‘It’s time to act for better health outcomes for our Aussie kids’: Mobilising health literacy for change through the Curriculum

The study purpose was to address a gap in the literature and gain a better understanding of Australian, specifically Tasmanian, primary school classroom teachers’ experiences of teaching health education (HE). By classroom teachers we mean generalist primary teachers, who in Australia typically teach all eight key learning areas (KLAs). In most Australian states and territories, HE exists within the health and physical education (HPE) mandated KLA, but often the delivery of HE is a responsibility assumed by classroom teachers as opposed to HPE specialists. Our study involved 53 primary classroom teacher participants in Tasmania and examined the state of play of HE. We used a mixed methods research design that included an online survey through which participants were subsequently invited to take part in semi-structured interviews. While participants tended to value HPE, we found HE was even more disenfranchised than physical education, within HPE as an already marginalised area, compared to “more academic” KLAs. This “double marginalisation” contributed to reports of inconsistent delivery of HE. Consistent with the health promoting schools agenda, we suggest a whole of school approach in addition to increased collaboration between teachers and increased HE professional learning opportunities for classroom teachers is required to facilitate change and increased prioritisation of HE in schools.

PurposeHealth education still tends to be dominated by an approach designed to achieve individual behaviour change through the provision of knowledge to avoid risk. In contrast, a critical inquiry approach educates children and young people to develop their capacity to engage critically with knowledge, through reasoning, problem solving and challenging taken for granted assumptions, including the socially critical approach which investigates the impact of social and economic inequalities on, for example, health status and cultural understandings. The purpose of this paper is to explore the conditions of possibility for a socially critical approach to health education in schools. It examines the ways in which preservice health and physical education (HPE) teachers talked about their experiences of health education during their school-based practicum.Design/methodology/approachIn total, 13 preservice HPE teachers who were about to graduate with a Bachelor of Health and Physical Education from a university in New South Wales, Australia were interviewed for the study. Five group interviews and one individual interview were conducted. The interviews were coded for themes and interpreted drawing on a biopedagogical theoretical framework as a way of understanding the salience of particular forms of knowledge in health education, how these are promoted and with what effects for how living healthily is understood.FindingsThe HPETE students talked with some certainty about the purpose of health education as a means to improve the health of young people – a certainty afforded by a medico-scientific view of health imbued with individualised, risk discourses. This purpose was seen as being achieved through using pedagogies, particularly those involving technology, that produced learning activities that were “engaging” and “relevant” for young people. Largely absent from their talk was evidence that they valued or practiced a socially critical approach to health education.Practical implicationsThis paper has practical implications for designing health education teacher programmes that are responsive to expectations that contemporary school health education curricula employ a critical inquiry approach.Originality/valueThis paper addresses an empirical gap in the literature on the conditions of possibility for a socially critical approach to health education. It is proposed that rather than challenging HPE preservice teachers’ desires to improve the lives of young people, teacher educators need to work more explicitly within an educative approach that considers social contexts, health inequalities and the limitations of a behaviour change model.

Health education (HE) courses in schools are vital paths for improving teenagers' health literacy. HE and physical education (PE) teachers lead HE courses, and their teaching intentions and competency influence the effectiveness of the courses and the ability to promote students' health literacy. This study attempted to understand HE and PE teachers' health literacy teaching intentions and professional competency and to investigate their relationships. This study adopted a cross-sectional design. A questionnaire survey was administered to 906 middle school HE and PE teachers in Taiwan by mail, and 545 provided valid data with consent. Participants had a favorable health literacy (47.78/50), positive health literacy teaching beliefs and attitudes, and acceptable efficacy. They intended to implement health literacy instruction within the subsequent year. Teaching beliefs, attitudes, and efficacy were all positively correlated with intentions (all p < .001). Demographic variables, health literacy, and teaching beliefs, attitudes, and efficacy explained 33.5% of the variance of teaching intentions. Teaching beliefs, attitudes, and efficacy were crucial predictors of health literacy teaching intentions. To improve students' health literacy, educational authorities and schools should pay attention to HE and PE teachers' intentions and vital factors, thereby enhancing teachers' willingness to perform health literacy instruction.

