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Addressing Health & Equity through Schools
In June 2007, the World Health Organization convened a meeting to discuss future directions in school health promotion. One of the themes discussed at that meeting was how to correlate school-based and school-linked programs more closely with the local community contexts in which schools operate. These contexts included schools in low income countries, schools in communities that have been disrupted by war, disasters and epidemics, aboriginal communities and schools serving low income communities within high or medium income countries.
Subsequent to that meeting, the Canadian Association for Community Education, the Canadian Association for School Health and the International School Health Network established a Community of Practice on Schools in Disadvantaged Communities. In order to focus the discussion, the following summary statement has been developed. This statement has been discussed on-line, been presented and discussed at a Canadian conference in April, 2010 and was then presented and discussed at an international school health symposium in Geneva in July 2010. Subsequent to that, the statement will be translated into French and German and presented to the individuals and groups who participated in the June 2007 meeting.
Visitors to this web page are encouraged to either comment on the draft below using the "thread" tool found at the bottom of this page or to use the "Easy Edit" tool found at the top of the page to open up and edit this document. (Don't worry, all versions of the draft are automatically saved by this wiki platform)
The purpose of this statement is to describe the needs and strengths of populations or communities that have been disadvantaged by lower incomes, discrimination, geographical or social isolation with a view to identifying and describing the approaches, strategies and programs that have proved to be relevant and effective in these types of circumstances. This statement can be used as a lens to focus our collective efforts on the sub-populations that need more support and development. It is also a explicit recognition that there are disadvantaged communities or groups of people within all countries and states that require cohesive, focused action such as suggested herein.
There is a distinction to be made here between disadvantaged communities or groups of people in societies/nations and individual students or families that are residing in communities or regions that are more vulnerable to risks or problems because of individual or family circumstances or traits. Examples of this would be students with intellectual or physical disabilities, children of alcoholics or addicts or students who are being bullied because of their sexual orientation.
We should also remind ourselves that although this statement focuses on disadvantaged communities in high income countries, there are advantaged and disadvantaged communities in all countries. For example, there are schools serving wealthy and advantaged communities in low, middle and high income countries (who also have specific health and social development needs) but in this discussion, we are focusing on populations/schools in disadvantaged communities in high income countries.
Preamble and Principles
Every child has a right to education, health, safety, human rights, social and economic opportunity and freedom from discrimination. All educational, health and social development agencies and systems have the responsibility to provide equitable opportunities, programs and services to serve all children through public schools. Universal access and equitable outcomes are among the basic values included in almost all statements for publicly funded school, health and social service programs and institutions. Yet we know, that despite these statements, easy and equitable access to these services is often not achieved. As one participant noted in our discussions; "After all is said and done, more is said than done".
Consequently, this statement is not about all students or all schools, nor is it a statement about the rights to universal access. This statement is also not a re-iteration of the need for comprehensive and coordinated approaches. This statement is about the students, schools and communities that face greater challenges and therefore need relatively more resources and different/adapted services. In the same way that health programs are differentiated with such terms as universal, targeted or indicated based on individual characteristics, we need to select, adapt/develop and coordinate programs that are in closer harmony with the local contexts in which they are delivered.
In order to provide equitable access, opportunities, programs and services, it is incumbent upon education, health and other public systems to provide additional supports to those who are facing greater adversity. This can be done in all schools for individual students facing greater adversity, but it is particularly important where and when local communities face a number of simultaneous challenges. It is equally important that these additional resources and specific programs build on the strengths within these communities, enable these communities to identify the issues of priority concern and then develop, select or adapt programs suitable to their needs and aspirations.
