Corporate managerialism has pushed for schooling to be measurable and accountable. In the expectation for schools, teachers and students demonstrate that they are ‘working’ there is considerable pressure to engage in ‘commonsense’ activities. It is
these activities that require students to be rated against their peers , teachers to deliver a reduced (vocationally orientated) curriculum, and schools to be compared in a league table using ‘objective’ results. The current pressures on school, particularly HPS and how they respond to the standarisation of education is further developed in the section Capitalising on the HPS model (pp81-8). However at this point it is suffice to say that schools and schooling systems are increasingly being restructured. Schools are becoming self-managing, answerable to the school community, and are seeking relationships with community and industry gr oups in various ways, including sponsorship. Schools are able to determine what is necessary to cover in the
classroom through timetabling and subject groupings, and what constitutes appropriate teaching and learning experiences.
Parents and local school communities want and expect to have more to say in what happens in their children’s school. The role of family and community can be fundamental to the way it prompts the purpose, nature and offering in particular schools ⎯ for instance, religious schools, schools that reflect counter-hegemonic culture such as those that provide an Aboriginal perspective, and schools that describe themselves as elite on the basis of academic results, music or sporting
achievements. Schools can even describe themselves as health promoting. As a setting for health promotion, the school can provide opportunity to access children and adolescents, workers and employees (teachers and administration staff) and the wider school community (AHPSA 1999; Nutbeam, Wise, Bauman, Harris & Leeder 1993; Mukoma, & Flisher 2004).
The health promoting school (HPS) is a relatively recent phenomenon. Colquhoun (1997a) suggested that the movement had a history (then) of a little over ten years. There have been a number of national initiatives that use the HPS model to leverage their relevance and impact in schools. For instance KidsMatter is a primary school mental health promotion, prevention and early intervention initiative developed in collaboration with stakeholders making use of intersectoral partnerships and creating schools that enhance mental development and well being through a whole school
approach ( APAPDC 2007). The National School Drug Education Strategy
strengthens the provision of educational programmes and supportive environments that contribute to the goal of no illicit drugs in schools. One of its aims is to create a safe school environment and to have drug education as a part of the curriculum (Department of Education Science and Training, 2007). Active Australia supports a Schools Network across Australia that shares an interest in sport and physical activity and value the contribution to the overall health and wellbeing of young people and communities. It does this by building intersetoral connections (Australian Sports Commission 2007).
Emerging from the philosophies encompassed in the Ottawa Charter ,where public health is a socioecological condition (Colquhoun 1997a), the basis of the HPS reflects its theoretical heritage. Where the Ottawa Charter espouses healthy public policy, creating supportive environments, strengthening community action, developing personal skills and reorientating health services, HPS are said to be characterised by the same principles but tailored to be a reflection of the school setting (Ackermann 1997). Devotees of the HPS actively ensure that the links between it and the Ottawa Charter are explicit.
Figure 3.3 WHO Health Promotion Emblem and the Australian Health Promoting Schools Association logo (sources:
http://www.who.int/healthpromotion/conferences/previous/ottawa/en/index4.html; http://www.ahpsa.org.au)
Predicated on the mutually reinforcing relationship between health and education, the HPS concept requires a commitment to promoting and protecting the health of students and to the creation of conditions that are supportive of effective learning (WHO 1994; 2006). Health is linked to quality of life, educational achievement and career development (WHO 1995). The European Network of Health Promoting Schools (1997) makes the link between health and education citing education, as a major determinant of health in that it contributes to people’s health through health literacy ⎯ knowledge and risk management, and by equipping people to fulfill civic responsibilities, asserting legal and human rights that ensure effective participation in a democratic society.
As an example of a change to schooling the HPS rates better than most in its
recognition of schools as complex places. However, determining if the impact of the HPS movement is significant for schooling, health outcomes or both is yet to be determined. McRae (1988) provides five characteristics of schools that he suggests programs for change need to consider. He suggests that schools are complicated in that they are influenced in a myriad of ways and that these influences usually operate outside clear structures of authority. The internal communities of schools are often uneasy alliances, and are fragile. In managerial terms, schools focus on ‘inputs’ rather than ‘outputs’, and constant staffing changes are inevitable and significant distracters (MacRae 1988).
A model for the HPS (National Health & Medical Research Council (NH & MRC) 1996) identifies three main activities that contribute to better than average
performance. These are curriculum, teaching and learning; school ethos, environment and organisation; and partnerships and services, and in Australia these have become critical components for demonstrating the components of the HPS concept (AHPSA 1999). According to Colquhoun (1997a), this model incorporates the complex nature of schools in addition to a broader perspective on the HPS.
