Abstract
School health educational content often entails different subject areas and a variety of topics that students are supposed to learn, and when taught in diverse classrooms, potentially positions students as at-risk. Using vignettes in interviews with migrant students in Sweden, the study focuses on views of the content of health education in relation to different ways that health as risk is enacted. Four aspects of risk were identified: (i) risk as content in health education and risky, including topics such as nutrition, stress, smoking, and pollution; (ii) risk as content in health education but not so risky, including topics such as health care and disease prevention; (iii) not-so-risky topics in health education, including topics such as physical activity, physical health, and social relations; and (iv) not risk as content in health education but still risky, including topics related to sex education. Teachers in health education, regardless of school subject, should be aware that some topics position students as being at-risk, other topics put students at-risk even if the topics are not about risk per se, and lastly, that risk can be something with pedagogical potential if it is used purposefully and educationally.
Introduction
This study concerns risk in health education in school, where the educational content often entails different subject areas and a variety of topics that students are supposed to learn. Some of these topics explicitly concern risks, while some, according to Fitzpatrick and Tinning (2014), position students as at-risk. In Canada, for example, the educational content about health ranges from topics explicitly concerning risk, such as fitness management and mental health, to topics not explicitly concerning risk, like safe relationships and community work (Robinson et al., 2024). In Australia, where the subject area is mostly referred to as Health and Physical Education (HPE), the two curricular strands “personal, social, and community health” and “movement and physical activity” are divided into sub-strands such as “being healthy, safe, and active,” “moving our body,” and “contributing to healthy active communities” (Australian Curriculum Assessment and Reporting Authority (ACARA), 2022). In Sweden, where the present study takes place, four school subjects include issues and topics related to health. These are biology, social studies, home and consumer studies, and physical education and health (Swedish National Agency for Education (SNAE), 2022). In these subjects, the educational content about health, as stated in the national curriculum, entails topics like movement skills and an interest in being physically active in physical education and health, lifestyle choices relating to consumers and the environment in home and consumer studies, knowledge about democracy and human rights in social studies, and knowledge about the physical body, lifestyle risks, and sex education in biology (Varea et al., 2025).
Hence, the educational content of health education is, as in many European countries, complex and broad and includes a wide variety of topics, potentially encompassing all areas of life, from individual risks to societal issues. Risk at the societal level has been discussed by Beck (1992, 1999) as a perception of insecurities and uncertainty connected to global risks, such as, for example, health and wellbeing. As Beck (1992) argues, these real or imaginary risks: “can be changed, magnified, dramatized or minimized within knowledge, and to that extent they are particularly open to social definition and construction” (23). Scholars like Curtis (2008) have further argued that societal risks can also be understood more locally, indicating different topics in education and, in our case, in health education as being risky.
Differences in how health is perceived, however, pose not only challenges but also, at an educational level, entail possibilities for developing health resources (McCuaig and Quennerstedt, 2018). These possibilities potentially relate to what Biesta (2013) calls the “beautiful risk of education.” Risky topics can be understood as a potential in health education when certain content about health is enacted in classes with students with different cultural backgrounds. Teaching something, in this case, health, can, as Biesta (2013) argues, be understood as bringing something to the educational situation that was not already there. Alternative meanings of health in different cultures then provide an example of what Todd refers to as disturbances occurring “not simply through the curriculum but through small, transformative moments that punctuate classroom life” (Todd, 2014: 232).
In a previous study (Varea et al., 2025), we explored health education content in Swedish schools from a teacher perspective. In that study, different topics taught in health education were perceived as problematic in increasingly culturally diverse classrooms, not least due to the growing numbers of migrant students in Swedish schools. To add to this complexity, health also has different meanings for different people in different cultures (e.g. Korp et al., 2023). This makes teaching health to students from different cultural, indigenous, or ethnic backgrounds potentially challenging. Topics like sexuality, food, faith, or body weight can become sensitive and have the potential to position young people as vulnerable and at-risk. Such topics, according to teachers, sometimes need to be avoided or handled with care. Issues of health, both in terms of health risks and health resources, consequently become more sensitive and thus risky when taught in diverse classrooms where the positioning of students as at-risk becomes particularly apparent, requiring further exploration.
However, content is not only about what teachers teach or plan to teach. Questions concerning content can, from a didaktik theory perspective (Hopmann, 2007; Hudson and Meyer, 2011), also focus on which content is enacted, and with respect to this investigation, which content students potentially learn about health. These different ways to understand content entail that teaching content and enacted content can clash or have educational potential when culturally diverse students encounter health education in school. The content can put aspects of risk in focus and/or be risky for the students. Hence, the purpose of this study is to contribute with knowledge regarding health education in terms of risky topics in Swedish health education from the perspective of migrant students. The study focuses on migrant students’ views of the enacted content in relation to different ways that health as risk is enacted, both when students perceive that the content is about risk and when the content is risky for them. Our research questions are:
- Which topics in health education are about risk according to the migrant students?
