Scientific and popular health knowledge in the education work of community health agents in Rio de Janeiro shantytowns

Health education for socially marginalized populations challenges the efficacy of existing strategies and methods, and the pertinence of the educational and philosophical principles that underpin them. The Brazilian Community Health Agents Initiative (CHAI) hires residents of deprived marginalized communities to undertake health promotion and education in their communities. The ultimate goal of the CHAI is to connect populations with the public healthcare system by promoting social re-affiliation, protecting civil rights and enhancing equity of access to health services. In this article, we present the education work of community health agents through interplay between popular and scientific health knowledge in nine Rio de Janeiro shantytowns. A critical ethnographic research design, using thematic analysis, allowed us to explore agents' education work to enhance family health literacy in shantytowns. Local culture and social practices inspire Agents to create original strategies to reconcile forms of health knowledge in their work.     

Health promoting schools in England--a way forward in development.

Schools are identified as a key setting for health promotion in the UK Government's consultation report on the public health strategy for England. The concept of the 'healthy' or 'health promoting school' provides the basis for a broad settings approach to health promotion in schools. The approach extends beyond the formal health education curriculum to include a consideration of the physical and social environment of schools and their links and partnerships with parents and the wider community, in pursuit of better health. There is growing evidence that the health promoting school approach is effective in influencing outcomes related to health and education. Initiatives in the form of projects and schemes are commonly used by Health Promotion Specialist services and health partnerships, to stimulate and support the adoption of the approach by schools. A national healthy school scheme is to be launched alongside these local initiatives in 1999. The paper reviews research and practice in this area and makes recommendations to inform the future development of schools as health promoting organizations.     

Overview and summary: School Health Policies and Programs Study 2006

BACKGROUND: The School Health Policies and Programs Study (SHPPS) 2006 is the largest, most comprehensive assessment of school health programs in the United States ever conducted. METHODS: The Centers for Disease Control and Prevention conducts SHPPS every 6 years. In 2006, computer-assisted telephone interviews or self-administered mail questionnaires were completed by state education agency personnel in all 50 states plus the District of Columbia and among a nationally representative sample of districts (n=538). Computer-assisted personal interviews were conducted with personnel in a nationally representative sample of elementary, middle, and high schools (n=1103) and with a nationally representative sample of teachers of classes covering required health instruction in elementary schools and required health education courses in middle and high schools (n=912) and teachers of required physical education classes and courses (n=1194). RESULTS: SHPPS 2006 describes key school health policies and programs across all 8 school health program components: health education, physical education and activity, health services, mental health and social services, nutrition services, healthy and safe school environment, faculty and staff health promotion, and family and community involvement. SHPPS 2006 also provides data to monitor 6 Healthy People 2010 objectives. CONCLUSIONS: SHPPS 2006 is a new and important resource for school and public health practitioners, scientists, advocates, policymakers, and all those who care about the health and safety of youth and their ability to succeed academically and socially.     

Time for action: key considerations for implementing social accountability in the education of health professionals

Within health professional education around the world, there exists a growing awareness of the professional duty to be socially responsible, being attentive to the needs of all members of communities, regions, and nations, especially those who disproportionately suffer from the adverse influence of social determinants. However, much work still remains to progress beyond such good intentions. Moving from contemplation to action means embracing social accountability as a key guiding principle for change. Social accountability means that health institutions attend to improving the performance of individual practitioners and health systems by directing educational and practice interventions to promote the health of all the public and assessing the systemic effects of these interventions. In this Reflection, the authors (1) review the reasons why health professional schools and their governing bodies should codify, in both curricular and accreditation standards, norms of excellence in social accountability, (2) present four considerations crucial to successfully implementing this codification, and (3) discuss the challenges such changes might entail. The authors conclude by noting that in adopting socially accountable criteria, schools will need to expand their philosophical scope to recognize social accountability as a vitally important part of their institutional professional identity.     

How can we increase children’s understanding of the social determinants of health? Why charitable drives in schools reinforce individualism,responsibilisation and inequity

This paper examines the ways in which neoliberal responses to social health issues shape the educational discourses and practices of schools. As schools are increasingly identified as ideal spaces for health promotion, the question of how and why educators and public health practitioners can and should work together continues to be debated. Using Bourdieu’s theory of reproduction, we use this indicative example of emergency food to examine how ‘charity alone’ models reproduce and perpetuate inequitable health outcomes in neoliberal societies. This individualistic view of health continues to work against public health and social justice education initiatives increasingly found in schools, curricula and wider society; creating a dissonance between rhetoric and reality. Revolutionary critical pedagogies are explored to examine the implications of these practices in schools, and how the framework of service learning may offer an approach for involving primary students in empathy, caring and social justice. We seek to extend the existing literature by exploring ways of shifting, rather than reproducing, the current practices of educators and public health practitioners in how children experience health inequality and the social determinants of health.     

