The principal health education writer of the Draft Health and Physical Education Curriculum shares the theoretical background that underpins the document, and explains the process involved in developing a new curriculum.
TOTAL WELLBEING:
Health education for the new millennium
GILLIAN TASKER Christchurch College of Education
This article is an edited version of For whose benefit? The politics of developing a health education curriculum, in the 1996/97 double issue of Delta: Policy and Practice in Education, 48 (2), 49(1), pages 187–201.
Introduction
The implementation of health education programmes in schools has passed through a number of developmental stages in New Zealand. As in other Western countries, the pattern of change is a reflection of a wider range of contemporary influences which have impacted on developments in health education. These include: prevailing paradigms of the structure and function of schooling; current political and community values and expectations for health outcomes in relation to the curriculum; societal perceptions of the meaning of health; current theories of teaching and learning; contemporary socioeconomic and political issues; and, of course, contemporary theorising on the effectiveness and practice of school health education programmes.
Directions for a new health education curriculum
In the last 25 years there has been a significant shift in the dominant concept of health, from a notable “absence of disease” to a more holistic concept of “wellness”. How society views health is, of course, central to the processes and practices of health education. The dominant approaches to health education employed through the 1970s and early 1980s were based on a medicalised disease-prevention view, often delivered to students by health professionals devoid of teaching skills and any personal knowledge of their pupils.
In New Zealand, the 1985 revision of the New Zealand Health Education Syllabus 2 was a major step forward for health education as it partly reflected a more expansive, multidimensional approach to health teaching. For example, it maintained that:
Health is a state of well-being, and in the context of this syllabus it encompasses physical, mental, and social health.
Another innovation of the 1985 syllabus was that it promoted a needs-based approach to health education, and incorporated concepts of home and community involvement.
The syllabus described the learning outcomes or behaviours which were considered to be achievable by all members of the community. There was little overt acknowledgment of the complex interplay of economic, socio-political, cultural, and environmental factors which impact on an individual’s health status, nor was there any substantive recognition of the bicultural nature of New Zealand.
Individualistic approaches to health and health education, described as healthism by Crawford (1980), identify the individual as the major determinant of personal health. Such approaches target behaviour and life-style changes as key ways of improving personal and, ultimately, societal health status.
While the focus on individual responsibility and behaviourial outcomes is an important epidemiological strategy, it ignores environmental factors and deflects attention away from the structural/social dynamics which affect health status (for example, class, gender, and ethnic locations, and the role of other social processes and institutions such as the state). A curriculum which emphasises individualism and healthism fits well with the philosophy and practice of a market driven society where the primacy of the individual, as an isolated social and economic unit making choices in the market place, is now one of the main discursive features of our social and educational landscape. Such a model sits well with the changing concept of education that this embodies; one which (according to Tones, 1996) emphasises the acquisition of skills deemed necessary “in order to enhance the economic prospects of a particular nation”. Not surprisingly, a wide range of research has demonstrated that health improvements which focus primarily on health behaviours only work for those in the upper and middle class populations (see notes). As Naidoo (1986), Combes (1989), and Colquhoun (1990) have argued, such programmes have disadvantaged half of the children in Australian schools through their failure to address health issues in relation to their causal antecedents, those based in the socio-environmental contexts in which those children live and develop.
A major global shift forward in developing effective models for (school) health education came in 1986 with the development of the World Health Organisation’s (WHO) Ottawa Charter. This recognised that major health gains were linked not so much to advances in medical knowledge but, rather, to increases in wages and living standards coupled with improvements in public health services and health oriented legislative requirements. One consequence of this WHO initiative has been a movement involving 39 countries in a European network with the addition of many Pacific Rim and other countries which has translated these principles into the concept of the health-promoting school. This model, as described by Green et al. (1996), identifies three complementary and interlinked contexts for effective health education in a school setting. These are: the taught health education classroom programmes; the school environment and milieu; and links with and support from the family and community. Supportive school health policies and environments are seen as essential in establishing and maintaining congruence between these three contexts.
Recent health-focused curriculum models such as Jewitt’s (1994) “ecological integrative perspective” and Lawson’s (1992) “socio-ecological conception” of health also advocate these kinds of interlinked requirements. They place emphasis on the importance of addressing the personal, interpersonal, and societal aspects of health and on recognising the complex inter-connections between individuals and the environment.
