From policy ambition to classroom practice : health education in China’s physical education and health curriculum reform

Abstract

Background: Recent reforms in physical education and health (PEH) increasingly speak the language of holistic health, prevention, and wellbeing. In China, these holistic ambitions have been sharpened through Healthy China 2030. The 2022 PEH curriculum reform reflects this policy moment, formally elevating health education as a core learning area. Yet PEH has long been shaped by healthism, where health is understood primarily as an individual responsibility. What remains less clear is how the holistic policy vision is interpreted, produced, and lived out in everyday practice. Purpose: This study examined how health education is understood and enacted within China’s new PEH curriculum, focusing on how teacher educators and in-service teachers interpret the health learning area and how these interpretations shape classroom practice. Methods: This study used conversational inquiry to explore participants’ perspectives and experiences through thirteen semi-structured interviews with PEH teacher educators and secondary school PEH teachers in Shanghai. Interview data were analysed using concept and structural coding, supported by analytic memo writing, and deductive theoretical analysis using healthism. Findings: Three interrelated findings emerged. First, teacher educators strongly endorsed the curriculum’s alignment with Healthy China 2030, framing PEH as a vehicle for early intervention. Second, despite policy ambition, health education remained marginalised in practice due to gaps in teacher preparation, entrenched professional identities, limited time, and scarce resources. Third, teachers adapted the curriculum in pragmatic ways, reducing health education to manageable reminders and risk-avoidance practices. Through these stages, health was gradually redefined through individual responsibility, motivation, and self-management – shifting away from the policy intent. Conclusion: The PEH curriculum was reshaped as it moved through interpretation, preparation, and practice. Holistic health was not sustained but displaced by healthism, narrowing what health education could become. These findings highlight the limits of curriculum reform when underlying assumptions about health remain unexamined. Impact statement: This study shows how healthism can settle in as ‘common sense’, shaping policy intentions and classroom practice alike, even within reforms framed as holistic. It suggests that meaningful change in health education requires attention not just to the content added to the curriculum, but to how health itself is imagined and lived in schools