Advancing a Health Promoting Schools Agenda for Black Students [1st ed. 2023] 3031447018, 9783031447013

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Advancing a Health Promoting Schools Agenda for Black Students

Lawrence Nyika

Advancing a Health Promoting Schools Agenda for Black Students

Lawrence Nyika

Advancing a Health Promoting Schools Agenda for Black Students

Lawrence Nyika Institute for Capacity Development Great Zimbabwe University Windhoek, Namibia

ISBN 978-3-031-44701-3    ISBN 978-3-031-44702-0 (eBook) https://doi.org/10.1007/978-3-031-44702-0 © The Editor(s) (if applicable) and The Author(s), under exclusive licence to Springer Nature Switzerland AG 2023 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Cover credit: pattern © Melisa Hasan This Palgrave Macmillan imprint is published by the registered company Springer Nature Switzerland AG. The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland Paper in this product is recyclable.

To my parents, Anthony Nyika and Esther (Vambire) Nyika.

Preface

Health promoting schools (HPS) have existed for the past 30 years with the goal of ensuring school populations are healthy and educationally prosperous; however, the agenda for Black students appears to be articulated only weakly. This book discusses how HPS may be made more equitable in relation to Black students in their role as historically marginalized school stakeholders. The book presents a comprehensive, race-based intervention that seeks to adapt HPS to Black students’ sociocultural contexts. This model of culturally relevant school health promotion is derived from the concept of social determinants of health, which considers cultural constructs (not disease!) a constraint to people’s health, such as race and racism, disability, and politics. Culturally relevant school health promotion presupposes that marginalization as an injustice can be reduced and prevented by attending to social determinants of health as an underlying cause of marginalization. The pro-equity model challenges the legitimacy of the predominantly Eurocentric HPS knowledge at a time humanity is becoming more aware of the importance to human life of race and racism. I conclude by applying culturally relevant school health promotion in the often-marginalized context of developing countries in the African continent, specifically in Zimbabwe. This book contributes significantly to theory and practice of HPS. First, the book casts the limelight on Black students in their role as significant school stakeholders who have the right to participate equitably in HPS.  Second, the book presents a novel comprehensive, whole-school intervention aimed at uplifting Black students’ participation in HPS. Third, to my knowledge, this is the first-known HPS text written from an African vii

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viewpoint, whose perspective is a valuable alternative to Eurocentric perspectives. It is my hope the reader will be encouraged to (re)envisage how HPS may be designed to more effectively engage Black students so they can be successful at school, at home, and in life. The book may appeal to school health researchers and professionals, education academics and professionals (including professors, teachers, and student teachers), post-­ secondary school students, and anyone interested in social justice education. Chapter 1 describes stories of experience related to the development of my interest in HPS and Black students’ health and schooling. As an African of Bantu lineage, my understanding of the world is greatly influenced by the philosophy of collectivity known as Ubuntu, which informs and is relevant to the HPS concept and Black students of Bantu lineage. The chapter highlights the importance of the book’s theoretical framework of social justice to Black students as historically marginalized stakeholders. Chapter 2 discusses health promoting schools’ purpose, key components, underlying assumption, and history and development to highlight the approach’s Eurocentric origin and implications for Black students’ schooling. It is important to discuss the structure and function of the HPS, as the book’s central phenomenon, to highlight opportunities and challenges related to Black students’ participation in HPS. Chapter 3 reports on a literature review conducted to establish the state of knowledge related to the involvement of Black students in HPS across the globe to highlight knowledge gaps and key issues and concerns. The review, which is undergirded by a critical theory-based framework, underscores a need for a comprehensive, race-based interventions to authentically engage Black students in HPS. Chapter 4 presents culturally relevant school health promotion, an intervention that was developed from six key social determinants of health to adapt HPS to Black students’ sociocultural contexts. The social determinants of health framework is compatible with the HPS approach in that both concepts fundamentally interrogate underlying issues of power and equity. Chapter 5 shows how the model of culturally relevant school health promotion can be used in practice, using the example of Zimbabwe, a southern African country keen on reviving its education system. Zimbabwe exemplifies the alternative and often-­ marginalized story of developing countries in the African continent. Windhoek, Namibia

