In the introductory article of the current issue of „Chowanna”, the author introduces readers to the topic of health, which is commonly associated more with medical sciences than with the humanities. In recent years, however, there has been a growing interest in the broadly understood issue of health also within the field of social sciences, although this interest has, in fact, a centuries-long tradition. This growing attention is linked to the increasing emphasis on the importance of environmental factors, lifestyle, psychological and cultural aspects, and socio-economic conditions — not just genetics — as determinants of health and illness. It seems that the interest of non-medical sciences in health and illness will contribute to a complementary approach to these issues from a broad, interdisciplinary perspective. It is worth noting, however, that the concepts of health and illness are interpreted in various ways, which creates methodological challenges. The World Health Organization (WHO) defines health as a positive state (well-being) of physical, mental, and social well-being, and not merely as the absence of disease or infirmity, emphasizing the subjective feeling of well-being, which does not necessarily align with the medical assessment of an individual’s health status. Illness, when considered from a medical perspective, takes on a different dimension than when viewed through the lens of social behavior, as in the concept by T. Parsons (1969), where illness is defined as a form of social deviance due to an individual's inability to fulfill social roles and participate in the multifaceted social life.

The field of health education is as extensive as the concept of health itself, encompassing all its dimensions and aspects: physical, mental, and social health; objective and subjective; individual and public. It covers the entire area of medicine (hygiene, prevention, therapy, and rehabilitation), enriching it with an educational intention. Moreover, it introduces a new element — the enhancement and improvement of health. This broad scope is affirmed by Edward Mazurkiewicz’s definition: “Health education consists in shaping habits that serve the preservation and improvement of health, in developing a positive interest in health based on essential knowledge and role models, and in forming an attitude that enables effective prevention, rescue, treatment, care, and the application of hygiene requirements in the life of the individual and the human community.” Health pedagogy serves as the theoretical foundation of health education. Its main task is to develop a framework for cooperation between pedagogy and medicine, and subsequently to translate medical categories into pedagogical ones. The central concept in this regard is the concept of health. The way we understand this concept determines the very foundation of health education — its approach, strategy, and programming. The common understanding of health is still often burdened by a static and negative view. In such an approach, health is merely the gateway to all diseases — as humorously stated by Honoré de Balzac — or an abstract opposite to real ailments, as Jan Kochanowski (Jan of Czarnolas) vividly expressed. Such a perception of health provides only the premises for therapeutic and preventive action. For educational purposes, it is far too limited. Pedagogy requires a different, more positive and dynamic approach — one that emphasizes the potential for development and enhancement of health.

The article focuses on the issue of the social sciences' “interest” in health, detached from the medical sciences. This is evident in the significant revival of health-related discussions observed over the last quarter-century in modern sociology and psychology, and in recent years also in pedagogy, giving hope for an even deeper understanding of aspects related to improving public health, including psychosocial dimensions. This marks the definitive end of the traditional approach, according to which — firstly — the issue of health and illness was almost exclusively constituted by medicine, a natural and practical science, distant from the theoretical and practical traditions of the social sciences. Secondly — researchers in the social sciences used medical categories only within the conventions of social medicine epidemiology (or the so-called sociology in medicine). Finally, it has been accepted — almost as a tautology — that the human organism is increasingly affected by new, human-made environmental factors (such as noise, vibrations, toxic substances, etc.) that were not encountered throughout phylogeny, during the development of the human biological-social form. Physiological, cultural, or technological adaptations often — though not always — protect the human body from the harsh influences of the environment surrounding the human "individual." These adaptations enable survival in a given (often new) environmental space, although sometimes they merely reduce the effectiveness of physiological adaptation mechanisms in the ever-changing human habitat.

The analysis presented in this article does not aim to offer a comprehensive overview of the issues that health pedagogy should address. Its purpose was solely to demonstrate the potential application of social role theory in organizing the social issues of health and illness, which should be the subject of research within health pedagogy. This includes developing effective ways to support individuals and groups through education in maintaining health and overcoming the consequences of illness—whether one's own or that of a loved one. As J. H. Turner writes, “role theory is potentially useful because it concerns the complex interrelations of expectations derived from the social structure, their influence through the self, and individuals’ role-playing abilities [...].” He also believes that role performance is among the most observable phenomena, which is particularly important for the methodology of empirical research. This usefulness of social role theory should be recognized and utilized to a greater extent in health pedagogy research than it has been so far. Doing so would allow for a deeper understanding of the full range of connections between individuals facing health-related issues and the social structure. One of the earlier and most universal attempts to create a model linking health and illness issues with human social functioning is based on the theory of social roles. The concept of a social role, although it belongs to the fundamental concepts of the social sciences—especially sociology—is very difficult to define unambiguously and, consequently, to apply in research processes. This difficulty arises from the fact that the referents of this concept must be sought in two distinct areas of social reality: the normative and the behavioral. However, the most frequently cited definitions in the literature tend to relate exclusively to one of these dimensions. For example, sociological dictionaries state that a social role is "a defined and socially determined, internally consistent set of rules and expectations regarding desirable behavior of individuals in specific situations, connected with their social positions, as well as a set of fundamental privileges, duties, and rights socially assigned to a position within a group." Another definition describes a social role as "a set of expectations concerning the behavior of a person occupying a given position in the social structure, or the totality of rights and responsibilities associated with a given social position or status." A classic figure in Polish sociology, J. Szczepański, defined a social role as "a relatively stable and internally consistent system of behaviors that are reactions to the behaviors of other people, occurring according to a more or less clearly established pattern." T. Newcomb expressed a similar view, stating that a social role is "consistent behavior of an individual within a more or less stable relationship with another person or several persons." Likewise, J. H. Turner defined a social role as "the behaviors of individual persons within social positions in relation to each other, taking into account norms and other cultural symbols."