PurposeThe purpose of this paper is to explore issues of race and culture in health education in the secondary school health and physical education (HPE) curriculum in Ontario, Canada.Design/methodology/approachUsing Ontario’s secondary school curriculum as a point of analysis, this paper draws from critical race theory and a whiteness lens to identify how cultural and race identities are positioned in contemporary health education documents. The curriculum document and its newest strategies for teaching are the focus of analysis in this conceptual paper.FindingsWithin the curriculum new teaching strategies offer entry points for engaging students in learning more about culture and race. In particular, First Nation, Métis and Inuit identities are noted in the curriculum. Specifically, three areas of the curriculum point to topics of race and culture in health: eating; substance use, abuse and additions; and, movement activities. Within these three educational areas, the curriculum offers information about cultural practices to teach about what it means to understand health from a cultural lens.Social implicationsThe HPE curriculum offers examples of how Ontario, Canada, is expanding its cultural approaches to knowing about and understanding health practices. The acknowledgment of First Nations, Métis and Inuit health and cultural ways of approaching health is significant when compared to other recently revised HPE curriculum from around the globe. The teaching strategies offered in the curriculum document provide one avenue to think about how identity, culture and race are being taught in health education classrooms.Originality/valueFirst, with limited analysis of health education policy within schools, the use of critical theory provides opportunities for thinking about what comes next when broadening definitions of health to be more inclusive of cultural and race identity. Second, curriculum structures how teachers respond to the topics they are delivering, thus how HPE as a subject area promotes healthy practices is highly relevant to the field of health education. This paper provides an important acknowledgment of the educative work being undertaken in the revision of HPE curriculum.

This quantitative research study aims to understand the factors that influence the participation of secondary school students and teachers in Physical and Health Education (PHE) in public schools located in the Federal Capital Territory. The study involved a sample of 150 students and 20 PHE teachers, selected using a stratified random sampling technique to ensure diversity in the participant groups. Data collection was primarily done through a structured four-point Likert scale questionnaire, which evaluated level of participation, factors and barriers to engagement in PHE programmes. Descriptive and inferential statistical analyses were conducted to summarise and analyse the data obtained. ANOVA was used to test for significant impacts of different factors on student participation in PHE, including student-related, teacher-related, and institution-related factors. The findings of the study indicate that teacher-related and institution-related factors have a significant impact on participation in physical and health education among secondary school students, while student-related factors were not found to be determinants. The study also found that the perceived importance of physical and health education, availability of facilities, and support from teachers and peers were the key factors influencing students’ participation in the subject. Based on these findings, the study recommends enhancing the importance of PHE in the curriculum, improving facilities and resources for physical and health education, and fostering greater collaboration between teachers and students to promote participation. Implementing these recommendations could potentially enhance student engagement and overall participation in physical and health education in secondary schools.

Objective: The ability of schools, school leaders and teachers to promote critical health literacy in teaching and learning is central to the development of health literacy in schools. However, research focusing on teachers and planning for health literacy through health programmes in school is minimal. This paper describes how one school Health and Physical Education (HPE) department planned for and implemented health literacy learning across Years 7–10 as part of the first-year delivery of the Australian Curriculum: Health and Physical Education in New South Wales, Australia. Design: Single setting case study. Setting: A Years 7–10 Catholic school for boys. The HPE department comprised five teachers and one head of department. Method: Thirty-four lessons and 61 learning activities were analysed using Nutbeam’s health literacy hierarchy and the Australian Curriculum: Health and Physical Education outcomes and content. Results: A large number of learning activities were categorised as interactive ( n = 37, 60.7%) and a smaller number of learning activities categorised as critical ( n = 16, 26.2%). The number of learning activities categorised as functional was the smallest ( n = 5, 8.1%). Conclusion: Findings suggest that school-based health programmes that lack a connection to a whole school approach may fail to provide opportunities for students to achieve the critical understandings of health literacy that will provide them with the capability to enhance the health of others.

In New Zealand (NZ) and Japan, despite comprehensive national health and physical education (HPE) curriculums which guide teachers in delivering health education to children in schools, there continue to be significant health issues for children. A qualitative interpretative descriptive research method was used to compare how primary school teachers (5 New Zealanders, 5 Japanese) in both countries delivered HPE and the influence they believed their teaching had on the childrens health. The major child health issue identified by teachers in NZ was obesity/overweightness, while in Japan teachers identified insufficient sleep, inadequate food intake and the polarization between unfit and fit. In New Zealand, there is some freedom in relation to how the school interprets and delivers HPE that enables the schools to address the specific health needs of their community. However, there is disparity in how the curriculum is delivered, particularly between schools in low and high socio-economic areas. In Japan, the government directs what, when, and how HPE is delivered using government-designated textbooks. Therefore, while there is no disparity in the delivery between schools, teachers cannot customize health education according to their students needs. The flexibility of HPE in NZ is both an advantage in that it enables a creative and innovative teaching approach customized to the community in which the school is situated and a disadvantage in that often health education is decided on not according to the needs of the children but according to the available financial resources and teachers enthusiasm. It appears that even low-quality educational lessons could meet the curriculum standards. In Japan, while children do receive education on health issues that may be useful for the future, the HPE curriculum does not address the current health issues the children face. Moreover, it is difficult to teach all the content within the government-designed HPE textbook because of Japans official time designations for health education. This studys results suggest that both countries need to review the delivery and resourcing of their HPE to ensure that children receive education that addresses their current and future health needs and those of their families.