Lawrence Nyika

Acknowledgments

I wish to thank Jesus Christ, my Lord and savior, for the many opportunities and capacities he bestowed upon me in this life. Thank you Gerard and Anna Overmars for your unwavering support to me and my family. Many thanks to Nova Scotia’s St Francis Xavier University, especially the Department of Education, for the enriching academic environment and programs. I acknowledge Dr. Anne Murray-Orr, the one scholar who greatly impacted my scholarly growth as my master’s and doctoral thesis supervisor. Yet, there was no shortage of inspiration from scholars of African descent (e.g., W. E. B. Du bois, Collins Airhihenbuwa, Dambudzo Marechera, and George Sefa Dei) to keep me motivated as I composed sentences after sentences, paragraph after paragraph, page after page, slowly but persistently. Many thanks to Calvin Scott of Nova Scotia for greatly enhancing my understanding of anti-Black racism. Thank you to all the reviewers and Linda, the editor.

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Contents

1 Autobiographical  Context: Who Am I as a Person and Researcher?  1 2 Introduction  to Health Promoting Schools (HPS): An Integrated Approach to Schooling 19 3 Being Black in Health Promoting Schools (HPS) 41 4 Culturally  Relevant School Health Promotion: Fighting Black Students’ Marginalization and Disproportionate Schooling 63 5 Culturally Relevant School Health Policing in Zimbabwe 83 Appendix97 Glossary103 Index105

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Abbreviations

BIPOC Black, Indigenous People of Color CRT Critical Race Theory HIV/AIIDS Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome HPS Health Promoting Schools LGBTQIA+ Lesbian, Gay, Bisexual, Transgender, Queer or Questioning, Intersex, Asexual, and more SDoH Social Determinants of Health UNESCO United Nations Education Scientific and Cultural Organization WHO World Health Organization

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List of Figures

Fig. 2.1 Fig. 2.2 Fig. 3.1 Fig. 4.1

Generalized HPS model Reflexivity in school and schooling Summary of review process Culturally relevant school health promotion: Empowering Black students’ HPS participation

22 33 44 74

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List of Tables

Table 5.1 Culturally relevant school health policy review framework Table 5.2 Summary of review findings

86 87

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CHAPTER 1

Autobiographical Context: Who Am I as a Person and Researcher?

Abstract  This chapter describes stories of experience related to the development of my interest in health promoting schools so readers can determine potential biases and make informed judgments about the credibility of research claims. The chapter introduces the philosophy of collectivity known as Ubuntu, which greatly influences my understanding of the world as an African of Bantu lineage. In addition to being a Black health and education professional, my experiences of racism as an African immigrant student in Canada greatly inspired the writing of this book. The chapter concludes by discussing the importance of the book’s theoretical framework of social justice to Black students as historically marginalized school stakeholders. Keywords  Coordinated school health • Comprehensive school health • Minoritized • Blacks • Student participation • Equity

Introduction My interest in health promoting schools (HPS) is traceable to secondary and post-secondary school where I studied science, education, and medical laboratory sciences. A health promoting school can be described as an integrated school system designed to ensure school populations are healthy

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 L. Nyika, Advancing a Health Promoting Schools Agenda for Black Students, https://doi.org/10.1007/978-3-031-44702-0_1