- Which topics are perceived as risky, and which topics are perceived as not risky according to the migrant students?
In the article, we will also use Biesta’s notion of the “beautiful risk of education” to discuss the educational potential of certain health content. In this way, a more nuanced picture, and thus re-understanding, of risk in health education can be gained.
The content of health education in school
Health education and its content can be understood in different ways. Jensen (1997), for example, over 25 years ago, introduced a paradigmatic approach to school-based health education, contrasting moralistic and democratic health education. While Jensen focused mainly on the pedagogies, that is, the how(s) and the purposes, that is, the why(s) of health education in school, in this paper, we foreground the content of health education, in other words, the what(s). Fitzpatrick and Tinning (2014) describe this content in schools as education about health rather than education for health, and it is within this area of health education that the study contributes with new insights. In the following, we provide an overview of research on the enacted content of health education.
Education about health—curricular topics, teacher, and student perspectives
When subject content is the focus of research, it is often understood from the perspective of what is included in the curriculum, and even if there are differences between countries, a wide variety of topics ranging from individual and interpersonal issues to broad societal issues are often presented. For example, in Canada, Robinson et al. (2024) described different health education curricula in the different provinces in Canada. These topics included physical literacy, community health, mental well-being, health decision-making, healthy lifestyle practices, fitness management, technology and community work, sexual health, safe relationships, emotional well-being, first aid, and alcohol and drugs. In a review of the school health content in Japan, Tomokawa et al. (2021) similarly revealed a broad range of curriculum content that included healthy lifestyles, mental health, injury and disease prevention, development of body functioning, health and environment, safety in social life, and lifelong health. Sex education is also an area of health education that has been foregrounded in terms of its content, especially in terms of being risky. Sex education curricula cover topics such as sexual behavior, sexually transmitted diseases (STDs), safe sex, and reproductive health (e.g. Robinson et al., 2019), but also positive attitudes toward sexuality, interpersonal relationships, sexual diversity, and interrelatedness of sexual health with indigenous health and wellbeing as for example in the curriculum in Aotearoa/New Zealand (Ellis and Bentham, 2021; Sinkinson and Burrows, 2011). In Sweden, Varea et al. (2025) described health education as spread across the school subjects biology, home and consumer studies, social studies, and physical education and health, with health content being interwoven with other content in each subject area.
Education about health from teachers’ perspectives is described by Leahy (2014) as often being risk-focused, covering issues such as drug use, sexual activity, bad food choices, and mental unhealth, as well as actions to handle various risks. Varea et al. (2025) explored the educational content regarding health that is taught in health education in Swedish schools. They identified six interrelated health discourses offered in the four school subjects: “(i) Physical activity discourse, (ii) Identity and social relations discourse, (iii) Sex and romantic relationships discourse, (iv) Psychological health discourse, (v) Risk discourse, and (vi) Democracy and society discourse.” According to Varea et al., the discourses that are offered reflect relatively narrow notions of health and do not really include social determinants of health. Further, Dickson et al. (2020) explored the content of sexual health education in the USA and revealed that topics involved, for example, sexual abstinence, reproductive anatomy, STDs, sexual health care, sexual orientation, gender roles, and risk behavior. In contrast, Fitzpatrick and Allen (2019) explored critical approaches to health education in Aotearoa/New Zealand involving topics such as people’s well-being in school and the broader community, democracy, social justice, and issues related to gender and sexuality in society.
Research from a student perspective reveals that education about health entails a variety of topics. Begoray et al. (2009), for example, describe healthy living, healthy relationships, health information, and decision-making as essential topics for students in Canada. Dixon et al. (2021, 2023) explored the potential for school-based health education to develop critical health literacy in Aotearoa/New Zealand. They revealed that long-term outcomes of health education included, among other things, the importance of social justice for health, connection to the community, critical evaluation of health information, and a broad notion of determinants of health at individual and societal levels. Further, in their integrative review of adolescents’ perceptions of sexual health education, Corcoran et al. (2020) concluded that the educational content varied considerably from abstinence-only to comprehensive sexual health education, including sexual health decisions, puberty, relations, emotions, and pleasure. Corcoran et al. (2020) also emphasized that educational content was sometimes experienced as non-diverse and that students from minority backgrounds felt excluded from what they call “one-size-fits-all” sexual health education programs (108). Similar results are highlighted in the review by O’Farrell et al. (2021) and the survey by Schindele et al. (2023), which suggested that LGBTI+ students often felt excluded in current sexual health education since the content was approached from a heterosexual perspective and in a study from the United States (Hobaica et al., 2025) often focusing on abstinence and religious principles which made LGBTQ+ students feel excluded. Laverty et al. (2021) further explored students’ experiences of sexual health education in Canada, including the prevention of negative aspects of sex like STDs or unwanted pregnancy, and also more balanced information about positive aspects of relations and sexuality like sexual pleasure. Students also wanted more teaching about inclusivity in relation to what they labeled LGBTQ2S+ issues. Bruselius-Jensen et al. (2017) added that cross-culture dialog between students from Denmark and Kenya promoted understandings of their own and others’ health conditions, food cultures, and family structures in relation to health. Alfrey et al. (2021) further discussed the problems with traditional health education from a student perspective where health is risk-focused, moralizing, and directed toward the individual, including instrumental ideas about the health benefits of exercise and correct food.
