A table in the article underlines the differences between "selective approaches" (linear thinking) focused on preventing specific problems and "systems thinking" In linear thinking, the program is developed from a blueprint, developed by trials in controlled circumstances, that are top-down in nature, often without considering local contexts or potential unintended consequences. In systems-based approaches, learning and context drive the action and selection of issues to be addressed as well as the programs. In linear thinking, the programs target disease-specific, quick-wins. Planners develop a specific program for a specific population and assess its ability to produce specific short-term outcomes. In systems-based approaches, the action is across various sectors, with key stakeholders involved from the beginning to develop and implement approaches across the relevant sectors. In selective thinking, there is a reliance on isolated, quantitative measures. Single snap shot data points are used by specialized experts to assess if the programs are meeting their objectives. In systems thinking, multiple interative measurements and synthesis as well as relationships are used to assess progress. Longitudinal, real-world data from multiple qualitative and quantitative sources are used to monitor relevant effects. Read more>>
(From the ISHN Member information service) An article in the June 21, 2014 issue of The Lancet calls for systems thinking from governments and Un agencies when they decide on the set of goals to replace the existing MDG goals. The authors assert that "Global priorities have progressed from the Millennium Development Goals (MDG) that will expire in 2015 to global sustainable development. Although there is not yet a consensus on the specific goals for the post-MDG era, the post-2015 investment agenda for health will probably emphasise social determinants of health, sustainable development, non-communicable diseases, health systems strengthening, universal health coverage, the health of women and children, and ageing." They then go on to make the case for "systems thinking". " The MDGs were undoubtedly successful in focusing international donor financing and domestic investments to achieve the targets set in these goals. Yet, undue emphasis on financing narrow disease programmes used to achieve disease-specific targets in the MDGs often missed opportunities to effectively strengthen health systems.1 Consequently, several low-income countries with weak health systems have struggled to reach the targets set in health-related MDGs and will not achieve them by 2015.2 An important lesson from the MDGs is that current and emerging global health challenges require action that embraces interdisciplinary and intersectoral approaches to development,3 which acknowledge the path-dependence and context-dependence of implementation."
A table in the article underlines the differences between "selective approaches" (linear thinking) focused on preventing specific problems and "systems thinking" In linear thinking, the program is developed from a blueprint, developed by trials in controlled circumstances, that are top-down in nature, often without considering local contexts or potential unintended consequences. In systems-based approaches, learning and context drive the action and selection of issues to be addressed as well as the programs. In linear thinking, the programs target disease-specific, quick-wins. Planners develop a specific program for a specific population and assess its ability to produce specific short-term outcomes. In systems-based approaches, the action is across various sectors, with key stakeholders involved from the beginning to develop and implement approaches across the relevant sectors. In selective thinking, there is a reliance on isolated, quantitative measures. Single snap shot data points are used by specialized experts to assess if the programs are meeting their objectives. In systems thinking, multiple interative measurements and synthesis as well as relationships are used to assess progress. Longitudinal, real-world data from multiple qualitative and quantitative sources are used to monitor relevant effects. Read more>>
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(From the ISHN Member information service) The news release describing the new Ontario Government vision for education, Achieving Excellence includes well-being as one of the three sub-headings for the release. The release itself includes these two points among the four used to provide examples of how the new educational policy will be implemented:
The web page introducing the Ontario policy document states that Ontario's renewed and inter-connected goals for education are:
The political party that governed Ontario at the time this policy paper was published (April 2014) has recently been elected, so this emphasis on equity and wellness as part of the planned education goals would appear to have a good chance at implementation. the education ministry also released documents linking this policy paper Achieving Excellence to various health issues and directions being taken in the Ontario Healthy Schools Program. Read more from the news release (From the ISHN Member information service) An article in Issue #3, 2014 of Health Promotion Practice illustrates the challenges of working in loosely-coupled education and health systems. This Canadian study examined policy documents on school nutrition and education in Canada at the federal, provincial and regional or local authority levels. The researchers note that "Results reveal distinct differences across federal, provincial, and regional levels. The availability of nutritious food in schools and having nutrition education as part of the curriculum were key components of the physical environment across federal and provincial levels. Federal and provincial priorities are guided by a health promotion framework and adopting a partnership approach to policy implementation. Gaps in regional-level policy include incorporating nutrition education in the curriculum and making the link between nutrition and obesity." Read more>>
