Abstract
Background:
Many health education scholars over the last 20 years have argued that critical approaches to the discipline are needed. Despite these calls, there are few published examples of actual critical practice in action in school classrooms. Some have argued that part of the explanation for this lacuna lies in a dichotomy in the field between ‘traditional’ approaches to health education and more critical approaches.
Purpose and Methods:
This article draws on an ethnographic study of schools in Aotearoa New Zealand and shares two different narratives of what we identify as critical approaches to health education. New Zealand is unique in that health education is a credentialed subject in senior high school that allows access to national qualifications. We outline the approaches of two different teachers within this system, and evaluate these alongside key literature in the field, and five pedagogical themes.
Conclusions:
Teachers who engage with critical classroom practice are also likely to include traditional and biomedical teaching approaches. Rather than viewing this as problematic, we argue that health education programmes that value criticality will also value traditional forms of health knowledge, while simultaneously questioning them. Such an approach is necessarily messy but is more successful when teachers embrace a pedagogy of uncertainty.
Defining critical health education is a challenging task. Primdahl et al. (2018) argue that there is very little consensus in health education about purpose, ‘desired outcomes effective teaching strategies, or legitimate curriculum content’. They surmise that this is due to the field (as a whole) being beholden to two general discourses: The first and most prevalent is the bio-medical discourse, which is typically (or/and pejoratively?) portrayed as traditional, individualistic, preventive, moralistic, or behaviour-regulating. The second is the socio-ecological discourse, the proponents of which, for example, associate it with the critical, structural, participatory, setting-based, or emancipatory. (p. 3)
This analysis suggests that we might recognise critical approaches to health education if they are oriented towards, for example, the determinants of health, political issues or ‘equity, democracy and social justice’ (Primdahl et al., 2018: 3). Fitzpatrick and Tinning (2014) note that Critical health commentators assert that schools have a responsibility to critique and, where necessary, resist many health messages and policies and instead engage young people in learning about, rather than for, health. The social and political environments surrounding and framing health issues, however, also require attention. (p. 2)
Fitzpatrick (2014) argues that ‘Critical approaches to health education do have the potential to speak back to, or at least unravel, discourses of healthism which … cause damage to young people and their communities’ (p. 185). She notes that ‘a critical pedagogy [of health] may even provide the space for young people to engage in a critique of, and resistance to … narrow forms of health education’ (p. 185). In a similar vein, Martinson and Elia (2018) suggest that utilising critical pedagogies in school health education would support: understanding of political, economic, cultural, and ideological contexts of health and related systems-level thinking about structural conditions that influence health and health behaviours; exploration of who defines ‘health’ and ‘illness’, why they are defined that way, who benefits from these constructions, and, importantly, who may be harmed by them. (p. 138)
Regardless of these arguments for critical approaches to health education, there are few examples of practice in school classrooms and ‘little research that sheds light on the complexities and challenges of the everyday practices connecting health and education in schools’ (Leahy and Simovska, 2017: 430). There are, however, examples of what critical health education is not. These illustrate aspects of the above-mentioned critiques, including an orientation to health education as a health intervention (to improve students’ physical health outcomes and change behaviours), as well as a lack of questioning of simplistic health messaging, scare tactics and pedagogies that foreclose knowledge contestation. In an especially evocative illustration of non-critical practice in the classroom, Leahy and Malins (2015) describe a drug education lesson involving the teacher pouring a can of dog food on the table and likening it to taking drugs. In another study in Aotearoa New Zealand, Powell (2018) observes the decidedly uncritical engagement the schools in his study demonstrated by supporting sponsored products, including health education resources promoting corporate brands. The schools in that study engaged with resources and visits from companies such as MacDonalds and Nestlé that purported to promote health messages. Many teachers viewed these as helpful and harmless, but Powell argues that this kind of ‘edutainment’ simply uses health concerns to enhance corporate profit.
In numerous studies, Burrows and Wright have recorded the perspectives and experiences of children when it comes to health messaging in schools (Burrows, 2005, 2010; Burrows and McCormack, 2014; Burrows and Wright, 2004a, 2004b, 2004c). They conclude, among other findings, that children and families who do not conform are stigmatised. Wright et al.’s (2018) Australian study suggests that many preservice teachers are passionate about health education, primarily because they see it as risk-mitigating for young people (see also Fane and Schulz, 2017). Indeed, discourses of risk are deeply embedded in the history of health education internationally. Leahy et al. (2016) identify this as the ‘most ubiquitous of the archetypes in the health education literature: namely, that of the ‘at-risk’ child’ (p. 28; see also Leahy, 2014).
