowledge is subjective, malleable and contestable (Renwick, 2013b, p. 8).
This then starts to look like what Kemmis (2012) calls educational praxis that
there is deliberate positioning and action to educate to live well while also striving to
have a world that is worth living in. There is no more important a time to define the
work of both teachers and students given the impact of globalisation, colonisation
and standardisation that is occurring (Wallowitz, 2008). Being able to recognise how
ideology pervades social life and that knowledge is contextual is a fundamental
premise for health literacy. Considerations about how shared action between
teachers, students and the wider community builds capacity for developing both
personal skills and community action produces new understandings and practices
that benefit more and most rather than a privileged few (Arnold, Edwards, Hooley,
& Williams, 2012). Exploration of how health knowledge is created and generated,
its purposes for individuals in specific cultural contexts and life experience together
with understandings about the variety of health text (Ryan et al., 2012) all contribute
to critical knowings to achieving health.
As Eriksson and Lindstrm (2008) argue, the salutogenic view of health draws on
what people can do to create potential and capacity, to build health for a life well

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lived. Seeking understanding about how personal experiences and school knowledge
can be connected is important work in health promotion and education that is
genuine in its goal of engaging youth people in meaningful learning and working for
social justice. How might, therefore, students and teachers engage in learning about
health that draws on both practice and theory within context of the students
sociocultural and environmental experiences? What are the possibilities for engaging
in reflection, action to facilitate transformation, what Freire (1972) called praxis?
And how are we as educators to do what Hooley (2008) challenges us to consider
about giving young people opportunity to explore (health) knowledge and to become
serious epistemologists in their own right (p. 46).
Rethinking textual practices
One way to think about developing critical health literacy skills is to consider the
shared work of teachers and students in the process. Mulcahy (2008) contends that
teachers need to provide opportunity in classes to study a range of health texts; to
give students opportunity to examine these texts against their lived experience; and
then to consider how to construct and reconstruct health and well-being in their
family and community contexts. This application of criticality to health texts elicits
response that are active and have meaning (Park, 2012) developing from teachers
and students working together to use and give educational value to the expertise that
students have developed within their cultural context outside the school and that
they bring into the classroom (Morrell, 2012). As an example of this, Greens (1999,
2012) three-dimensional model facilitates work in three dimensions of literacy
operational, cultural and critical. Each dimension has a particular focus for literacy
work to be undertaken; however, they are interrelated and mutually germane rather
than being separate or isolated considerations.
Using Greens three-dimensional model to develop critical health literacies
becomes shared work in the classroom as health texts are interrogated for a range
of meanings. Health texts contain specific information that the writer wants to
convey. Thus, the reader engages in operational literacy as they scan the text to
determine the plain facts including who the writer was, what information is being
conveyed and why it is important to know. Texts can be considered for what
meaning they can convey in context, so readers make connection between the
message and how it may inform understanding about their daily life as cultural
literacy. The last way to interrogate texts is through critical literacy. In this
dimension, the thinking focuses on whose message is contained within the texts
and whose is missing, together with why the texts are presented the way they are and
which particular meaning is being conveyed. Table 1 provides some examples to
demonstrate what each of the dimensions might look like reading health texts
generally and food texts specifically.
When experiencing texts there are, according to Harris (1993), one of three
possible responses: (1) ignore it, remain alienated from the text and risk being
(self) labelled as illiterate; (2) accept what is being conveyed by developing enough
literacy to be able to read and understand the text at a pragmatic level or (3) take
up the challenge, engage with the discourse and thus be critically literate. We take
this into the classroom and consider reading (health) texts such as dietary advice as
eat a variety of foods from the student perspective then the following might apply.

Asia-Pacific Journal of Health, Sport and Physical Education

Table 1.

3D health literacy (based on Green, 1999; Thoman & Jolls, 2004; Renwick, 2013b).

Literacy

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Operational
Turning it on
Knowing what to do to
make it work

Cultural
Using it to do
something meaningful
and effective

Critical
Recognising social
practices and their
meaning systems are
partial and
selective
shaped by power
relations

.
.