Education, Not Training (even in health or social skills) Builds Character, Leads to Development6/10/2014 (From the ISHN Member information service) ISHN and ASCD have been sponsoring an international dialogue on how health 7 social programs can be integrated within education systems. One aspect of that suggests that H&S advocates should support a broad, liberal and student-centered approach to learning as outlined in the ASCD Whole Child approach. However, should we also be asking H&S advocates if they are actually doing that in their various instructional programs that seek to teach specific knowledge and skills about particular health or social topics? A recent blog underlines this question when it describes the difference between education and training (or education based on outdated factory models). The blog article, appearing in the Smart Blog on Education (Jun 9, 2014) suggests that " Our traditional approach to schools was based on a factory model where workers had to be “trained” to perform actions and repeat them in the same way and at the same time. Anything that distracted them from performing the way the factory prescribed was just a distraction to be extinguished as quickly as possible. A person’s natural interests, including the desire to socially connect to others, needed to be put aside in favor of the required work. Workers needed to be “trained” in a way of acting that was foreign to how they were naturally wired to learn. Since the work they did was arbitrary, relatively meaningless and tedious, they needed to be rewarded for performing in a certain way and penalized for performing in a different way." "In this factory model of schools, character and social/emotional skills are not integrated into the interactions between teachers and students. There is one main social skill: Do what you are told. Policymakers recognizing that schools are missing this social/character element decided to have character education and social emotional skill training inserted into the traditional structure of schools." "The environment and structure of a school sends a message to students that very often contradicts the content of many social emotional and character education programs. In addition, when the basic structure of schools does not change, neither do the attitudes of many teachers. It’s not surprising that many of them view these programs just as add-ons or distractions from teaching academic content. ".Instead of training students, schools should be educating them. Education comes from the Latin words e and ducere–meaning to lead out of. Education therefore is not about creating skills and abilities in people who are blank slates waiting to be shaped and molded. Education assumes that people come ready to learn with special abilities, capacities, interests and affinities, and need guidance and support from human relationships for their unique human qualities to come out."
Based on this analysis, can we truly say that we are guiding students to learn about their health and social development based on their interests, needs and abilities, OR, are we designing instructional programs to teach specific, predetermined content to all students based on a factory style approach? (An item from the ISHN Member information service) The research supporting multi-intervention approaches and programs in school health promotion is abundant and long standing. Recent research is underlining the need for long-term, systemic planning and investments in capacity-building in areas such as coordination, work force development, inter-agency agreements, coordinated policy development and joint issue management. However, experience in the real world suggests that local health authorities (LHA) do not follow that research and instead, constantly try to implement short-term, project-style interventions based on a "training, then hoping" strategy. Four articles in Issue #6, 2013 of American Journal of Preventive Medicine examine evidence-based decision-making in LHA's and provide clues for this cognitive dissonance. One article examines the factors that affect evidence-based decision-making (EBDM) and found that "Although most people understood the concept, a relatively small number had substantial expertise and experience with its practice. Many indicated that they applied EBDM unevenly. Factors associated with use of EBDM included strong leadership; workforce capacity (number and skills); resources; funding and program mandates; political support; and access to data and program models suitable to community conditions." A second article found that "Local decision-making authority was perceived as greatly restricted by what public health activities were legally mandated and the categoric nature of funding sources, even as some leaders exercised deliberate strategic approaches. One’s workforce and board of health were also influential in making decisions regarding resource allocations. Programmatic mandates, funding restrictions, local stakeholders, and workforce capacity appear to trump factors such as research evidence and perceived community need in public health resource allocation." A third article suggested that LHA participation in a "Practice-based Research Network" will help in the implementation of research. A fourth article introduced the idea that LHA's could make use of local taxation revenue. Read More>>