In this article, we draw on an ethnographic study of four schools in Aotearoa New Zealand and share two different narratives of, what we are identifying as, critical approaches to health education. Each of these is complex and, while we do recognise critical practice, we also recognise biomedical-oriented learning (Primdahl et al., 2018) and discourses of risk. We also appreciate the contingencies of the practices we have observed and have tried not to edit out the contradictions, obscurities and uncertainties of schools. Our representations of practice thus include discussions, content and ideas that are incomplete, unresolved and even contestable in terms of their critical approach.
Health education in Aotearoa New Zealand
Despite the lack of examples of critical practice in school health education, one is evident in the work of Fitzpatrick, who detailed the pedagogical approaches of a teacher named Dan (see, Fitzpatrick, 2013b; Fitzpatrick and Russell, 2015). That work identified five key elements of Dan’s teaching that structured critical engagement with health education and physical education in senior high school classes. Before briefly outlining the approach adopted, we need to note that, health education has status as a credentialed qualifications-based subject in the final 3 years of high school in Aotearoa New Zealand. Other than in Australia (see Leahy et al., 2013, 2016), this is relatively unusual internationally, and significant in that health education is completely separate from physical education in the qualifications framework (called the NCEA: National Certificate in Educational Achievement). Furthermore, health education content and assessment in this system are very much aligned with Primdahl et al.’s (2018) definition of critical health education, although there is also inclusion of the more traditional and biomedical (for discussion of health education curriculum in Aotearoa New Zealand, and senior high school programmes see Fitzpatrick and Burrows, 2017; Hargreaves, 2013). Assessment standards
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(for high school qualifications) include, for example, Analyse an international health issue. Analyse issues related to sexuality and gender to develop strategies for addressing the issues. Take action to enhance an aspect of people’s well-being within the school or wider community. Evaluate health practices currently used in Aotearoa New Zealand. Analyse a contemporary ethical issue in relation to well-being. (Ministry of Education New Zealand, n.d.)
Within this system, it is possible for teachers to take an educative approach to the subject of health, and explore health as a discipline of study, including evaluating and critiquing a range of health discourses, data, health services and equity issues.
In her study, Fitzpatrick (2013) noted that the teacher Dan, framed his practice around five pedagogical features: building the environment, deconstructing power, playfulness, studying critical topics, and embodied criticality. Building the environment included conscious attention to relationships in the class, and establishing trust and connection with students. Deconstructing power described the verbalisation and overt challenging of power relations in school, including naming and critiquing gender power, racism, and school-imposed hierarchies. Playfulness was employed by Dan to diffuse tension, expose the arbitrary nature of schooling practices. In addition to these three elements, Dan’s critical practice was embedded in his choice of critical topics.
While the NCEA programme certainly allows for critical approaches to health education, teachers still have a great deal of choice about the orientation they take to units of work. Dan chose to question health and social norms in his practice, to champion social justice and approach health issues as socially constructed. Finally, Dan ‘walked the talk’ of critical health education by ‘being’ critical in the way he dressed, talked and interacted with students. This was conceptualised as ‘embodied criticality’. This term was used to describe how Dan embodied a critical approach, not only in relation to the topic of study, but also in how he was as a person, and in his relationships with students. For example, he challenged the power positioning of male teachers by dressing in clothing that was not typically masculine. He also played with gender norms by showing his vulnerability, talking openly about feelings, and making jokes about his masculinity. He performed a masculinity that challenged stereotypes about male teachers (especially health and physical educators) being motor elite, highly masculine and dominant (Brown, 2005).
In an attempt to add to the literature illustrating that critical health education practices are possible in schools, further below we read the pedagogies of the two teachers in this study against these five elements of Dan’s practice. The research project we draw on was a critical ethnographic study of young people’s engagement in health education.
