Framing health, behavior, and society: a critical content analysis of public health social and behavioral science textbooks

ABSTRACT Despite the increasing focus within public health on the social determinants of health and ‘structural approaches’ over the past three decades, controversy remains regarding the field’s relative emphasis on the behaviors of individuals versus the organization of societies when explaining why some are healthy and others are not. This research seeks to clarify how authoritative sources within public health instruction frame the relationship among behavior, society, and health by identifying common themes within social and behavioral science textbooks assigned within MPH programs located primarily in the US. Textbook analysis was informed by a modified grounded theory approach and is situated broadly within the critical discourse analysis tradition. Common themes include: the primacy of behavior to health outcomes; the purpose of public health theory is explaining behavior and informing behavior change; social and individual factors influence health behaviors; and ecological approaches are necessary for behavior change. Notable divergences from these themes are also discussed. These findings suggest a continuing need to think critically about how health, behavior, and society are framed within public health instruction specifically and within the field of public health more broadly. We close by considering the relevance of social theories of health inequality and structural competency to these discussions.