Praxis der Gesundheitsförderung an Schulen in Ostwürttemberg

Background

The current situation regarding school-based health promotion programs was assessed for different types of public and private schools in the East Württemberg region of Germany.

Methods

Two hundred and fifteen schools were asked to report their present and planned school-based health promotion activities. Data were collected by an online search and a questionnaire survey.

Results

Fifty percent (n=108) of all schools responded. Present and planned health promotion activities were reported for the areas of nutrition, physical activity, and coping skills (violence, addiction, stress). The survey showed schools to be responsible for conceptualizing and implementing half of all reported projects. Although satisfaction with the health promotion activities was high, only one-third of all projects has been evaluated on at least a basic level.

Conclusions

To better embed health promotion in everyday school life, health promotion should be integrated into the schools’ curricula. To assess the efficacy and acceptance of health-promoting activities, evaluating the programs is essential. Enhanced networking between schools and external partners of health promotion could lead to more health-promoting activities and might improve the availability of resources.     

Educación para la salud en la escuela primaria: opinión del profesorado de la ciudad de Alicante

ObjectiveThis study explores the opinions of primary school teachers about health activities carried out in schools in Alicante city (Spain).MethodsAn exploratory study was conducted through qualitative content analysis. Three focus groups were conducted with 25 primary school teachers (14 women and 11 men) working in 14 public and 7 private schools in the city of Alicante. Participants were asked about the health activities carried on in their schools.ResultsTeachers distinguished between health education activities promoted by the school and those included in external programmes promoted by public and private institutions. External programmes were considered as impositions, lacking continuity and chosen according to passing fads. Although teachers demonstrated a more positive attitude towards activities arising from their own initiative, they identified health education as a secondary task. Teachers considered that improving their own health education training and promoting the involvement of parents, health professionals and public institutions were the most appropriate ways to promote health education in the school.ConclusionTeachers showed a more positive opinion and greater commitment towards health activities that complement and facilitate their teaching tasks. Their didactic programme and opinion should be taken into account to maximise the efficiency of the health promotion and education activities promoted by external organisations.     

Social Marketing: Principles and Practice

This book provides a comprehensive review of the key principlesof social marketing, and critically appraises their applicationto health education and health promotion. The authors seek tomove beyond the (original) definition of social marketing as‘...an application of marketing principles and tools tothe achievement of socially desirable ends’ and, consequently,they adopt a broader approach which has particular relevanceto health promotion. For example, in addition to emphasizingthe distinction between social and commercial marketing, thebook also elaborates on the nature of the particular sociallydesirable goals that should be espoused by health promotion—assertingthat these should be firmly rooted in the ideology of the UnitedNations Charter on Human Rights. In short, the authors not onlyreject a narrow victim-blaming approach     

Preparing public health leaders for the 1990s.

Public health leadership is urgently needed throughout the world. In most local, provincial, and national jurisdictions, such responsibility has been assumed by doctors of clinical medicine, who know much about treatment of disease in individual patients but very little about prevention of disease and promotion of health in populations or the management of health systems. Effective leadership in public health requires a new profession, with generalized education in the basic tools of social analysis, health and disease in populations, promotion of health and prevention of disease, and health care systems and their management. More than 40 distinct scientific subjects have been developed in these fields over the years, and current faculties are qualified to teach them. To provide this education would require about 5 years of academic and field studies, after a bachelor''s degree. Schools of public health now train doctoral-level specialists who are prepared in the PhD tradition for academic posts. These schools should also develop educational programs for doctoral-level generalists who are qualified to provide community health leadership at local, provincial, and national levels.     

Schools, health literacy and public health: possibilities and challenges

Health literacy is a concept that can be widely embraced by schools. Schools throughout the world contribute to the achievement of public health goals in conjunction with their educational commitments. In this paper, the interface between a school's core business of education and public health goals is identified, and examples provided in the area of nutrition demonstrating how these links can operate at school level. The structure and function of the health promoting school is described and the author proposes that there is a very close connection between the health promoting school and the enabling factors necessary in achieving health literacy. Major findings in the literature that provide evidence of good practices in school health education and promotion initiatives are described. Also, those factors that make schools effective and which facilitate learning for students are identified. There is a substantial overlap between the successful components of a health promoting school and effective schools. This enables schools to potentially achieve all three levels of health literacy, including level 3-critical health literacy. However, there are three challenges that must be addressed to enable schools to achieve this level: the traditional structure and function of schools, teachers practices and skills, and time and resources. Strategies are proposed to address all three areas and to reduce the impediments to achieving the goals of health literacy and public health using the school as a setting.     