Methodology
Critical ethnography is the overarching methodology adopted in this study. We are inspired by Madison’s (2012) definition of critical ethnography as a process of going ‘beneath surface appearances’ and unsettling both ‘neutrality and taken-for-granted assumptions by bringing to light underlying and obscure operations of power and control’ (p. 5). In line with theoretical developments in sociology and feminist studies (e.g. Lather, 1998, 2007), critical ethnographers are acutely aware of issues of positionality and power relations in the field, as well as the troubling realities of making change in communities. The drive for social justice is thus tempered by a commitment to forming deep relationships, a focus on trust, and an ethic of care. A critical approach is connected to our theoretical commitments here to humanising research, and to attending to relations of power in education at the intersection of gender sexuality, culture, ethnicity, social class and place (Madison, 2012).
We draw here on Fitzpatrick and May’s (2018) nine tenets of critical ethnography. These include attention to issues of power, in/justice, and in/equity; meaningful question setting; relationships and reciprocity; and attention to positionality and reflexivity.
In this ethnography, we employed a range of methods. Space limits preclude us from explaining these in detail (for a fuller discussion see Fitzpatrick and Allen, 2017), but they included observing and participating 2 in health education classes and having research discussions with students, attending and participating in student-led groups (such as queer support groups and feminist groups), conducting individual and group interviews, and arts-based methods such as photovoice (Pink, 2013) and poetic representation (Faulkner, 2009).
While the wider study included four schools, in this article we focus on only two teachers, each of whom engaged with health education in critical but completely different ways. Both schools are located in the city of Auckland and have quite different demographic characteristics (all names of students, teachers and schools are pseudonyms). We spent 3–5 days per week for 20–30 weeks (two to three school terms). The timing differed slightly in each school due to school priorities and logistical factors.
Malietoa college
Malietoa College is a large co-educational high school with approximately 2000 students. It is located in South Auckland in a low socioeconomic area. Malietoa College is diverse in its ethnic makeup with the largest group of students identifying with Pacific ethnicities (28% Samoan, 12% Tongan, 6% Cook Islands Maori and 7% from other Pacific ethnicities, including Niuean, Fijian and Tuvaluan). The rest of the school comprises Māori (26%), Indian (7%), South East Asian (6%) and European/Pākehā (5%) students.
Pātiki college
Pātiki college is located in central Auckland. It is a diverse, public, co-educational school in a mixed community, socioeconomically. Pātiki has about 1500 students and is known for diversity of ethnicity. The two largest groups are students who identify as European/Pākehā (30% approx.) and Indian (30% approx.). Chinese students comprise approx. 11% and Māori 9%, with Samoan and Tongan students making up about 7% each. The rest of the student population identify as African, middle eastern, ‘other’ Pacific island (Cook Islands Māori, Niuean, Fijian, Tuvaluan) or with other Asian ethnicities.
Narrative enquiry
We draw on Clandinin and Connelly’s (2000) notion of narrative enquiry to illustrate the practices of the two teachers. McDrury and Alterio (2003) note that ‘Story telling is a uniquely human experience that enables us to convey, through the language of words, aspects of ourselves and others, and the worlds, real or imagined that we inhabit’ (p. 31). Within the lacuna of examples of critical practice in health education, using narrative allows us to convey a sense of the context as we experienced it; in this sense, we are clear that these stories are our reconstructions of events, based on interviews and classroom experiences.
Findings
Two narratives of critical health education
Ms Felix (Pātiki college) (fieldwork undertaken by K.F.)
Ms Felix bounces into the room. She brightly says ‘hello!’ to the class and asks them to grab notebooks from the charging station. When everyone is set up she gets the students’ attention by asking for a show of hands of who is going to the upcoming school ball (formal). About three quarters of the class raise their hands:
So, who is going to an after-ball party, you know, organised by ‘parents’ and then not really organised by anyone, you know?
(lots of laughter and chat): there’s a party at Sam’s house!
More laughing and joking and Sam denies this vociferously. A few discussions break out about the after-ball party: ‘did you go to Olli’s last year?’ ‘I didn’t go but I heard it was … you know, did you go?’
ok, ssshhhhhh now, we’re talking about balls and alcohol. Have a look at this article (she hands out a news website article about after-ball parties).
The students read the article and then Felix asks them to offer any comments.
The % of students getting alcohol from parents is interesting (40%).
