(From the ISHN Member information service) The National Association of Chronic Disease Directors (NACDD) has just released an easy-to-read summary of a research article (Bradley & Greene, 2013) published in the May 2013 issue of the Journal of Adolescent Health. the relationship between health risk behaviors and academic achievement. This article, along with a recent Cochrane Review (Langford et al, 2014) of the effectiveness of multi-intervention approaches in school health promotion, has raised questions about what we know (and don't know) about such comprehensive approaches, their impact on on health and educational achievement and how new understandings based on ecological and systems-based thinking need to be taken into account as we move forward. This blog post provides a brief introduction to a discussion which ISHN will undertake this fall in cooperation with its International Discussion Group addressing healthy school models and frameworks.
As we noted in our ISHN members weekly report on news/research in May 2013, the connections between health status, risk/protective behaviours, health inequities and health promoting conditions and learning have been well-established by many studies and reviews. This 2013 review correlated risk behaviours such as violence, tobacco use, alcohol and other drug use, sexual behaviors contributing to unintended pregnancy and sexually transmitted diseases, inadequate physical activity and unhealthy dietary behaviors to various measures of academic achievement and found that for "all six health-risk behaviors, 96.6% of the studies reported statistically significant inverse relationships between health-risk behaviors and academic achievement.". In our view, the direct connection between health and learning is not really the issue for us to consider again today. The current question, already being discussed in several recent reviews and reports is whether multi-intervention approaches such as healthy schools affect educational achievement. The recent Cochrane Review (Langford et al, 2014) did not find sufficient evidence to support this claim but there have been several sources who suggest otherwise, at least in part, for health and social problems that have a direct impact on school attendance and participation. These sources include a review sponsored by WHO-Europe (Suhcrke $ de Paz Nieves, 2011), our ISHN analysis (McCall, 2010), a health inequities analysis (Basch, 2010), the Centers for Disease Control and Prevention (Web page summary, nd) and many others focused on specific health/social behaviours or conditions. A recent discussion paper from the intergovernmental consortium on school health in Canada (Hussain & Freeman, 2013) offers an interesting elaboration of the concept of "educational achievement" and starts a conversation about some indicators depicting some student and school outputs that can be jointly pursued by health and education systems. We need to sort out these claims and counter claims about whether and which types of multi-intervention approaches are most effective in promoting student achievement, student success, school and health, education and other system effectiveness.
The Langford et al, 2014 review has also caused some decision-makers to question the value of school health promotion in general. Coming at a time when public health systems and authorities around the world are withdrawing from long-term commitments to school health promotion as their resources are reduced from the economic downturn, this is an alarming coincidence. Advocates for comprehensive school health approaches need to point out that the 2014 review essentially echos the findings of a similar review done for WHO in 2006 (Stewart-Brown, 2006) insofar as concluding that the evidence supporting the use of multi-intervention programs is limited to specific health issues and behaviours, and that there are several other systematic reviews with findings that contradict or clarify the Langford et al review. But we also develop and argue for a new paradigm for evaluating the impact of multi-intervention approaches that is truly based on ecological and systems-based evidence. Comprehensive school health programs in which school efforts are supported by school board and other agencies as well as by several ministries of government working together take several years to develop. They require holistic understandings of health rather than measures based on the absence of disease or specific health/social behaviours. We need to be measuring realistic outputs (basic health knowledge, generic and applied life skills, mindful self-understanding and realistic behavioural plans) that can be observed as students graduate from schools. The limitations of random controlled trials that often compare specific, artificially supported programs to existing programs without much clarity or understanding of the complexity of systems needs to be challenged. We need more multi-level models and analysis and systematic reviews that use mixed method studies as their basis.
Our ISHN May 2013 weekly report also questioned the wishful thinking in the JAH article when it suggested that a "unified (health & education) system that addresses both health behavior and academic achievement would have reciprocal and synergistic effects on the health and academic achievement". In our view, establishing such a "unified system" runs counter to the reality of government structures. Instead, ISHN and other organizations have initiated an international discussion that suggests that health and other systems need to revise their approach so that health and social programs are integrated within the core mandates, constraints and concerns of education systems. ISHN, ASCD and other organizations have initiated an international discussion group that suggests that health and other systems need to revise their approach so that health and social programs are integrated within the core mandates, constraints and concerns of education systems. A global consensus statement has prompted and international dialogue in several regions of the world leading up to a forum with UN agencies in May, 2015. International school health symposiums have already been Asia and North America on the many aspects of this integration challenge.