Child and adolescent workers: a commitment for collective health

This paper presents some issues pertaining to child and adolescent labor and their impact on health, pointing out the main structural characteristics which are responsible for and socially justify the early incorporation of this segment into the labor market. In Brazil, legislation governing adolescent labor is frequently ignored, showing the need to implement health surveillance programs involving both public institutions and civil rights movements.     

Perception of physical education classes among young adolescents: do physical education classes provide equal opportunities to all students?

From a public health perspective, physical activity in children and adolescents is seen as important for disease prevention and health promotion. Physical activity patterns are learned through socialization processes where one of the influential sources is the school through physical education classes. The purpose of the present study was (1) to examine young adolescents' general perception of physical education classes, and (2) to explore the relationship between these perceptions and students' social resources, gender and level of leisure time physical activity and self-evaluated competence in physical education. A total of 895 seventh graders (13 year olds) were surveyed in Norway concerning their perception of physical education classes. Indicators of social resources were chosen from the arenas of family, friends and school. The main finding was that a majority of students liked physical education classes. Physical education classes seemed, however, not to offer the less socially resourceful minority the same opportunities for positive experience with physical activity as the resourceful majority. Boys' general perception of physical education classes seemed to be more positive than girls' and physically active students perceived physical education classes more favorably than less physically active students.     

A comprehensive "Healthy Schools Programme" to promote school health: the Hong Kong experience in joining the efforts of health and education sectors

Both health and education are linked to economic performance. The success of education depends on good health, and vice versa. Modern education should help young people to determine values, and accept responsibility for their health and social behaviour. The success of health promotion in schools requires the joint efforts of both the health and education sectors. A comprehensive programme is needed to include teachers' training, curriculum development, community participation, changing policies and practices, and research. All these components are needed to build up a successful model of a health promoting school. The "Healthy Schools Programme" in Hong Kong gives a good example of close partnership between the health and education sectors, and moves towards a multidisciplinary approach and active learning towards health promotion.     

Child for child in Zaire: school children in the service of health

In Gecamines, Zaire, a coordination unit examines ways to introduce medical education in 90 business schools in order to promote and protect health with and through children and in favor of the community. Its activities include analyses of the causes of failure to implement medical education in the past; proposing solutions and strategies allowing the unit to succeed at proposed activities; initiating a training program for physicians, teachers, social workers, and all persons promoting the program; introducing the child-to-child pedagogy at schools and for health education for children; informing teachers about screening methods for certain abnormalities and early detection of illnesses; and helping teachers control the vaccination status of children and participate in increasing vaccination coverage. School-based activities are personal hygiene; general cleanliness of class rooms, halls, and rest rooms; screening for illnesses, especially sight, hearing, and walking anomalies; children-organized health education conferences; and transmission of health education messages via drama, songs, conferences, and drawings. Out-of-school activities include relay of new health information to families and the community through children and surveillance of schools to prevent window thefts (source of air currents leading to upper and lower respiratory infections). The oldest children care for the health of other children, especially those who live near them; inform their parents about community health resources; serve as health volunteers (e.g., growth monitoring); and actively help control and evaluate the progress of health activities in their neighborhoods. After one year of primary health care coordination activities, the results are encouraging. Children play a substantial role favoring the promotion and protection of health. They can give life to prevention activities and even care for the youngest children. They can be excellent health volunteers in their community. They influence adults and other children.     

An attempt to prevent lifestyle-related diseases of schoolchildren in collaboration with parents, schools and communities

PURPOSE: The authors focused on preventing lifestyle-related diseases among schoolchildren on the basis of health surveys with blood examinations and questionnaires on lifestyle in collaboration with parents, YOGO teachers, and public health nurses. The present study purposed to evaluate this approach using the PRECEDE-PROCEED Model. METHOD: The authors inquired of schoolchildren's parents their awareness of their children's health through health surveys of their children. Additionally, changes in the role of YOGO teachers and public health nurses before and after our attempt were assessed. The significance and problems with our approach were then evaluated based on the PRECEDE-PROCEED Model. RESULTS: Based on the PRECEDE-PROCEED Model, it was clarified that, for prevention of lifestyle-related diseases among schoolchildren, health surveys with blood examinations and questionnaires on lifestyle increased parents' interest in their children's health. On the basis of the results of health examinations, the role of YOGO teachers changed from leading figure for general health education to supporters of health promotion for individuals, with provision of health education classes in schools for this purpose. The role of public health nurses also changed from providing health education at the request of schools to supporting families to improve their lifestyle, including that of their children. CONCLUSIONS: In collaboration with children's parents, YOGO teachers and public health nurses, the present approach to prevent lifestyle-related diseases of schoolchildren on the basis of health surveys has advantages for increasing interest in schoolchildren's health, and should be useful for health promotion.     