209

Health focus

Food focus

Who created this?

Why was it created/developed?
How can it be used/utilised?
What resources are needed and
who has them?

Are a variety of foods available?

How can food life be extended
through storage and
preservation techniques?
Where does our food
come from?

What is it about this that has

meaning and/or interest for me?
How do I understand this and
how might others?

What foods do we eat at home?

Are they reflective of a
particular cuisine or family
tradition?
What informs the purchasing of
bought food? For example,
brand loyalty; where the food is
sourced from marketed or
seasonality?
What particular foods might be
grown or processed within
the home?

What/whose values, lifestyles

and points of view are
represented and/or omitted
from this?
What could be done differently
to benefit/enable the least
advantaged?

Do ethics inform our concerns

about the production of food
and therefore our choices?
How do our food purchasing
choices impact on Australian
food producers?

Some students might (1) not engage with the advice because they want to ignore it,
because it does not include their favourite foods or those of their friends; (2) they
recognise what a variety of food looks like but these are not available to them and
their families or (3) students develop understandings about why a variety of foods
are necessary and what this variety includes and then explore how achievable this
variety is in context of their family and community and what actions they are able to
take. It is this third possibility where students draw on their experiences of life lived
outside the classroom and newer knowledge gained from within the classroom,
together with the interplay between theory, informing practice and informing theory.
It is helpful of the Australian National Curriculum to refer to health literacy,
even if it is not yet well developed, as it places a key issue on the education agenda at
a time of health scares, such as the childhood obesity crisis (Campos, Saguy,
Ernsberger, Oliver, & Gaesser, 2006; Kirk, 2006; Moffat, 2010). Where some
research suggests that the current rhetoric about an obesity-driven health crisis is
being driven more by cultural and political factors than by any threat increasing
body weight may pose to public health (Compos, Saguy, Ernsberger., Oliver, &

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Gaesser, 2006, p. 55). Within the context of the National Curriculum for Health and
Physical Education health literacy is defined as (t)he ability to selectively access and
critically analyse information, navigate community services and resources, and take
action to promote personal health and the health of others (ACARA, 2012, p. 30).
So in Australian classrooms, obesity texts, for example, are interrogated using this
version of health literacy to access available data on obesity rates, to determine why
claims of an obesity epidemic are being made, by whom and for what purpose or
benefit. Additional considerations are then made as to the relevance of these health
texts for those within the particular classroom and for their community with
opportunity for subsequent and relevant action.
The roles of who is the teacher and who is the student can become blurred as the
classroom experiences that arise out of discussion and exploration of health texts can
cast anyone into these classroom roles. It is ultimately dependent on who brings
relevant experience and understanding to bear. For example, in any exploration of
what informs the purchasing of food, students are in the privileged position of
being able to describe what their families do according to the resources that exist
within their communities. This cultural literacy provides students with the opportunity to lead any discussion, since it draws on those experiences and learning they
have gained from interactions with family, friends and their wider community, that is
contained within what Thompson (2002) calls their virtual school bag. The virtual
school bag is the collection of the things they have already learned at home, with
their friends, and in and from the world in which they live (Thompson, 2002, p. 1)
and that in an era of high-stakes schooling, the experiences and needs of young
people are too often and increasingly not the standard or normal life of those in
power determining the curriculum (Kincheloe, 2008).
Through critical literacy, students have opportunity to explore their epistemological positioning, that is, their views on the nature of knowledge and learning
(Schommer-Aikins, Mau, Brookhart, & Hutter, 2000). Critical health literacy
therefore positions students to see how health knowledge/information changes, is
context dependent and where engaging in critical health literacy also facilitates
praxis because there is opportunity for students to both reflect and act for
transformation (Freire, 1970). Developing skills to decode texts and to explore their
meaning within the context of their life world, students are able to read the word and
world. This can also mean that students also have to consider how they locate
themselves in the classroom, to consider their own subjectivity in the classroom and
therefore the assumptions that they hold about teaching and learning (Breunig,
2005). Participation in praxis means that students get to challenge their taken-forgranted positions to effect change because they get to expose something that
appears to be a natural law as, in fact, constructed and therefore changeable (Davis
and Harrison, 2013, p. 14).
Praxis
According to Reckwitz (2002), praxis describes the whole of human action and is an
absolute term to describe reflection and action upon the world in order to transform
it (Freire, 1970, p. 33). Hooley (2008) argues that praxis exists at the individual and
social level, such as within classrooms, as discovery and change enables learning for
everyone. The process of becoming aware of how our perception of reality is both