Whilst it is essential to address the concerns of the individual (recognising that all students are unique individuals engaged in a search for personal meaning in a constantly changing world), a shift away from individualism still allows the acknowledgement of the individual within their wider social context. The behaviourial, biological, cultural, economic, environmental, and social factors which interact to enhance, or detract from personal wellbeing must be taken into account and in essence must be treated as having or contributing to real health effects. A socio-ecological perspective thus requires balance and integration between individual and societal considerations. It encourages self reflection, critical thinking, and critical action. It is designed to remove barriers to total or holistic wellbeing through the empowerment of individuals and communities to create societal conditions conducive to health for all.
Developing a new health education curriculum
In May 1995, the Christchurch College of Education won the Ministry of Education’s contract to develop a Draft Health and Physical Education Curriculum Statement. I was the principal health education writer, and Ian Culpan was the principal physical education writer.
The first phase of development occurred within the Ministry of Education in 1994, with a commissioned literature review which described and critiqued current research findings in the teaching and learning of health and physical education both in New Zealand and overseas. In addition, submissions were called for from interested educators, health sector workers, and community groups as to the structure, content, and key issues to be addressed in a new curriculum document
The then Minister of Education (Dr Lockwood Smith) established a policy advisory group (PAG) comprised of people considered to have expertise in the fields of health education and physical education. The people selected were from both the health and education sectors. The PAG was chaired by Dr Diana Twigden from the Health Research Council of New Zealand. A representative from the Policy, Learning and Assessment section of the Ministry of Education was present at all meetings.
The initial role of the PAG was to produce the specifications, entitled Policy Specifications for a National Curriculum Statement in Health and Physical Education, which became a public policy document in 1995 after the contract for the development of the draft curriculum had been let to the Christchurch College of Education. Once the contract had been let, the role of the PAG was to examine the emerging document submitted by the contractors in each milestone report to ensure that this met the policy specifications.
As has been the pattern with all recent curriculum developments, phase two of the development process required the principal writers to establish a team of writers and a consultative network of experts in the field. The team comprised fifteen writers with a balanced representation of health and physical education expertise drawn nationally from primary, secondary, and tertiary backgrounds. Of these, one member of the writing team had expertise in home economics and two writers were Maori. Within their own region, each writer established a reference group of six to eight teachers considered to be experts in teaching and learning in this curriculum area. As principal writers, the consultative networks established by Ian Culpan and myself drew from a wide range of experts and groups. Over 150 groups and individuals were involved in the consultative process.
During the ten months the contract operated, there were five rounds of consultation, each round involving writing, refining draft material, consultation with networks and reference groups, evaluation, feedback, and critiques. The final outcome of the extensive process, the Draft Health and Physical Education Curriculum Statement, was presented to the Ministry of Education in late February 1996. It was also sent to all those who had been part of the consultation process. The writers were informed that the PAG had unanimously accepted the material and had recommended to the then Minister of Education (Mr Wyatt Creech) that it be released to schools in the form of a draft document.
Theoretical considerations
As principal writers, Ian Culpan and myself believe a health and physical education curriculum should be designed to improve the social and learning environments of our schools, and to enhance the health prospects of all students in a changing and challenging twenty-first century. We believe such a curriculum needs to address the antecedents of health issues and problems which have their locations in socio-cultural, historic, or economic factors as opposed to individualised actions, contexts, or situations. We also believe that such a curriculum needs to incorporate the three key concepts of total wellbeing (hauora); health promotion; and the socio-ecological perspective discussed previously in this paper and which was embodied in the PAG’s policy specifications.
These concepts fit well with recent trends to construct curricula informed by the tenets of post-modern curriculum theory. Doll (1989) argues that such concepts and pedagogy are designed to address an ever-changing environment, rather than focus on the acquisition of a fixed body of knowledge (as in the past) which is regarded as unchanging, static, and unresponsive to change.
A post-modern health education curriculum would enable a school community to participate in an ever-changing society for the improved health and welfare of all its members, not just its children. Such a curriculum would need to adopt a critical analytical approach. It would be emancipatory, in that it would engage us as learners and teachers in a pedagogy through which we come to understand the social processes and relationships that dominate our practices and structures (for example, the way we teach and learn health education).
A curriculum based on this model aims to enable learners to participate in a broad range of learning experiences that can empower them to develop the knowledge, skills, and attitudes needed to enhance personal identity and health status. It encourages them to critically interpret their own and others’ health experiences; to think about these in real terms that analyse the social structures they are enmeshed in; and to consider the contradictions and tensions underlying all health issues in our society. It was encouraging to the writers to note that this critical approach was endorsed in the PAG’s Policy Specifications for the Health and Physical Education National Curriculum Statement. Accordingly these state that:
This essential learning area encompasses integrated learning processes which inform, extend and critique practices that promote the health, development and wellbeing of individuals and groups who live in a changing world.
