Health Promotion as Collective Pedagogy: Reframing Health Literacy in the Post-Pandemic Era

Introduction

Critical health literacy (CHL) occupies an increasingly central position in health promotion scholarship. By foregrounding the social, political, and structural dimensions of health, and by enabling people and communities to question, challenge, and act on the social determinants of health, CHL extends far beyond earlier conceptions of health literacy as information access and individual decision-making (Chinn, 2011; Nutbeam, 2000; Sørensen et al., 2012). It has provided health promotion with a more adequate theoretical vocabulary—one capable of naming power, inequity, and structural conditions alongside knowledge and skills (Jacobs & Morton, 2024).

Recent scholarship has sought to consolidate the conceptual foundations of CHL. For instance, Abel and Benkert (2022) defined CHL as the ability to reflect upon health-determining factors and processes and to apply the results of that reflection to individual or collective action for health. Drawing on Freire’s critical pedagogy and Bourdieu’s theory of practice, they identified reflection and action as the two constitutive dimensions of CHL and situated the concept explicitly within the context of social health inequalities.

Despite these advances, an important gap remains within the field. While CHL scholarship has been diagnostically effective in critiquing individualized models of health literacy, it remains comparatively underdeveloped in relation to the pedagogical processes through which capacities for critical reflection and collective action are formed. As Abel and Benkert (2022) themselves acknowledged, the social conditions that enable the acquisition of CHL, as well as the institutional mechanisms through which such capacities develop, remain insufficiently specified. Contemporary health promotion programs continue to prioritize the communication of health information to individuals, often giving comparatively less attention to the relational, institutional, and participatory environments through which critical health capacities emerge (Kruger et al., 2025).

This paper addresses that pedagogical gap by proposing a collective pedagogy framework for CHL. It argues that the capacities for reflection and action identified by Abel and Benkert (2022) should not be understood primarily as outcomes of individual cognitive development, but as socially produced capacities cultivated through structured participation in collective, institutional, and community settings. To develop this argument, the paper draws on the applied collective pedagogy of Anton Semyonovich Makarenko alongside post-pandemic scholarship concerning collective agency, institutional trust, and effective population-level health responses.

At the same time, the paper does not approach collective pedagogy as an uncomplicated solution to the limitations of existing CHL frameworks. Drawing on Bourdieu and Passeron’s sociology of educational reproduction and field relations, it also examines the structural conditions that constrain the development and institutional realization of collective CHL within contemporary health promotion and education systems. Rather than assuming that critical engagement automatically produces emancipatory outcomes, the paper argues that educational institutions themselves are shaped by unequal distributions of power, legitimacy, and cultural capital. Clarifying these constraints constitutes, it is argued, a necessary contribution to the theoretical and pedagogical development of CHL.

Critical Health Literacy: Theoretical Strengths and Pedagogical Gaps

Health literacy emerged as a productive framework for broadening the skills recognized as essential to navigating health systems and information (Nutbeam, 2000). However, its dominant formulation — organized around the individual as the primary unit of analysis — systematically underestimates the formative power of institutions, collective norms, and the upstream structural conditions that shape health exposure and response (Chinn, 2011; Jacobs & Morton, 2024). Critical health literacy scholars have long challenged this emphasis. For instance, Chinn (2011) argued that health-related competence is constitutively shaped by social context, and that the individualist framing of health literacy risks locating the problem of health inequity in deficits of personal knowledge rather than in the structural conditions that produce differential exposure and capacity.