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constructed and influenced represents Freires (1972) conscientisation and is an

important step to becoming human. This pursuit requires us to engage with critical
thinking about not only why things are but also to act to make them better. And
while this ontological engagement helps us to think about what exists in the world
and what could be, Blackburn (2000) reminds us that this is not a purely intellectual
process, rather it is dynamic in that conscientisation leads to action based on
reflection, provoking further reflection based on action.
Teachers are too often caught up in delivering mandated content within the
curriculum and teaching to the test at the expense of the student experience and
potential for alienation. Giroux (2010) has argued that when the classroom
experience focuses on the corporatisation of the curriculum and high-stakes testing
as legitimate assessment, the result is a technocratic, bureaucratic education
(Winchell & Kress, 2013). Classroom experiences are increasingly connected to the
lived experience of young people and their teachers in the development and
proliferation of consumerism and economic activity. Educational intent therefore
requires that any engagement in praxis opens us to the variety of experiences of life
diverse, complex, and rife with tension (Winchell & Kress, 2013, p. 154), and as
shared experience between teachers and students, is co-created.
Kincheloe contends that (a)ll descriptions of pedagogy like knowledge in
general are shaped by those who devise them and the values they hold (2003, pp.
56). Hence, it is not particularly difficult to predict (in the Australian context) what
the National Heart Foundation, the Anti-Cancer Council and Diabetes Australia are
concerned about. Considerable effort is put into the development of programs and
resource materials for schools that is about preventing their development in
Australians by educating young people or mitigating onset. The dilemma is that
epidemiological risk does not automatically equate to development of that disease.
So the focus of health education in schools on the pathology of specific lifestyle
diseases is problematic with young people who are under 20 years of age and may
never develop a particular illness or who are prepared to risk the probability of a
disease presenting in 2040 years time.
However, what young people are more likely to develop are understandings
about the ways in which the health system assumes that particular diseases and
illness will develop and therefore what it requires of individuals to manage
themselves. The challenge is that social inequities in health are actually the
consequence of our set of social and economic arrangements (Marmot, 2011) and
that these are not readily amenable to behaviour change interventions. Green and
Bigums (1993) concern for the creation of the alien nation within classrooms can be
used to invite critical health literacy as a means for primary health promotion in
schools. This requires acknowledging what experiences students bring into the
classroom as a means to rethink health education for what it can offer and do, in
meaningful ways that draw on students lived experiences and offer insight into lives
that can be well lived. If, as Burbules and Berk (1999) argue, that the greatest single
barrier against the prospect of liberation is ingrained, fatalistic belief in the
inevitability and necessity of an unjust status quo (p. 51), then what are teachers
to make of their work if is to develop hopeful possibilities for health in a more just
society?
Students who reside in communities with unequal health require more from their
education than reinforcement of the status quo and their consignment to future