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and educationally prosperous (Salm, 2015; Macnab, 2013; Tymchak, 2001; Sánchez-Hernando et al., 2022). This definition draws on the philosophy of collectivity known as Ubuntu (Samkange & Samkange, 1980), whereby a health promoting school is viewed as a “village”, to which is brought together various services in an effort to enhance stakeholders’ health and wellbeing. Indications are that a typical health promoting school would have four pillars or domains (Lee et al., 2020) of education, health-related programs, healthy school environment, and HPS policy (Pan-Canadian Joint Consortium for School Health, 2021; Salm, 2015; Lee et al., 2014, World Health Organization (WHO) & United Nations Education Scientific and Cultural Organization (UNESCO), 2021a, b; Lee et al.; Samdal & Rowling, 2012; Macnab, 2013). While professional leadership is not typically recognized as a pillar, I believe it is vital to the functioning of HPS as suggested by the literature (Kwatubana et al., 2021; Shung-King et  al., 2014; Gleddie & Robinson, 2017; Rasberry et  al., 2015; Storey et al., 2016). The three terms of HPS, comprehensive school health, and coordinated school health may be used interchangeably (Kontak et al., 2022; Ohinmaa et al., 2011; WHO & UNESCO, 2021a); however, the reader is advised only the term HPS will be used in this text for convenience purposes. As a health and education professional I bring interdisciplinary professionalism to the HPS conversation. Whereas education taught me how to teach children and youth, medical laboratory sciences taught me how to interpret biomedical information. The dualism, I believe, enhances my ability to interact with and communicate school health knowledge to a variety of stakeholders, including students, teachers, health professionals, and school health researchers. Indeed, I did a research project on secondary school students’ perceptions of malaria as part of my BEd requirements in 2003 (Nyika, 2003). On completing BEd I taught secondary school science for about two years in Zimbabwe before enrolling at a community college to study medical laboratory sciences. Thereafter, I worked as a medical laboratory scientist/technologist at a central hospital in Zimbabwe for almost two years before moving to Canada in 2009 to pursue master’s and doctoral education. It is the goal of this chapter to reveal who I am as a person and as a researcher so readers can determine potential biases and make informed judgments about the credibility of research claims (Cooper & White, 2012). The following are the chapter’s objectives:

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(i) To describe stories of experience related to the development of my interest in HPS and Black students’ health and schooling. (ii) To highlight the significance of the philosophy of Ubuntu to me, the author, the HPS approach, and Black students. (iii) To discuss the importance of the book’s theoretical framework of social justice to Black students as historically marginalized school stakeholders. Growing Up Active, but Sometimes Hungry at School I grew up in a family of five children in a city in the southern African country of Zimbabwe. My father worked in the army as a soldier while my mother remained home and looked after the children. In the 1980s many Black students in Zimbabwe walked to school as their families did not have cars and public schools did not provide transport. This is perhaps unsurprising for a country that had been at war for nearly 15 years to end White minority rule. Walking the approximately two kilometers to my primary (or middle) school was fun because along the way my friends and I played soccer. I often felt hungry at school, hardly surprising for someone who burned numerous calories kicking, shoving, and chasing after a plastic ball the size of three to five tennis balls. Even though I did not arrive at school starving, I looked forward to the school’s breakfast program that served milk and could hardly sit still the last class before tea break. I thought the school cared little about the breakfast program as nobody ever come to check on students. While students fought over the milk by the car park, teachers queued peacefully for their tea at the school dining hall a few blocks away. The breakfast program was discontinued within a few years of operation, but I never got to know why this happened. I missed the nourishment, I missed the hustling and tussling, I missed the fun. Apart from the provocative aroma from the food served to teachers, watching teachers stroll into the school dining hall for their tea as usual made me feel sick to my stomach. Why was I, a student and therefore an integral part of school, not consulted about how things ought to be? Why I was not told why the breakfast program ended? If only teachers could see things my way, if only they knew how heartbroken I was. Alas! These experiences make me wonder if students today experience such feelings of dejection and

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hopelessness about school. It is reasonable to wonder about the relevance of school to children and youth in this era of Covid-19, the greatest health challenge of this generation. How quickly do school systems respond to students’ health issues and concerns? Feeling Hungry and Insecure at High School Against my mother’s wish (but, with full support from my dad) I attended boarding school, a move that had huge implications for my family. Firstly, it meant a big portion of the stringent family budget went to my school expenses. Secondly, I was going to be away from home nearly nine months each school year. Like most boarding schools in Zimbabwe, students at my high school attended school full-time three months a term and went home for break one month between terms. Students at my high school attended church service every Sunday and studied religious education. I was an active member of the church choir and sometimes enjoyed singing more than the Scriptures. Someone always prayed each morning before classes, after evening studies, and before meals. Wednesday afternoon was time for recreational activities, such as dance, chess, and quiz. Chess and quiz were enjoyable but I avoided dance because some sectors of the Zimbabwean culture had me believing that “real man” did not dance. Still, marijuana and alcohol were used by students in violation of the school rules. I vividly remember the day one of my friends returned drunk from a soccer match played away from school. Because I was an engaged and keen high scholar, it felt good to be part of the school setting, its culture, and its practices. One wonders about the experiences of students who were on the margins, who did not fit in as happily as I did. It has been a while since high school, but I would say about half the number of my teachers were immigrants. I am very grateful to the government of Robert Mugabe for allowing immigrant teachers to teach in Zimbabwe as there were a few Black teachers at that time in the 1980s. I remember having teachers from England, Germany, Canada, and possibly Asia. My school was all Black students except for one White Canadian student, whose dad taught English and coached volleyball. My high school addressed students’ nutritional health inadequately as the food served at the school cafeteria was neither nutritious nor well-­ cooked. There were no grocery stores within five kilometers radius; hence, students brought food from home to supplement the school diet.