Abel and Benkert (2022) represent the most theoretically developed recent attempt to address this challenge. By defining CHL through the paired concepts of reflection and action, and by grounding these in Freire’s critical pedagogy and Bourdieu’s theory of practice, Abel and Benkert (2022) anchor CHL firmly within the discourse of social health inequality and the reproduction of inequities. Their framework identifies both an individual and a collective dimension of CHL — recognizing that capacities for reflection and action are shaped by habitus, structured by the unequal distribution of capital, and embedded in the social fields within which people pursue health. Abel and McQueen (2021), developing the related concept of CHL in pandemics (CHL-P), demonstrate that in conditions of urgency, complexity, and scientific uncertainty, the competences required for effective health response are fundamentally collective in character — requiring individuals to be understood as agents and citizens capable of collective action, not merely as recipients of health information. Okan et al. (2023) extended this through the concept of health literacy as a “social vaccine”: a process of social and political mobilization that empowers individuals and communities to act with solidarity and collective responsibility, and that specifically positions critical health literacy as oriented toward supporting effective social and political action. Jacobs and Morton (2024) have further examined CHL through a social justice lens, stressing its potential for interrogating power relations and supporting transformative action.

Recent scholarship has expanded the conceptual terrain of CHL beyond Western individualist framings. For instance, Tian et al. (2025), in a scoping review of Western and East Asian perspectives, identify increasing emphasis on civic engagement, social advocacy, collective responsibility, and structural awareness within contemporary conceptualizations of CHL. Their analysis suggests growing recognition that health literacy needs to be understood as socially situated practice embedded within broader cultural and institutional environments rather than as an isolated individual competence. Pithara (2020), also, drawing on the capabilities approach, argues that health literacy should be conceptualized in relation to individuals’ real opportunities to exercise agency within unequal social conditions rather than as a decontextualized set of skills or competencies.

Similarly, Soultatou and Economou (2026), reviewing critical pedagogy applications in school-based health education between 2014 and 2025, identified persistent tensions between transformative pedagogical aspirations and the institutional constraints of standardized curricula, performativity frameworks, and biomedical models of health education. Their findings suggest that while critical and socio-ecological approaches are increasingly visible within health education discourse, their pedagogical operationalization remains uneven and frequently constrained in practice.

Together, these contributions have substantially strengthened CHL’s theoretical reach and deepened its social justice and structural orientation. Contemporary CHL scholarship increasingly acknowledges the importance of social participation, civic engagement, structural awareness, and collective responsibility in shaping health-related agency (Abel & Benkert, 2022; Okan et al., 2023; Tian et al., 2025). Yet an important pedagogical question remains comparatively underdeveloped: how are these capacities deliberately cultivated through educational practice and institutional environments? While CHL theory has been highly effective in identifying the social conditions that enable or constrain critical health competence, less attention has been given to the pedagogical organization of collective reflection, shared accountability, and transformative action in practice. Abel and Benkert (2022) called for social theory to guide the application of CHL; Abel and McQueen (2021) emphasized the need for context-sensitive interventions capable of fostering critical reflection under pandemic conditions; and Okan et al. (2023) highlighted the importance of developing citizens’ capacities to contribute to collective good. The present paper addresses this pedagogical specification problem through a collective pedagogical framework grounded in Makarenko’s educational theory.

It is worth recalling that the tension between individual and collective approaches to education is not new. At the beginning of the 20th century, John Dewey and Anton Semyonovich Makarenko developed distinct educational philosophies in response to comparable conditions of social disruption, institutional instability, and mass displacement (Holtz, 2002). While Dewey foregrounded experiential learning and the development of individual interests within democratic communities, Makarenko placed greater emphasis on disciplined participation in organized collective life as the primary condition for individual formation (Caskey, 1979; Holtz, 2002). Contemporary pedagogies in health promotion have often prioritized individual development and behavioral competence, reflecting assumptions more closely aligned with liberal-individual pedagogical traditions than with Makarenko’s collective orientation.

Pandemic Recurrence and the Urgency of Structural Health Education

One of the most consequential lessons of COVID-19 is that large-scale infectious threats are not exceptional disruptions but recurrent risks produced by enduring structural conditions. The intensification of industrial agriculture, ecological degradation, habitat destruction, and global interconnectedness continue to create conditions favorable to pathogen spillover and rapid transmission (Waitzkin, 2021). Clinical and pharmaceutical innovation, however important, cannot substitute for upstream prevention, ecological literacy, and population-level education organized around collective responsibility.