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K. Renwick

ill-ease. Within the current sociocultural context of hyperconsumerism and corporatisation and the associated concern for loss, or at least reduction in democratic
principles, McKenzie and Scheurich (2004) remind us that it is too easy to forget that
schools have long been sites for crises of democracy and equity in society and
therefore schools as social institutions become sites for contention about the enacting
of ideology.
We are reminded of Freires position that to be fully human is not possible,
rather life is what Blackburn (2000) describes as an ongoing encounter with reality,
which is itself permanently changing (p. 5). Thus, praxis is an incomplete, lifelong
body of work that is worthy of engaging with and in. This requires teachers of health
to look to what is offered in the classroom to reconsider how it might be enacted
differently, with their students and for the intent of transformation. The challenge
here is that teachers do not necessarily perceive themselves as cultural workers
(Freire, 2008) and, in an era of high-stakes schooling, their work is increasingly
under scrutiny and constraint and increasingly difficult to do. Teachers can be
complicit in the making of passive or rebellious students (Thompson, 2002) as they
are less likely to be able to articulate not only what they are for or against but also
whom (Freire, 2008). Critical health literacy informs health education praxis
combining reflection and action for transformative purposes, for both teachers and
students. Praxis is therefore considered and valued for the ways in which it is
transformative about how health teachers view and work with their students rather
than as aliens inhabiting the classroom.
The HPE subject area of the Australian National Curriculum argues for building
capacity for health promotion where students develop the skills, self-efficacy and
dispositions to advocate for and positively impact their own and others well-being
(ACARA, 2012, p. 2). This echoes two of the principles articulated in the Ottawa
Charter for Health (WHO, 1986), specifically to develop personal skills and
strengthen community action. It is here that critical health literacy as an underpinning capability of the HPE curriculum facilitates an interactive dialogue between
action being informed by research and research informed by action, described by
Freire (2008) as an education that critically provokes the learners consciousness
(p. 209). This paper has provided insights through the concept of critical health
literacy as to what this can look like in practice.
Conclusions
Learning to read about the treatment and management of particular diseases is not
necessarily relevant for young people. Developing critical health literacy at the
primary level of health promotion (i.e. in classrooms) is a more sound strategy;
however, this requires a different approach that empowers young people to be able
to engage in transformative action both as individuals and as community members.
Praxis in critical health literacy asks us to link two theoretical domains of literacy
and health, as discussed earlier in this paper, with changing the practices of health
education in schools. If teachers avoid the theoretical challenges of both domains
and two extra domains is a big ask for any busy teacher in this era of risk aversion
and performativity (Ball, 2009) then they will remain ill-equipped to take up the
challenges of the national curriculum and their practices are likely to sustain narrow
forms of health illiteracy. Students must be empowered to act themselves to develop

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a critical capacity to navigate their own health and that of their families and
communities.

Notes on contributor

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Kerry Renwick is a lecturer in health education in the College of Education at Victoria

University, Australia. Her research is focused on critical pedagogies, in particular the
relationship between social justice, health education and health promotion. Kerrys teaching
focuses on supporting preservice teachers to evolve their professional development through
praxis.