Students drinking unlimited alcohol at after-ball parties is surprising. Does that happen?
Well, it is illegal
‘the basic laws of economics kick in … if people want it they will find a way’
So, do you provide an environment where students can drink (breaking the law) or do you ban it and it goes underground?
mumbling in groups …
‘at the end of the day, no one will go to an alcohol-free party, they would rather stay home and drink with their friends’. Would you go to an alcohol-free party?
Several students responded.
Yes, yeah, of course! Yes, as long as there was something to drink.
We don’t think it’s that common at this school.
it depends where you grow up, you hear about what’s happening in South Auckland. Like, I’m not stereotyping or anything, but it’s different in other places.
Do you think growing up in this area – in a very multicultural school – is different from growing up in (she names a small rural town)?
The students all laugh and some ask: where is that? Is that a made up place?
So, is it different growing up here?
No.
The discussion continues and students share stories of friends and families, and different cultural approaches to drinking. Before the end of the lesson, Felix explains that the class will be researching the determinants of health over the coming weeks.
Felix grew up in the UK, and has a background in art and design. She continues to make jewellery, and she designs and makes clothing in her spare time. While interviewing her, I (K.F.) laugh at the notion she might have ‘spare time’: she is the head of her department and has two children. She describes her approach to teaching thus: I think my approach to teaching in general would be a collaborative approach where students get to have some say in what they’re learning and how they are learning it … I don’t like being the one at the front of the room for more than a couple of minutes … I really like to be able to sit with students and talk with them. I think it is really important to build those relationships.
Felix’s approach can be described as direct but relaxed. She seemed to genuinely like the students and enjoy hanging out with them in class. At the same time, she was well organised and stayed ‘on the case’ to make sure they were focused and completing the tasks. She did not get impatient and she maintained a positive but relaxed demeanour.
During the year, Felix focused the class on a wide range of topics, in line with the curriculum and the national assessment (NCEA) system. In one lesson, students were exploring issues of workplace bullying and discrimination, and Felix asked the groups to report back. Groups offered the following definitions:
‘Repeated unreasonable behaviour that creates a risk to a person’s wellbeing’.
‘Repeated conduct that is threatening and humiliating’.
‘Threatening and intimidating behaviour, spreading rumours, exclude (fail to invite them). Tell jokes about them’.
One group stated that a cause of workplace bullying can be ‘being overweight: having more body fat than is optimally healthy’. Felix interrupted with ‘um, no, disability and body weight are actually really about the bully’s attitudes not the person being discriminated against’. Small interruptions like this were common in her classes. While approaching health education very much as a topic of study, she also brought a gentle and low-key critical approach to issues such as a body and beauty. She tended to challenge attitudes or comments that were sexist, racist or fatphobic (although, in the discussion above, the stereotyped comment about South Auckland went unchallenged).
Mr Johnson Malietoa college (fieldwork undertaken by J.M.A.)
It is week 1 of my (J.M.A.’s) critical ethnography, and I am sitting in Mr Johnson’s year 12 health education class. Two long tables run across each side of the room with students dotted sporadically around them. Faces all turn to Mr Johnson as he walks down the middle of the tables sporting his usual shorts, sports shoes, school polo shirt and jacket. Students settle in to listen. Mr Johnson takes his jacket off and launches straight into the lesson: What do these terms mean and in what situations are these terms used? ‘heterosexual’, ‘homosexual’, ‘intersex’, ‘transgender’ ‘What does it mean to be queer?’
One student starts to respond but mutters something under his breath and then remains quiet. Johnson waits for other members of the class to respond, but they remain silent and look at each other. Johnson then loudly addresses the class, ‘Don’t tell me what you think I want to hear. Keep it real’. The student who attempted to answer previously speaks up saying, ‘when you have a dick, but you like guys?’ Mr Johnson questions, ‘so it’s when you act gay?’ Aho (another student) then responds with an aggressive tone, ‘what do you mean “act” gay? What’s acting gay?’ Silence falls over the classroom. ‘What do you guys think?’, Mr Johnson asks a group of male students. The group shrug and look at each other.
