Europe's Health Goals & Working with Education Systems: A Traditional Less-than-Effective Approach

(From the ISHN Member information service)  A summary of the desired partnership between the health and education sectors has published by the European office of the World Health Organization. The four-page 2014 summary on Education and Early Development is part of several documents published as part of the European health goals, Health 2020. It is a good summary and a clear statement of how schools can contribute to the health of young people. However, it also offers an opportunity to examine what we can call a traditional approach in the health sector to forming partnerships with educators. There are some good parts to the statement, including a reiteration of the links between health status and learning and a focus on the underlying causes of problems for children such as poverty and other forms of stress. The document calls for education and health to work together with other systems to form a safety net for children. There is also a clear articulation of how the health system can contribute to school health promotion in a side-bar of the brief summary, where it suggests that the health systems should:

• provide robust pre-natal and child health services that support the development of language and social skills among pre-school children
• provide early referral to parenting support for children who are struggling 
• work to ensure that public health care is accessible and available to all school-age children
• work with schools to provide high quality health and counselling services
• work to ensure that children have access to decent living conditions such as high quality, safe and adequately sized housing that allows them to stay well and perform at school   
  

These five points about the responsibility of the health sector to provide health services to children, and to work with schools in doing so, is an improvement on many recent statements and models of school health promotion that have avoided using any specific reference to the s-word (services provided by government funded agencies and professionals) and replace that word with vague references to "community partnerships". However, it is in the main text of the WHO summary that we find the traditional health approach to partnerships with the health sector; one that essentially enumerates the things that the educators and schools need to do for the sake of children and the partnership. While these duties are not necessarily unreasonable, the current global discussion of the challenges and new approaches to integrating health and social programs/approaches within the core mandates, constraints and concerns of school systems (See the International Discussion Group and Consensus Statement) would suggest that the European health goals team might have started by describing what the health sector can do to contribute to the partnership. These contributions can include:

• an ongoing commitment and investment in school nurses 
• funding and training public health staff to facilitate and coordinate the multiple interventions needed within comprehensive approaches to school health
• creating infrastructure within the health systems to manage and coordinate the various demands/requests being made of schools on a wide variety of health issues so that they do not compete and overlap with each other
• working with other sectors such as welfare on community schools, justice on safe schools, environment on eco-schools, etc 
• returning to a "health" approach by investing in structures, funding and staffing in health promotion rather than continuing the retreat to an "absence of disease" strategy even if some of the prevention/diseases oriented approach is bundled into non-communicable diseases, infectious diseases etc

The opening paragraphs of the WHO Europe summary are an illustration of this "health in all policies" approach (ie where health asks education to shoulder part of the burden for health without committing anything in return). The opening paragraph includes these requests for educators:
"Together with the home and lamily environment, the educational environment - from nursery through tertiary education-is vital for children.By work ing together, the health and education sectors can create synergy between the two and
create environments that enab e children lo perform to their greatest  potential, allowing them to grow into healthier adults. Everyone involved in educating children, from teacher trainers,principals, •eachers and eaching assistantslo ministers,mayors andlocalgovernment officials, has important health roles that can allow children lo grow into adults that enjoy a higher sense of health and well-being and societylo better fulfilits potential.
The education sector can help create healthier people and commvniies by:
• ensuring access to education for all,because education levelis a key determinant of health;
• training its prof essionalslo understand the health dimension of their work,because teachers can help create the foundations that buid healthy and resilient populations;
• enhancing health literacy, because people's capacity to access,vnderstand and vse informationlo improve their health and well-being is a key determinant of health; and
• working with the health sector as another employer of women,to ensure that both sectors remain high on the agenda of national governments and address gender inequities in participation in the labour market."

Throughout the document, we find several specific tasks for educators, including:
"Schools provide a crucial setting in which to improve the health and well-being of children and young people. Health-promoting school programmes, for example, locus  on  a  whole-school  approach such as actively  involving  whole  school
communities 'in identifying ways to make school environments more health promoting.
This can build resilience and benefits by:
• facilitating a participatory and action-oriented approach to  health education, taking into account the students' own concepts of health and well-being;
• developing community-wide endorsement for health-promoting school policies;
•developing the physical and social environment of the school,such as by enabling more physical activity;
• developing life competencies;
• making effective links with home and the community; and
• making effective use of health services in and around the school setting."
The current priority concerns of the health systems in Europe (social determinants, women, non-communicable diseases) as the usual longer list of specific issues (school food policies, sugar in foods, physical activity, mental health, STD's, violence, health literacy), /are also strongly embedded in the summary. While part of the side-bar in the document identifies some concerns which educators will likely already see as priorities (ensuring that all children have basic (reading) skills, conducting primary education in small groups with skilled teachers, preventing school-dropouts, etc, there is not recognition of how the health sector might contribute to the primary concerns of school systems. For example, how the health systems work closely with other services to provide "wrap-around" or Integrated services for children who may dropout. Or, how the health sector can focus in the sub-populations of youth most likely to drop-out such as pregnant teens, LGBT youth, male students who are now dropping out and discontinuing their education far more than females, children with poor dental health, students in alternative schools or in vocational training programs etc. The WHO summary also does not identify or address some of the current concerns that are dominating school systems around the world these days. These include a huge debate on the purposes of education (whole child vs technical, scientific and entrepreneurial skills), increased pressures on teachers to be more accountable as they take on counselling and other roles previously provided by parents, extended families and religious institutions for children who are increasingly detached and vulnerable.   
The concluding paragraph in the WHO-Europe statement is also a clear indication of the tradition health sector approach to partnership. "Health 2020 sees the education sector as a co-producer of health;a setting in which healthy behaviour is learned and promoted; on employer of o key workforce for children•s health and well-being;a trainer of professionals who play a vital role in the health and well-being of the future society; and a partner in striving for investment in sectors that contribute lo developing social capitol and gender equity.  It truly reflects a traditional and less than successful approach to truly engaging and supporting the school system. A better and more sustainable partnership request might better begin with an articulation of the health systems's role in school health promotion. This could include a strong commitment to coordination, school nursing, school-based or school-linked health services, training of public health staff in unfamiliar school/community development roles, negotiating with other sectors seeking to access schools, creating school health teams and funding streams at the national/state and local health authority levels (instead of by diseases/behaviours) and more