In conclusion, research about health as educational content covered in health education from student, teacher and curricular perspectives reveals that health can encompass a wide variety of topics. While the curricular topics ranged from relatively risk-focused content like STDs or drug use to content where risk is in the background, such as social relations, teachers’ perspectives reflected relatively narrow notions of health. In contrast, studies examining student perspectives indicated wider notions of health, but also that students experienced content as insufficiently diverse. So, even if knowledge about health as educational content exists, there is an urgent need for more knowledge of the enacted content in classrooms as experienced by students and, in our case, migrant students.
Theoretical considerations
In order to explore Swedish migrant students’ views of the enacted content in terms of risky topics in health education, we turn to didaktik theory since this helps us to explore and understand content in different ways (Hopmann, 2015; Hudson and Meyer, 2011). The use of didaktik theory in research has taken different forms. For example, in the French didactique tradition, questions about what happens with the content as cultural practice in different classrooms are often in focus, and concepts like didactic transposition and the didactic contract are used (Amade-Escot, 2023). In the German didaktik tradition, often building on the work of Klafki, issues of being educated (i.e. Bildung) and what teachers teach in relation to learning content as a meaningful whole are related to being an educated citizen (Hopmann, 2007). The Scandinavian didaktik tradition has several similarities with the German and French traditions, and often entails questions like: “. . .what, how and why, in terms of what and how teachers teach, what and how students learn and why this content or teaching is taught or learned. . . who is teaching, who is learning, when and with whom” (Quennerstedt and Larsson, 2015: 567). In raising these types of questions, education is understood from a didaktik perspective as located in-between students, teachers, and content in relation to school and society. It is in this context that the questions of risky topics are relevant. However, from this perspective, content is always understood in the plural—as different what(s)—so it is essential to be clear about which contents are being investigated.
Understanding content in plural (see Quennerstedt, 2019) can be conceived as (i) educational content (societal ideas about knowledge to be “transferred” to the next generation e.g. Bildung), (ii) curriculum content (national and local curriculum policy documents), (iii) teaching content (the content the teachers teach), (iv) intended learning content (what teachers envision or expect students to learn), (v) enacted content (the content as it unfolds in practice), and (vi) learned content (what students actually learn and know). In contrast to most studies in health education focusing on either curriculum content or teaching content, this study focuses on the enacted content as experienced by migrant students. The enacted content is here understood as the content as it unfolds in practice when the teaching content offered is enacted in the classroom, meeting a diversity of students. The enacted content is then explored both in terms of how the migrant students perceive how the content concerns risk and when the content becomes risky for them. This is important first, because the enacted content from a student perspective has received little attention in research, second, because studies of health education from a student perspective are often from a majority population perspective, and third, because teachers, not the least in Sweden, express concerns about teaching certain topics in classrooms with migrant students that is, concerns about how the content is enacted. In the article, we will also discuss how to move beyond looking at risk in health education merely as risks to health or risks to students in terms of putting them at-risk. In this way, a more nuanced picture, and thus a re-understanding, of risk in health education can be gained.
Methods
Data generation
The findings draw on interview data generated with 20 migrant students (11 female and 9 male) from three different schools. Rather than making claims about individual migrant students, or even migrant students in general, our ambition in this study is to provide a detailed picture of risk in health education through the perspectives of a group of students who had migrated to Sweden for different reasons. The rationale for this approach is that teaching health to students from different cultural, religious, or migrant backgrounds can be potentially challenging for teachers (European Commission, 2019). More knowledge is needed that extends beyond majority perspectives, since schools are increasingly culturally diverse. Hence, the ambition was to include a diverse sample in order to provide such diversity. The students were between 15 and 19 years old and had migrated to Sweden between 3 months and 8 years prior to data generation. Their respective home countries were: Afghanistan (2), Bosnia (1), Burma/Myanmar (1), Congo (1), Eritrea (1), Ethiopia (1), Gambia (1), Iran (2), Kenya (1), Lithuania (1), Netherlands (1), Nigeria (1), Pakistan (1), Somalia (1), Syria (2), and Ukraine (2). The participating students had migrated to Sweden for various reasons, although most of them sought a less risky and more prosperous life. Before the project started, ethics approval was gained from the Swedish Ethical Review Authority (Dnr 2019-06129), and informed consent was obtained prior to data collection.