A post-modern health education curriculum thus aims to produce young adults who are able to participate responsibly, reflectively, and actively in their communities in order to create healthy environments. Of course the well-known example of such an approach is in the Freirian concept of empowerment, involving social action by children and students around issues of community and societal concern. This approach has been actively embraced in some Australian state curriculum documents. For example, the Victorian Ministry of Education’s Personal Development Frameworks states that:
Health education must foster the capacity for young people to develop a socially critical perspective about health issues…. Students should also be given the opportunity to evaluate social conditions which might lead to health problems in our community. They may develop strategies to deal with these from a personal perspective, and where practicable, such studies should lead to action projects.
The four aims of the health and physical education curriculum determined by the PAG led directly to an inter-related four-strand structure enabling the theoretical assumptions discussed above to be incorporated into the learning outcomes which were subsequently developed. The four aims set out in the PAG’s policy specifications are to enable students to:
promote understanding, skills, and attitudes for personal health and physical development;
develop motor skills and kinesthetic awareness through movement, acquire knowledge and understanding about movement, and develop positive attitudes to physical education and physical activity;
develop understanding, skills, and attitudes to enhance interactions and relationships with others; and to
participate in creating healthy communities and environments by taking responsible and critical action.
Learning and teaching in health education
Current pedagogy in health education is strongly influenced by a constructivist approach to learning (see notes). This approach empowers the learner in the control of his/her learning process and is in harmony with the needs-based approach underpinning our 1985 Health Education Syllabus; the tenets of a post-modern curriculum; and the learning approaches promoted in the new curriculum statements of mathematics and science. To be consistent with this kind of approach, there must be flexibility in the learning activities and contexts to ensure relevancy for the learners as well as responsiveness to cultural and individual difference. Again, this perspective is supported by the PAG’s policy specifications which state:
The achievement objectives and learning activities should not be seen as providing a rigid structure. Rather it should be recognised that students will approach learning with different levels of achievement, individual needs, and different learning styles.
The new health education curriculum will make a particular contribution to the development of the essential skills identified in the New Zealand Curriculum Framework. These include communication skills, problem-solving skills, self-management and competitive skills, and social and co-operative skills. Similarly, the new health education curriculum reflecting current health education practice, promotes effective interpersonal communication, decision making, problem solving, mediation, and conflict resolution.
Issues for implementation
A key issue that bedevils those implementing health education programmes in schools is that of curriculum delivery. Health education is a relatively recent arrival in the compulsory core curriculum in schools. The 1985 health syllabus was made mandatory in 1990 for students from new entrants (year 1) to form 4 (year 10). Colleges of Education have only included it in their training programmes in the last 5–10 years. Consequently, there is a shortage of effectively trained teachers in schools in this curriculum area. When school health co-ordinators are surveyed to identify their needs, the lack of trained staff is always high on their list. Furthermore, earlier perceptions of health education as primarily a body of knowledge, largely medical in nature, and unfamiliar to teachers because of its omission from their formal training, have ensured that schools have traditionally viewed health education as set apart from the “other” areas of the curriculum. There has also been a lack of a shared academic tradition amongst health teachers. As a consequence, many teachers have not seen health education as a legitimate component of the curriculum and have little sense of content issues, responsibility for it or ownership of it.
This lack of teacher ownership and responsibility is exacerbated by the multitude of outside agencies and individuals offering shortterm, single-focus packages for covering particular aspects of the health education curriculum (for example, drug education, conflict management education, parenting skills, and sexuality education). Whilst some of these agencies are genuinely seeking to meet student needs, others are responding to the increasingly competitive economic environment and operating primarily to take advantage of the educational market-place. By virtue of its nature, health education addresses uniquely personal and sensitive issues, the responses to which can often vary according to cultural background. This requires teaching programmes and strategies underpinned by sound pedagogical foundations. Single-focus packages do not always have these. In addition to the commercial motive, some organisations with political and moral agendas seek to influence the population through the school curriculum. Examples of these are the vocal and radical conservative Christian communities who oppose current curriculum content and pedagogical practices in sexuality education, and the plethora of groups offering drug education from widely disparate philosophical and theoretical positions.
For schools grappling with education marketisation, the realities of school site management, lack of adequately trained staff, constant administrative reform, pressures to compete for students, and the necessity to avoid public controversy of any kind, expediency often takes precedence over learner needs. The Education Review Office’s New Zealand School Sector Report to Parliament (1993) stated that only 50 percent of the 213 schools surveyed were providing a health education curriculum in accordance with the health syllabus. Three years later, their Reproductive and Sexual Health Education which reviewed the implementation of sexuality education in schools, revealed a similar pattern.