Watch for the announcements of our discussions in webinars and web meetings on the evidence and experience in multi-intervention approaches to school health promotion and development in the fall of 2014 on the ISHN webinars and conference schedules foubnd at the Wikipedia style web site at www.schools-for-all.org .
As we noted in our ISHN members weekly report on news/research in May 2013, the connections between health status, risk/protective behaviours, health inequities and health promoting conditions and learning have been well-established by many studies and reviews. This 2013 review correlated risk behaviours such as violence, tobacco use, alcohol and other drug use, sexual behaviors contributing to unintended pregnancy and sexually transmitted diseases, inadequate physical activity and unhealthy dietary behaviors to various measures of academic achievement and found that for "all six health-risk behaviors, 96.6% of the studies reported statistically significant inverse relationships between health-risk behaviors and academic achievement.". In our view, the direct connection between health and learning is not really the issue for us to consider again today. The current question, already being discussed in several recent reviews and reports is whether multi-intervention approaches such as healthy schools affect educational achievement. The recent Cochrane Review (Langford et al, 2014) did not find sufficient evidence to support this claim but there have been several sources who suggest otherwise, at least in part, for health and social problems that have a direct impact on school attendance and participation. These sources include a review sponsored by WHO-Europe (Suhcrke $ de Paz Nieves, 2011), our ISHN analysis (McCall, 2010), a health inequities analysis (Basch, 2010), the Centers for Disease Control and Prevention (Web page summary, nd) and many others focused on specific health/social behaviours or conditions. A recent discussion paper from the intergovernmental consortium on school health in Canada (Hussain & Freeman, 2013) offers an interesting elaboration of the concept of "educational achievement" and starts a conversation about some indicators depicting some student and school outputs that can be jointly pursued by health and education systems. We need to sort out these claims and counter claims about whether and which types of multi-intervention approaches are most effective in promoting student achievement, student success, school and health, education and other system effectiveness.
The Langford et al, 2014 review has also caused some decision-makers to question the value of school health promotion in general. Coming at a time when public health systems and authorities around the world are withdrawing from long-term commitments to school health promotion as their resources are reduced from the economic downturn, this is an alarming coincidence. Advocates for comprehensive school health approaches need to point out that the 2014 review essentially echos the findings of a similar review done for WHO in 2006 (Stewart-Brown, 2006) insofar as concluding that the evidence supporting the use of multi-intervention programs is limited to specific health issues and behaviours, and that there are several other systematic reviews with findings that contradict or clarify the Langford et al review. But we also develop and argue for a new paradigm for evaluating the impact of multi-intervention approaches that is truly based on ecological and systems-based evidence. Comprehensive school health programs in which school efforts are supported by school board and other agencies as well as by several ministries of government working together take several years to develop. They require holistic understandings of health rather than measures based on the absence of disease or specific health/social behaviours. We need to be measuring realistic outputs (basic health knowledge, generic and applied life skills, mindful self-understanding and realistic behavioural plans) that can be observed as students graduate from schools. The limitations of random controlled trials that often compare specific, artificially supported programs to existing programs without much clarity or understanding of the complexity of systems needs to be challenged. We need more multi-level models and analysis and systematic reviews that use mixed method studies as their basis.
Our ISHN May 2013 weekly report also questioned the wishful thinking in the JAH article when it suggested that a "unified (health & education) system that addresses both health behavior and academic achievement would have reciprocal and synergistic effects on the health and academic achievement". In our view, establishing such a "unified system" runs counter to the reality of government structures. Instead, ISHN and other organizations have initiated an international discussion that suggests that health and other systems need to revise their approach so that health and social programs are integrated within the core mandates, constraints and concerns of education systems. ISHN, ASCD and other organizations have initiated an international discussion group that suggests that health and other systems need to revise their approach so that health and social programs are integrated within the core mandates, constraints and concerns of education systems. A global consensus statement has prompted and international dialogue in several regions of the world leading up to a forum with UN agencies in May, 2015. International school health symposiums have already been Asia and North America on the many aspects of this integration challenge.
Watch for the announcements of our discussions in webinars and web meetings on the evidence and experience in multi-intervention approaches to school health promotion and development in the fall of 2014 on the ISHN webinars and conference schedules foubnd at the Wikipedia style web site at www.schools-for-all.org .
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