There are many frameworks, models and multi-intervention approaches, programs and strategies that have been developed by various sectors, working with schools, to promote different aspects of human development for all children. Community schools, healthy schools and safe schools and eco-schools are just four examples of these approaches. All of these recognized models provide benefits to all children. In other words, all schools should be safe, healthy, protect the environment and work closely with their communities. However, in almost all of the prominent statements about these recognized school-related strategies, there is an explicit recognition that such approaches should specifically address the needs of the more vulnerable. In health promotion, the term "social determinants is often used. Disparities, poverty, higher or special needs, marginalized, at-risk and other terms are used in other sectors. Consequently, this statement attempts to create a shared focus on addressing determinants, reducing disparities and alleviating disadvantages by empowering schools and communities to build on their strengths, identifying the issues of most concern to them and selecting/developing and coordinating a set of programs relevant to their needs.
The research on these multi-intervention approaches to health, safety and social development is consistent in one respect. Having a variety of carefully selected policies, programs and services whose delivery is coordinated and aligned is far more effective than single issue or single intervention strategies. Consequently, this statement seeks to identify and describe a cluster of policies, programs, services and practices that are more suited to the strengths and needs of communities that face several challenges or disadvantages.
It is suggested here that the pursuit of a detailed common framework or model to mesh all of these models together would be a mammoth undertaking because each of these approaches has already established long-term visions, shared terminologies and complex relationships between education systems and the health, welfare, law enforcement and environmental sectors. This paper suggests that it is more useful to simply note what is common or compatible in the approaches, identify where expertise and experience resides from among the various sectors/models and then encourage jurisdictions and local communities to select the programs and work with the sectors that they see as being most relevant to them.
Further, there is already significant knowledge and experience in implementing these comprehensive approaches that we need not re-invent in this statement about selected populations and contexts of specific concern. The International School Health Network, in its consensus statement, has identified several broad implementation strategies that are common to almost all school-based and school-linked programs. They include:
School-based and school-linked programs can be implemented in several arenas. By clarifying the levels of action and the systems/agencies/personnel involved, we can be clearer about intended outputs. The arenas or levels of action for school-related programs include:
The following selection of issues, strengths and related school-based or school-linked programs is presented to stimulate discussion about the policy/program options that schools, communities and governments can realistically consider in order to address social determinants, reduce disparities and alleviate the impact of disadvantage through schools. This is an important first step, since these issues and programs are usually addressed in isolation from each other by different sectors such as health, education, welfare and law enforcement.
We have attempted to identify practical program options that schools can implement to reduce the impact of poverty, geographical isolation, cultural, religious and linguistic barriers, discrimination based on gender, sexual orientation, physical or intellectual abilities or race rather than pretend that we can eliminate these geographical, social or economic problems through school programs. The reduction of poverty and other disparities is something that must be addressed by fundamental changes to public services, to wealth redistribution mechanisms/taxation and other aspects of society that are beyond the scope of schools to change directly. Further, these specific issues/programs discussed here should be considered within their community contexts because those local situations will create constraints and opportunities within which schools must work .
We have tried to identify a cluster of issues that are likely to be more relevant to the ecology or context of low-income communities. Economic disparity is often a common denominator among other forms of disadvantage, so we have used poverty or social determinants as our focal point. Far too often we approach communities and schools that face these clusters of issues with a silo approach, whereby we address only one or two of their issues with one or two programs or changes. We need a comprehensive, coordinated approach.
The Issues Relevant to Disadvantaged Communities
Some of the health, economic and social issues that are likely more relevant to the school communities in this context include the list below. Two recent analysis done in Canada (Mikkonen & Raphael, 2010) and the United States (Basch, 2010) point out the urgent need for greater focus, descriptive and action-oriented studies on such determinants, disparities and disadvantages. While not all of these issues will be present in al disadvantaged communities, research shows that there are often clusters of such issues and conditions. As part of the community development process, each community should be enabled and supporting the issues, strengths, strategies most relevant to their situation.