Purposeful sampling (Patton, 2014) was used to select students for the interviews in order to reach as diverse a sample as possible. The interviewer (author 2) contacted teachers at three different schools who had participated in an earlier stage of the project and asked them to invite students who met the sample criteria to take part in the study (Varea et al., 2025). Students who agreed to be interviewed in the study were informed about the study’s general focus, orally and by letter. This included information about the research topic, that is, views of health, health education and wellbeing among young people with migration backgrounds. At the time of the interviews, the students were again informed about the study. In addition, they were told that participation was voluntary and that they could withdraw from the interviews at any time. The participating students were interviewed individually, in pairs or in groups of their own choice to create as safe an environment as possible. This resulted in one individual interview, four pair interviews, and three group interviews. Similarly, as stated by Acocella (2012), the group interviews generated rich discussions compared to the individual interview, as the students could engage in more in-depth discussions and support each other in terms of language barriers. In the individual interview, on the other hand, the interviewer could build a closer rapport with the student and have a more one-to-one discussion about the topics covered. We realize that interview data can be valued differently depending on what kind of interview (individual, pair, or group) is conducted; however, letting the students be interviewed in a format of their own choice was mainly made for ethical reasons. All interviews lasted approximately 60 minutes.
Data generation process
In this study, general questions about health and health education in Sweden, as well as vignettes in terms of written scenarios and photos, were used in the interviews. Vignettes are here understood as “written, visual, or oral stimuli [. . .], reflecting realistic and identifiable settings that resonate with participants for the purpose of provoking responses” (Skilling and Stylianides, 2020: 542–543) and were used as conversational props in the interviews. Some of the reasons for using vignettes were to elicit information through responses and discussions to obtain insights into participants’ attitudes and beliefs on the research topic at hand (Skilling and Stylianides, 2020). Vignettes are thus useful for studying topics that can be viewed as abstract and need contextualization, in our case, health and wellbeing. Another advantage of conversational props is that they allow the participants to distance themselves from the topic in the scenario or photo (Hall et al., 2007).
In using vignettes, the interviewees were presented with four different scenarios about health and wellbeing using concepts commonly encountered in school health education in Sweden to ensure that the interviews revolved around their perception of the enacted content in school (Varea et al., 2025). An example of a vignette is: Farid’s social sciences teacher has been talking about relationships in the last lesson. So far, it has been quite interesting, but the teacher has said that she will cover the topic of ‘consent’ in the next lesson. Farid is planning to skip that lesson because this is a taboo topic in his family, and no one has sex before marriage in his culture.
Follow-up questions to the vignettes were, for example, “Do you recognise yourself in this scenario?,” and “How would you act in this case?”
The written vignettes were available in both Swedish and English due to the students’ different proficiency levels in Swedish. During the interviews, the scenarios were also read aloud by the interviewer in Swedish and/or English and explained further when the students asked for clarification. The scenarios functioned as points of departure for discussions about different health education topics in school. We chose to have the vignettes before the photo elicitation part of the interview to avoid participants having a pre-established image in their mind around topics related to health, nutrition and lifestyle. The specific topics included in the vignettes related to consent, relationships, sex, sexuality, fears about nature, religion, spirituality, doing physical activity while fasting and identity.
In the second part of the interviews, the interviewees were presented with photos depicting different dimensions of health as described in the literature and were asked to comment on their personal experiences of these dimensions and how the dimensions related to school health education. The dimensions included (1) sense of community, (2) spirituality, (3) Western medicine, (4) nutrition, food and meal culture, (5) natural versus urban places, (6) psychological health and stress, and (7) physical activity and sport. The students’ comments revolved around whether or not the topics were important to them and how the topics were taught in school. In this way, using photos in interview situations helped to bridge the social and cultural worlds of the interviewer and the interviewees (Harper, 2002; Katzew and Azzarito, 2013). In this study, the photos were primarily useful in that they helped the students to verbalize notions of health and wellbeing as depicted in the photos being, as Leonard and McKnight (2015) argue, “experts” on the topic at hand (Leonard and McKnight, 2015).
One of the challenges of using photos and vignettes was that students sometimes became sidetracked and discussed issues that were not directly related to the aim of the research. The chosen methods nonetheless proved beneficial for the study, particularly in light of language challenges and the sensitive nature of the topics. While having “ordinary questions” in an interview can be a more organized way, elicitation and open-ended questions helped to stimulate conversation, and participants expressed relevant aspects that we were not expecting to find. Further, and most importantly, this interviewing technique allowed us to build rapport with the students and allowed the students to avoid the feeling that they were under investigation/interrogation.
Analysis
Didaktik theory was used to identify migrant students’ views about the enacted content of Swedish health education, and thus provided a way to understand both when students perceived that the enacted content is about risk and when the content is risky for them, in line with our research questions. The analysis was conducted in four steps inspired by Goodyear et al.’s (2019) deliberative analytical strategy: Analytical questions were used by all researchers independently to answer the research questions. Each researcher formulated initial themes that became the basis for deliberation to make the themes something ‘in common’. (216)
The deliberate strategy is not an analytical strategy to “find” an essential truth in the matter, but rather a way to use deliberation as a collective agreement, building on our joint theoretical assumptions (see Smith and McGannon, 2018), where all co-authors are given the possibility to make judgments in relation to different arguments. In the deliberations, the different backgrounds of the researchers originating from three countries on three continents, as well as experiences from education, public health science, physical education and sport science, helped in providing different perspectives in the analysis. At the same time, different perspectives also made the analytical process quite time-consuming, demanding discussions over time, and several meetings to make the themes something “in common.”