Abel and McQueen (2021) demonstrated that acute pandemic conditions are characterized by three interconnected challenges for CHL: the urgency of action at all levels, the complexity of causes and consequences, and the need to act under conditions of evolving and uncertain scientific knowledge. These conditions create serious difficulties for individuals to engage in critical thinking and reflection — particularly in the context of information overload, political failure, and the social stratification of pandemic impacts, which are unevenly distributed across social classes and living conditions.

The parallel “infodemic” of misinformation that accompanied COVID-19 further exposed the limitations of narrowly individualized models of health literacy. The large-scale circulation of misinformation and declining trust in public institutions undermined vaccine confidence in ways that individual information-processing skills alone could not adequately address (The Lancet Infectious Diseases, 2020). Effective pandemic response depended not only on personal competence, but also on institutional trust, social solidarity, and coordinated collective action.

Okan et al. (2023) developed this insight through the concept of health literacy as a social vaccine: a process of social and political mobilization through which individuals and communities develop the consciousness and collective capacity to protect population health. Applied as a public health strategy, this concept underscores that the development of health literacy competencies serves not merely to equip individuals with information but to push forward the political and social change required to secure equity in population health responses.

This structural reality has direct implications for CHL pedagogy. If future epidemics are a question of when rather than whether, then health promotion education cannot be oriented primarily toward managing existing health information landscapes. It must also cultivate the ecological literacy, democratic dispositions, and institutional trust necessary for collective prevention and response. Baum (2021) has argued for health promotion to engage more directly with the systemic drivers of global health threats; the pedagogical corollary is that CHL must extend its scope to the capacity to build and sustain the social conditions for collective health action — including the solidarity and shared responsibility that both Abel and McQueen (2021) and Okan et al. (2023) identify as central to effective pandemic response.

These demands align closely with what socio-ecological frameworks have long maintained: health behaviors are shaped within layered, interacting systems — interpersonal, organizational, community, and policy environments alike — and any adequate pedagogy must engage with these layers rather than treating health competence as an individual cognitive achievement (Green & Kreuter, 2004; McLeroy et al., 1988; Merzel, 2021). These structural demands point to the need for an educational tradition that explicitly foregrounds collective formation.

The Collective Pedagogy of Makarenko: A Resource for Critical Health Literacy

Makarenko occupies a prominent position within comparative education scholarship and has at times been described as “the John Dewey of the Soviet Union” because of his influence on 20th-century educational thought and practice (Gehring et al., 2005). Like Dewey, Makarenko was responding to a society destabilized by war, displacement, and institutional collapse. Unlike Dewey, he concluded that the individual could not serve as the starting point for educational theory. His central assumption was that individual formation occurs through participation in collective social life rather than in isolation from it (Caskey, 1979; Gehring et al., 2005).

Situated within the broader tradition of socialist educational thought, Makarenko’s framework belongs to a lineage that Pavlidis (2017) both critiques for its reductionist narrowing of education to technical skill and reinterprets through what might be described as a reimagined polytechnicalism: an educational orientation that integrates intellectual, ethical, social, and practical dimensions of human development rather than reducing education to technical or market-oriented skill acquisition. This critique applies with equal force to health literacy frameworks that reduce health education to information access and individual decision-making, a limitation also identified by Abel and Benkert (2022).

In this paper, the term collective pedagogy refers to educational approaches that understand learning, agency, and subject formation as emerging through participation in structured collective life rather than through isolated individual development.

What Makarenko’s framework offers is several practically grounded pedagogical principles with direct relevance for CHL. First, according to Zilberman (1988), the collective functions as a mini-society — an organization of mutual responsibility, self-governance, and shared purpose within which individual health-related capacities are most durably formed. If CHL is socially produced, the institutional environment of health promotion programs — its relational norms, participatory structures, and shared purposes — is not supplementary to learning but constitutive of it. This principle resonates directly with Abel and Benkert’s (2022) argument that the acquisition and application of reflection and action are always dependent on the context in which people strive for better health, and with Okan et al.’s (2023) emphasis that health literacy as a social vaccine requires building collective consciousness and shared capacity rather than equipping individuals in isolation.