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Additionally, the school seldom gave permission to visit home so students relied on school trips for opportunities to leave school. Further, it was difficult to access the school by road because of its location at the foot of a mountain range some 35 kilometers from the nearest town. I learned about these troubles the hard way, after going hungry much of the first term. The social class differences at the school were telling. On one hand, students from poor families (like me) brought little extra food and were hungry all the time. On the other hand, students from rich families had more food than they needed. The school’s poor diet combined with limited access to alternative food choices summed up my nightmarish first term of high school. This was a shocking reality for my parents who grimaced at the site of my skeletal body when I came for the first term school holidays. Much to the bemusement of my siblings I spent that school break eating ravenously in an effort to restore my body weight. At times my school felt like a military camp as prefects had power to literally run other students’ lives. I recall the story of one senior prefect who would burst into the shower rooms early morning to shout: “Sonny! Put on your underwear and go for prayers, now!” Such behavior may or may not be intimidating, but it is important for teachers to perceive school and schooling from the perspective of students. Suggestion boxes or some opportunity for students to communicate their concerns could have helped, but no such option existed. Overall, my secondary school experiences highlight the significance of healthy school environments and educators who value students’ health and wellness. The following sections show how experiences in my adult life and workplaces spurred my interest in school health research and the motivation to write this book.

Stimulating Workplaces On completing the two-year teacher education program, I graduated with a Diploma in Education in 1996 and taught secondary school science in Zimbabwe. Several years later in 2003 I completed BEd and taught high school for nearly two  years. I taught seven years with the Diploma in Education prior to obtaining the Bachelor’s degree specializing in biological sciences. In 2005 I pursed a second career in medical laboratory sciences as I was passionate about health issues. This was after Zimbabwe’s medical laboratory scientists’ board had invited applications from individuals with health-related degrees to study medical laboratory sciences.

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In 2007 I qualified as a medical laboratory scientist and worked for two years at a central hospital in Zimbabwe before moving to Canada to complete master’s and PhD studies. As a biology teacher in the late 1990s I had difficulties teaching reproductive health topics due to limitations imposed by cultural traditions. Rather than teachers, the Zimbabwean culture recognizes aunts and uncles as sexual health counselors for girls and boys respectively. For example, aunts can meet and talk with their nieces during school breaks to discuss the risks of risky sexual behaviors and how this can be resolved. There is no formality about the meetings, which are voluntary and based on familial relations and the family member’s opinions. Although the informal teaching of sex education by aunts and uncles was effective, it was dying out as people moved to cities and other countries. Increasingly, the Zimbabwean government directed schools to take a leading role in young people’s sexual health education, but the tradition of men teaching male relatives and women teaching female relatives was still strong. This complicated my role as an educator as it was not the norm to discuss sexual health matters with mixed-gender groups of girls and boys. As a teacher in this challenging situation, I became aware of issues and tensions associated with the task of providing valuable sexual health guidance and especially in the era of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). My students were not able to engage with me on the topic of sexual health education due to traditional beliefs, and were therefore not gaining access to useful sexual health knowledge. These pedagogical experiences made me begin to question the ability of education to enhance the health and wellness of students. Working at a hospital was new and thought-provoking. Though I did not know it then, my hospital experiences gave indications that biomedicine was but one way of viewing and could not fully explain human health. For example, there were cases of patients whose laboratory test results (as determined by standard diagnostic methods) suggested the patients would be medically dead, but they were surprisingly not. These experiences make me appreciate the value of comprehensive approaches that account for diverse understandings of human health, including biomedicine, sociology, and spirituality. As part of my hospital duties, I performed laboratory diagnostic tests for sexually transmitted infections such as syphilis, hepatitis, and human immunodeficiency virus (HIV). Occasionally, I recorded positive HIV results from patient samples. While such a result is potentially devastating

