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Didactic and
Contrasts between didactic and Deweyan
Deweyan approaches to health approaches
education
467
Corey H. Brouse
Department of Health Promotion and Wellness, SUNY Oswego, Oswego, Received 1 April 2004
New York, USA Accepted 1 March 2005
Charles E. Basch
Department of Health and Behavior Studies, Teachers College, Columbia
University, New York, USA
Michael Kubara
Department of Philosophy, University of Lethbridge, Lethbridge, Alberta,
Canada

Abstract
Purpose Over the past few decades, several theories and models have evolved to guide health
education practice. Some of these models are participatory and democratic; nevertheless, much health
education practice is based on achieving goals established by health authorities, which are called
here the didactic model. The purpose of this paper is to consider that model and contrast it with a
Deweyan model, based on the pragmatist philosopher, John Dewey.
Design/methodology/approach First provides a historical perspective on the didactic and
Deweyan models stressing their implications for health education. The didactic approach is contrasted
with a dialectical approach implied by the Deweyan model. Then briefly discusses pragmatism and
cognition noting the importance of emotions in the learning process and consider the implications of
various philosophical perspectives for understanding human behavior. The final two sections discuss
the goals of health education and the role of the health educator based on the essentials of
pragmatismin which health education is value-laden and lifestyle specific
Findings Concludes by advocating for a greater emphasis on a Deweyan philosophy in public
health education practice and research.
Originality/value Over the past several decades, theoretical frameworks for health education have
evolved and a wide variety of educational, social-psychological and program planning frameworks
have been proposed and utilized to guide practice, but none specifically follow the philosophy of John
Dewey. This paper is original in that it outlines the Deweyan philosophy and relates it to health
education. If that philosophy were to guide health education practice and research, it would improve
our service to the community as well as our understanding about why people make the choices they
do.
Keywords Health education, Ethics, Public health, Pragmatism, Philosophy
Paper type Research paper

Aims of this paper Health Education

Vol. 105 No. 6, 2005
An important guide to health education practice is the theoretical foundation upon pp. 467-476
which it is based. Over the past several decades, this theoretical base has evolved and a q Emerald Group Publishing Limited
0965-4283
wide variety of educational, social-psychological and program planning frameworks DOI 10.1108/09654280510630803
HE have been proposed and utilized to guide practice (Glanz et al., 2002). Some of these
105,6 models have stressed participatory and democratic health education practice in schools
(Jensen, 1997; Jensen, 2004; Jensen and Simovska, 2002; Jensen and Simovska, 2002;
Tones, 2002) and community settings (Green and Kreuter, 1991; Society for Public
Health Education, 2003; Tones, 2002).
Nevertheless, it appears that much health education practice is still based on
468 achieving goals established by health authorities rather than community
development or participatory democratic models that stress community members
formulating goals and objectives. Programs aimed at achieving goals established by
health authorities we call the didactic model.
The purpose of this paper is to consider the didactic model and to contrast it with a
Deweyan model, based on the pragmatist philosopher, John Dewey. We first provide a
historical perspective on the didactic and Deweyan models. We then briefly discuss
pragmatism and cognition noting the importance of emotions in the learning process.
Next, we consider the implications of various philosophical perspectives for
understanding human behavior. and characterize them in terms of their implications
for education. The final two sections of the manuscript discuss the goals of health
education and the role of the health educator based on the preceding topics. and
characterize them in terms of their implications for health education didactic
approach is contrasted with a dialectical approach implied by the Deweyan model in
which health is value-laden and lifestyle specific. We conclude by advocating for a
greater emphasis on a Deweyan approach in public health education practice and
research.

Didactic perspectives
The roots of the didactic model go back to the Cartesian idea that knowledge must
have a firm and permanent foundation, base or fundament (Descartes, 1998) think
of an architectural foundation supporting an ever increasing number of scientific
stories. The foundation must be thought eternally true, never correctable (one form of
perfection the perfect representation of reality) and infallible (another perfection,
making believers incapable of error). Infallibility if it were really attainable would
provide justification or proof for unshakable belief; conflicting data would be discarded
or recast. The fundamental eternal truths represent reality as it is in-itself. The role of
science is to discover that underlying reality, which includes all things living and non
living. Within this model health comes under the umbrella of science. A persons
refusal to accept the fundamental ideas must be fixed somehow, ideally by education,
but if not, then by medical or political/legal intervention, treatment or punishment.
