Classically, health education has provided mainly factual knowledge about diseases and their prevention. This educational approach is within the so called Biomedical Model (BM). It is based on pathologic (Pa), curative (Cu) and preventive (Pr) conceptions of health. In contrast, the Health Promotion (HP) approach of health education intends to improve health by promoting healthy habits (He) and by developing empowerment (Ep) for a healthy decision-making with regard to environmental (Ev) challenges. The aim of the present study focused on a comparison of the emphasis on either model (BM or HP) as it is presented by textbooks from 16 countries. Each country team analysed the textbooks that are more frequently used at each educational level. Text and image analysis identified that some countries, such as France and Italy, as more associated with the Biomedical Model, whereas Germany, Mozambique and Finland were more linked to the Health Promotion approach. Data organised for four pupils' age groups (6-9, 10-12, 13-15, 16-18 years old) showed that text and images of the same textbooks gave similar results in terms of following either the BM or HP model, and showed different indicators of consistency (Pa, Cu, Pr for BM; and He, Ep, Ev for HP). Furthermore, although the analyses might be, to a certain extent, subjective (depending on the researcher), it was shown to be very reliable, since all countries, whose textbooks were analysed for the 4 age groups or only the 3 age groups, showed a similar tendency of evolving from a HP (early ages) to a BM approach (elder ages). The interesting finding that the younger pupils' textbooks were more associated with the Health Promotion pole, whereas the older pupils' textbooks were consistent with the Biomedical Model pole seems to be a matter of further and deep investigation. (Contains 1 table and 7 figures.)