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to anybody, it was the positive results for young people that worried me most. I wondered why young people engaged in risky sexual behaviors that exposed them to incurable sexually transmitted infections like HIV/ AIDS.  How could school be modeled to encourage protective health decision-­ making, attitudes, and behaviors? Findings from my master’s research (Nyika & Murray-Orr, 2014) added to the growing body of literature suggesting schools can do a better job enhancing students’ health decision-making. The findings stimulated my interest in understanding the role of school in helping Black students interact productively with the various determinants of health, such as individual factors and milieu.

Awakening to Race and Racism For the longest time I was not too concerned about race and racism possibly because Black people are the majority in my native country of Zimbabwe. I was least interested even after a few months’ stay in South Africa in 2007 and 2009 gave indications of a racially prejudiced world. At that time, the issue of race and racism did not bother me quite as much as making money. I peripherally heard about it as I went about the business of trying to get rich like many other people who left Zimbabwe for countries with better economies. However, this all changed when I moved to Canada in 2009. Moving to Canada was exciting with prospects of endless learning and work opportunities, albeit there were surprises. People were generally quite friendly but slowly I began to notice a peculiarity about the way some White folks interacted with me both on and off campus. There appeared to be a pattern of sarcastic attitudes and behaviors meant to downplay what I said or did. Regardless, it took me a while to become mindful of the racially prejudiced world and it did not matter that I was an immigrant. My skin color of Black was the all-important marker. It was a huge cultural shock when a cashier at a store in Nova Scotia tried to teach me how to use my debit card against my will. These experiences of what I perceived as racial oppression may not appeal to every reader, but they were an important part of my journey as an African immigrant student in Canada as indicated in my doctoral thesis (Nyika, 2017). Until then, I had barely experienced racism having lived in post-colonial Zimbabwe during the time of Robert Mugabe who, despite his governance shortcomings as president, was resolute against White supremacy.

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Introducing the Philosophy of Ubuntu Being in Canada was culturally different from Zimbabwe where I grew up believing in the philosophy of collectivity known as Ubuntu (Samkange & Samkange, 1980). Ubuntu celebrates the cultural differences between humankind and all other creatures since, as humans, we are able to separate good from bad, to love unconditionally and otherwise, and above all to bond together as family. Gade (2011) traced the history of Ubuntu in African literature of Bantu lineage to the mid-nineteenth century, suggesting Ubuntu is endemic to some parts of Africa. As argued by Waghid and Smeyers (2012), African countries of Bantu lineage have strong cultural ties bound by Ubuntu: If a person is invited as a guest by a particular community, one usually experiences the hospitality of the group as a way of making one feel at home, and participating in the activities of the group as an acknowledgement of respect. This is in line with the tribal social practices of most African communities, in which sharing and connecting with the group are seen as paramount. (p. 11)

The sense of oneness helps build neighborhoods by linking people “soul to soul” in friendships even though they may be complete strangers. For example, there are Zimbabweans whom I consider to be family not because of genetics, but because of a shared allegiance to the elephant totem of nzou. Weird as it may sound, totems have for generations proved to be important primers for family-building in Zimbabwe’s Black communities. Likewise, bride money paid to the bride’s folks as part of the traditional marriage process of lobola has helped establish familial ties of great strength, resilience, and significance to people’s wellbeing. One goal of having totems is to prevent close breeding as people of the same totem cannot marry; however, I have seen the taboo broken a few times. Ubuntu places the concept of love at the core of human life and being human. This can be gleaned from Ubuntu’s characteristic features as indicated in the literature (Ewuoso & Hall, 2019; Hailey, 2008; Chibvongodze, 2016): • Selflessness • Friendliness • Connectedness • Caring • Compassion • Respect • Solidarity