In the first step of our analysis, we explored the enacted content as a whole, asking the analytical question: Which content is enacted in health education in school according to the students? In the second step, we considered health education in terms of risk. We asked the questions: How is health as risk enacted in the content? Which content of health education is not about risk, according to the students? Here, aspects of risk were identified. In the third step, the different aspects of risk were explored in the interviews as the enacted content unfolds in practice when the offered teaching content is enacted in the classroom. In this step, we used the analytical questions: Which specific topics in the enacted content are not about risk according to the migrant students? Which topics in the enacted content are about risk but not experienced as risky according to the migrant students? Which topics in the enacted content are about risk and experienced as risky according to the migrant students? Which topics in the enacted content are not about risk but experienced as risky according to the migrant students? The result of step three is used as a structure and presented in the results section in terms of risky topics in health education.
Results—Risky topics in health education
Ten risky topics under four aspects of risk were identified in the enacted content: (i) risk as content in health education and risky, (ii) risk as content in health education but not so risky, (iii) not-so-risky topics in health education, and (iv) not risk as content in health education but still risky (see Table 1). Below, we present all four aspects where the content can be both risky for the students and content that puts aspects of risk in focus. We illustrate the different risky topics with representative quotes from the interviews.
Risky topics in health education.
Risk as content in health education and risky
This aspect of risk is about the enacted content explicitly putting health risks in the foreground and, as such, also positioning students as being at risk in relation to the content. Several topics in health education are enacted as risky, where risks to the students’ health are also in focus. These topics include risks of disease and injuries related to: (i) nutrition in relation to body weight (risks to physical health), (ii) stress and stress management (risks to mental health), (iii) smoking (risks to physical health), and (iv) environmental pollution (risks to the planet such as greenhouse effect and to individuals’ physical and mental health in the longer term). The students also describe these topics in terms of risks toward their health and, in that sense, positioning them as at-risk.
The topic of nutrition in relation to body weight entails the notion that nutritious meals are good for you and that eating healthy food can affect both physical and mental health.
It’s about eating correctly, I think? This (pointing at a picture) is, like, a diagram of all the types of food. This is about diet and physical exercise. Here’s taking food from somewhere, and here it’s just a family eating and maybe it’s not healthy, but it’s part of tradition or something. I don’t know what I should take from it. Maybe I think that it’s about that food can also influence your physical and mental health.
The relation between nutrition and exercise is also part of the topic related to nutrition in terms of students often addressing them together, not least when they address the enacted content within PEH. Good nutrition is described as not eating too much fat and eating more nutritious meals, including more vegetables. Food is at times also described as problematic per se in terms of eating too much as a risk. As one student explained: “If you let yourself eat too much, it can cause problems with your health. [. . .] No matter the foods, if you overdo it, it can’t be good.”
In this way, food becomes risky in relation to body weight, and what the body looks like, and eating becomes a potentially dangerous practice where one’s health is at stake. The students suggested that there is an ideal body weight, and that exceeding this weight constituted a risk.
Stress and stress management as a risky topic is enacted in terms of stress being unhealthy, potentially leading to risks to students’ mental health, such as anxiety and burnout. Stress and stress management are mainly addressed in social studies and are often related to students’ everyday lives in school and schoolwork.
What do they [the teachers] say about stress?
That you should study . . . not leave everything to the last minute and how do you say it . . .?
Do things one at the time?
Yes, do things one at the time . . . then you don’t get stress . . . but it happens . . . always . . . maybe you don’t have time to do it.
In this way, schoolwork itself is positioned as a risky practice, where stress has to be managed by the students. Students should study, but they should also create routines and learn whom to talk to if they struggle to cope. The students relate to the school nurse and the school counselor as people they have learned that they should contact if they feel anxious or stressed.
Smoking is also a topic defined in terms of risk by the students in health education:
[during a discussion on health risks] Yes, and smoking too.
. . . it is not good for your body. That’s what the teachers say.
Smoking is always enacted as a risky topic in relation to health. At the same time, the students indicated that not all adhere to what is taught and state that young people smoke a lot.
The final topic in health education enacted as risky content, where risk is in focus, is environmental pollution in relation to climate change. Here, emissions from industries are put forward as a main issue, and described as detrimental not only for people’s health, but also in terms of its effect on the environment.
We get to learn about pollution. Because it’s not good for the environment.
And the greenhouse effect.
Yes.
In conclusion, these four topics in the content of health education are enacted as risky. Practices of eating, smoking, and doing schoolwork become risky practices, and health also involves relationships with the environment. As a consequence, students are positioned as being at risk in the enacted content in relation to these topics.
