What we Know and Don’t Know About School Health by sammyc2007


									What we Know and Don’t Know
     About School Health
          Irving Rootman, Ph.D.
 Professor and Michael Smith Foundation
for Health Research Distinguished Scholar,
           University of Victoria
1. To introduce SHRN
2. To describe what we know and don’t
   know about school health
3. To start the discussion about a School
   Health Research Agenda (Conceptual
   Framework, Themes & Topics)
                       Purpose of
•   To develop a team and long-term program
    of research on the impact of the physical
    and social environment of the school on

•   Irving Rootman (Co-PI), U.Victoria
•   Paul Cappon, (Co-PI), CMEC
•   Bonnie Leadbeater, U Victoria
•   Maryanne Doherty-Poirier and Xin Ma, U.
•   Louise Potvin, U. Montreal
•   Bill Morrison, U.N.B

•   Develop framework for research
•   Create database of Canadian studies and
•   Establish electronic network
•   Identify, and select priorities for further
•   Develop proposals for further research
                   The SHRN is:
• A small group of researchers,
  practitioners and policy-makers
• Willing to help others connect about
  SH research
• Reaching out to other research projects
• Open to others
                    The SHRN has:
• Completed a lit review
• Conducted a survey on concept, themes,
• Made international connections
• Built a web site and email lists
• Started policy assessments
• Pulled together researchers on PA and
                      This overview
                       comes from:
• a summary of several international
  reviews and landmark studies in
  school health
• a review of the research literature with
  an emphasis on ecological and
  systems theories
• a web survey of school district and
  public health officials
• interviews with key informants
                    This Workshop
Is an opportunity for representatives
  from national health and education
to comment on the research agenda and
to be invited to become affiliated with the
                   Why School Health?
- best public setting to reach youth
- schools can teach knowledge & skills, but
  also a place where kids are socialized, eat
  meals, kept safe, recreate, treated,
  screened, vaccinated, teased, bullied,
  engaged, alienated etc
- also a place to reach parents and
- Inform over 5% of the Canadian workforce
                  International Quotes
• “Schools could do more than perhaps any other
  single institution in society to help young people,
  and the adults they become, to live healthier,
  longer, more satisfying and more productive
  lives.”(Carnegie Council on Adolescent
  Development, 1989)
"An effective school health programme can be one
  of the most cost effective investments a nation can
  make to simultaneously improve education and
  health." (WHO Director-General, April 2000)
                            Canadian Quotes
“an effective school-based smoking prevention program
  could result in an initial 6% reduction of smoking and 4%
  over the long term. A cost-benefit of up to $619 million
  annually” (Romanow quoting Stephens et al. 2000)

"we can start to redefine the mission of public education as a
  community resource… early learning centres in every
  school; health and dental clinics; agencies in underutilized
  space; city recreation programs and social services being
  offered in schools” David Reid, Director of Education,
  Toronto School District, Jan. 23, 2004.
                      Why School Health?
The importance of the school setting (WHO, 1997):
• Health Status Affects the Capacity to Learn
• Educational Attainment Affects Health Status
• Purposeful interventions using the school as the
  delivery system can influence short-term and long-
  term health status, social development and
  educational achievement.
                     Evolving Concept
Evolving conception of school-based HP:
• The “medical model” lingers on in “disease
  of the month” or “disease-school” models
• From health facts, to skills, to social
  influences to merger with social and
  educational outcomes
                         More Evolution
• Comprehensive Education (instruction) becomes
  Comprehensive Approach
• From school system to multiple systems and
  systems based thinking
• From components (AU) to coordination (US) to
  values/outcome (EU) to systems (CA)
• From tidy pictures to messy ecology, complexity,
  chaos, open systems and bureaucratic politics of
  change and sustainability (i.e. back to reality)
From Tidy Pictures
    To Messy
Ecology & Systems
                           SHRN Approach
1. Use Cochrane Collaboration techniques
2. More Cost-benefit studies
3. Define realistic school "outputs”
4. Explore limits of school to promote health
5. Develop new measures of school environment
6. Use multi-level modeling
7. Understand inter-sectoral coordination
8. Understand systems & micro-environments
9. Develop better Indicators
10.Understand link between health & learning
                              Work with Others
Other School Health Research Projects:
• University of Calgary
• University of New Brunswick (CSH approach to tobacco)
• University of PEI/Atlantic HP Centre
• University of Western Ontario/CAMH
• University of Montreal (Psychosocial & disadvantage; Health
interdisciplainary )
• Queen’s University (eg Sexual Health, HIV and AIDS)
• WHO Collaboration (IUHPE) & CDC on SHPPS 2006
                           What We Know
A. Even when information is effectively taught, it
   doesn’t necessarily lead to changes in behaviour

B. Affective approaches have no significant impact on
   substance use

C. A “social influences approach” seems to be effective
   in reducing drug use

D. A “skills” approach combined with knowledge of
   health risks is associated with avoidance of risk
   taking and more healthful behaviours
                           What We Know

E. Effective programs appear to require multiple

F. Early, repeated, and strong intervention
strategies will have a higher probability of
success than single-component approaches
or those of short duration
                            What We Don’t
A. The Relationship between Health and Learning
B. The Nature and Influence of the Social and Physical
Environment of the School
C. The Effect, Cost-Effect and Cost Benefit of Linked
Strategies and Interventions
D. Multiple, Coordinated Interventions and the Process
of Coordination
E. Policies, Program Implementation and Monitoring
F. Development of New Research Methods and Practices
                         Survey Findings:
Support for School Health Research (78%)
• Key priorities are
  –   Collaboration
  –   Best Practices
  –   Health & Learning
  –   Participation
  –   Barriers & Solutions to SH Research
Respondents were interested in:
• Linkages between schools and agencies
• How to encourage collaboration
• How coordinated are services now?
• What incentives, directives, training etc can
  be used to overcome “silos”.
                      Best Practices
Respondents were interested in
• How accessible and used are health
• School-based or school-linked health
• Barriers to interagency cooperation
• Roles for non-educators in School Health
                   Health & Learning
Respondents were interested in:
• Connection between basic literacy/academic
  achievement and health
• Realistic limits for school-based programs,
  what can be achieved on each health issue
  (KAB) and on social development and basic
  academic outcomes?
Respondents were interested in:
• Youth participation
• Parent involvement
• Community involvement in school
                            SH Research
Respondents reported:
• Barriers such as a lack of shared values/agendas
   and a lack of capacity both in terms of funding
   and time for educators to participate
• Potential solutions such as developing a shared
   vision and better communications

Leadership at the FPT level was seen as critical.
                      Your Turn
It is time:
• To ask questions
• Discuss
1. the approach,
2. Concept/diagram,
3. themes
4. topics

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