Second, Zilberman (1988) identifies Makarenko’s law of dynamics of the collective: a collective must constantly aspire toward new shared ideals and cannot remain satisfied with immediate gains. Without forward momentum organized around achievable collective goals, the shared orientations that make critical health action possible dissolve. For CHL pedagogy, this implies that community partnerships and experiential learning must be structured around evolving, staged collective outcomes rather than one-off information campaigns if they are to cultivate durable capacities.

Third, Caskey (1979) highlights that style, tone, and tradition — the characteristic ways an institution conducts itself — are not supplementary to pedagogy but constitute its actual foundation. Health promotion programs that lack shared relational norms and institutional traditions may struggle to sustain collaborative orientations regardless of the quality of their formal curriculum.

Fourth, Bergen (1997) identifies the mixed detachment as Makarenko’s most important technical contribution to collective-building: structured role rotation that crosses group boundaries, prevents the emergence of fixed hierarchies, and cultivates accountability to the collective rather than loyalty to a subgroup. This principle is directly applicable to interprofessional health promotion education and community service-learning partnerships, where role rotation across settings can prevent subgroup insularity and build the cross-cutting orientations that effective collective health action requires.

Together, these principles outline a pedagogical architecture for cultivating the capacities for reflection, solidarity, and coordinated social action that contemporary CHL increasingly demands, particularly under post-pandemic conditions.

The Structural Limits of Collective Pedagogy

The pedagogical principles identified in the preceding analysis offer a practically grounded architecture for collective CHL. It is necessary, however, to engage with the structural conditions that constrain their realization — not as an external qualification appended to an otherwise optimistic proposal, but as a constitutive element of the argument itself.

Bergen’s (1997) analysis of Makarenko’s institutional trajectory offers a form of structural caution: collective pedagogical models become difficult to sustain when institutional incentive structures continue to reward individual rather than collective performance at decisive moments. In this reading, the collective spirit was affirmed rhetorically while the systems that made individual achievement decisive remained intact. This is a reformist critique — it implies that better institutional design, greater coherence between stated values and operative structures, might in principle produce different outcomes, and leaves open the possibility of successful collective pedagogy under reformed institutional conditions.

A structurally deeper analysis emerges from the sociology of education. Bourdieu and Passeron’s (1990) account of educational fields asserts that institutions do not simply transmit knowledge or values — they reproduce the social relations of the broader fields within which they are embedded, and they tend to do so while misrecognizing this reproductive function as pedagogical neutrality. The concept of habitus is particularly instructive: the dispositions that educational institutions cultivate are not freely chosen pedagogical outcomes but are shaped by the objective conditions of the social field, which assign differential value to different forms of capital and orient agents — including educators and learners — accordingly. Abel and Benkert (2022) draw on precisely this framework to show how CHL operates as a form of cultural capital, unequally distributed along the lines of established social hierarchies, and how the chances to acquire and use CHL are structured by the very inequalities that CHL nominally seeks to address. They also reinforced this point in the pandemic context, emphasizing that the capacity for CHL is not only an expression of social inequity but may itself play an active role in the social reproduction of health inequalities in a pandemic.

Pavlidis (2017) pushes this critique toward a deeper structural analysis. The author argues that the repeated historical reduction of collective educational ideals to forms of individualist instrumentalism should not be understood simply as a failure of implementation. Rather, it reflects the reproductive logic of broader social relations. Within these relations, the individualization of risk and responsibility, the marketization of educational identity, and the defunding of the public infrastructures necessary for collective health practice are not contingent policy failures. Instead, they are understood as structural features of the fields within which education operates.