Risk as content in health education but not so risky
In some of the teaching content in health education, health risk is foregrounded in the teaching content, and it is also enacted as focusing on risks. However, the migrant students did not experience the enacted content as risky. Instead, positive aspects of (i) health care in society, and (ii) disease prevention were highlighted as resources for health.
The topic of health care in society in health education is, according to the students, enacted as knowledge about Swedish health care and how one, as a resident of Sweden, has access to free health care. This is something students highlight as positive about moving to Sweden.
Yes, but they take care of us. Well, doctors and health care and stuff. If you feel ill, you can get help. This has a lot to do with health.
Which kind of health is this about?
All types. If you feel ill or if you are sick, then they [doctors and nurses] are there.
Yes, mentally and physically.
Health care in society is also about trusting the system in terms of health care and access to, for example, hospitals or school nurses. The students experience that they can easily access medical professionals or book appointments. Going to hospitals or doctors when one is sick or for check-ups or advice, thus, becomes a natural thing to do for students. Even if the content in itself is about risk, the trust in the system does not necessarily make hospitals risky for the students.
Closely related to health care in society, diseases and disease prevention, as content in health education is about knowledge of different diseases and how to prevent them (both physical and mental illnesses). Prevention frequently concerns eating habits and physical activity.
Well, you don’t learn a lot, it’s about ‘Yes, your body should feel well’ and stuff like that. But it can be like in school, they say ‘Have you eaten?’ or ‘Should you go to the school nurse?’ or checking if you have a headache and should I then take a medicine for that.
In conclusion, the enacted content here is about the risk of illness and disease, both in terms of prevention and the role of health care in society. At the same time, the migrant students do not experience the enacted content as risky. Instead, it is seen as important knowledge and a health resource in their lives. However, the content still, in many senses, positions students as at-risk since diseases are constituted as something that potentially threatens health.
Not-so-risky topics in health education
Several topics in the content are about health, but the ways in which the topics are enacted do not foreground risk, and they are not experienced as risky by the migrant students. These topics include: (i) physical activity and sports, (ii) physical health, and (iii) positive social relations.
Physical activity and sports as enacted content is about how exercise, sports and various physical activities are good for your health and how playing sports or doing physical activity makes you feel better emotionally, psychologically, as well as physically.
Because sports come from health.
Yes, health, physical fitness, everything is important.
When you have good physical health, you also have mental health automatically.
The enacted content also involves low-intensity physical activities like walking, where the students take a walk just for the “fresh air” during PEH classes. Further, there is a close connection in the enacted content between physical and mental health, where they express that they feel better mentally when being active in the outdoors or in a gym. Some students also described how motor development training was part of the enacted content of PEH in relation to health and becoming healthy.
Physical health as enacted content also relates to science education and knowledge about the body and the biological functions of the body in different ways. The content includes knowledge about how different organs, like the lungs and the heart, function and how these bodily functions relate to health and wellbeing.
Because, well, your well-being depends on them working properly.
Another topic in health education that is not about risk is positive social relations. This includes living together, hanging out with friends, learning to cooperate with others and valuing everyone equally.
It’s not always, but talking about health and such things, it’s healthy to hang out with people.
For me, it’s more important to be with other people and not feel alone than knowing about vegetables.
A sense of community, particularly in relation to friends, is enacted as part of health education and in PEH in particular. Cooperation, helping each other and learning to cooperate with different people are related to health. In this way, health education is much about creating a community and doing things together in a respectful way.
In conclusion, the not-so-risky topics in health education highlight that the enacted content about health is more about positive aspects of health, like physical activity and social relations or more “objective” aspects like knowledge about the functions of the body. This content does not position students as at-risk in the same way as in the previous two aspects of health education.
Not risk as content in health education but still risky
This aspect of risk is about the enacted content, not explicitly being about risk, but still being experienced as risky by the migrant students in terms of embarrassment, shame and that it challenges their religious identity. These topics were all related to sex education, and included issues such as sexual consent, LGBTQI+, and menstruation. Within sex education in Sweden, many topics are not enacted in terms of risk, in contrast to, for example, teaching about STDs. These topics include sexuality and identity, romantic relations, reproduction, puberty, love, consent, and mutual responsibility (Varea et al., 2025). However, some of these topics are still experienced as risky by the migrant students, such as, sexual consent, sexuality in terms of LGBTQI+ and gay pride, and menstruation.
Sexuality and sexual consent were perceived as risky topics both in terms of how early during school the content was enacted and because of the migrant students’ cultural and religious backgrounds. Some students claimed that they would avoid classes where sex and sexual consent were part of the teaching content since it was against how they practised their religion.
I would say that I can’t participate in that lesson.
And why can’t you participate?
Because of religion.
I would do the same, skip class because I think that what he is doing is the right thing.
Why?
Because he believes and according to culture and religion, you should follow what is written in the Quran and you shouldn’t talk about sex and . . . or until you are married . . . or have sex before you are married . . . I think it is right to follow your religion.