The didactic model is at least associated if not alternately named by other
ism-words: foundationalism and fundamentalism emphasize the structure of
knowledge or science; infallibilism emphasizes the alleged epistemic authority of
believers, which is the basis of political authority; realism emphasizes the nature of the
object of knowledge and its relation to those who know. In this paper we use the term
didactic to emphasize the educational implications of this ideological scheme. Within
this model, educators are experts, authorities; their students are uninformed, needing to
be fixed and to obey the authorities.
The word didactic goes back to Aristotle who distinguished didactic from
dialectical argument: didactic argument appeals to foundational, allegedly self-evident
premises listeners (students, clients, patients) are required to accept. Didactic argument Didactic and
has its place: whenever we need to teach both conclusions and the reasons for them Deweyan
mathematics and theoretical sciences, for example.
approaches
Pragmatism and Dewey
Pragmatism in general is diametrically opposed to most planks in the didactic
platform. It is itself evolutionist versus foundationalist. A famous metaphor likens 469
science to a ship being rebuilt at sea: a totally new ship might arrive at port; yet at any
stage reconstruction cannot be so drastic to sink the original.
Dewey was on the frontier of the pragmatist movement along with C.S. Peirce, its
prime mover (Peirce, 1933a,b,c; 1958a,b) and William James (James, 1948). Ideological
movements are like species, they evolve; each contributor adds a mutation, though the
main tenets of pragmatism are championed today by many philosophers in the USA as
well as Europe. One of Deweys special contributions to pragmatism was to think
through its implications for education, a theme explored in this paper.
According to pragmatism the basis of scientific and philosophical evolution
however is not natural selection but dialecticnot in an esoteric Hegelian (Hegel and
Kainz, 1994) or Marxist (Marx, 1991) sense but in a simple Socratic sense (Plato, 1993;
Kubara, 1975). Dialectical argument is a form of dialogue, and seeks agreement
between participants (Aristotle, 1992, 1998). It is appropriate whenever the goal is to
critique and change beliefs, values or ideologies. Pragmatism sees each generation as
beginning with a conceptual legacy to be exposed, which is then critiqued to yield a
better idea which at least should not be subject to the same critique, and so on. The
fittest ideas survive dialectical critique.
Dialectical pragmatists are forward looking. They believe that we can always do
better: re-search is the cornerstone of all academia, not just the sciences.
Pragmatism is fallibilism, seeing infallibility as too high a bar for humans: to err is
human. The highest attainable standard of human proof and knowledge (short term
invulnerability to dialectical critique) is beyond reasonable doubt, and in practice, on
countless occasions this standard is met only to have the judgment subsequently
overturned as erroneous. Not only can new data become available but also types of
data hitherto unimagined DNA evidence for example. That, according to
pragmatism is the human condition: all action regardless of risk is in the face of more
or less uncertainty. Minimizing the uncertainty is the best we can do.
Pragmatism opposes realism with irrealism or idea(l)ism. Truths are mainly
linguistic representations; reality does not represent itself. Representations, concepts,
ideas, words, theories and so on are creations of people and they themselves have
evolutionary histories. This much is traditional idealism or ideaism; but pragmatism
makes ideals basic to reality, not in a Panglossian sense of construing reality as the
best of all possible worlds, but in the sense that our representations of reality are the
products of ideals regarding good methodology, good evidence and more basically
good people. For Peirce, Logic, Ethics, and Aesthetics were the basic normative
sciences systems of thought and all sciences were dependent on them (Peirce, 1958,
1933).
If reality does not have an identity in itself, it certainly does not have a value in
itself. Vocabularies divide into words, which are value neutral or merely classificatory,
and those, which are implicitly evaluative. For example tree, dog, human, are merely
HE classifications with no value implications trees, drugs, humans may be good or bad
105,6 in many respects. The rules for applying classification words are found in dictionaries
which do not make them but just report them. Evaluative words require not
definitions but standards, which dictionaries do not give (except that definitions
themselves are the standards for correct linguistic behavior of a sort).
Beliefs may be true or false, a pulse or respiration rate may be good or bad. These
470 are value neutral. But knowledge cannot be false (a bad representation) or ill-founded
(irrational belief); a healthy pulse is a good one. Knowledge and Health are value
concepts, good dictionaries will tell us they are defined in terms of good/bad or
right/wrong, but they will not specify the standards of value. Physical health is (at
least) good physiological functioning, which includes the functions of organs, as well
as more holistic systems. Nevertheless the standards of such functioning are not
matters of definition or discovery but rather matters of normative commitment. It can
even be argued that establishing the functions is ipso facto establishing norms
(Kubara, 1974).
