Of the smaller number of studies about promoting health in ECCD settings, the majority have emerged from developed countries in Europe or North America (Guldbrandsson & Bremberg, 2005; Gupta et al., 2005; Taveras, LaPelle, Gupta & Finkelstein, 2006; Williamson & Drummond, 2000). Little has been written about child health needs identified in ECCD centres within developing countries. Some of the studies of ECCD settings in developed countries have targeted families from centres located in low-income areas (Taveras et al., 2006; Williamson & Drummond, 2000), which may be transferable to the South African context. Jaramillo and Mingat (2008) in their World Bank report on early childhood care and education in Sub-Saharan Africa acknowledged the effect of the environment on a child’s health and development. This supports the recent findings from the WHO on the importance of the social determinants of health (Marmot et al., 2008).
2.5.2.1 Lifestyles, Childhood Environments and Parental Influences on Health
Health promotion strategies aimed at pre-school aged children have been discussed in various studies. However many studies have ignored the broader context or environment that contributes to health. Instead they have implemented selective health promotion, which has targeted either specific risk factors for illness or the promotion of healthy lifestyle choices, as seen in the following literature. Healthy eating, increased exercise and obesity prevention have been the priority of pre-school health promotion interventions in many developed country contexts such as Australia (Hesketh, Waters, Green, Salmon & Williams, 2005). A cross- sectional study in Brazil evaluated the nutritional status of children attending day care centres and found it to be higher than children not attending (Silva, Miranda, Puccini & Nobrega, 2000).
Roden (2003) discussed illness prevention and promoting healthy behaviour, in her Sydney based FGDs of parental understanding of health behaviour. The study results showed that participants were in agreement that health and safety issues were the responsibility of parents. The parents perceived illness prevention and health promotion as distinct from one another. Some parents saw their role as simply preventing childhood illness. However, other parents discussed illness prevention along with the promotion of healthy lifestyles as a parental responsibility. The study cited health-promoting behaviours as important for child emotional health and included teaching children life skills, reinforcing confidence and talking honestly with children. Other studies of health needs of pre-school aged children have used a medical focus and targeted children with specific diseases or conditions who were not attending ECCD centres.
Understanding health needs of disabled children in a South African township was the focus of a descriptive study by Saloojee, Phohole, Saloojee and IJsselmuiden (2007). Using a mixed method design, the study noted that the majority of these children were not attending pre- schools and there was a general lack of coordinated care for this specific pre-school population. This study was limited by its snowball sampling method, as many disabled children may not have been included because they were hidden away in the community, due to the stigma of their condition. This study did acknowledge the added challenges that the social and economic environment presented to parents who were caring for their children.
Challenges in the environment may limit a parent’s ability to choose a healthy lifestyle for their child. Williamson and Drummond (2000) cited this in the results of their parent focus group discussions with Canadian low-income families. Parents participating in the study viewed recreational activities as being important for their child’s health. Physical activity was perceived as a major determinant of physical and mental health. But the expense of organized sporting and recreational activities, along with a lack of transport, were considered barriers for participating in this perceived healthy lifestyle. The study noted that parents with higher income levels were more likely to mention social determinants of health, as compared to a more narrow perception of health. It is important to note that parents who participated in this study were already active in existing parent groups at the Head Start pre-school and this may have affected their sense of empowerment and subsequent responses.
Factors in the living environment have been cited as challenges to child health. Sanders and Chopra (2006) claim that children from rural and predominantly black communities in the Eastern Cape of South Africa are more likely than children from more urban and racially mixed
areas, to experience malnutrition, food security issues, lack safe sanitation and be exposed to indoor pollutants6.
In their report of South African’s historical roots determining health, Coovadia, Jewkes, Barron, Sanders & McIntyre (2009) argue that public health programmes need to address the social determinants of health such as poverty and violence in order to address the increasing child mortality rate in South Africa. The authors explain that in rural communities in South Africa, it is often common for children to be raised in the absence of their fathers. Coovadia et al. (2009) elaborate that this can lead to challenges for children (and boys especially) in developing into responsible adults; and therefore programs that encourage non-violent masculinity need to be promoted. Consistent with this explanation, is Sanders and Chopra’s (2006) claim that a large burden of disease among the poor in South Africa, is due to trauma and violence. ECCD programmes have been shown to help prevent addictive and criminal behaviour in adults, in research undertaken in Australia (Catford, 2000).