The practice of outside organisations coming into schools and delivering single-focus lessons or courses militates against schools seeking appropriately trained and qualified health education teachers to deliver this area of the school curriculum. It not only takes the responsibility for delivering health education away from the school but also works against the development of the broadly based health-focused curriculum models which are necessary for ongoing and comprehensive health education programmes. To be effective, links must be made across health topics. Skills developed in one context should be reinforced in others in a co-ordinated way within the wider health education programme and across other curriculum areas as well. In addition, many areas may need to be revisited and followed up within the overall programme, and ongoing support with health issues must be provided for students by teachers they trust and who understand their particular needs and concerns.
There is a further underlying issue here related to the professionalism of teachers. Health education, like all other curriculum areas, should be taught by trained teachers. All primary teachers need to be specifically trained in this area, and all secondary schools need teachers for whom health is an area of curriculum specialisation. Currently, all tertiary teacher education institutions provide compulsory health education curriculum development for their primary sector trainees. They also provide courses for their secondary trainees who wish to teach health, and inservice opportunities for practising teachers in health education. Expansion of this area of teacher development is needed to meet the demands of the new curriculum.
In addition, these teachers need to operate in environments where school structures and processes incorporate policies and practices which support the health curriculum. For example, classroom programmes addressing healthy eating will be undermined if the school canteen does not offer a substantial choice of healthy foods, or if the school policy is to have soft-drink vending machines in the school environment for the purposes of fund raising. Assertiveness and conflict resolution programmes and mediation skills courses lose their credibility as alternatives to bullying and harassment if teachers adopt aggressive or sarcastic tactics in their interactions with students. The overall school environment and actual practices within the school reveal the true level of commitment the institution has to the programmes it teaches.
Conclusion
The draft document Health and Physical Education in the New Zealand Curriculum has now been released to schools for consultation. The final document to be available from the beginning of 1999, and to be gazetted by December 2000, will respond to feedback from schools and the community. The health issues that influenced the initial development of this essential learning area, and which are major educational issues for young New Zealanders, have not changed since the curriculum development process began. The public data that we have about some of our more highly publicised health and social issues (for example, suicide rates, teenage pregnancy, automotive fatalities, drug use, and adolescent mental health problems), and the frequency of their coverage in the news media, would suggest they are acute for secondary school practitioners. When considered alongside other major classroom concerns relating to negative influences on learning (such as a lack of appropriate interpersonal skills, disruptive behaviours, negative self concepts, harassment, and bullying), these make comprehensive implementation of this curriculum urgent. It is to be hoped that the Ministry of Education will provide the necessary financial resourcing to ensure effective implementation.
This paper has discussed the theoretical underpinnings of a health education curriculum which is designed to facilitate a personally liberating pedagogical process. Such a document will inform and encourage a health-literate society where the critical analysis of public policies and practices is encouraged, and where the learning outcomes generated by health education contribute to the nurturing of autonomous individuals and an empowered populace. The aim of such a society would be to promote health and wellbeing for all its people. The tension between these analytical foundations in health education and the current political climate of economic rationalism and fiscal restraint which shapes all education policy has also been acknowledged. Now the draft curriculum has been released one has to ask, Will the pressures impinging upon health educators in this climate be similar to those exerted by groups such as the New Zealand Business Roundtable in 1996 following the publication of the Social Studies Revised Draft? This group argued that the subject should revert to its discipline bases of history and geography, so as to deflect attention away from what was claimed to be the critique of equity and social issues encouraged by the document.
Health education attracts controversy by its very nature. Current curriculum developments and concerns can be summarised by asking a number of broad questions. How strongly can the vested interests of pressure groups compete with the pressing educational needs of our children and adolescents? When the “final” document emerges in 1999, will it demonstrate a commitment to the integrity of the extensive consultative process that led to the development of the draft document? Will the statement reflect a theoretical commitment to health for all in the twenty-first century or will it be a step backwards to the individualism of the past? Perhaps the key question to ask in a context in which the development of market relations in all areas of our social and economic life appears paramount is, Whose interests will it serve?
NOTES
GILLIAN TASKER was principal health education writer for the draft health curriculum and is senior lecturer in health education at the Christchurch College of Education. E-mail: gillian.tasker@weka.cce.ac.nz
The author acknowledges the editorial contributions made by Anne-Marie O’Neill to earlier drafts of this paper, which appeared as:
Tasker, G. (1996/97). For whose benefit? The politics of developing a health education curriculum. Delta: Policy and Practice in Education, 48(2),49 (1), 187–201.
