Promoting Health and Wellbeing through Schools

Peter Aggleton, Catherine Dennison, Ian Warwick

• Publisher: Routledge
• Year: 2010
• eBook ISBN: 9781135281205
• Topic: Education
• Subtopic: Education General

The contribution schools can make to improving students' health and wellbeing is increasingly recognised. Schools that have embraced this role and adapted policies and practices to create an environment in which young people feel safe and happy have reported broad and significant gains.

Through expert contributions from active researchers and experienced practitioners, Promoting Health and Wellbeing through Schools combines recent research with knowledge of the current climate in which schools are operating. Offering authoritative advice on effective intervention, this book provides an overview of the key issues that need to be addressed, including:

• alcohol use
• sexual health
• drug use
• obesity
• mental health.

This accessible text is innovative in its focus on how schools can build partnerships with young people, parents, and health professionals to promote their commitment to health and wellbeing. It highlights successful approaches for promoting health and educational goals, and provides useful advice on planning and evaluation.

Promoting Health and Wellbeing through Schools is invaluable reading for professionals working in and with schools to implement healthy schools programmes and to bring about improvement in health and wellbeing, including teachers, nurses, and health and education managers. It is also of interest to students, researchers and policy-makers.

Chapter 1
Introduction

Peter Aggleton, Catherine Dennison and Ian Warwick

The last two decades have seen a growing focus within the UK on the ways in which schools might promote physical and mental health. From an initial concern with the physical and mental well-being of pupils, this has broadened to engage the wider school community, including teachers, classroom assistants, school meals providers, health workers and others working in and with schools. Yet more recently, through notions of the extended school, the National Healthy Schools Programme and in other ways, schools have been promoted as beacons for the engagement of entire communities in health-related work and activities (DCSF, 2008).

Concurrent with the above changes, there has been a broadening of definition as to what might count as school-based health promotion, with work being extended to include colleges of further education and early years settings. Perhaps it is better now to talk of ‘health promotion through educational settings’ rather than health-promoting schools, healthy schools or one of the other narrower definitions used earlier. In parallel with this broadening of scope, there has been growing recognition of the close synergy between health- and education-related goals. Health- promoting activities in schools tend to be associated with better education outcomes (Powney et al., 2000; Stewart-Brown, 2006; Murray et al., 2007; Fuller, 2009), and schools which perform well academically often have healthier members and are part of a healthy community (Lister-Sharp et al., 1999; St Leger and Nutbeam, 2000; Mukoma and Flisher, 2004; St Leger et al., 2007).

But we should never forget that there are exceptions to this general rule. Some high-performing schools achieve success at the expense of the emotional health and well-being of at least some of their pupils. And pupils in some schools with more modest academic results can show high levels of physical and mental health and well-being. Nevertheless, as chapters in this book make clear, the reciprocal relationship between education and health and between health and education is clear; it is one in which both school staff and health professionals should be interested.

The idea of using schools and colleges as settings in which to improve health is not new and models of how to work towards becoming a health-promoting school have existed internationally since the 1970s. However, within the UK this agenda is gaining increasing impetus. Developments in government policy mean that, as part of the Every Child Matters agenda, schools are assessed on their contribution to health-related outcomes. Several initiatives, most notably the National Healthy Schools Programme (NHSP) in England and the Health Promoting Schools initiative in Scotland, have been put in place or transformed to support this. The NHSP provides a framework for schools to enhance pupils’ emotional and physical health. Its popularity is almost unparalleled in the history of UK education, with 99 per cent of all English schools voluntarily participating in the programme, and 76 per cent having gained National Healthy School Status. Most recently, new legislation has conferred on schools statutory responsibility for the well-being of pupils and, as we write, indicators of a school’s efforts to promote well-being are being issued which confirm the requirement that schools must now support the needs of children and young people beyond attainment and achievement and will be judged on this (Ofsted, 2009). A similar emphasis is being placed on integrating health into a broad range of education settings across the UK.