The article focuses on the issue of young people's lack of life and social skills, as the rapid and numerous political, social, and economic changes in recent decades have created new threats to the development and health of children and adolescents. These changes have led to new health and social problems, in particular triggering health-risk behaviors, also known as problem behaviors (such as smoking, alcohol consumption, use of other psychoactive substances, early sexual initiation, and violence). In response, primary prevention programs for these behaviors have been implemented, mainly in schools. The core element of these programs is the education of children and adolescents. These programs have evolved, driven by the need to find effective strategies and models. In the 1980s, special attention began to be paid to the development of life skills in these programs. In the early 1990s, the World Health Organization (WHO) Headquarters in Geneva launched an initiative to introduce life skills education in schools. Today, other international organizations are also involved in promoting this concept as an important element of children's and adolescents' education, health promotion, and school-based prevention efforts. In 2000, actions aimed at developing life skills were initiated, in cooperation with UNICEF, within the European Network of Health Promoting Schools.

The reduction of health inequalities occurring both between countries and among social groups within countries has been recognized as a key objective of public health policy. This issue was first formally addressed in 1984 with the development of the European "Health for All" strategy, and its significance was reaffirmed in 1991 in response to the sociopolitical transformations in Central and Eastern Europe. Health inequalities are primarily identified through epidemiological studies assessing population health. These assessments employ both objective and subjective indicators. Among objective measures, mortality and morbidity rates are commonly used as negative indicators of health status. Subjective measures, on the other hand, frequently include self-reported health assessments. The analysis of population health is conducted by a range of experts, including physicians, demographers, public health specialists, and sociologists specializing in health. Various indicators are used to reflect disparities in health status, with life expectancy emerging in recent years as a key composite measure. This indicator reflects not only the general health of the population but also the quality of healthcare services, living conditions, and environmental quality. In Poland, life expectancy currently stands at 68.1 years for men and 76.6 years for women. In contrast, in the European Union in 1995, the corresponding figures were 74.0 and 80.7 years. Similar disparities can be observed in the proportion of individuals reaching the ages of 65 and 85. In the mid-1990s, global averages for reaching these ages were approximately 70% and 20%, respectively. However, in less developed countries—where the population has limited access to adequate living standards and healthcare—these figures were significantly lower, at 47% and 9%, respectively. It is also noteworthy that the United States national health strategy includes health indicators disaggregated by income level and minority group status, including ethnicity. This approach is substantiated by epidemiological data demonstrating that adverse health outcomes—such as miscarriages, low birth weight, congenital defects, and infant mortality—are closely associated with low income, limited education, low occupational status, and other indicators of socio-economic disadvantage.

Among the four main types of maltreatment described in the literature — physical abuse, sexual abuse, neglect, and emotional abuse — the most serious definitional issues, and thus difficulties in formulating a concept for intervention purposes, concern emotional abuse. It is perceived both as a dimension of abuse that accompanies all other types and as a form of harm that can occur independently. Emotional abuse includes behaviors that are psychologically destructive (harmful) to a child's functioning in behavioral, cognitive, emotional, and physical domains. Neglect involves the absence of certain parental actions or behaviors aimed at protecting the child from harm, danger, or illness. It includes situations where basic care and support are not provided in the areas of emotional connection, supervision, nourishment, safety, education, as well as a lack of appropriate external stimuli and adequate environmental conditions. These four categories of abuse often co-occur, creating a discouragingly complex, multidimensional, and multilayered issue for a potential therapist. It is no surprise that the range of possible interventions that may be applied in such cases is broad and varied. Whatever other factors may be involved, emotional abuse is "supported" by parental indifference, which reflects and exposes a deeply rooted emotional rejection of the child. The interactions between different types of abuse are not sufficiently understood, making it difficult to resolve many issues related to this complex psychosocial problem, and consequently to develop a coherent intervention plan. Another complicating factor is the lack of sufficient clinical trials, meaning that empirically supported therapeutic recommendations cannot be fully trusted. The primary focus of attention is the perpetrator of the abuse. In no way can treatment of the child be effective or meaningful without a change in the behavior and attitudes of the parents. S. T. Azar, M. M. Ferrare, and S. J. Brenton argue that, because they carry direct risks for the child, interventions in families where abuse is present must initially focus on deficits in parenting skills, aggressive and rejecting behaviors (e.g., instilling a sense of responsibility, using positive guidance strategies, communication), stress management, emotional regulation, and cognitively based strategies (e.g., problem-solving, reframing, cognitive restructuring of perceptions of the child's behavior).

Review

Review

Review

Report