After a moment, Johnson explains that Pacific languages can offer alternative ways of thinking about sexual identity, and he teaches them words such as fa’afafine 3 and fakaleiti. 4 A group of Samoan students discuss the term fa’afafine and how they feel that the literal translation of the word is negative. Johnson responds, ‘I thought, in Samoan culture, it was fine to be a fafa [slang for fa’afafine]’? One of the students tells Johnson ‘it is, you can say fafa, like, joking around, but, it translates to a bad meaning in English, so we don’t use it’. More discussion regarding the various sexual identities continues. Towards the end of the class, Johnson comments, ‘I don’t care what your orientation is as long as you are good kids who go out into the community and make positive changes’.
I (J.M.A.) would describe Mr Johnson as a loud, proud and straight up health and physical education teacher. He identifies as Samoan, Māori and Cook Islands Māori, and traces his Māori ancestry to the Ngati Kahungunu and Ngati Whatua iwi (tribes). Johnson grew up in South Auckland and felt that his experiences growing up in the local community provided him with ‘street cred’
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: I grew up in Otahuhu (a suburb of South Auckland) pretty much and know it like the back of my hand. Not that I was like a hood or street kid, but I used to roam a bit around my neighbourhood … I was a real narcissistic, real conceited growing up. I felt like everyone owed me something and I didn’t have to do much for anything. I wasn’t resilient at all. So, because of my experiences growing up in South Auckland and, like, I’ve gone through being jumped, being in fights, staying out late roaming the streets at like midnight … So those are like real, still there and real fond memories and … I carry that, a lot and I think it gives me a bit of street cred in regards to what we [South Aucklanders] face.
Johnson was coach of the school First XV rugby team and was also Dean for his whanau group.
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He explained his approach to health education: The reason why I love health so much is that you look at what is ‘normal’ and, man, you’ve got to break that stuff down. You have got to realise what is ‘normal’ isn’t necessarily right, and it’s not right for me and my friends, or me and my family, or me and my culture. So, that is why I love health because you are able to look at what is happening and look at what is happening in society … and then challenge it.
Johnson often started his class with a piece of news or a small video clip. One day, he showed a video about beauty standards. Terms such as ‘lumbersexual’ and ‘metrosexual’ were used to describe male beauty from different countries. When the video turned to beauty standards for women in Aotearoa New Zealand and the Pacific, it depicted Pacific island children being sent off to ‘fat farms’ where they were fed high calorie diets because, according to the video, being fat was seen as a symbol of wealth and pride. Similarly, the video depicted tā moko
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as an indigenous Māori beauty practice. After the video finished, the class was divided into groups. Johnson asked ‘what did you find unusual about the video? Did it challenge your perception of what it means to be male and female?’ T.S. (one of the health education students) told the class that she felt challenged by the video when it referred to tā moko (which the narrator in the video pronounced incorrectly) as a means for indigenous women to look sexy. Breanna (another student) agreed, it’s not really beauty standards, it’s just cultural practices. That wasn’t beauty because it’s cultural, there’s reasons behind why you get tā moko. I don’t like how they put it under beauty, it’s like they are trying to make it a trend.
Johnson replied, ‘yeah, that’s deep right, some deep thinking’. He then proceeded to highlight ideas of assimilation, colonisation and how dominant understandings of beauty were often based on white western norms.
Critical pedagogies of health education?
We now draw upon the above narratives of the two teachers, as well as our wider interviews and observations of their practice, and examine these in relation to the five aspects of critical pedagogy identified by Fitzpatrick (2013b), Fitzpatrick and Russell (2015).
Building relationships
Building relationships with students is a key feature of both teachers’ approaches. Johnson stated that: [the] key to building those relationships, if you want to get cooperation or anything like that, you’ve got to be able to do that with them first [get to know the students]. If you can’t do it then you will get a lot of, like before, those answer you want to hear as opposed to what they really think.
He maintained what he called a ‘high trust model’ in class. This meant giving students options for engagement with the class, and removing barriers to participation. For example, if students forgot their books, he would allow students to use their mobile phones to take notes and look things up online. He stated, ‘I trust you not to be using your phone for the wrong thing … I’m not going to penalise you based on your access to paper and pen’. Johnson’s approach created an atmosphere of trust, as well as understanding students’ socioeconomic challenges. Many of the students in his classes came from families with few resources but nearly everyone had a phone.