From this perspective, health promotion pedagogies that invoke solidarity, shared responsibility, and collective accountability while sustaining competitive credentialling systems and performance frameworks oriented toward individual outcomes may not thereby produce collective health practitioners. It risks producing instead what Bourdieu and Passeron (1990) would recognize as a form of symbolic misrecognition — in which the normative language of collectivity functions as a legitimating aspiration while the operative conditions of practice systematically reproduce the individualist dispositions it nominally opposes.

To engage with this critique is not to conclude that collective CHL pedagogy is without value — it is to insist on clarity about what pedagogy can and cannot accomplish. Pedagogical reform within existing capitalist institutional structures may cultivate critical dispositions, extend the vocabularies available for naming structural determinants of health, and sustain meaningful spaces of collective practice. These are not trivial achievements. Yet the conditions under which CHL could become a genuinely transformative social force — rather than an educational ideal perpetually deferred — are conditions that exceed the realm of curriculum design. They are conditions of political economy. Pedagogy can orient learners toward those conditions and equip them to act within and against them; it cannot, by itself, produce them.

At the same time, recognizing these structural constraints does not render pedagogical intervention meaningless. Educational spaces may still function as sites of partial resistance, critical reflexivity, and collective experimentation, even when operating within broader institutional systems shaped by unequal social relations.

Implications for Curriculum Design and Educational Ecosystems

The foregoing analysis — both the pedagogical architecture and the structural diagnosis — has concrete implications for how pedagogies of health promotion are designed and sustained. These implications are advanced in the awareness that their realization is constrained by the conditions identified above; they are offered as directions for practice within those constraints, not as resolutions of them.

Summary and Conclusion

Critical health literacy has established a powerful challenge to individualist frameworks in health promotion. Abel and Benkert (2022) have provided the field with a theoretically grounded definition — CHL as reflection and action upon health-determining factors — and have anchored it in the sociology of social reproduction. Abel and McQueen (2021) demonstrated that, under pandemic conditions, effective health responses depend not simply on individual information-processing capacities, but on forms of individual and collective agency that are themselves unequally distributed across social conditions.

Okan et al. (2023) have shown how health literacy, applied as a social vaccine, functions as a process of collective mobilization oriented toward solidarity, shared responsibility, and structural change. What remains underdeveloped across these contributions is the pedagogical specification: how capacities for reflection, collective action, and solidarity are actually formed, sustained, and transmitted through educational environments. This paper has argued that Makarenko’s collective pedagogy offers a practically grounded architecture for addressing that question.

The persistence of upstream structural drivers means that future epidemics are a question of when, not whether — and that health promotion education must build the institutional and community capacities necessary for collective response, sustained prevention, and shared accountability. The pedagogical principles drawn from Makarenko — collective formation, institutional culture as pedagogy, dynamic shared goals, and structured role rotation — offer concrete directions for achieving this.

The paper has not, however, advanced this argument without critical scrutiny of its own limits. Bourdieu and Passeron’s (1990) analysis of educational fields, reinforced by the structural dimensions of Pavlidis (2017) account, compels the recognition that collective pedagogical frameworks are already embedded within social relations that tend toward their re-absorption into the reproduction of individualist dispositions. The gap between the normative aspirations of collective CHL and the operative conditions of health promotion education is not a problem that better curriculum design can fully resolve. It is a structural problem — one whose resolution requires transformations in the political economy of health and education that exceed the reach of any pedagogical proposal.

This recognition does not diminish the value of the theoretical framework proposed here. It locates that value precisely. Pedagogy can cultivate the critical dispositions, collective vocabularies, and relational capacities that equip health promotion practitioners to act within and against the structural conditions they inhabit. It can sustain spaces of genuine collective practice at the margins of fields that otherwise reproduce individualism. And it can orient learners toward the structural conditions whose transformation is the ultimate horizon of critical health literacy. The significance of the framework proposed here lies not only in the pedagogical architecture it offers, but also in the structural diagnosis it enables regarding the limits and possibilities of collective health literacy within contemporary educational and health systems.