Within this context, headteachers, governors, curriculum leaders and others are looking for support as to how to meet their new responsibilities, and a growing number of other professionals are partnering with schools to make their contribution. Health professionals including teenage pregnancy co-ordinators, school and community nurses, drug action teams, child and adolescent mental health services, and voluntary sector agencies need support in identifying the contribution they might make and the best way to make it. Too often the evidence base is elusive and inaccessible to those working in and with schools. There is an urgent need to share what is known about the key issues children and young people are facing, and to disseminate research evidence concerning effective programmes and examples of promising practice. This book aims to satisfy this need. Prepared for a broad but critical readership, it aims to increase readers’ awareness of the health needs of young people, to share with them current evidence in relation to ‘what works’ – or rather, what we know has worked in the past (Biesta, 2007) – and to draw out implications for practice. Rather than taking a single topic focus, it covers a wide range of health issues, highlighting their inter-relatedness together with links to broader educational goals. It aims to help educators and health professionals think, sort fact from fiction, and identify practical ways forward across a range of school and college settings.

In twelve chapters, the book brings together contributions from a range of prominent writers including researchers, policy leads and advocates, and practitioners. It offers an up-to-date summary of what is known about particular health topics and issues, together with guidance on how schools might engage with these. The experience and guidance it provides are firmly rooted in the current policy context with its emphasis on raising education standards, minimising social exclusion and health inequality, and maximising health gain. While it focuses predominantly on the UK, international research and experiences are drawn upon where appropriate. Our focus throughout is on children and young people in mainstream education. However, chapter authors have been encouraged to consider the diverse range of individuals this represents, including girls and boys, young women and young men, young people from differing ethnic backgrounds, and children and young people growing up in challenging circumstances or with special needs. Throughout the text, authors stress the importance of working with the wider community and parents, and the value of participation as a means of enhancing engagement; for unless schools and all those within them feel they ‘own’ a health issue or problem, little headway can be made in promoting health and well-being.

Chapter 2, by Fiona Brooks, provides a comprehensive overview of the health and well-being of young people. While focusing on the UK, it also examines international and historical trends. It describes findings from a variety of health surveys, pointing to key issues and topics which are taken up in detail later in the book. These include mental health and well-being, sexual health, alcohol and substance use, and physical activity, healthy diet and healthy weight. The chapter examines individual and social differences in health and stresses the importance of considering young people’s own perspectives on health and wellbeing. Rather than seeing health risk behaviours as ‘bad’ choices made due to lack of understanding and immaturity, we need to appreciate how environmental and socio-economic inequalities shape the options available to young people, constraining the ‘choices’ they can make.

In Chapter 3, Katherine Weare offers a detailed account of mental health issues and problems arising in schools together with the steps that schools can take to promote the mental and emotional health and well-being of their members. The chapter describes the recent growth of interest in schools as settings for the promotion of mental health and well-being, and details findings from recent evaluations of programmes and interventions in school and college settings. These include those focusing on the social and emotional aspects of learning as well as anti-bullying initiatives, particularly those involving a whole school approach.

Chapter 4 has as its theme reducing disaffection and increasing school engagement, which links closely with health and well-being outcomes. Its authors, Colin Noble and Marilyn Toft, examine how teachers and other professionals working in schools can go about reducing disaffection and increasing engagement, particularly for those children and young people who may be especially vulnerable or who are at risk of exclusion. Disengagement from school can occur for a number of reasons: problems at home, care responsibilities, poor mental and emotional health, substance misuse and physical health problems. Whatever the cause, schools are required to ensure that they reach and engage all pupils, irrespective of ability and background. The chapter offers a number of ways forward, stressing in each case the importance of belonging and participation.

Since the 1970s, rates of obesity among school-aged children have doubled or tripled in countries such as the UK, USA, Canada and Australia, with major short- and long-term consequences for individuals and society. Chapter 5, written by Wendy Wills, addresses this problem, explaining carefully what childhood obesity is and why both healthy eating and physical activity matter. A range of positive frameworks for reducing obesity are outlined, including socio-cultural and assets-focused approaches to promoting physical activity and healthy eating in schools. The importance of schools engaging with parents and the wider community is stressed in order to address structural barriers and influence pupils’ choices.

In Chapter 6, Willm Mistral and Lorna Templeton look at another topic of ongoing public concern – levels of alcohol use and alcohol-related harm among young people. Media panics over binge drinking and drunkenness make it difficult for those working with young people in school settings to take a balanced approach. This chapter examines the evidence along with young people’s own perspectives on the role of alcohol in their lives. Stressing the importance of using methods known to be effective, the chapter describes traditional and more innovative ways of educating children and young people about alcohol use. It highlights the potential contribution that schools can make as part of a comprehensive and multi-component approach.

