Comprehensive School Health Promotion Evolution In Canada & Other Countries


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Presentation to national conference

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Comprehensive School Health Promotion Evolution In Canada & Other Countries

  1. 1. Comprehensive Approaches, Coordinated Programs, Health-promoting Schools Progress in Canada towards effective approaches to promoting health, social development and learning in middle childhood Douglas S McCall Learning Summit on Middle Childhood Ottawa, April 23, 2007
  2. 2. Purposes of Presentation <ul><li>School role in middle childhood </li></ul><ul><li>CSH History – diverse strands and approaches, different & competing, emerging systems approach </li></ul><ul><li>SH in Canada today – promising strategies and lingering problems </li></ul><ul><li>Some potential CSH futures – challenges & opportunities </li></ul><ul><li>Through the lens of the Canadian CSH Consensus Statement 1990-2007 </li></ul>
  3. 3. The 1990 Statement - From CSHE to CSH <ul><li>CSH in Canada: shared responsibility of several agencies, professionals, tri-level implementation, whole child not just one disease) </li></ul><ul><li>HPS in Europe: values, culture, democracy, empowerment, coordinators, accountability </li></ul><ul><li>CSHP in United States : focus, programs not projects, coordination, evaluation, surveillance, research </li></ul><ul><li>HPS in Australia: education mission of school, practicality, mental health </li></ul><ul><li>HPS in Latin America : Context of low income communities, role of corporate sector </li></ul><ul><li>C&S in Aboriginal communities (need to develop) </li></ul><ul><li>Things in common: (1) instruction, services, social support, physical environment (2) started in basements & university offices (3) Focus on context, complexity, coordination, capacity & characteristics </li></ul>
  4. 4. School & Other Roles: Measure & Monitor Outputs <ul><li>Learn about : web safety, child abuse, meal prep. relationships, puberty, fire, accidents, basic HL </li></ul><ul><li>At school : school meals, transport, playgrounds, connect with teacher, </li></ul><ul><li>- schools </li></ul><ul><li>libraries, museums </li></ul><ul><li>private/remedial tutoring </li></ul><ul><li>recreation programs </li></ul><ul><li>web-based learning? </li></ul>Learning <ul><li>meals at home, lunches to school, expectations, attitudes </li></ul><ul><li>TV/games/web practices </li></ul><ul><li>honesty, character, outlook, friends, spirituality </li></ul><ul><li>participation in supervised after school </li></ul><ul><li>- parents </li></ul><ul><li>media </li></ul><ul><li>Internet </li></ul><ul><li>other adults </li></ul><ul><li>faith Organizations </li></ul><ul><li>youth centres/programs </li></ul>Social Development <ul><li>injuries </li></ul><ul><li>allergies </li></ul><ul><li>vaccinations </li></ul><ul><li>child neglect/alone </li></ul><ul><li>sexual abuse </li></ul><ul><li>weight, body image </li></ul><ul><li>physical activity levels </li></ul><ul><li>divorce/separation rates </li></ul><ul><li>- family physician </li></ul><ul><li>immunization </li></ul><ul><li>early id/ screening </li></ul><ul><li>day care services </li></ul><ul><li>taxes/subsidies for poor families </li></ul>Health & Welfare
  5. 6. What we Know <ul><li>Recent reviews, CCL SH Research Seminar, IUHPE & UN Agencies Ctte. </li></ul><ul><li>Good instruction works, but not enough, but Health Literacy possibly a prerequisite </li></ul><ul><li>Multiple, coordinated programs and services have greater impact </li></ul><ul><li>On some issues, on specific aspects or behaviours, in certain situations, for a certain time, can save dollars, but let’s measure outputs not life-long outcomes </li></ul><ul><li>Investing in SH capacity (critical mass) affects several issues </li></ul><ul><li>CSH improves health and achievement </li></ul>
