Whole-School Approaches to Promoting Health – Comprehensive Study Notes

Learning Objectives

• Define “health promotion” and recognise its placement within the wider health-delivery continuum
• Describe local, state, national and international health-promotion strategies, with emphasis on the Ottawa Charter, WHO SDGs, and the Australian Health Promotion Association (AHPA)
• Develop the skills needed to audit the local environment, locate services, and forge community partnerships for children and schools
• Explain whole-school approaches, including the WHO Health Promoting Schools Framework and its three interacting components
• Appreciate community diversity and list classroom/school practices that celebrate and leverage this diversity

What Is Health Promotion?

• WHO Definition (1986; reaffirmed $2017$): “Process of enabling people to increase control over and improve their health”
• Health = resource for everyday life (physical, mental, social wellbeing) → not the sole responsibility of the health sector
• Fundamental conditions/prerequisites (Ottawa Charter, WHO $2017a$): peace, shelter, education, food, income, stable eco-system, sustainable resources, social justice & equity
• Links to Maslow’s Hierarchy (Physiological → Safety → Love/Belonging → Esteem → Self-actualisation)
– Example: A child who slept in a car and skipped breakfast cannot reach self-actualisation; health promotion strives to satisfy lower-level needs first

Five Stages of Health Delivery

1. Health promotion (cheapest, capacity-building)
2. Prevention ("better than cure")
3. Early intervention (e.g. first high BP reading)
4. Treatment (short → long term)
5. Rehabilitation (regain quality of life)

Key International Frameworks

• Ottawa Charter for Health Promotion (First International Conf. on Health Promotion, Ottawa $1986$)
– Aim: “Health for all by $2000$ & beyond”
– Actions: Build healthy public policy; Create supportive environments; Strengthen community action; Develop personal skills; Reorient health services
• UN → WHO → National → State → Local “trickle-down & ripple-up” effect
• Sustainable Development Goals (SDGs, $2015–2030$): $17$ universal goals; e.g. SDG 3 “Ensure healthy lives and promote wellbeing for all at all ages”, SDG 10 “Reduced inequalities”, SDG 14 less relevant to land-locked nations

Australian Health-Promotion Landscape

• AHPA mirrors WHO/Ottawa principles; core values:
– Ethical practice (culturally informed, respectful, safe)
– Health equity (address social determinants)
– Innovative & evidence-informed approaches (best practice, adapt don’t reinvent)
– Collaboration (partnership culture; funding bodies prefer cooperative bids)
• Communication channels: TV, billboards, apps, social media, shock campaigns (e.g. “Grim Reaper”, TAC ads)
• Example Tech Solutions:
– Dental Health Services Victoria $2$-min tooth-brushing app
– Wearables & fitness trackers
• National statistics (AIHW $2014$):
– Health spend $\$140.3\,\text{billion}$ ( $2011–12$)
– Life expectancy: boys $79.9\,\text{yr}$, girls $84.3\,\text{yr}$
– Vaccination ↑ ; Smoking ↓
– Yet: adult overweight/obesity ↑ ; dementia to almost triple by $2050$ ; Diabetes ↑
– Indigenous health gaps: Kidney disease $7\times$ higher; Diabetes $3.3\times$; Youth suicide F $5.9\times$, M $4.4\times$

From Global to Local

• Each state/territory drafts strategic frameworks (e.g. WA Health Promotion Strategic Framework $2012–16$ → priorities: healthy eating, physical activity, healthy weight, smoking, alcohol, community safety)
• Local needs assessment tools: MySchool ICSEA, council demographic reports, service maps, informal “café & newsagent intelligence”
• Example local programs:
– Port Macquarie–Hastings falls-prevention (linked Heart Foundation pedometers)
– Ipswich “Mums & Bubs” free/low-cost activity schedules
– ACT “It’s Easy Being Green” veg-increase for people with Hepatitis
– Foodbank WA “Food Cent$” (train welfare staff on nutritious aid)

Whole-School Approach (WSA)

• Definition: All community stakeholders co-plan, implement and evaluate wellbeing initiatives; systematic, inclusive, sustained
• Response Ability key features:
– System-wide wellbeing focus
– Inclusive of staff, students, parents, allied professionals
– Ongoing PD, policy backing, continual action/evaluation
• Benefits: Shared ownership → higher relevance, consistent messaging; addresses truancy, safety, mental health, etc.

