Ethical underpinnings for the development of health literacy in schools: ethical premises (‘why’), orientations (‘what’) and tone (‘how’)

Abstract

BackgroundSchools are seen as crucial environments to influence and develop the health literacy of new generations, but without sufficient reflection on the ethical underpinnings of intentions and interventions around health literacy. In contrast, we argue here that ethics are fundamental to all education. The article adopts a ‘One world’ approach that generalizes broadly across the so-called Global North and Global South. It also generalizes across various age groups among school pupils, advocating age appropriate application of the arguments advanced.Main textOur analysis examines why health literacy should be promoted in schools and argues that the purpose should embrace the values of social justice and should not stop at individual and national cost benefit analysis. Discussion about the orientation of health literacy highlights meta-cognitive skills around critical thinking, self-awareness and citizenship rather than lists of practical skills. Finally, approaches to health literacy in classrooms are presented with an ethical tone that draws attention to the power relations responsible for health inequities and that does not assume that such power relations are the given framework for health literacy interventions and activities. These arguments are reinforced by urging that related debates address dynamic social realities such as international migration.ConclusionsWe reiterate the need for ethical questions to be consciously and systematically addressed from early on, beginning with intentions to promote health literacy even before these intentions are translated into action, within the political space where education meets public health and health promotion. We underline again the context of fluidity and dynamism, as new challenges emerge within pedagogies and curricula, especially in response to changing populations in the society around.

“When I feel well all over, I study and learn better” - experiences of good conditions for health and learning in schools in the Arctic region of Sweden

“…This was described as a context in which democracy is brought into practice, which would allow students to have an influence. This aligns with the arguments that an ethical and open school community in which everyone has an equal voice will enable health education to promote health literacy of [13].…”

A Comparative Study on Adolescents’ Health Literacy in Europe: Findings from the HBSC Study

“…On the other hand, one might ask whether education in health issues could actually increase differences in HL. Research up to now has indicated that schooling decreases cognitive gaps as compared to non-schooling experiences [36], with the implication that education in health issues would be beneficial in every possible respect [6]. However, we also know that some adolescents learn better than others, which would mean that even if average HL increases through education, the deviation between high and low performers could become larger.…”

“…According to the pairwise comparisons, both Macedonia and Finland had statistically significantly higher mean scores than any of the other countries (Table 1). Multiple comparisons with Bonferroni; the mean difference is significant at the 0.05 level; 1 Austria, 2 Belgium, 3 Czechia, 4 England, 5 Estonia, 6 Finland, 7 Germany, 8 Macedonia, 9 Poland, 10 Slovakia .…”

“…Since HL can be developed, it can undoubtedly act as a way of addressing adolescents' health disparities, which tend to track forward to adulthood [5]. It is also linked to power gained through knowledge [6], with a potential for empowerment and autonomy [1].…”

Health literacy among participants from neighbourhoods with different socio-economic statuses in the southern region of Hungary: a pilot study

“…However, some studies have shown no correlations between age [ 11 ], socio-economic status [ 11 ] and HL. Low HL can also be associated with an unhealthy lifestyle, physical inactivity [ 16 , 17 ], an unhealthy diet [ 17 ], smoking [ 17 ] and obesity [ 16 , 17 ]. For patients with CVD, their HL level are associated with their health behaviours and health status [ 18 ].…”