Identifying and Building on Strengths
Another area for urgent attention is to identify and describe the family and community strengths within disadvantaged communities that can be used to guide, focus and support school-based and school-linked programs. The recent work of Valladares & Anderson Moore (2009) is an illustration of this strength-based approach where they examine low, middle and high income families. They suggest that low income families have equal or more capability in these areas:
In a project and Community of Practice similar to this one, indigenous nations around the world identified some of the strengths of aboriginal communities. These attributes would be similar in some respects to cultural and linguistic minority communities. They can include:
Some of the programs that are described briefly in this overview paper address many of those factors and conditions. These programs, policies, services and practices can be brought together in a variety of multi-intervention approaches, programs or strategies. These interventions are listed in these five domains below:
Policy
Subsequent to that meeting, the Canadian Association for Community Education, the Canadian Association for School Health and the International School Health Network established a Community of Practice on Schools in Disadvantaged Communities. In order to focus the discussion, the following summary statement has been developed. This statement has been discussed on-line, been presented and discussed at a Canadian conference in April, 2010 and was then presented and discussed at an international school health symposium in Geneva in July 2010. Subsequent to that, the statement will be translated into French and German and presented to the individuals and groups who participated in the June 2007 meeting.
Visitors to this web page are encouraged to either comment on the draft below using the "thread" tool found at the bottom of this page or to use the "Easy Edit" tool found at the top of the page to open up and edit this document. (Don't worry, all versions of the draft are automatically saved by this wiki platform)
Creating and Maintaining Schools for All: Addressing Determinants, Reducing Disparities and Alleviating Disadvantages
An Initial Identification of Priority Issues, Related Strengths and Relevant Programs
Purpose and Use of this Statement An Initial Identification of Priority Issues, Related Strengths and Relevant Programs
The purpose of this statement is to describe the needs and strengths of populations or communities that have been disadvantaged by lower incomes, discrimination, geographical or social isolation with a view to identifying and describing the approaches, strategies and programs that have proved to be relevant and effective in these types of circumstances. This statement can be used as a lens to focus our collective efforts on the sub-populations that need more support and development. It is also a explicit recognition that there are disadvantaged communities or groups of people within all countries and states that require cohesive, focused action such as suggested herein.
There is a distinction to be made here between disadvantaged communities or groups of people in societies/nations and individual students or families that are residing in communities or regions that are more vulnerable to risks or problems because of individual or family circumstances or traits. Examples of this would be students with intellectual or physical disabilities, children of alcoholics or addicts or students who are being bullied because of their sexual orientation.
We should also remind ourselves that although this statement focuses on disadvantaged communities in high income countries, there are advantaged and disadvantaged communities in all countries. For example, there are schools serving wealthy and advantaged communities in low, middle and high income countries (who also have specific health and social development needs) but in this discussion, we are focusing on populations/schools in disadvantaged communities in high income countries.
Preamble and Principles
Every child has a right to education, health, safety, human rights, social and economic opportunity and freedom from discrimination. All educational, health and social development agencies and systems have the responsibility to provide equitable opportunities, programs and services to serve all children through public schools. Universal access and equitable outcomes are among the basic values included in almost all statements for publicly funded school, health and social service programs and institutions. Yet we know, that despite these statements, easy and equitable access to these services is often not achieved. As one participant noted in our discussions; "After all is said and done, more is said than done".
Consequently, this statement is not about all students or all schools, nor is it a statement about the rights to universal access. This statement is also not a re-iteration of the need for comprehensive and coordinated approaches. This statement is about the students, schools and communities that face greater challenges and therefore need relatively more resources and different/adapted services. In the same way that health programs are differentiated with such terms as universal, targeted or indicated based on individual characteristics, we need to select, adapt/develop and coordinate programs that are in closer harmony with the local contexts in which they are delivered.
In order to provide equitable access, opportunities, programs and services, it is incumbent upon education, health and other public systems to provide additional supports to those who are facing greater adversity. This can be done in all schools for individual students facing greater adversity, but it is particularly important where and when local communities face a number of simultaneous challenges. It is equally important that these additional resources and specific programs build on the strengths within these communities, enable these communities to identify the issues of priority concern and then develop, select or adapt programs suitable to their needs and aspirations.