"Physical-Medical Integration" combines sports science and medical disease prevention, supporting the "Healthy China 2030" strategy. Health education, originating from medicine, is vital for promoting youth health knowledge and is key to integrating with school sports. This study examines the challenges and solutions of combining school sports and health education under this integration. The study uses literature review, mathematical analysis, and logical reasoning. Core journal papers from databases like CNKI, Wanfang, and VIP were analyzed using keywords like "Physical-Medical Integration," "Health Education," and "School Sports" (2000-2025). CiteSpace is used for keyword clustering to support challenge diagnosis. The study also compares policy evolution and international experiences to propose solutions for the coupling of school sports and health education. (1) Health Education Analysis: From 2000 to 2025, "mental health" and "social health" co-occurred in only 18.7% of papers, much lower than "physical health" at 61.3%. Policy comparison shows China's focus on disease prevention and sports skills, while the U.S. emphasizes mental health and social adaptability, requiring them to account for at least 40%. (2) Cross-departmental Collaboration: Only 9.5% of 42 policy documents address inter-departmental cooperation, mostly in vague terms. Data sharing between education and health sectors is just 22.4%, leading to "information silos." (3) Pre-service Teacher Training: Medical courses in China's physical education programs are under 5%, while U.S. universities include "sports medicine" and "public health" as required courses (15%-20%). (4) Health Education Evaluation: Keywords like "health literacy" and "behavioral intervention" have increased since 2016, but policy development of evaluation tools and standardized guidelines is still behind. Conclusions: (1) Coupling Challenges: 1. Health education in school sports lacks "localization" and focuses too much on physical health, conflicting with the three-dimensional health model. 2. Poor coordination between education, sports, and health departments hinders interdisciplinary integration. 3. Gaps between physical and medical health education create a shortage of interdisciplinary talent. 4. Health education outcomes are not reflected in school sports evaluations. (2) Strategies: 1. Strengthen "three-dimensional" health education by increasing focus on mental and social health in curricula. 2. Establish a joint health education office for education, sports, and health departments to develop regional standards and policies. 3. Add medical courses related to health education in physical education programs and pilot joint "health education" minors. 4. Develop a multidimensional health education evaluation framework using physical, psychological, and behavioral indicators.

Physical and health education learning process in high school have not shown the teacher’scompetency. This is due to not all of the teachers equipped with the ability on physical andhealth education. Therefore, teacher’s knowledge on physical and health education mustbe put in concern to develop their ability which will impact on the effective and efficiency ofthe learning process. The success of learning process is influenced by several factors, suchas: (a) Awareness of the profession, competence and duty of teacher, (b) teacher’s ability inimplementing high school physical and health education curriculum, (c) teacher’s ability indoing administration of physical and health education learning process, (d) teacher’s abilityin creating learning method strategy, (e) teacher’s ability in implementing principals ofphysical and health education learning process, and (f) teacher’s ability in implementinglearning method of physical and health education. Keywords: learning administration, physical education

* Abbreviations: NAM — : National Academy of Medicine NHES — : National Health Education Standards Only 12% of American adults have proficient health literacy, defined as a set of skills needed to effectively function in the health care system.1 This is troubling given that health literacy is a stronger predictor of health than age, income, employment status, educational level, or race.2 A growing body of research also shows that low health literacy is associated with worse child health outcomes,3 higher health care costs, and elevated mortality rates.1 Although Americans are increasingly expected to be knowledgeable consumers of health care, it is clear that many individuals lack the core health literacy skills needed to understand their health insurance.4 This inadequate understanding of health care information creates challenges beyond the selection of a health insurance plan or payment calculations. Poor health literacy, including health numeracy, extends into one’s ability to seek care at an appropriate time, navigate through the health system, and share in important medical decisions. In this Perspective, we describe national efforts to combat low health literacy rates and argue that they fail to adequately prepare children and adolescents to be health-literate adults. We then propose several steps for educators, health care providers, and policymakers to improve health literacy among children and adolescents in the United States. The US Department of Health and Human Services, the National Academy of Medicine … Address correspondence to Tyler N.A. Winkelman, MD, MSc, University of Michigan, Robert Wood Johnson Foundation Clinical Scholars Program, North Campus Research Center, 2800 Plymouth Rd, Building 14, Room G100-20, Ann Arbor, MI 48109-2800. E-mail: tywink{at}med.umich.edu