References
ACARA. (2012). The shape of the Australian curriculum. Health and Physical Education.
August 2012. Retrieved from http://www.acara.edu.au/verve/_resources/Shape_of_the_Aus
tralian_Curriculum_Health_and_Physical_Education.pdf
Antonovsky, A. (1996). The salutogenic model as a theory to guide health promotion. Health
Promotion International, 11, 1118. doi:10.1093/heapro/11.1.11
Apple, M. (2013). Education and power (2nd ed.). New York, NY: Routledge Farmer.
Arnold, J., Edwards, T., Hooley, N. & Williams, J. (2012). Conceptualising teacher education
and research as critical praxis. Critical Studies in Education, 53, 281295. doi:10.1080/
17508487.2012.703140
Au, W. (2007). High-stakes testing and curricular control: A qualitative metasynthesis.
Educational Researcher, 36, 258267. doi:10.3102/0013189X07306523
Australian Bureau of Statistics. (2012). Year book Australia. Retrieved from http://www.abs.
gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/1301.02012Main%20FeaturesAborigin
al%20and%20Torres%20Strait%20Islander%20population50
Ball, S. (2006). Education policy and social class: The selected works of Stephen J Ball.
Abingdon. Routledge.
Ball, S. J. (2009). Privatising education, privatising education policy, privatising educational
research: Network governance and the competition state. Journal of Education Policy, 24
(1), 8399.
Beavis, C., & Green, B. (2012). Conclusion. In B. Green & C. Beavis (Eds.), Literacy in 3D:
An integrated perspective in theory and practice (pp. 188197). Camberwell, Victoria: ACER
Press. Chapter 12.
Becker, C. M., Glascoff, M. A., & Felts, W. M. (2010). Salutogenesis 30 years later: Where do
we go from here? International Electronic Journal of Health Education, 13, 2532.
Blackburn, J. (2000). Understanding Paulo Freire: Reflections on the origins, concepts, and
possible pitfalls of his educational approach. Community Development Journal, 35, 315.
doi:10.1093/cdj/35.1.3
Bourdieu, P., & Passeron, J. (1977). Reproduction in education, society and culture. Beverly
Hills, CA: Sage.
Breunig, M. (2005). Turning experiential education and critical pedagogy theory into praxis.
Journal of Experiential Education, 28, 106122. doi:10.1177/105382590502800205
Burbules, N. C., & Berk, R. (1999). Critical thinking and critical pedagogy: Relations, differences
and limits. In T. Popkewitz & L. Fendler (Eds.), Critical theories in education: Changing
terrains of knowledge and politics (pp. 4566). New York, NY: Routledge. Chapter 3.
Campos, P., Saguy, A., Ernsberger, P., Oliver, E., & Gaesser, G. (2006). The epidemiology of
overweight and obesity: Public health crisis or moral panic? International Journal of
Epidemiology, 35, 5560. doi:10.1093/ije/dyi254
Connell, R. W., Ashenden, D., Kessler, S., & Dowsett, G. W. (1982). Making the difference:
Schools, families, and social division. Sydney: Allen & Unwin.
Cope, B., & Kalantzis, M. (2009). Multiliteracies: New literacies, new learning. Pedagogies:
An International Journal, 4, 164195. doi:10.1080/15544800903076044
Davies, N. (2011). Flat Earth news: An award-winning reporter exposes falsehood, distortion
and propaganda in the global media. London: Random House.