For Felix, connecting with students was a key part of her everyday classroom practice. This was done in low-key and subtle ways as she moved around the classroom talking with individuals and mixing personal conversations with content-based questions and discussion. For example, Felix frequently asked students about their weekend activities, the results of their sporting competitions, or the activities of their cultural groups. She would often spend the first few minutes of class asking individuals about their lives and interests. She seemed to know who played which sports, and who was involved in particular school-based groups.
Critical pedagogues such as Paulo Freire, Jean Anyon and bell hooks (Anyon, 2005; Freire, 1996; hooks, 1994, 2003) argue that teaching should be a humanising process; they emphasise compassion and relationship building as fundamental to addressing social justice concerns. Fitzpatrick and Russell (2015) argue, likewise, that given the importance of subjectivity to young people’s experiences in school, relationships with teachers deeply frame the potential (or not) to engage with issues of power and social justice. They write: What is perhaps needed … is a more embodied and lived approach to critical health and PE, which combines the intensions of critical practice with an understanding of complex embodied experience and connects directly with students; one, possibly, which is more playful and less rational, one which requires us as educators to connect with our students and expose our own place in the hierarchies of power. (Fitzpatrick and Russell, 2015: 162)
Playfulness
Fitzpatrick (2013b) argues that teachers who employ playful approaches to teaching are able to diffuse tension in the class, and can more easily introduce difficult and contentious topics, because their approach is unthreatening (Lugones, 1994). Both teachers used playfulness in different ways to create a relaxed atmosphere. Johnson relied on humour, while Felix used quick-witted and quirky responses. Johnson’s use of humour connected well with the Pacific students in his classes, and he often used a gentle teasing approach. In one lesson, his class was discussing family protocols for dating. J.M.A.’s field notes recorded the following: The class is working in groups to discuss family rules for taking partners home when Carlito says ‘yeah but it’s not that easy Mr Johnson’. Johnson jokes ‘yeah it’s not for you because of those maturity levels, aye Carlito. Your family will be like ‘nah not Carlito, he’s not ready yet’’. The group Carlito is sitting with start laughing, and Carlito laughs too. Then he responds with pride: ‘I am a mummy’s boy, I will never be ready’. The group continue to laugh, and Mr Johnson moves on to the next group.
Johnson could joke around with his students because he had developed relationships with them both in class and through his coaching, as well as culturally. Strickson-Pua (2013) argues that, for Pacific peoples, ‘humour has been a blessing of healing, social change and justice’, and emanates from storytelling traditions (p. 286).
Felix often used quick witted ‘in the moment’ responses to show her light-hearted approach. One day early in the year, Dallas was sitting at his desk near the front of the class with a belt around his neck. He had looped the belt all the way through the buckle and was pulling the end upwards; it was an obvious and visual display and most students were looking his way. The loop of leather was tightening around his neck. When I (K.F.) noticed this, it gave me a slight jolt of alarm, evoking both hanging and bondage. Felix looked towards him and, laughing, asked ‘what are you doing Dallas? [pause] It’s not that kind of party!’ Everyone laughed and after a moment he took the belt off. This moment was quite ‘edgy’, evoking both risk and self-harm. A teacher who responded with alarm may have escalated rather than dissipated the tension. Felix read this moment, not as a threat, but as a performance evoking rebellion against the constraints of the classroom.
Deconstructing power
Johnson is both a teacher and a dean (with disciplinary and pastoral oversight of a year group). This latter role placed him in a position of authority, and he frequently contacted parents and addressed disciplinary issues with students. Despite this, his teaching practices also subverted this authority. In one class discussion about sexuality and gender, Johnson told students to ‘keep an open mind’, then noted, I didn’t do that today [keep an open mind]. I was in year 10, and a kid said that homosexuality was a sin. I ripped into him [told him off]. But I was wrong, and I apologised to him in front of the whole class.
He was admitting here that he dealt with this moment in the wrong way, and wished instead that he had opened up discussion, rather than shutting it down. He regretted responding to the student aggressively. Admitting he was wrong showed vulnerability; a move that destabilised his performance of dominant masculinity (see below).