Another strategy that students adopted in relation to sexual consent as enacted content was being in class because they now live in Sweden, but to handle religious issues privately. At the same time, there is respect toward the school and the teacher, and when you are a student, you follow the teaching offered by the school. If a teacher said that sexuality was to be covered, the students stated that they would attend since they would respect the teacher’s authority.
Another issue that some of the migrant students expressed as risky was when sexuality and identity, in terms of LGBTQI+ or themes around gay pride, were enacted as content in health education.
[The teacher] she will anyway [talk about LGBTQI+ issues], I’m a lesbian, I’m gay, I’m something like this. It’s not okay. Okay, you’re gay. So . . . I don’t want to talk about gay, lesbian, trans . . . like this. I have no problem, but I don’t want to talk.
The riskiness in relation to the issues of sexuality and identity revolves around the students’ claims that the issues should be discussed in private with friends or family, not talked about openly in school. In this way, embarrassment also made some issues risky due to the expectation in the enacted content to talk about sex with other students.
I feel a bit awkward when we’re talking about relationships or sexual consent or something in a room with other students. I like it to be an intimate talk and not with many people. I feel really embarrassed in that regard.
Embarrassment is, according to the students, also part of the riskiness in relation to menstruation being a part of the enacted content as something that should be talked about with family or with a nurse, not in school.
If you have periods or something, you don’t ask in the whole class. You go and ask your nurse. If you have any questions about sex, you can go and ask her. Yeah.
It’s like. . . Like you got sick, and you go there [to the nurse]. It’s like this. [Laughing]
Menstruation becomes risky for some students if discussed in class rather than in private. For other students, discussing the topic in school is something normal, mainly so girls do not think that there is something wrong with them.
In conclusion, in topics where risk is not explicitly the teaching content but still enacted as risky in health education, issues of culture and religion of the migrant students and embarrassment come to the fore. In sex education, students take risks in participating in the enacted content and are, in that sense, at-risk. Hence, religion and culture become private spheres that students have to deal with individually and, in that sense, become a risk and position them as at-risk in health education.
Discussion
The purpose of this study was to contribute with knowledge regarding health education in terms of risky topics in Swedish health education from the perspective of migrant students. The study focused on the content in relation to different ways that health as risk was enacted, both when they perceive that the content is about risk and when the content is risky for them. In the following, we first discuss our results and the contribution of the study in relation to previous research. We then discuss how students are positioned as at-risk in different ways. Finally, we use Biesta’s notion of the “beautiful risk of education” to discuss how to move beyond looking at risk in health education just as risks to health or risks to students in terms of putting them at-risk.
In our analysis, we identified four dimensions of risk covering different risky topics:
(i) risk as content in health education and risky, including topics such as nutrition, stress, smoking, and pollution,
(ii) risk as content in health education but not so risky, including topics such as health care and disease prevention,
(iii) not-so-risky topics in health education, including topics such as physical activity, physical health, and social relations, and
(iv) not risk as content in health education but still risky, including topics related to sex education.
Previous research on the content of health education in school revealed that health can encompass a wide variety of topics, from risk-focused content like physical inactivity, STDs, or bad food choices (Alfrey et al., 2021; Leahy, 2014) to content about health, where risk is in the background or is not even part of the content. Examples of the latter include social relations, gender roles, general wellbeing, and democracy (e.g. Dickson et al., 2020; Fitzpatrick and Allen, 2019; Varea et al., 2025). Similar to these studies, our investigation shows that the enacted content in Swedish health education from the perspective of migrant students involved several topics such as environmental pollution, health care in society, social relations, sex education, outdoor education, physical activity, nutrition and body weight, and smoking. The enacted content in Swedish health education is thus primarily about health and not, as Fitzpatrick and Tinning (2014) describe, education for health, where health education supposedly should lead to measurable health outcomes. At the same time, our results also reveal that when talking about health education in school, the content, as described by the migrant students, was reduced to a quite narrow understanding of health in terms of mainly medical and psychological aspects.
Our previous investigation of teaching content in Swedish health education illustrated six interrelated health discourses offered in the four school subjects. These discourses, similar to what is described by the migrant students, reflect relatively narrow notions of health and do not include social determinants of health or salutogenic ways to perceive health as stipulated in the national curriculum (Varea et al., 2025). Here, risk was present in several of the discourses, sometimes explicitly, as in physical inactivity or eating disorders and sometimes more implicitly, as in nutrition or community health. Even if all curricular content in health education in Sweden is not mentioned by the migrant students, similarities with the enacted content from our study are obvious. A notable difference is that while the teachers described physical activity as a response to health risks, the migrant students did not express that the enacted content around physical activity and sport was about risk. Instead, the migrant students addressed physical activity as a health resource (McCuaig and Quennerstedt, 2018) that makes one feel better emotionally, psychologically and physically. At the same time, other topics like sexual consent and menstruation were enacted as more risky in relation to the migrant students than expressed by the teachers (Varea et al., 2025).