There are many frameworks, models and multi-intervention approaches, programs and strategies that have been developed by various sectors, working with schools, to promote different aspects of human development for all children. Community schools, healthy schools and safe schools and eco-schools are just four examples of these approaches. All of these recognized models provide benefits to all children. In other words, all schools should be safe, healthy, protect the environment and work closely with their communities. However, in almost all of the prominent statements about these recognized school-related strategies, there is an explicit recognition that such approaches should specifically address the needs of the more vulnerable. In health promotion, the term "social determinants is often used. Disparities, poverty, higher or special needs, marginalized, at-risk and other terms are used in other sectors. Consequently, this statement attempts to create a shared focus on addressing determinants, reducing disparities and alleviating disadvantages by empowering schools and communities to build on their strengths, identifying the issues of most concern to them and selecting/developing and coordinating a set of programs relevant to their needs.
The research on these multi-intervention approaches to health, safety and social development is consistent in one respect. Having a variety of carefully selected policies, programs and services whose delivery is coordinated and aligned is far more effective than single issue or single intervention strategies. Consequently, this statement seeks to identify and describe a cluster of policies, programs, services and practices that are more suited to the strengths and needs of communities that face several challenges or disadvantages.
It is suggested here that the pursuit of a detailed common framework or model to mesh all of these models together would be a mammoth undertaking because each of these approaches has already established long-term visions, shared terminologies and complex relationships between education systems and the health, welfare, law enforcement and environmental sectors. This paper suggests that it is more useful to simply note what is common or compatible in the approaches, identify where expertise and experience resides from among the various sectors/models and then encourage jurisdictions and local communities to select the programs and work with the sectors that they see as being most relevant to them.
Further, there is already significant knowledge and experience in implementing these comprehensive approaches that we need not re-invent in this statement about selected populations and contexts of specific concern. The International School Health Network, in its consensus statement, has identified several broad implementation strategies that are common to almost all school-based and school-linked programs. They include:
- addressing the needs of the whole child to identify clusters of strengths, problems and conditions
- recognizing the limits of school-based and school-linked programs while still maximizing their potential use in partnership with parents, communities and agencies
- selecting a corresponding synergistic combination of programs and policies to address them
- striving for comprehensive approaches, coordinated programs and whole school strategies through means such as assigning and staffing coordinator positions, coordinating policies at the ministry and agency levels, using formal mechanisms such as inter-agency protocols and informal means such as joint professional development programs
- using multiple, coordinated interventions, including school, agency and health authorities policy, instruction, health, social and other services, different forms of social support (such as parent involvement, youth engagement, community participation) and changes to the physical environment to improve student knowledge and skills, alter risk and protective factors and influence pr alleviate social and economic determinants
- selecting or adapting evidence-based and experience-tested programs, policies and practices as well as implementation plans/models
- building community, system, agency and professional capacity for sustainable programs, policies and practices through adequate budgets, ongoing knowledge exchange and workforce development, regular monitoring and reporting on program capacity etc
- seeking congruence with the educational mandate and constraints of school systems
- deepening our understanding of the complex, ecological factors that are the reality of the multiple, open, loosely-coupled and bureaucratic systems that work with and within schools
School-based and school-linked programs can be implemented in several arenas. By clarifying the levels of action and the systems/agencies/personnel involved, we can be clearer about intended outputs. The arenas or levels of action for school-related programs include:
- enabling, engaging and empowering young people to develop fully through attention to the whole child and not just specific problems, by building assets such as positive relationships with others and mental health while timing interventions to match developmental stages
- informing, involving, educating and supporting parents and families through school-linked parent programs delivered in cooperation with other agencies
- the transition from early childhood programs and the home into primary school is a time of vulnerability and potential continued strength as young children leave from various pre-school programs. Other transitions (into secondary schools, between schools when families are forced to move often due to economic needs,from school to work or training) also need attention.