The staffing and outsourcing of the marginalised curriculum area Health and Physical Education (HPE) has been an area of growing concern, alongside rising concerns for the decline of students’ health due to increased sedentary behaviour and mental health problems, yet there has been little research attention to the staffing and delivery of HPE in Australian schools. This article addresses that gap in understanding with analysis of data from a larger study examining positioning and implementation of HPE in schools. A mixed methods questionnaire was completed by 30% of government schools in New South Wales ( n = 556) providing data on staffing, delivery and outsourcing arrangements. Findings suggested that specialist HPE teachers are not in-charge of teaching HPE; and the majority (67%) of schools outsource at least some HPE, with far-reaching impacts on curriculum coverage and student exclusion from lessons evident. Findings also suggested that students experience varied methods of delivery in Physical Education (PE), and Health Education (HE) lessons. Together, these findings raise questions regarding the assurance of quality and equity, with implications for future policy and practice and the health and wellbeing of school children.

The goal of learning in physical and health education (PHE) is for the student to improve physical abilities, motor skills and knowledge in physical and health culture, in order to preserve health and apply proper and regular physical exercise in modern living conditions and work. On the basis of the goal of the PHE teaching, the biological, pedagogical, and educational tasks are determined, the realization of which leads to the outcome of the PHE teaching. The biological tasks of physical education imply that a positive influence on students' proper growth and development is possible if the teacher is familiar with the structure and functions of the most important organic systems, the biological laws of development, and the impact of physical exercises on the organism. Pedagogical tasks include educational and learning tasks that intertwine and complement each other. Learning tasks should primarily contribute to the acquisition of motor skills and habits (sports-technical education), but also to the theoretical knowledge aiming to understanding the purpose of exercise, structure, method, and performance of certain exercises. Educational tasks, the teaching content, methods and forms of teaching are planned in accordance with their educational potential so that during the PHE classes, the students acquire the qualities and values contained in the PHE syllabus and at the same time represent universal human qualities and values that contribute to the development of the student's complete personality which is the ultimate ideal to strive for in education. By achieving the goals of the PHE syllabus, students acquire knowledge, skills, attitudes, and values about exercise (basic terms about exercise, how to perform an exercise and what a specific exercise is for), physical education, sports, recreation, and health. Specially planned and designed information about exercise and health is delivered immediately before, during, and after exercise in class. The goal, tasks, and outcomes of the course are achieved through the teaching of physical and health education (2 school hours per week) and compulsory physical activities for each student (1.5 school hours per week). This research is focused on the most frequent disruptive factors that lower the efficacy of implementation of PHE teaching in the higher grades of elementary school. The research was based on the general assumption that the teaching of physical and health education significantly contributes to the growth, development, health, upbringing, and education of students, but that it is not implemented as effectively as it could be. In contrast to many previous studies in which answers were collected from teachers or parents, in this research the answers were collected from the students in the higher grades of primary school themselves, since they are direct participants in the PHE classes and their development, education, and learning in PHE classes is the main outcome of teaching (Parkes et al, 2022; Amamou et al, 2021; Holden et al, 2020). It was interesting to analyse from the students' point of view what the most frequent disturbing factors are and whether some of the criterion variables affect it, such as the class the students attend; grade in physical education in the previous semester; and the general success of students in the previous semester. The research was conducted in January 2023 on a sample of 101 students at the Kirilo Savić Elementary School in Ivanjica. The data collected by the Scale - EE-MCDF-RPHET (a = 0,602) were processed by factor analysis, analysis of variance, and the Mann-Whitney U test. Factor analysis identified five factors that indicate educational efficiency and the most disruptive factors of PHE teaching. They are: 1) inconsistent practicing of different sports contrary to the student's assessment of the educational efficiency of the PHE teaching; 2) effectiveness of teaching; 3) the importance of active sports training; 4) football training contrary to the student's assessment of the educational efficiency of the PHE teaching; and 5) student safety. The analysis of variance showed that such assessments of students are not significantly influenced by the class they attend, success in physical and health education and education and general success in the previous semester, while the Mann-Whitney U test determined that such assessments of students are significantly influenced by actively playing a sport. Based on the results of the research, a proposal was made for an innovative approach to the implementation of physical and health education teaching in elementary schools, according to innovative teaching systems and innovative didactic-methodical teaching models. Teaching according to these models is planned, implemented, and evaluated in a multi-step and reverse design. In such a class, students are more involved in practicing, active learning, and participating in PHE classes. Based on the desired outcomes of the PHE classes, the goal is for as many students as possible, preferably all, to get involved in the work of sport clubs and in the future take up sports. In this way, the knowledge, skills, habits, and abilities the students develop in PHE classes and in sports clubs will be of fundamental importance for students outside the classroom and serve them in their daily activities in various situations in the family, school, local environment and wider social community. In order to achieve this, it is necessary to constantly strengthen the competences of teachers for planning, implementation, and evaluation of PHE teaching.