The teachers also viewed some content as risky to teach, even if the content did not entail risk per se (Varea et al., 2025). Examples of this content were swimming, LGBTQI+ issues, abortion or euthanasia, topics becoming risky to teach, not least in student groups with ethnic and religious diversity. This aligns well with our current study, where sex education in relation to LGBTQI+ was enacted as risky for the students, while topics like swimming were not mentioned.
Further, our study reveals how different topics put the students at-risk in different ways. First, some topics in the enacted content are more about positive aspects of health, like physical activity and social relations. Within these topics, health education contradicts what previous research (e.g. Alfrey et al., 2021; Leahy, 2014; Varea et al., 2025) has criticized as being too risk-focused. Second, some topics are enacted in ways that make practices of eating, smoking, and schoolwork risky practices and consequently position the students as being at-risk. Third, in some topics like disease prevention and the role of health care in society, the topics are about risks of illness and disease, but in contrast, here, the students are not expressing that the enacted content is risky for them. This content thus positions students in a different way in relation to risks, even if the topics in themselves are focused on what threatens health. Finally, there are topics that fall within sex education where risk is not part of the teaching content but is still enacted as risky, as experienced by the migrant students. Here, students are positioned as at risk in relation to their culture or religion, and students take risks by participating in the enacted content, thus making the risk something for the individual student to handle. We would argue that risk in this way is more difficult to resist since the issue is individualized. It is up to the individual student for example, to decide if they skip class, or listen out of respect and trust for the school and the teacher. Hence, religion and culture become private spheres that students have to manage individually in relation to the content of health education.
Importantly, our results regarding which topics are considered risky or not, could apply to all students. Questions of risk only become more acute when we, as we have done in this study, foreground the perspectives of migrant students. That some content in health education is considered risky and thus avoided or handled with care by the teachers is something that changes the health education for all, and the knowledge we have provided can accordingly help teachers to make more well-founded judgments about the choice of content in their teaching.
While risk in health education is often either discussed on a societal level (Beck, 1992, 1999) or as an explicit topic in health education (e.g. Leahy, 2014; Varea et al., 2025), the matter of how to understand risk as enacted content in health education can also be discussed in relation to what Biesta (2013), in relation to education in general, calls the “beautiful risk of education.” Even if Biesta’s theorizing is about education in general, there is a particular point in using his work in relation to health education, since here, notions of risk are foregrounded. By using Biesta, we can support teachers in going beyond just looking at risk as risks to health or risks to students in terms of putting them at-risk.
In this way, the enacted content can go beyond only being about medicalized risks and challenges, but also entail possibilities when enacted by teachers in classes with culturally diverse students, something common in many European countries today. Risk is then understood as the unpredictability and openness of the educational situation. In Biesta’s words: The risk is there because [. . .] education is not about filling a bucket but about lighting a fire. The risk is there because education is not an interaction between robots but an encounter between human beings. The risk is there because students are not to be seen as objects to be molded and disciplined, but as subjects of action and responsibility. (1)
In our results, many aspects of the enacted content are about knowledge in order to mold students into responsible, healthy citizens within a wide range of topics like physical activity, nutrition, smoking, safe sex, disease prevention and health care. At the same time, in some of the topics described, the teachers seem to, as Biesta (2013) argues, bring something not asked for to the situation. They do not shy away from difficult questions in relation to health, and thus open up spaces for transformative moments regarding health. Topics with this potential in our study include, for example, social relations, sexual consent, sexuality in terms of LGBTQI+ and gay pride, but also issues related to different ethnicities and religious beliefs regarding health in general. Also, other topics have potential in this regard, for example, differences in the ideas of what health is and can be between different cultures (e.g. in relation to family or sense of place) and important public health issues like human rights or topics related to democracy. This, as Biesta reminds us, involves that teaching “. . . is not a matter of following recipes but ultimately requires teachers who are able to make wise situated judgments about what is educationally desirable” (Biesta, 2013: 140).
Conclusion
Through interviews with migrant students, our study has shown how risk is enacted in different ways in health education in relation to different topics taught. Teachers in health education, regardless of school subject, should be aware that some topics they teach position students as being at-risk, other topics put students at-risk even if the topics are not about risk per se, and lastly, that risk can be something with pedagogical potential if used purposefully and educationally.
It is difficult to define in advance what health education becomes in relation to different topics, and it is difficult to ascertain the educational consequences. However, even if teachers do not know where their teaching potentially leads in the long term, health education opens up interesting and important topics in modern societies. As long as the teaching is purposeful this can pave the way for the “beautiful risk” of health education.
Footnotes
Declaration of conflicting interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The study was funded by the Swedish Research Council [Grant Number 2020-03309].
Ethical approval and informed consent statements
Ethics was gained from the Swedish Ethical Review Authority (Dnr 2019-06129), and informed consent was obtained prior to data collection.