Traditional approaches to health education include transmission of knowledge about health issues with the aim of changing students’ behaviour. This is usually done in timetabled classes (the formal curriculum) and without much regard to what else is happening in the school (the informal curriculum). Health education is usually perceived as an area of study students ought to do, but only after they have completed the have-to-do curriculum. The have-to-do curriculum is about literacy that now includes information technology and numeracy. The HPS is a change in schooling in that it is a departure from traditional approaches to health in schools (Hagqvist & Starrin 1997). Ackermann (1997) asserts that health and education are inseparable, but within a health promoting school the education is for rather than about health.
Health promotion when applied in schools as a tool of hegemonic control can provide access to the otherwise private domain of family. The notion of
empowerment as an aspect of the HPS sees individuals and community remaining as their own gatekeepers; the community maintains the control and degree of
participation in creation of environments ⎯ including the private domain that supports health and healthy choices (Colquhoun et al. 1997). This is perceived to be very different from the traditional approach to health promotion in schools, which focuses on changes to behaviour preferred by the health ‘experts’ who work an underlying claim of ‘what can we do for you’ (Gore 1992) style of empowerment. Table 3.4 illustrates how the focus and activities of health promotion in schools varies from that in the HPS concept, together with an insight into why a particular view of empowerment evolves. When health promotion in schools, or any other setting (O’Connor & Parker 1995) occurs, the focus is predominately about behaviour change where external agents identify particular health issues and seek to reduce the impact and costs of the health issue by working to outcomes that generate preferred behaviours, for example sun smart, smoking and weight loss. Within the HPS the focus is on promoting lifelong learning, health and well being (AHPSA 1999) that may create behaviour change but will contribute to cognitive ability, critical and social engagement, and the learning is facilitated through a pedagogy that reflects
Table 3.4 Comparison of approaches to health promotion in the context of schools
Health Promotion in Schools Health Promoting Schools Definition The process of enabling people to increase
control over and to improve their health (WHO 1986, p.4).
A school that has an organised set of policies, procedures, activities and structures designed to protect and promote the health and wellbeing of students, staff, and the wider school community members (Rowling 1996).
Focus Seeks to create organisational change and thus supportive environments that allow for behaviour change and comprehensive school intervention strategies (StLedger & Nutbeam 2000).
Seeks to create organisational health, quality of school relationships, with attention to
empowerment and equity (Ackerman 1997).
Activities Implementation of health policies; provision of products and services conducive to health; mobilisation of community resources 'Healthy choices, easy choices' (Catford & Nutbeam 1984).
Curriculum, teaching and learning; school organisation, ethos and environment; and partnerships and services (NH&MRC HPS Model 1996).
As a departure from the traditional school health model, the HPS has health at its core of work. Based on a settings approach, schools are recognised as places where students spend a large amount of time in their formative years. In ‘doing their time’ at school, students should have exposure to healthy practices and opportunity to
develop health-enhancing skills and knowledge (AHPSA 1999; Colquhoun 1997b; WHO 2006).
The HPS movement has links with the effective schools movement; in both, the school has a strong sense of shared purpose, clear goals and high expectations (McGaw 1991). There is local responsibility for decision- making that includes teachers, parents and students; the school is responsive to the needs of the local community; and the school is reviewed and evaluated in ways that enable
identification of direction, collaboration, and clear articulation of expectations and progress in attaining them. These are also indicators of a manageralist perspective ⎯
vision, teamwork, objectives and targets ⎯ and it is possible to see how common- sense is commandeered. Thus, schools are steered away from being able to be responsive to their community and instead are geared to be responsive to the actions of the quasi- market that is solely education for economic purposes.
Challenges for successful educational change to a HPS lie in the ability of the school community to address HPS principles (curriculum, teaching and learning; school ethos, environment and organisation; and partnerships and services ⎯ see Figure 1.1, p 2), to implement them, and to undertake evaluation and review (WHO 2006). Other challenges include re-evaluation of existing power relationships within the school, including teachers to students and parents to teachers. Health promotion in the school setting assumes connectedness with the community, and it has been argued (Kolybine 1991) that any program’s efficacy is compromised when families are not able to support it, when community attitudes vary from those of the program and when community structures are missing. There is contestation of the view that all parents and carers want to or are able to participate equally in the life of their children’s school (Connell et al. 1985; McRae 1988; Beckett 1997). Thus, schooling becomes more than ‘skilling’. It is also about the reproduction and escalation of existing socioeconomic and cultural divisions (Ryan 1995; Beckett 1997). Critiques of health promotion and the HPS do exist and will be explored in some detail in the section entitled ‘Same wolf, different clothing: critiques of health promotion’on p 72.
Health promotion and health education have reinforced the value of schools as settings for health promotion. In particular the philosophy and principles of a health promoting school have generated documentation of the experiences of and