There weren’t obvious or overt ways that Felix deconstructed power that I (K.F.) observed. But there were certainly practices she employed that helped distance herself from teacher power. For example, she would always let students use her classroom during interval and lunchtime, and she was the teacher who supported the school’s Queer 8 group and the feminist group. For both of these student-led groups, she provided gentle background support in the way of logistics and helping students navigate school regulations (such processes for running events) but she acted as a kind administrator for these groups, rather than a teacher-leader. In this sense, her actions communicated trust in the students to run the groups, facilitate discussions, decide on content, and support each other. These actions subverted teacher authority, including discourses of ‘risk’ that tend to position students as unable to facilitate discussions about abuse and sexism (common topics in the feminist group).
Embodied criticality
Health education in Aotearoa New Zealand high schools is uniquely placed internationally in terms of its status as a credentialed subject for national qualifications. However, it is also positioned in gendered terms, and often assumed to be a low status discipline of study (Leahy et al., 2016). It is taught in Aotearoa New Zealand by far more women teachers, is not offered as a senior subject in most boys’ schools, and is chosen by more girls in senior high school than boys (New Zealand Qualifications Authority, n.d.). Johnson’s embodiment – as a Pacific (brown) man and a health education teacher, disrupts the gender norms associated with health education (Paechter, 2000; Yager and O’Dea, 2010). At the same time, discourses of indigenous Māori and Pacific masculinities in Aotearoa New Zealand often centre around sporting prowess, physical force and violence (Biersack, 2017; Calabrò, 2017; Hokowhitu, 2003).
Although Johnson in some ways performs according to discourses of the masculine, brown sporting body, he also undermines this. He tells students ‘you’ve got to be tough, you’ve got to hold your own’ but also states ‘you need to build your worldview on things and not be angry and not be ungrateful for the help that you get, and don’t be shy to ask for help’. The fact that Johnson positions himself proudly as a health education teacher and is passionate about the subject disrupts dominant notions of the subject and reinscribes health as (also) a subject for cis gendered masculine men.
As a white, cis-gendered woman, Felix aligns with the gendered narratives of health education. Interestingly, however, she also goes against the trend in Aotearoa New Zealand schools of health education teachers also being physical education teachers. Significantly, Felix is the head of department in her school (in charge of health education, PE, outdoor education and sport) despite not being a PE teacher, nor having studied sport or PE. Her creative background means that she often dressed in quirky bright colours, patterned tights and clothing she had sewn herself. She also makes and wears her own jewellery. She embodied discourses of a creative, colourful and non-normative nature.
Critical content
Johnson communicated that he thought it essential to connect learning in class with students’ real-life experiences and understandings of culture; he often introduced indigenous and current issues for discussion. Most lessons would start in this manner and he would typically show a video or begin a discussion about Indigenous or other marginalised perspectives. For example, in one lesson, Johnson showed a video about a trans couple who had children together. The video outlined their struggles living in a community where others did not understand them. By showing videos and topics which challenged ideas of normalcy, Johnson centred his practice around what he saw as the aim of health education: challenging normative views. The following example is from another lesson: Johnson is continuing yesterday’s topic of gender and sexuality. He opens up by saying ‘transgender people are seen differently in different cultural groups. Like, in Native American culture, being a male or female, but embodying a different sexual orientation is seen as very special … What are some transgender identities you know of?’ Carlito responds: ‘fakaleiti and fa’afafine’. Discussion erupts regarding these terms … As the students get excited so does Johnson. He exclaims: ‘this is the juicy stuff. What health education is about, challenging those assumptions’. He also reminds students to keep their minds open to the different ways people see the world. Once the discussion has died down Johnson asks the class: ‘if you were gay, would you walk hand and hand down Queen Street
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with your partner? How about the Otara Flea market
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?’ Laughter takes over, and students begin to have discussions with the people around them. One student calls out across the class: ‘it’s normal down there [Queen Street] but, nah, not at the [Otara] markets’. Most of the class join in and agree. Mr Johnson then said ‘society often dictates what labels we should all wear, but it’s up to us to push back against them’.
This lesson – like the one we began with – is imperfect in terms of Johnson’s representations of gender and sexuality, and there is clearly some confusion between the two. However, opening up this conversation at least allowed students to engage with and contest heternorms.
Felix’s engagement with critical content was comprehensive and linked with assessment protocols in the NCEA system. The topics of study included the determinants of health and alcohol; analysing how personal, interpersonal and societal factors impact resilience; analysing and evaluating western and non-western treatments for contemporary youth health issues (such as anxiety and depression); and analysing issues related to gender and sexuality in society. I asked her to describe her vision for health education in her school.