Health literacy is an important asset for adolescents to develop through engagement in schooling and curriculum. The few studies that have focused on teachers, health literacy pedagogies and assessment, show that teachers find it difficult to enhance students' critical health literacy levels and to measure students' health literacy knowledge and capabilities using valid models. The aim of this study was to develop a longer-term PD programme for secondary school teachers to enhance their ability to plan for critical health literacy learning and to co-design with teachers a curricular model for assessing health literacy. Two face-to-face (F2F) PD sessions and two online PD sessions were scheduled with three participating specialist Health and Physical Education (HPE) teachers, seven HPE programmes were deductively analysed using Nutbeam's health literacy hierarchy and the Australian Curriculum: HPE outcomes and content. Analysis showed that interactive learning activities were dominant (64%), compared with functional (4%) and critical learning activities (4%). The co-designed curriculum model for measuring student health literacy was also developed for use in Australian schools. The resultant rubric is informed by Nutbeam's model, Broder etal.'s definition and Bloom's taxonomy. To our knowledge, this is the first ongoing teacher PD programme that has embedded co-design processes for teachers and researchers to design a curricular health literacy assessment model for Australian and international HPE programmes. SO WHAT?: The valid measurement and assessment of child and adolescent health literacy has largely been ignored in previous research. This study is the first attempt to co-design a curricular health literacy assessment for secondary schools that can be used by teachers and health professionals.

The development of health literacies, in relation to health, well-being, safety and physical activity, is a key pillar of the ‘Australian Curriculum: Health and Physical Education’. Implications, therefore, arise for teachers of health and physical education (HPE) and their pedagogical practices. These practices of HPE inform ways of thinking, the acquisition of dispositions and constitution of subjectivities. They also impact on student success and positioning in relation to societal and cultural assumptions. We argue that bodies, including how they move, are exercised, nourished, represented and understood, should be central to pedagogies for developing health literacies. In this paper, we use interview and media excerpts to explore pedagogical practices and understandings in relation to bodies. We attempt to analyse practices of the body as they relate to health literacies. In arguing for socially critical pedagogical practices around bodies, we highlight the need to develop critical health literacies that disrupt common sense readings of ‘acceptable’ and ‘desirable’ bodies as lean, youthful and able-bodied. We conclude by identifying implications for pre-service teacher and in-service teacher education around the development of socially critical pedagogical practices and health literacies.

The way school Health and Physical Education (HPE) is conceptualized and taught will impact on its ability to provide equitable outcomes across gender, sexuality, ethnicity, religion and social class. A focus on social justice in HPE is pertinent in times when these ideals are currently under threat from neoliberal globalization. This paper draws on data from the initial year of an international collaboration project called ‘Education for Equitable Health Outcomes – The Promise of School Health and Physical Education’ involving HPE and Physical Education Teacher Education researchers from Sweden, Norway and New Zealand. The data in this paper record the researchers’ presentations and discussions about issues of social justice and health as informed by school visits and interviews with HPE teachers in the three different countries. The analysis of the data is focused on what is addressed in the name of social justice in each of the three countries and how cross-cultural researchers of social justice in HPE interpret different contexts. In order to analyse the data, we draw on Michael Uljens’s concepts of non-affirmative and non-hierarchical education. The findings suggest that researching social justice and health (in)equality across different countries offers both opportunities and challenges when it comes to understanding the enactment of social justice in school and HPE practices. We conclude by drawing on Uljens to assert that the quest for social justice in HPE should focus on further problematizing affirmative and hierarchical educational practices since social justice teaching strategies are enabled and constrained by the contexts in which they are practised.