Two excellent sources for curriculum issues are:
Delta: Policy and Practice in Education, 48 (1), 1996 and Delta: Policy and Practice in Education, 48 (2), 49 (1), 1996/97.
For physical education issues, see:
Culpan, I. (1996/97). Physical education: Liberate it or confine it to the gymnasium? Delta: Policy and Practice in Education, 48 (2), 49 (1), 203–219.
The draft curriclum document is:
Ministry of Education. (1996). Draft health and physical education curriculum statement. Wellington: Author.
The current official syllabus is:
Department of Education. (1985). New Zealand health education syllabus. Wellington: Author.
Healthism is described in:
Crawford, R. (1980). Healthism and the medicalisation of everyday life. International Journal of Health Services, 10, 365-88.
The quote from Tones is from page 3 of:
Tones, B. K. (1996). Editorial. Health Education Research, 11 (4).
That certain health improvements work only for upper and middle class populations is noted by:
Baumann, A. (1989). The epidemiology of inequity. In U. Brown (Ed.), Proceedings of a sustainable healthy future, National Workshop. Melbourne: La Trobe University.
Green, L. & Kreuter, M. (1990). Health promotion as a public strategy for the 1990’s. Annual Review of Public Health, 11, 319–334.
Kickbusch, I. (1980). Good planets are hard to find — Approaches to ecological base for public health. In U. Brown (Ed.), Proceedings of a sustainable healthy future, National Workshop. Melbourne: La Trobe University.
The failure of health programmes in Australia is noted by:
Colquhoun, D. (1990). Emancipating health education and the potential and limitations of health based physical activity. Paper presented at the International Association for Physical Education in Higher Education conference, Loughborough University.
Combes, G. (1989). The ideology of health education in schools. British Journal of Social Education, 10 (1), 67–80.
Naidoo, J. (1986). Limits to individualism. In S. Rodwell & A. Natt (Eds.), The politics of health education: Raising the issues. London: Routledge & Kegan Paul.
The Ottawa charter is described in:
World Health Organisation. (1986). The Ottawa charter for health promotion. Ottawa: Author.
The health-promoting model is described in:
Green J., Tones B. K., & Manderscheid, J. C. (1996). Editorial. In B. K. Tones (Ed.), Health Educational Research, 11 (4).
For the ecological integrative perspective, see:
Jewitt, A. (1994). Curriculum theory and research in sport pedagogy. Sport Science Review: Sports Pedagogy, 3 (1).
For the socio-ecological conception, see:
Lawson, H.A. (1992). Towards a socio-ecological conception of health. Quest, 44, 105–121.
The PAG aims are from page 2, and the quote on PAG specifications are from page 4, of:
Ministry of Education. (1995). Policy specifications for a national curriculum statement in health and physical education. Wellington: Author.
For the post-modern curriculum theory, see:
Doll, W. E. (1989). Foundations for a post-modern curriculum. Journal of Curriculum Studies, 21 (3), 243–253.
For the Freirian concept of empowerment, see: Freire, P. (1973). Education for critical consciousness. New York: Seabury Press.
The quote from the Victorian state documents is on page 79 of:
Ministry of Education. (1989). The personal development framework. P-10. Melbourne, Victoria: Office of Schools Administration.
For the constructivist approach to learning, see:
Alton-Lee, A. & Nuthall, G. (1991). Understanding learning and teaching project phase two. Christchurch: University of Canterbury Education Department.
Osborne, R. & Wittrock, M. (1987). The generative learning model and its implications for science education. Studies in Science Education, 12.
For the learning approaches promoted in new mathematics and science curriculum statements, see:
Ministry of Education. (1993). Mathematics in the New Zealand curriculum framework. Wellington: Author.
Ministry of Education. (1994). Science in the New Zealand curriculum framework. Wellington. Author.
The essential skills are described in:
Ministry of Education. (1993). The New Zealand curriculum framework. Wellington.
For a survey of school health co-ordinators, see:
Tasker, G. (1992). School health education needs: A survey of secondary schools in the Wellington region. Wellington Health Teachers’ Association Newsletter, 1.
For reports showing that schools are not providing health education in accordance with the health syllabus, see:
Education Review Office. (1993). New Zealand school sector report to Parliament. Wellington: ERO.
Education Review Office. (1996). Reproductive and sexual health education. A report provided by the Education Review Office for the Ministry of Health. Wellington: ERO.