Pragmatism is also meaning-consequentialism; an important aspect of meaning and
interpretation is the action implications of words and all semiotic data: icons, indices
and symbols. Lexical competence requires more than correctly applying and defining
words, it also requires knowing how the words affect behavior, the behavior of
interpreters as well as whatever the words apply to. Pragmatic means only the rule of
referring all thinking, all reflective considerations, to consequences for final meaning
and test. Nothing is said about the nature of those consequences; they may be aesthetic
or moral or political or religious in quality anything you please (Dewey, 1916 p. 334).
Pragmatists and Dewey in particular, searched for continuities rather than
discontinuities; they preferred thinking in terms of spectra as opposed to dichotomies
(Dewey, 1981,1998; Sleeper, 2001), for example, the traditional division of mental
faculties was reason/cognition, motivation, and emotion/affect. But as Peirce puts it
emotion is just another car a little farther down a train of thought. Linguistic
representations are symbolic; percepts, and other states of consciousness, emotion
included are indexical like meter readingsand they too may be true or false.
Merely teaching/learning to represent reality in language is educationally incomplete.
(Peirce, 1933a,b,c; 1958a,b)

Philosophical perspectives on education

No three philosophers were more closely related or mutually revered than Socrates,
Plato and Aristotle, yet Socrates had no greater critic than Plato, nor Plato than
Aristotle. Socrates is the god of philosophy because he loved and pursued wisdom not
the mere reputation for it (who are they to judge?), even insisting on his own ignorance
called Socratic Irony, and committed to dialectic called the Socratic Method, but
Plato and Aristotle complete the trinity. In the company of gods, Dewey is a lesser
light, but he stood on their shoulders.
Despite their dialectic progression each thinker put forward profoundly different
conceptions of human nature, the psyche, the explanation of human behavior, virtue
and vice, each with implications for education. To sum up the philosophies of
education the process of making children more mature or of making the mature more
virtuous in some special way: Socrates give them knowledge; Plato knowledge
plus will power (courage and temperance); Aristotle knowledge, will power and
good habits; Dewey all the above, but habituation should begin with the characters Didactic and
and interests of individual learners. Deweyan
approaches
Didacticism, pragmatism and the goals of health education
Didactic health education programs begin with antecedently and externally set goals
often set by health authorities and try to impose them on individuals. Regarding diet
and nutrition for example there are recommended daily dosages from the food groups 471
as well as vitamins and minerals. On average these diets result in fewer health
problems or longer life spans. But just as courts of law cannot determine guilt or
innocence of particular persons on the basis of profiling, on average recommendations
need not apply in particular cases.
In the didactic model, Olympic athletes may be the paragons or pictures of physical
health, examples of complete physical well being, and by those standards almost all of
us are physically unhealthy. However, as gaining Olympic level physical well-being is
a full-time job, this sets the bar of optimum physical health unrealistically high. For
most of us the lack of Olympic level achievement merely indicates inability it is not
indicative of ill health or dysfunction at all. People live well with a great variety of
lifestyles: some are more sedentary than others are. Those unfit for Olympics can be
perfectly fit for their lifestyle.
Dewey argued that it is better to start with individual personality traits and
interests. Ideally education is not an imposition but an opportunity to mature or
develop. For adult learners Dewey would stress dialogue or even a dialectical process.
According to pragmatism, people are entitled to different conceptions of the good life.
There is no one and only good life plan. Something which constitutes a disability
within one lifestyle might be of little or no significance for another.
A shorter life span need not be due to ill health. Some careers involve great risk to
life: a shorter life span is probable. Yet merely because of a shorter probable lifespan,
these activities are not in themselves indicators of ill health. Similarly for sedentary
lifestyles which may shorten longevity. Novel writing may be just as dangerous to
your longevity as soldiering (shrapnel can clog arteries as well as cholesterol); but
these life styles need not be intrinsically unhealthy.
Just as Dewey urged us to think in terms of better inquiry instead of its idealized
goal state, knowledge, he urged thinking in terms of healthier living rather than the
idealized goal state of perfect health. The latter is like a mathematical limit
approachable but not reachable; and the limit itself may progress. We keep raising the
bar. This can be one form of evolution within the species not by natural but by
domestic or artificial selection.
Olympians are less paradigms of health than entertainers, sometimes amateur, now
mostly professional, entertaining by pushing the standards of physiological
performance for their own sake by single-minded devotion to very narrowly
conceived projects. They are examples of what can be done given an idee fixe. They are
one-dimensional superstars; perhaps more sub than super-normal. Standards of health
are unrealistically high if they require full-time jobs or obsessions to meet them.