(An item from the ISHN Member information service) The protocol for a cross-border study of health ministry use of evidence-based practices in chronic disease prevention is presented in the December 2013 issue of Implementation Science. The authors state "Evidence-based public health approaches to prevent chronic diseases have been identified in recent decades and have the potential for high impact. Yet, barriers to implement prevention approaches persist as a result of multiple factors including lack of organizational support, limited resources, competing emerging priorities and crises, and limited skill among the public health workforce. The purpose of this study is to learn how best to promote the adoption of evidence based public health practice related to chronic disease prevention. This study has the potential to be innovative in several ways. This study will be among the first to provide the public health field with information about the facilitators and strategies that state level practitioners use in evidence based chronic disease prevention. Measures of dissemination among practitioners working in prevention of cancer and other chronic diseases are lacking [79-82]. This study will be among the first to develop, test, and utilize such measures. This study is among the first to apply Institutional Theory with frameworks used in public health, specifically Diffusion of Innovations and a knowledge transfer and utilization framework. The study has the potential for future large scale impact as it may identify effective ways to disseminate public health knowledge needed for EBDM processes in different contexts and help shorten the time between research evidence discovery and program application delivery." To this list of innovative aspects, we add one more. This is one of the first times that the subjects of the study are officials in health ministries, identifying their concerns, rather than focusing on front-line practitioners. At the same time, it should be noted that the specific focus of the study appears to be focused on whether the ministry officials are aware of and are using knowledge about better practices. Since knowledge exchange and transfer is only one of several system capacities required to implement and maintain quality improvements (others include coordinated policy, assignment of coordinators, formal and informal mechanisms for cooperation, ongoing work force development, regular monitoring/reporting, joint strategic issue management across systems and explicit sustainability planning), the study may or may not determine or describe the real world roles of ministry officials in promoting better practices and system change. Read more>>
(An item from the ISHN Member information service) "Going beyond training and hoping" is a colourful way to describe the paradigm shift now underway in research, practice and policy-making in school health promotion and social development. The words in the titles of the articles the October 2013 Issue of implementation Science are indicative of the new concepts that must be among the new, fundamentally different way that we approach our work and careers in the future. Although these concepts are applied to non-school settings and practices, their resonance should be self-evident. They include: transfer and implementation, scale-up, spread, and sustainability, making change last, leadership in complex networks, multifaceted, multilevel continuous quality improvement programs, dynamic sustainability frameworks and Social network diagnostics. Read more>>
(An item from the ISHN Member information service) ISHN has suggested that the organizational development concept of "non-rational decision-making" should be used to understand how education, health and other systems truly operate. An article in Issue #6, 2013 of the Journal of Health Organization & Management may offer the application of a similar analytical framework. The article "explores the reasons for the sometimes seemingly irrational and dysfunctional organisational behaviour within the NHS in the UK. It seeks to provide possible answers to the persistent historical problem of intimidating and negative behaviour between staff, and the sometimes inadequate organisational responses. The aim is to develop a model to explain and increase understanding of such behaviour in the NHS. his paper is conceptual in nature based upon a systematic literature review. The concepts of organisational silence, normalised organisational corruption, and protection of image, provide some possible answers for these dysfunctional responses, as does the theory of selective moral disengagement". While the concept of "non-rational decision-making" is far less judgmental than the one discussed here, this type of analysis is necessary, rather than expecting organizations to behave logically. Read more>>
(An item from the ISHN Member information service) The school health movement has focused on transforming schools through "whole school" strategies. As proponents, we would learn much from reading Issue #2, 2013 of Improving Schools, where the concept of "schoolwide pedagogies" is discussed in a special issue. There are several articles but this quote from the concluding article is quite revealing. "The term schoolwide pedagogy was once rarely heard and yet has now become a part of most discussions around school improvement. But what does it really mean and why is the presence of a schoolwide pedagogical framework important? Some would say that in their school the adoption of an authoritative approach such as Habits of Mind, Bloom’s Taxonomies or the Productive Pedagogies is a schoolwide pedagogical framework. To some extent they are, but what is often lacking is the intellectual and social capacity that is built through collective professional sharing and articulation of strongly held beliefs about contextually relevant teaching and learning practices. Without this sense of ownership, teacher adoption ends up being sporadic at best with some teachers paying only lip service to imposed quality frameworks". If this is the case for matters at the heart of the school (ie how to teach), then what can we expect for matters such as health, which are often seen as secondary? (unless we truly understand and commit to working within schools in a sustained manner) Read more>>
(An item from the ISHN Member information service) An article in Issue #6, 2013 of the American Journal of Public Health reports on the growing use of the RE-AIM Framework, a planning/assessment tool that measures changes in the system implementing innovations.Almost all of the 45 studies reviewed used all five elements of the assessment tool, namely Reach, Effectiveness, Adoption, Implementation, and Maintenance. It is the latter two elements that offer greater insights into capacity and sustainability issues. Read more>>
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