Downloaded by [The University of British Columbia] at 12:25 29 January 2015

214

K. Renwick

Davis, T., & Harrison, L. M. (2013). Advancing social justice: Tools, pedagogies, and strategies
to transform your campus. San Francisco, CA: Jossey-Bass.
Der Derian, J. 2009. Virtuous war: Mapping the military-industrial-media-entertainmentnetwork (2nd ed.). New York, NY: Routledge.
Deschesnes, M., Martin, C., & Hill, A.J. (2003). Comprehensive approaches to school health
promotion: How to achieve broader implementation? Health Promotion International, 18,
387396. doi:10.1093/heapro/dag410
Eriksson, M., & Lindstrm, B. (2008). A salutogenic interpretation of the Ottawa charter.
Health Promotion International, 23, 190199. doi:10.1093/heapro/dan014
Freire, P. (1970). Pedagogy of the oppressed. New York, NY: Herder and Herder.
Freire, P. (1972). Cultural action for freedom. Ringwood, Victoria: Penguin.
Freire, P. (1985). The politics of education: Culture, power and liberation. South Hadley, MA:
Bergin and Garvey.
Freire, P. (2008). Teachers as cultural workers: Letters to those who dare to teach. In
M. Cochran-Smith, S. Feiman-Nemser, D. J. McIntyre, & K. E. Demers (Eds.), Handbook
of research on teacher education: Enduring questions in changing contexts (pp. 208213).
New York, NY: Simon & Schuster Macmillan.
Giroux, H. A. (2010). Rethinking education as the practice of freedom: Paulo Freire and the
promise of critical pedagogy. Policy Futures in Education, 8, 715721. doi:10.2304/pfie.
2010.8.6.715
Giroux, H. A. (2011). On critical pedagogy. New York, NY: Continuum International
Group.
Green, B. (1999). The new literacy challenge? Literacy Learning: Secondary Thoughts, 7,
3646.
Green, B. (2012). Subject- specific literacy and school learning: A revised account. In B. Green
& C. Beavis (Eds.), Literacy in 3D: An integrated perspective in theory and practice
(pp. 221). Camberwell, Victoria: ACER Press. Chapter 1.
Green, B., & Bigum, C. (1993). Aliens in the classroom. Australian Journal of Education, 37,
119141. doi:10.1177/000494419303700202
Harris, N. (1993). Critical literacy as political intervention: Three variations on a theme. In
C. Lankshear & P. McLaren (Eds.), Critical literacy: Politics, praxis, and the postmodern
(pp. 5780). SUNY Press. Chapter 1.
Hooley, N. (2008). Teacher education as democratic public sphere. The Australian Educational
Researcher, 35, 3751. doi:10.1007/BF03246288
Hursh, D. (2005). The growth of high-stakes testing in the USA: Accountability, markets and
the decline in educational equality. British Educational Research Journal, 31, 605622.
doi:10.1080/01411920500240767
Kalantasis, M., & Cope, B. (2008). Introduction: Initial development of multiliteracies
concept. In S. May & N. H. Hornberger (Eds.), Encyclopedia of language and education
(2nd ed.), Volume 1: Language policy and political issues in education (pp. 195211).
Dordrecht: Springer.
Kemmis, S. (2012). Researching educational praxis: spectator and participant perspectives.
British Educational Research Journal, 38, 885905. doi:10.1080/01411926.2011.588316
Kickbusch, I. S. (2001). Health literacy: Addressing the health and education divide. Health
Promotion International, 16, 289297. doi:10.1093/heapro/16.3.289
Kickbusch, I. S. (2009). Health literacy: Engaging in a political debate. International Journal
of Public Health, 54, 131132.
Kincheloe, J. (2003). Critical ontology: Visions of selfhood and curriculum. Journal of
Curriculum Theorizing, 19, 4764.
Kincheloe, J. L. (2008). Knowledge and critical pedagogy (2nd ed.). New York, NY: Peter
Lang. doi:10.1007/978-1-4020-8224-5
Kirk, D. (2006). The obesity crisis and school physical education. Sport, Education and
Society, 11, 121133. doi:10.1080/13573320600640660
Marmot, M. G. (2003). Understanding social inequalities in health. Perspectives in Biology
and Medicine, 46(3), Summer: S9S23.