Social science and medical education in Nigeria

In response to Nigeria's 'old' and seemingly intractable health problems and the emergence of a 'new' epidemiology of behaviour-related and social disorders, there is an urgent need for greater participation of social scientists in the training of front-line health care practitioners and delivery of care. This study was conducted to determine the current extent of involvement of the social sciences in Nigerian medical education. A survey was carried out in all schools/colleges of medicine in the country. Nineteen social scientists, comprising 1 anthropologist, 10 psychologists and 8 sociologists, were identified in 10 of the 12 schools. Questionnaires were sent to all of them and 12 were returned. Analyses of the data collected showed that most psychologists were affiliated with departments of psychiatry and sociologists with community health/social medicine. Psychologists spent most of their time in teaching, clinical work and research (in that order); and sociologists in teaching, research and health care delivery. Most of the social scientists perceived their work as essential in the training of medical doctors and thought that the medical school provided a good opportunity for research. But a significant number of them complained of status inequality with their medically-trained colleagues. This was regarded as one of several obstacles to greater participation of social scientists in Nigerian health care. It was suggested that while social scientists were essential in the training of health care personnel, they needed to diversify their inputs (emphasizing health promotion and disease prevention) in accordance with a broadened and socially relevant view of health and illness.     

Aufgaben des ÖGD im Rahmen der Kinder- und Jugendgesundheit

Children and adolescents increasingly show health-related problems which may not be considered as diseases to be treated but nevertheless severely affect academic performance and social behaviour. Regarding the consequences, e.g. from the PISA study, the significance of health problems and their negative impact on academic success are still not sufficiently taken into account. The tasks of paediatric public health services include: (1) health promotion in schools and kindergartens, (2) preventive and other medical checkups in kindergartens and schools to detect the individual needs of children and adolescents for support, (3) reducing the risk of long-term damage in handicapped or retarded children and adolescents by seeking out these children where necessary, and (4) advising the political decision makers by reporting on the population's health and social situation. The main aim is to provide children with special needs with what they need in order to prevent them, especially those whose parents cannot ensure this support themselves, developing a deeper disturbance, or to make sure that these young people are able to participate in social life and to integrate into society in spite of health problems or handicaps. To achieve these goals and to improve the health of children and adolescents, a community-based paediatric public health service has to cooperate with other institutions such as youth authorities, social welfare, education authorities, schools and other local institutions with an input into the health of children and adolescents.     

Smoking in pregnancy: smokescreen or risk factor? Towards a materialist analysis

This paper considers the topic of women's smoking in pregnancy within the general context of the current health promotion concern about smoking as a public health issue. Drawing on data from an ongoing research project which is investigating the interrelationships between‘risk’, social support and reproductive health, the paper argues that smoking in pregnancy constitutes an area of women's behaviour which is linked in systematic ways with aspects of their material and social position. Consequently, conventional individualist models of smoking behaviour both fail to explain why pregnant women smoke and are unable adequately to account for the health consequences of this behaviour. The reason for singling out smoking in this analysis inheres not in any detrimental health effect directly attributable to it, but rather to the way in which pregnancy smoking has been socially constructed as a reprehensible feature of women's life-styles.     

Advertising health: the case for counter-ads.

Public service advertisements have been used by many in hopes of "selling" good health behaviors. But selling good behavior--even if it could be done more effectively--is not the best goal for using mass media to prevent health problems. Personal behavior is only part of what determines health status. Social conditions and the physical environment are important determinants of health that are usually ignored by health promotion advertising. Public service advertising may be doing more harm than good if it is diverting attention from more effective socially based health promotion strategies. Counter-ads are one communications strategy that could be used to promote a broader responsibility for rectifying health problems. In the tradition of advocacy advertising directly promoting policy rather than products, counter-ads promote views consistent with a public health perspective. Counter-ads set the agenda for health issues, conferring status on policy-oriented strategies for addressing health problems. The primary purpose of counter-ads is to challenge the dominant view that public health problems reflect personal health habits. They are controversial because they place health issues in a social and political context. Advertising strategies for health promotion range over a spectrum from individually oriented public service advertising to socially oriented counter-advertising. The recent anti-tobacco campaign from the California Department of Health Services represents advertisements across the spectrum. Counter-ads that focus on a politically controversial definition for health problems are an appropriate and necessary alternative to public service advertising.