  6. 7. Mistakes (school abuse) in the past and present <ul><li>Captive audience vs shared responsibility </li></ul><ul><li>Primary role is….to educate! </li></ul><ul><li>Projects & packages vs principles and programs </li></ul><ul><li>Collect data on kids health at school but not schools do not have primary accountability for health, </li></ul><ul><li>Push for more school accountability for learning about health and exploring health jobs </li></ul>
  7. 9. Lots of approaches HS, AS SS, DS, TS, NS Choices still being made, challenges associated in those choices <ul><li>Lots of approaches to SH today. They are similar but also different. </li></ul><ul><li>Differing philosophies – individual responsibility or cultural/ determinants approach </li></ul><ul><li>Pre-select priority issues at the top or empower local agencies & schools to make choices based on data </li></ul><ul><li>Competition among diseases </li></ul><ul><li>Recent evidence that investing in climate and overall capacity can reduce several health and social problems. </li></ul>
  8. 10. 2007 CSH Statement: From One “C” to Five “C’s” <ul><li>From Comprehensiveness to: </li></ul><ul><li>Context – will shape most efforts </li></ul><ul><li>Complexity - systems approach to policy, programs and research </li></ul><ul><li>Capacity – system s , agencie s , schools/neighbourhoods </li></ul><ul><li>Characteristics – multiple, open, loosely coupled, bureaucratic </li></ul>
  9. 11. Building System Capacities <ul><li>Coordinated policy / policy on coordination </li></ul><ul><li>Assigned staff and infrastructure </li></ul><ul><li>Formal and informal mechanisms for cooperation </li></ul><ul><li>Knowledge transfer , translation, promising practices </li></ul><ul><li>On-going work force development (pre and in-service) </li></ul><ul><li>Strategic, coordinated issue management </li></ul><ul><li>Ongoing surveys of kids health , periodic surveys of policies & programs, reports on health literacy </li></ul><ul><li>Explicit plan for sustainability. </li></ul>
  10. 12. System Characteristics <ul><li>System Characteristics that Affect SH Program Effectiveness </li></ul><ul><li>Multiple Systems </li></ul><ul><li>Openess </li></ul><ul><li>Loose Coupling </li></ul><ul><li>Bureaucracies of Professionals </li></ul>
  11. 13. SH: A Pathway Forward <ul><li>From diverse beginnings, approaches – </li></ul><ul><li>A Clear and Shared Vision, at all levels, among all stakeholders </li></ul><ul><li>Better understanding of the school </li></ul><ul><li>More realistic but better monitored comparative results available to the public </li></ul><ul><li>No more disease competition, but still a focus on selected issues - sequential, managed selection without denial to any </li></ul><ul><li>No more projects without a plan and a commitment </li></ul><ul><li>Agreement at all levels in the systems – systematic sustained approach </li></ul>
  12. 14. Some Potential Futures <ul><li>Public health infrastructure is abandoned just when education ready to listen </li></ul><ul><li>Governments fund awards & projects </li></ul><ul><li>Governments continue with disease of the month or clumps of diseases and ignore all others </li></ul><ul><li>Safe schools is married with healthy schools and effective schools and democratic schools </li></ul><ul><li>Pandemic washes away all but health protection within PH </li></ul><ul><li>Basic life and family skills continue to be ignored and we wonder why school shootings are increasing </li></ul>
  13. 15. Some Opportunities <ul><li>New, impatient government – no more HL strategies that go nowhere, willingness to work with groups outside government, looking for results </li></ul><ul><li>New government unwilling to take leadership role on issues in PT jurisdiction, willing to achieve fiscal balance without accountability from PT’s </li></ul><ul><li>Youth and schools are a public concern – more than ever </li></ul><ul><li>International events hosted in Canada – UN Agencies, IUHPE, CCL settings symposium </li></ul><ul><li>Research on ecology of school, systems approach showing a new pathway </li></ul><ul><li>Four legs of the SH chair now in place in Canada albeit wobbly– now the seat, the padding, perfect the design, create chairs in each PT and more </li></ul>