Downloaded by [The University of British Columbia] at 12:25 29 January 2015

Asia-Pacific Journal of Health, Sport and Physical Education

215

Marmot, M. (2011). Fair society healthy lives. In N. Eyal, S. A. Hurst, O. F. Norheim, &
D. Wikler (Eds.), Inequalities in health: Concepts, measures, and ethics (pp. 282298).
Oxford University Press. Chapter 18.
Marmot, M., & Wilkinson, R. (2005). Social determinants of health. New York, NY: Oxford
University Press. doi:10.1093/acprof:oso/9780198565895.001.0001
McKenzie, K. B., & Scheurich, J. J. (2004). The corporatizing and privatizing of school: A call
for grounded critical praxis. Educational Theory, 54, 431444.
McLaren, P. (1998). Revolutionary pedagogy in post-revolutionary times: Rethinking the
political economy of critical education. Educational Theory, 48(4), 431462.
Moffat, T. (2010). The childhood obesity epidemic: Health crisis or social construction?
Medical Anthropology Quarterly, 24, 121. doi:10.1111/j.1548-1387.2010.01082.x
Morrell, E. (2012). Teachers as critical researcher: An empowering model for urban education.
In S. Steinberg & G. S. Cannella (Eds.), Critical qualitative research reader (pp. 548554).
New York, NY: Peter Lang. Chapter 40.
Mulcahy, C. M. (2008). The tangled web we weave: Critical literacy and critical thinking. In
L. Wallowitz (Ed.), Critical literacy as resistance: Teaching for social justice across the
secondary curriculum (Chapter 1, pp. 1528). New York, NY: Peter Lang Publishing.
Nieborg, D. B. (2010). Training recruits and conditioning youth: The soft power of military
games. In N. B. Huntemann & M. T. Payne (Eds.), Joystick soldiers: The politics of play in
military video games (pp. 5366). New York, NY: Routledge. Chapter 3.
Nutbeam, D. (1998). Health promotion glossary. Health Promotion International, 13, 349
364. doi:10.1093/heapro/13.4.349
Nutbeam, D. (2000). Health literacy as a public health goal: A challenge for contemporary
health education and communication strategies into the 21st century. Health Promotion
International, 15, 259267. doi:10.1093/heapro/15.3.259
Nutbeam, D. (2008). The evolving concept of health literacy. Social Science and Medicine, 67,
20722078. doi:10.1016/j.socscimed.2008.09.050
Nutbeam, D. (2009). Defining and measuring health literacy: What can we learn from literacy
studies? International Journal of Public Health, 54, 303305. doi:10.1007/s00038-009-0050-x
Park, J. (2012). Writing as critical literacy engagement: Outliners and the recursive nature of
critical quantitative research. In S. Steinberg & G. S. Cannella (Eds.), Critical qualitative
research reader (pp. 548554). New York, NY: Peter Lang. Chapter 40.
QUIT (2014). Health risks of smoking. Retrieved from http://www.quit.org.au/reasons-to-quit/
health-risks-of-smoking
Reckwitz, A. (2002). Toward a theory of social practices: A development in culturalist
theorizing. European Journal of Social Theory, 5, 243263. doi:10.1177/13684310222225432
Renwick, K. (2013a). Critical reading in health literacy. The International Journal of
Literacies, 19, 99107.
Renwick, K. (2013b). Food literacy as a form of critical pedagogy: Implications for
curriculum development and pedagogical engagement for Australias diverse student
population. Victorian Journal of Home Economics, 52, 617.
Ryan, M., Rossi, A., Lisa, H., Macdonald, D., & McCuaig, L. (2012). Theorising a
framework for contemporary health literacies in schools. Curriculum Perspectives, 32, 110.
Schommer-Aikins, M., Mau, W.-C., Brookhart, S., & Hutter, R. (2000). Understanding
middle students beliefs about knowledge and learning using a multidimensional paradigm.
The Journal of Educational Research, 94, 120127. doi:10.1080/00220670009598750
Sleeter, C., Torres, M. N., & Peggy Laughlin, P. (2004). Scaffolding conscientization through
inquiry in teacher education. Teacher Education Quarterly, 31, 8196.
Speros, C. (2005). Health literacy: Concept analysis. Journal of Advanced Nursing, 50, 633
640. doi:10.1111/j.1365-2648.2005.03448.x
Thoman, E., & Jolls, T. (2004). Media literacy A national priority for a changing world.
American Behavioral Scientist, 48, 1829. doi:10.1177/0002764204267246
Thompson, P. (2002). Schooling the Rustbelt Kids: Making the difference in changing times.
Crows Nest, NSW: Allen & Unwin.
Wallowitz, L. (Ed.). (2008). Critical literacy as resistance: Teaching for social justice across the
secondary curriculum. New York, NY: Peter Lang.

216

K. Renwick

Downloaded by [The University of British Columbia] at 12:25 29 January 2015

Willis, P. (1997). Learning to labour: How working class kids get working class jobs.
Farnborough, England: Saxon House.
Winchell, M., & Kress, T. (2013) Living with/in the tensions: Freires praxis in a high-stakes
world. In R. Lake & T. Kress (Eds.), Paulo Freires intellectual roots: Towards historicity in
praxis (pp. 145168). New York, NY: Bloomsbury Academic. Chapter 8.
World Health Organisation (WHO). (1986). Ottawa charter for health promotion. Retrieved
from http://www.who.int/healthpromotion/conferences/previous/ottawa/en/
World Health Organisation (WHO). (1997) The Jakarta declaration on leading health
promotion into the 21st century. Retrieved from http://www.who.int/healthpromotion/
conferences/previous/jakarta/declaration/en/index1.html
World Health Organisation (WHO). (2009). 7th Global conference on health promotion:
Track themes. Retrieved from http://www.who.int/healthpromotion/conferences/7gchp/
track2/en/