Besides, those pushing the limits of physical functioning who give 110 per cent as
coaches often demand, are very prone to injury. These individuals risk their health
because they push the limits of health. So theirs may be viewed as an unhealthy
lifestyle.
HE From a didactic perspective, people would be told to increase physical activity
105,6 for better cardiovascular functioning, and sedentary lifestyles would be
discouraged. In contrast, a Deweyan health educator will consider cardiovascular
functioning in relation to personal lifestyle preferences. Physical activity might not
pay off in happiness. People can become preoccupied or obsessed by the need to
exercise. Even without obsession, exercise takes time; time might be taken from
472 other pursuits valued by the individual. Costs are to be balanced with benefits.
The goals of health education have more to do with the whole person including
ideology and lifestyle and the overall quality of life (Dewey, 1975), rather than an
externally set physical health agenda. According to that agenda, people might
seem to choose to be unhealthy. But it may be that they are not dysfunctional for
their valued way of life.
The model of health education that emerges from pragmatism is one in which the
goal is giving informed choices for health, and health goals which are relative to good
lifestyle (Dewey, 1975). Individual conceptions of living-well might not include
maximum longevity, a minimum body fat to weight ratio or even looking good,
let alone being an Olympian. On the other hand, as a result of dialogue, people might
change their conceptions of the good life and the level of bodily functioning required to
live it. Endomorphs might be better off not being made over into mesomoprhs or
ectomorphs.
Different goal-setting methods apply to issues of quantity vs. quality, longevity
versus living well (which are not necessarily mutually exclusive but which may
conflict). Which is betterlongevity with physiological dysfunction and unhappiness
or a shorter happier life? The question is unanswerable in the abstract; it depends on
individual abilities to cope and idiosyncratic evaluations of dysfunction. Many
lifestyles assume great risks to life and limb: racecar driving, mountain or rock
climbing, bronc riding, soldiering, the sex trade and so on. For some it may even
depend on political ideology: New Hampshires license plates urge us to, live free or
die. Unlike Olympians, these life/death styles do not risk ill-health because they push
the limits of physiological functioning. They are extrinsically unhealthy rather than
inherently unhealthy. Novel writing, musical composition and television watching are
more sedentary but may have similar impact on longevity due to inactivity though,
Mozart and Schubert aside composers have a reputation for long life.
The argument here is not that being sedentary should be a source of happiness and
fulfillment, but rather there is no one good life plan; at least within dialectically
challengeable limits, ones conception of the good life should be a matter of choice and
the standards of good functioning should be relative to or coherent with this. One
cannot be decided without the other.
But individual rights often compete with public goods including public health. The
issue is not health and Paternalism but health and Utilitarianism (thanks to
anonymous referee). Both didactic and Deweyan models recognize the importance of
compromising the rights of individuals for the community as a whole. And while both
recognize Platos claim that the law is also an educational institution of sorts (a good
legislation would prohibit certain harmful substances and activities for good reason or
discourage them with sin taxes) our focus is limited to extra legislative measures
(Plato, 1991).
 It is a truism that harm to others is unacceptable. This is an easy line to draw in Didactic and
some cases, but more difficult in others. Prohibitions against some unhealthy Deweyan
substances and activities are uncontroversial: tainted meat, unsanitary restaurants and
polluted water and air. Even here matters are disputed: industry lobbies for rights to approaches
pollute on economic grounds. It is even more controversial when unhealthy lifestyles
are freely chosen. Some like to smoke, but the adverse effects of second hand tobacco
smoke provoked legislation making public places smoke-free zones. Other lifestyle 473
choices such as excessive intake of dietary fat may also tend have adverse effects on
society, but regulation of these practices would not be acceptable at this time. Where
the line is drawn is based on societal norms and values and political process.
In competitive contexts of all sorts, from games to sports to business, the aim of
winning entails the oppositions losing and often losing is harmful, mentally,
physically or economically. But people have a right to voluntarily assume these risks;
when they lose they are the agents of their own misfortune and cannot shift liability
elsewhere. If on average the risk taking is in the public good, it would be good to set a
social safety net to minimize the individuals maximum risk. This idea is now
attributed to Rawls (1999), but it is as old as Plato who argued for bankruptcy
protection of sorts (Kubara, 1974). The idea applies also to health care.