WHO Health Promoting Schools (HPS) Framework

• School = setting for “living, learning, working”
• Guiding principles (WAHPSA): promote student health; enhance learning; uphold equity; safe environment; student voice; staff wellbeing; parent/community collaboration; data-driven & continually improved
• Three Interlocking Components

1 Curriculum & Pedagogy

• Integrate across subjects; use student input; peer models; display work; access DoE resources; inventory quality materials

2 School Organisation, Ethos & Environment

• Review/write policies; inclusive signage; wellbeing staff; staff wellness programs; health weeks; diversity celebrations; audit physical spaces (canteen, quiet zones, disability access)

3 Partnerships & Services

• Engage parents, volunteers, local health providers; homework tasks linking home; info nights; display work in community hubs; joint conferences; newsletter promos
• Iterative Cycle (Cancer Council WA model): Create vision → Audit → Form committee → Plan with budgets/resources → Implement → Monitor → Formatively re-evaluate for sustainability

Exemplary Australian School-Based Initiatives

• Walking School Bus (VicHealth) → daily active transport, congestion ↓, attendance ↑
• SunSmart (Cancer Council Vic/VicHealth) → UV-safety policy, shade audits, curriculum links
• KidsMatter (now Be You) → mental-health WSA; see case-studies: Pomona SS (QLD), Glen Huon PS (TAS), Wanniassa School (ACT)
• Kitchen-Garden Programs (Stephanie Alexander Foundation) → cross-curriculum sustainability, literacy/numeracy, parent engagement; observed home-garden multiplication effect
• Respectful Relationships Education in Schools (RREiS, Our Watch) – WSA tackling family violence; evaluation shows attitudinal & policy change

Celebrating Diversity through Health Promotion

• Harmony Day (21 March; colour = orange; coincides with UN Day for Elimination of Racial Discrimination)
– Message: “Everyone belongs”
– Activities: cultural dress parades, shared lunches (allergy-aware), recipe books + teacher guides, multicultural dance workshops (e.g. Stomp hip-hop), AFL Multicultural Program clinics
– Stats: $\approx7.5\,\text{million}$ migrants since $1945$; ~$50\%$ of Australians born OS or have OS parent
• Links to health: social inclusion, mental wellbeing, reduction of racism-related stress, community cohesion

Cross-Curriculum Connections & Examples

• Kitchen Garden → Sustainability (CCP), Science (plant biology), Maths (harvest weights), English (procedural texts), HASS (history of crops), Arts (garden design)
• SunSmart → Science (UV radiation), English (persuasive letters for funding shade sails), HPE (sun-safe behaviours)
• Harmony Day → English (multilingual storytelling), Music (songs from cultures), PE (traditional games), Digital Technologies (create e-posters)

Practical Teacher Actions

• Role-model healthy lunches; invite students to co-design canteen audits
• Map local services with students; maintain community contact list
• Build a multidisciplinary WSA committee (leadership, staff, parents, students, external agencies)
• Use formative evaluation: simple surveys, attendance logs, focus groups, pre-/post-knowledge quizzes
• Seek small grants (council, philanthropic, health departments) – partnerships improve success

Ethical, Philosophical & Equity Considerations

• Equality vs Equity: treat people according to need (Figure 8.2 graphic)
• Example: Holding a sexual-health expo during Ramadan without consultation excludes Muslim students
• EAL/D patients need time, interpreters, culturally safe spaces; “one-stop-shop” aged-care models for equitable access

Numerical & Statistical References (LaTeX)

• $140.3\,\text{billion AUD}$ health expenditure ($2011–12$)
• Life expectancy $\text{M}=79.9\,\text{yr},\; \text{F}=84.3\,\text{yr}$ (born $2012$)
• Indigenous youth suicide: $5.9\times$ (F) & $4.4\times$ (M) higher
• Diabetes in Indigenous Australians: $3.3\times$ higher; kidney disease $7\times$
• Dementia cases projected $\approx3\times$ by $2050$

Summary “Cheat Sheet”

• Health promotion = empowerment + capacity-building → cheapest & earliest intervention
• Ottawa Charter & SDGs give macro direction; AHPA operationalises in Australia
• Ethical practice + equity + innovation + collaboration = AHPA pillars
• WSA/HPS Framework: Curriculum, Environment, Partnerships
• Evaluate early & often (formative) to refine initiatives
• Diversity celebrations (e.g. Harmony Day) strengthen mental & social health
• Teachers are linchpins: role-models, facilitators, connectors to community services
• Local context knowledge converts global frameworks into meaningful, inclusive action

Potential Exam Triggers / Review Prompts

• Draw & label Maslow’s pyramid; link to health promotion
• List & explain the $5$ Ottawa Charter action areas
• Diagram the HPS Framework, giving $3$ example strategies per component
• Argue for kitchen-garden programs as multisectoral health promotion (use curriculum, community & equity evidence)
• Contrast equality vs equity with a school-based scenario (e.g. canteen pricing, disability access)