- classroom instruction whose intended outputs are in the students’ knowledge, attitudes, normative beliefs, awareness of services and how to access them locally, skills such as social skills, self-knowledge and behavioural intentions (Note: most instructional programs produce minimal behaviour change but changes in knowledge, attitudes, skills etc may be a prerequisite for change)
- whole school strategies that can address broadly based issues such as preventing dropouts
- coordinated agency-community-school based/linked programs
- comprehensive approaches (multi-level, multi-system, multi-issue) include changes at the ministry level, school board/agency/health authority/police service level and the school-neighbourhood level. They include synergistic programs that address aspects of other issues such as addiction, violence, crime, and others. The focus at this level should be on system capacity and change.
The following selection of issues, strengths and related school-based or school-linked programs is presented to stimulate discussion about the policy/program options that schools, communities and governments can realistically consider in order to address social determinants, reduce disparities and alleviate the impact of disadvantage through schools. This is an important first step, since these issues and programs are usually addressed in isolation from each other by different sectors such as health, education, welfare and law enforcement.
We have attempted to identify practical program options that schools can implement to reduce the impact of poverty, geographical isolation, cultural, religious and linguistic barriers, discrimination based on gender, sexual orientation, physical or intellectual abilities or race rather than pretend that we can eliminate these geographical, social or economic problems through school programs. The reduction of poverty and other disparities is something that must be addressed by fundamental changes to public services, to wealth redistribution mechanisms/taxation and other aspects of society that are beyond the scope of schools to change directly. Further, these specific issues/programs discussed here should be considered within their community contexts because those local situations will create constraints and opportunities within which schools must work .
We have tried to identify a cluster of issues that are likely to be more relevant to the ecology or context of low-income communities. Economic disparity is often a common denominator among other forms of disadvantage, so we have used poverty or social determinants as our focal point. Far too often we approach communities and schools that face these clusters of issues with a silo approach, whereby we address only one or two of their issues with one or two programs or changes. We need a comprehensive, coordinated approach.
The Issues Relevant to Disadvantaged Communities
Some of the health, economic and social issues that are likely more relevant to the school communities in this context include the list below. Two recent analysis done in Canada (Mikkonen & Raphael, 2010) and the United States (Basch, 2010) point out the urgent need for greater focus, descriptive and action-oriented studies on such determinants, disparities and disadvantages. While not all of these issues will be present in al disadvantaged communities, research shows that there are often clusters of such issues and conditions. As part of the community development process, each community should be enabled and supporting the issues, strengths, strategies most relevant to their situation.
- Students arriving in school hungry and families not having sufficient food, clothes or financial resources
- Parents who are not able to access public services easily due to geographical, linguistic, cultural or other barriers and who often have a distrust of schools and other services
- High levels of poverty, unemployment and crime (eg. While anti-social behaviours such as vandalism or bullying are and should be of concern to all schools, some communities regularly face more extreme forms of aggression such as gangs and guns)
- Run-down school buildings and infestations of lice and other parasites as well as poor quality of water, air, heating and facilities. These conditions can lead to inappropriate responses/policies such as prohibiting students with head lice from attending school.
- High rates of staff turn-over and consequent use of inexperienced or under-qualified personnel
- A lack of sports, recreation and informal learning services and spaces in the community as well as disorganized communities and unsafe or inadequate public transportation
- Relatively more health problems related to early childhood ailments, hearing and vision problems, oral health/dental problems, genetic problems, FASD and similar problems
- A lack of basic literacy and health literacy among parents, the community and students. This is further complicated by transportation, employment and single parent families not having the time or resources available to read to their children at a young age.
