APPENDICES
3.2 Conceptual frameworks
3.2.1 The Concept of ‘Health Promoting Schools’
The South African Government as signatory to the United Nations Convention on the Rights of the Child has pledged to “put children first”, which is a commitment to ensure that the rights of children are upheld and provision is made to enable all children to reach their full potential (Departments of Health & Basic Education, 2012). This presupposes the need for the development of relevant psychology for the poor, marginalised and most vulnerable, which would play an active role in implementing approaches and methods that contribute to the well- being of individuals and communities, and endorse a commitment to community-based prevention of factors that place youth at risk (Johnson & Lazarus, 2003). Education can achieve this by promoting effective teaching and learning and simultaneously focusing on addressing barriers to learning. There is a growing interest in the relationship between community and public health and, according to Pretorious-Heuchert and Ahmed (2001), in the South African context community psychology aims to facilitate the process of social change and improve the well-being of all citizens. The World Health Organisation (WHO, 1993, p. 1) says “the health promoting school aims at achieving healthy lifestyles for the total school population by
developing supportive environments conducive to the promotion of health. It offers opportunities for, and requires commitments to, the provision of a safe and health-enhancing social and physical environment”. Health is defined as overall well-being which includes physical, social, psychological, spiritual and environmental health (Department of Health, 2000), whereas a school health programme is seen as a combination of services ensuring the physical, mental and social well-being of learners so as to maximise their learning capabilities (Departments of Health
& Education, 2012).
According to Johnson and Lazarus (2003), health promotion is an empowering framework that believes in providing individuals with skills necessary to make informed decisions regarding their well-being, which recognises the impact of external social and political influences on behaviour. This includes educational, political, economic, environmental, psychological and medical strategies designed to reduce disease and promote health. Vergnani, Filsher, Lazarus, Reddy and James (1998) maintain that school health education and promotion can play a role in changing not only knowledge and attitudes, but also behaviour. By targeting youth, one can reach them before they have established behaviour patterns that place them at risk for adverse consequences in terms of mental and physical well-being (WHO, 1992). According to Dryfoos (1991) South African youth, many of whom have been historically marginalised and disadvantaged, are at risk for the consequences of ‘new morbidities’ resulting from early and/or unprotected sex, drug and alcohol misuse, stress and various forms of violence, including high rates of exposure to political violence. This means that school health promotion must coordinate and monitor services aimed at youth, in particular campaigns to combat substance abuse, teenage parenthood and sexually transmitted diseases amongst the youth. The need to improve the health
status of South African youth and children is a major priority, and considering the large number of children who can be reached via the education system, schools are considered a logical venue for trying to address some of these problems. In an atmosphere were school health services are fragmented and inadequate, occupy low status and lack resources, with minimal community participation and partnership, the key purpose of the health promoting school is the provision of adequate school health services. This presupposed the adoption of a ‘whole school’ approach to planning and delivering positive and comprehensive activities, programmes, policies and environments.
The rationale behind the development of health promoting schools – according to the World Health Organization (2000) – is the belief that “children are the most important natural resource and must be at the heart of development, and that their well-being, capabilities, knowledge and energy will determine the future of villages, cities and nations around the world” (WHO, 2000, p. 1). South Africa developed the national guidelines for the development of health promoting schools in October 2000 and has implemented the concept in an attempt to address the historical imbalances and its consequences (Department of Health, 2000). The guidelines are congruent with the policy of inclusive education. According to Johnson and Lazarus (2003), the recognition of the school as a key setting for intervention has led to a focus on the development of health promoting schools as a means of addressing many of the inadequacies and inequalities of the health and educational support services. Unlike the traditional approach which prescribed a didactic, directive style aiming to change behaviour to avoid disease, this approach looks at much more than just curing; it’s a democratic process that aims to develop young people’s competencies in understanding and influencing lifestyles as well as living conditions (Barnekow,
Buijs, Clift, Jensen, Paulus, Rivett & Young, 2006). However, to achieve health promotion through schools, health education as part of lifeskills education should become part of the curriculum at both primary and high school levels, with a coordinator at each school, logically, the guidance teacher. Lifeskills education encompasses the teaching of not only skills but insight, awareness, knowledge, values, attitudes, and qualities that are necessary to empower individuals and their communities to cope successfully with life and its challenges. However, it must be remembered, as Vergnani et al., (1998) caution, that health promotion is a broader concept than just lifeskills.
The need for school-based assistance for teachers and learners led to the establishment of institution-base support teams called Teacher Support Teams (TST), which focuses on assisting teachers with the management of learners with special needs. The TST’s helps teachers deal with problems by themselves, and referrals are limited to cases the school-based team cannot deal with. The health promotion project (Appendix Q) resulted in schools operating in a holistic manner in addressing the needs of learners by mainly encouraging them to pursue the development of their physical, psychological, social and educational potential. This was achieved by promoting and enhancing their self-esteem and promoting positive relationships amongst all members of the school community. According to Johnson and Lazarus (2003), through health promotion schools can provide a holistic and comprehensive approach to dealing with difficulties and promoting learners’ well-being. This requires adopting an eco-systemic view whereby difficulties which are manifested are understood not only in terms of the individual but the environment as well. This means that intervention entails the transformation of the individual as well as the school environment and all its constituents.
As Johnson and Lazarus (2003) point out, the health promoting school is a strategy for promoting the well-being of members of the school and surrounding community. The driving force behind the development of health promoting schools is the belief that in every community, children are the most important natural resource and must be at the heart of development and that their wellbeing, knowledge and energy will determine the future of villages and communities.
This is in perfect unison to the mental health model which considers the social aspects of health, including lifestyle, socioeconomic status, and preventive education (Strein et al., 2003). The central characteristic of the public health model, which distinguishes it from the ‘medical model’, is its emphasis on prevention as well as treatment (ibid). Despite extreme personal and systemic stress and enormous challenges such as poverty and HIV and AIDS threatening the lives of teachers, parents and learners, the importance of the school and education as a symbol of hope in impoverished communities cannot be underestimated. According to Strein et al., (2003, p.24) schools are not merely an adjunct to the mental health delivery system, but are the primary providers of mental health services for children – the de facto mental health system for children.
Proponents of the mental health model recommend that mental health be redefined as an integral component of primary health, not as just an adjunct or an afterthought (Strein et al., 2003).
All members of the school community unite in providing the best possible learning environment for the children in order that they may rise above their circumstances and realise their dreams.
According to the UNICEF declaration, “through education children gain knowledge and skills to survive, to learn, to live dignified lives and to contribute to the development of their communities and their nation”. But, as Vergnani et al., (1998) put it, the policy of health
promoting schools can only be successfully implemented if it is accompanied by the allocation of adequate resources in the form of finances, person power and skills. Achieving this would pave the way for providing a healthier future for South African children. Vergnani et al., (ibid) maintain that in order to develop health promoting schools, inter-sectoral collaboration is essential. This should be understood as collaboration of people from different disciplines, sectors and government departments – as ‘partners’ in education. Health promotion resulted in schools operating in a holistic manner in addressing the needs of the learners. Together with educators, social workers, counsellors and school community, school health services should ensure that orphans and other vulnerable children are identified and referred appropriately to psycho-social support services (Departments of Health & Basic Education, 2012). This would combat the prevalent fragmentation, territoriality and duplication of services, which, among other things, impact on the delivery of School Psychological Services.