Chapter 7, by Martine Stead and Robert Stradling, focuses on the no less contentious issue of drug education. Throughout the UK, young people have access to a growing range of illegal substances at an increasingly accessible cost. Drug misuse continues to be a difficult issue for schools to address. With a focus on illicit drug use, this chapter examines the evidence base for effective curricular and whole school approaches, looks at some of the conflicting expectations surrounding school drug education, and argues for a more realistic assessment of schools’ role within broader substance use prevention efforts. While drug education’s long-term impact on drug use behaviour is unclear, there is evidence to suggest that well-developed programmes implemented in schools can have important short-term effects in terms of reducing and delaying the uptake of substances.

Chapter 8 looks at sexual health. Against the background of national priorities to prevent teenage pregnancy and sexually transmitted infections, Roger Ingham and Julia Hirst explore the role that schools can have in delivering high-quality sex and relationships education as well as health services with a sexual health component. The chapter reviews the current policy context before identifying key components of what has been shown internationally to be an effective response. So as to engage with young people’s needs and real-life circumstances, the chapter stresses the need for schools to take a broader view of sexual health; not solely focusing on a ‘prevention’ agenda, but ensuring that young people are equipped to make healthy choices in relation to sex and relationships.

Chapters 9, 10 and 11 stress in complementary ways the importance of partners and partnership in efforts to promote health and well-being. In Chapter 9, by Jo Butcher, the focus is on children and young people themselves. The need to engage with children and young people in efforts to improve health and well-being is increasingly recognised. However, knowledge about effective ways of doing so is not widespread. The chapter describes a number of innovative and successful approaches, the benefits to be gained, and the skill and resource requirements needed effectively to involve children and young people. Examples of promising practice along the spectrum from tokenism to authentic participation are provided.

In Chapter 10, Claire James looks at the contribution that parents (and carers) can make to promoting health and well-being in schools. The chapter identifies a number of general principles on how best to work with and involve parents, illustrating these with suggestions as to how schools might better involve parents in health-related programmes and activities. Building upon issues explored earlier in the book, the chapter looks at three key areas in which parental involvement might be strengthened: healthy eating and the introduction of healthier school meals; improving young people’s sex and relationships education; and promoting children’s emotional well-being and mental health through family support. While including parents as partners in promoting health is not necessarily straightforward, an open and respectful approach can minimise conflict, and an understanding of parents’ perspectives is likely to increase any programme’s chance of success.

In Chapter 11, Viv Crouch and Helen Chalmers examine the role of the nurse in supporting health-related work in schools. There is a long history of nurses being engaged with schools. Nurses’ early responsibilities were often restricted to checking for health problems and preventing childhood infectious diseases such as diphtheria and measles through immunisation. In recent years, however, there has been an extension of their role to include organising activities on healthy eating, smoking cessation and alcohol and drug use, running school health services, and supporting wider initiatives such as the delivery of PSHE. Such actions and interventions are often welcomed by young people, who may experience difficulties in accessing traditional health services. This chapter describes the different partnerships nurses have forged with teachers and other school members, the relationships they have built, and the value of an integrated approach in which the contributions of the health and education sectors are brought closer together.

Throughout this book, we have tried to stress approaches to undertaking health-related activities in school that ‘work’ in the sense that they engender worthwhile relationships and bring about desirable outcomes. Yet how do we know that a particular approach or style of work ‘works’, and how can we improve upon the methods that are being used in schools? These and related questions are addressed by Catherine Dennison, Ian Warwick and Peter Aggleton in the final chapter of this book. In addition to detailing different styles of evaluation, they describe experiences of evaluating healthy school activities. In so doing, they aim to provide teachers and health professionals with a realistic appreciation of what might be expected from evaluation, and what evaluation can and cannot do.

For many years, teachers have been interested in promoting the health and well-being o...

Table of contents

• Contents
• Contributors
• Acknowledgements
• Chapter 1 Introduction
• Chapter 2 The health of children and young people
• Chapter 3 Promoting mental health through schools
• Chapter 4 Reducing disaffection and increasing school engagement
• Chapter 5 Tackling obesity
• Chapter 6 The role of schools in reducing alcohol-related harm among young people
• Chapter 7 The role of schools in drug education and wider substance misuse prevention
• Chapter 8 Promoting sexual health
• Chapter 9 Children and young people as partners in health and well-being
• Chapter 10 The contribution of parents
• Chapter 11 The role of the school nurse
• Chapter 12 Evaluating health and well-being in schools
• Index