- Higher levels of early school leaving and dropouts/pushouts
- Higher levels of tobacco and alcohol use as well as illicit drug use and selling in the neighbourhoods
- etc
Identifying and Building on Strengths
Another area for urgent attention is to identify and describe the family and community strengths within disadvantaged communities that can be used to guide, focus and support school-based and school-linked programs. The recent work of Valladares & Anderson Moore (2009) is an illustration of this strength-based approach where they examine low, middle and high income families. They suggest that low income families have equal or more capability in these areas:
- taking their children on local outings such as parks, playgrounds
- feeling close with their children
- talking with their children about things that matter
- having their children attend religious service regularly
- feeling their child is safe while at home (there were stark differences about safety and support in the neighbourhood)
- feeling their child is safe while at school
- having meals together as a family
In a project and Community of Practice similar to this one, indigenous nations around the world identified some of the strengths of aboriginal communities. These attributes would be similar in some respects to cultural and linguistic minority communities. They can include:
- extended families, with more willingness to assist or lead in raising children
- strong community organizations
- more opportunities for community involvement in celebrations and customs
- more evident spiritual connections and religious beliefs
- more awareness of the connection to the natural environment and the land
- a better understanding of their ancestral roots
- particular and specific actions aimed at healing and righting historical injustices that often extend implicitly into the present
- A focus on personal relationships
- Acknowledging contributions
- Respecting the tacit, practical and cultural knowledge of community members
- Attending to the context / systems
- Inviting meaningful participation
- Providing opportunities for skill-building/ learning
- Recognizing interrelationships
- Concentrating on solutions / potential
Some of the programs that are described briefly in this overview paper address many of those factors and conditions. These programs, policies, services and practices can be brought together in a variety of multi-intervention approaches, programs or strategies. These interventions are listed in these five domains below:
Policy
- cooperation with day care and pre-school programs
- emphasis on early literacy programs
- cooperation with vocational training and youth employment programs to assist in transitions to work and training
- cooperation with post-secondary institutions to encourage PSE access
- use of comprehensive (community policing, community-development, rural development etc), agency-school (community schools, healthy schools, safe schools) or whole school models (Social-Emotional Learning, Effective Behaviour Supports) and frameworks
- head start or head start continuation programs
- school dropout prevention programs
- focused efforts on basic literacy and health literacy for all
- more instructional time allocated to programs that foster student interactions (health,social studies, music, the arts, family studies, physical education, moral and religious instruction)
- tutoring programs and remedial learning programs that recruit marginalized students
- alternative schooling and individual education programs (IEP's)
- emphasis on vocational programs (eg. Teaching assistants and nurse practitioners in education/health/caring professions can be used as a stepping stone to further employment and careers)
- additional assistance (financial, administrative flexibility, guidance services etc) to facilitate access to post secondary education
- use of early assessment/identification and screening for vision, hearing, learning problems
- school meal programs
- parent resource centres/school-based and school-linked parent education & support programs
- after school programs that actively recruit marginalized students and that offer a range of music, sports, technology, remedial and other opportunities
- crime prevention and youth justice programs that emphasize diversion and restorative justice that are linked to community policing strategies
- school-based or school-linked assignments of youth police officers
- working closely with youth employment programs
- delivery of basic health services such as dental, vaccinations, vision screening, etc
- support for special populations such as those with FASD, emotional-behaviour disorders etc
- cooperation with or hosting community-based Internet access programs
- cooperation with street youth and homeless programs
- incorporating and infusing diverse cultures into school activities and procedures so that all feel welcome
- parent education and training programs
- peer helper programs
- youth social justice clubs (eg gay-straight alliances, anti-racism campaigns, environmental and peace campaigns )
- service learning programs whereby university and college students do their field practice in schools
- school-based or school-linked mentoring programs
- family violence/neglect prevention programs
- cooperation with child protection services
- cooperation with housing authorities
- cooperation with local businesses, community groups, advocacy groups
- cooperation with youth employment programs and local employers
- school activities to reflect cultural makeup of the community
- working with elders and respected members of minority communities
- cooperation with immigrant service and cultural community organizations
- cooperation with community and youth programs preventing discrimination based on race, language, religion, orientation or culture
- school-based cultural heritage programs, school cooperation with community cultural and linguistic heritage programs/activities
- school and community restoration and renovation programs (clean water, parasites, lead pipes, asbestos, moulds etc)
- improved security measures for schools in high crime neighbourhoods
- organization of safe, active transportation routes to school
- cooperation with community libraries
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Latest page update: made by dmccall
, Nov 26 2011, 4:20 PM EST
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