I suppose … there are so many different aspects to health education … a lot of it is about students learning about themselves and then learning about themselves and their relationships with others but … also learning about what is going on in their community … Learning about what makes communities work … also learning about some of those challenges that people and communities are facing …
what would be really awesome is to have a student who gets so fired up about something they want to go and be an activist and promote human rights and things like that …
Felix’s approach to health education is clearly aligned with a philosophy of the subject as education about health, rather than education for health (Fitzpatrick and Tinning, 2014; see also Gard and Leahy, 2009). In this, she highlights learning, and she repeats this word several times. This is quite different to health education for health, which would more likely orientate to behaviour change and impacting physical health outcomes. Felix ends here with an explicit link to the possibilities that might arise from a critical approach to health education. Instead of suggesting that health education could lead to individual behaviour change, she instead imagines that the result of such learning might lead to activist work for social justice, such as human rights.
Conclusion: criticality and consistency
In reflecting on this study and the practices of these two teachers, we now wonder whether critical approaches to health education are a result of approaching health education as a discipline of study. If health education is taken seriously as a discipline of study, then will it also include learning about the biomedical, reviewing scientific epidemiological research, and gaining more conventional knowledge, but criticality might be applied to these as well. As the examples we have used in this article show, even when there is clear evidence of teachers’ critical approaches, discussions go wrong, get off track and can reveal teachers’ own lack of understanding. Fitzpatrick and Russell (2015) have explored some of these issues. When asked about the contradictions of being a critical pedagogue, Dan explained that it does go wrong all the time. This type of teaching is messy and fraught, and you find yourself in a constant battle to live up to your own expectations … at the heart of critical pedagogy is the idea of negotiation and contestation of sometimes competing priorities. (Fitzpatrick and Russell, 2015: 168)
Johnson’s lessons did not go according to plan and the discussions presented above (especially about gender and sexuality) went in directions he was clearly unprepared for. Felix had a deep knowledge of health education from multiple perspectives but also drew on more traditional approaches to health promotion, and biomedical views of the body. In her advocacy for a ‘less certain social science’, Lather (2007) calls for researchers to engage with a disruption of, as well as an application of, theory in order to, at once, apply and critique ontological positions. She explains that There is no exit from the lack of innocence in discursive stagings of knowledge. With a deconstructive goal of keeping things in process, keeping the system in play, fighting the tendency for our categories to congeal, my textual practices move toward some place of both/and and neither/nor, where I trouble the very categories I can’t think without. (Lather, 2007: 41)
We wonder here whether health education can also engage the both/and and the neither/nor – at once employing different approaches to the discipline (biomedical, sociocultural) while critiquing these as all limited, partial and inconsistent. The two teachers in this study engaged with health education content in ways that (planned or not) did open up uncertainties. Such engagements then necessarily meant that contradictions were inherent and knowledge was either directly contested or unresolved. At times, lesson discussions seemed tangential to the ‘purpose’ the teacher began with, and so obscurities were also present.
We began this article with a discussion of how Primdahl et al. (2018) conceptualised health education as a dichotomy between ‘traditional’ approaches to health education and critical approaches. They argued that: Desired learning outcomes can also be contrasted in these two discourses. In a traditional mode, health education tends to revolve around a curriculum that provides improved propositional knowledge and specific life-skills related to health and wellbeing, while that for a critical mode will tend to include a focus on developing students’ critical consciousness, empowerment and emancipation related to health and wellbeing within a wider socio-ecological perspective. (Primdahl et al., 2018: 3)
Perhaps critical health education actually encompasses both these modes, while simultaneously disrupting and questioning the underlying assumptions of each. Such an approach necessarily requires engagement with contradictions and uncertainties, and a willingness on the part of the teacher to open up and sustain pedagogical tangents and unresolved discussions. Is this then what a critical approach to health education might be about?
Footnotes
Acknowledgements
This research was made possible by a Rutherford Discovery Fellowship from Te Aparangi The Royal Society of New Zealand. The authors wish to thank the teachers and schools involved in this study and the very helpful feedback we received from the reviewers and editors of this journal.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