In jurisdictions which enjoy community responsibility for health care, other
considerations become important: if a community assumes default responsibility for
medical costs and costs of rehabilitation or coping with long term disability, they have
a right to force higher safety requirements on individualssuch as seat belt and
helmet legislation. But here too drawing the line is not straight forward. Should chronic
over-eating be illegal? Should people be prevented from voluntarily eating unhealthy
foods or failing to exercise, since doing so will have social costs? Should there be a legal
prohibition on excessive saturated fat intake? Should it be sold only to consenting
adults? These questions even if they have educational implications go beyond our
scope. But they illustrate the point that many of the key behavioral determinants of
health status are within the individuals choice, and any attempt to legislate such
choices would be unacceptable because the infringement on individuals rights would
be seen as outweighing the public health benefits, and, perhaps more importantly,
because the majority of the population would not support such legislation.
Finally, it should be noted that the goals of health education have too often focused
exclusively of changing individuals behavior rather than addressing the underlying
causes of that behavior. This issue, which has sometimes been referred to as blaming
the victim, has been discussed for decades in the health education literature
(Freudenberg, 1978; Green and Kreuter, 1991) and stress the importance of establishing
goals that focus on social change as well as educating individuals to make informed
choices (Freudenberg, 2000; Cuffaro, 1995). This is a critical point since a Deweyan
approach requires that learners are in a good position to learn.
People come in a great variety of degrees of ideological sophistication, ranging from
the clueless to connoisseurs. As Plato realized dialectical argument is not for the
clueless. But often when individuals are sophisticated in the good sense wise and
for whatever reason unwilling to merely blindly trust the professional, the challenge
may be received like a dissenter at a sermon. One lesson from the Socratic dialogues is
that whenever the rules of a type of discourse do not allow didactic argument, the line
between teaching and preaching becomes invisible to the untutored eye.
HE The role of the health educator
105,6 Too often in a didactic model, the role of the educator is reduced to disseminating
information. The educator is seen as the one who has knowledge that must be acquired
by the learner. As described above, this is consistent with the authoritarian philosophy
based on the premise: I know what is best for you. While more sophisticated didactic
approaches may try to tailor educational messages to a particular population of
474 learners, the tailoring is often cursory with respect to psychological, emotional, and
interpersonal communication factors.
The role of a Deweyan educator is more of an ideological or philosophical counselor:
it stresses education as a social process, specifically dialogue and dialectic
(Archambault, 1974; Dewey, 1981, 1997). As such, this requires the educator to take
the time to learn about the learner, and recognize that he or she may at times have as
much to learn from the learner as the learner does from the educator, going beyond
providing information and also attending to affective processes related to the learners
interests, concerns, values, and troubles (Greene, 1989).

Conclusion
One of the shortcomings of health education theory can be seen in the lack of research
on the reasons why programs work. Even when programs are successful in influencing
the behavior of the intended audience, process analysis evaluations intended to
understand why the programs worked are generally very disappointing. There are few
attempts to measure the hypothesized mediating variables and demonstrate
relationships between these variables and the intended behavioral outcomes. In the
rare cases where such studies are published, the extent to which they account for
variation in behavioral outcomes is often minimal. It should be noted that no published
studies could be identified that examined the extent to which the learner truly felt
connected with the educator, respected and trusted the educator, and felt that the
educator truly cared about him or her as a person, in relation to educational or
behavioral outcomes.
If Socrates were right, health education would be merely disseminating information
about health. If Plato were right, health education would be information plus programs
for information retention as well as techniques for resisting temptation and preventing
emotional mood swings from undermining better judgment. If Aristotle were right a
host of good habits would also need to be instilled. If Dewey were right the most
effective way to do that would be to build on the antecedent motives and emotions of
the learners.
Philosophies too have shelf lives and fashions. Dewey was in fashion in the first half
of the twentieth century, and so may now seem dated. However, it is time for recycling,
not only to improve the extent to which this field serves its intended audiences, but also
the extent to which it improves understanding about why people do the things they do.

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Further reading
Gould, S.J. (1981), The Mismeasurement of Man, WW. Norton and Co., New York, NY.
Simovska, V. and Jensen, B.B. (2003), Young-Minds.Net/lessons Learnt: Student Participation,
Action and Cross-cultural Collaboration in a Virtual Classroom, Danish University
Education Press, Copenhagen.
WHO Regional Office for Europe, Technical Secretariat of the ENHPS (1997), The health
promoting school: an investment in education, health and democracy, First Conference of
the European Network of Health Promoting Schools, International Planning Committee of
the European Network of Health Promoting Schools, WHO Regional Office for
Europe/European Commission/Council of Europe, Copenhagen, WHO Regional Office
for Europe.