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Epistemologically, Ubuntu is different from social constructivism even though the two philosophies subscribe to the sense of community___to an Ubuntist knowledge is familial and to a social constructivist knowledge is communal (Vygotsky, 1978). I am greatly inspired by the following Ubuntu-based sayings: umuntu ngubuthu ngabathu (translates to a person is because of others), my brother from another mother, and it takes a whole village to raise a child, which informs the HPS philosophy. Tymchak (2001) viewed a health promoting school as a “village”, whereby various services are brought together to collectively support the health and wellbeing of school stakeholders. The presence or absence of Ubuntu always shows because Ubuntu is an enactment of love, the love for humanity. When someone visits, even a total stranger, an Ubuntist shows love from within, from the heart. The visitor does not have to make reservation, no, just showing up at random is fine. It is well even if the food is little, even if there is little room for everyone, even if it is bad times. Yet, it is this friendliness, this camaraderie, this familiarity that can be abused by the oppressor, such as colonizers (Murove, 2012). Visitors may exploit and even abuse Ubuntu, but you can be wiser. My mother would say: If you want to know if your visitor is a good or a bad person, [if they drink] give them alcohol. The drunker they become the more they reveal their secrets to you. You can hear someone say “I did this and that, I can do this and that. I stole from so and so and lied about this and that.”

I do not know how well my mother’s strategy works and what to do when the visitor does not drink. What I do know is Ubuntu becomes second nature when you grow up the way I did, calling a perfect stranger brother or sister without flinching. Regardless, indications are that Ubuntu is valuable to African students of Bantu lineage’s education, health, and health promotion (Letseka, 2012; Wilson & Williams, 2013). It is possible the power of love causes Ubuntu to spread across many fields of study including education, theology, health promotion, and biology (Chibvongodze, 2016; Wilson & Williams, 2013; Letseka, 2012). Ubuntu is uniquely African and surely culturally appropriate even though, as a moralistic philosophy, its applicability in education may be debatable (Enslin & Horsthemke, 2004; Letseka, 2012; Matolino, 2015). Still, an outright emphasis on collectivity is somewhat dictatorial as it would eclipse individual agency (Hailey, 2008; Louw, 1998). Murove’s (2012) observation of discordance between Ubuntu and the oppressor is plausible since

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the oppressor’s intention to disempower contradicts Ubuntu’s spirit of love. Given that oppression is a major impediment to democracy, educational transformation would arguably need scholarship that is authoritative, accurate, and critical. The reader will be the judge if I express my thoughts in this book freely, fearlessly, and selflessly.

Social Justice: An Anti-oppression Concept This text is written from the perspective of a health and education professional of African ancestry with relevant experiences from Zimbabwe and Canada. My cultural-professional context coupled with my experiences of racism as an immigrant student in Canada greatly inspired the writing of this book. I am particularly inspired by the movie Black Panther (Coogler, 2018), which did not just target Black people, but also sought to authentically represent them as Blacks in Africa and in the diaspora. Because it took committed academic, political, corporate, and other sociocultural discourses to encourage people to accept as normal prejudiced views of race, I am convinced it will require more of such efforts to overcome the now solidified racial oppression. To overcome the personally and institutionally seated oppression in an ever-changing postmodernity demands a consideration of the impact on people’s lives of both the immediate and the broader social influences. These influences are discussed in this book and especially as they affect Black students in subtle or overt ways, intentionally and unintentionally. However, racism is not the only form of oppression as Black students can also be marginalized/minoritized in relation to such constructs as gender and sexual orientation, disability, and socioeconomic status (Henderson et al., 2019). Social constructs can interconnect to cause and aggravate educational, health, and health-related inequities, thereby contributing to marginalization at school. Given that marginalization happens when prejudices cause fellow citizens to be othered, ignored, and silenced (Hall & Carlson, 2016), my work supports the social justice framework as opposed to science-oriented frameworks, such as biomedicine, socioecology, and systems approach. Though relevant, science-­ oriented frameworks give a less critical view of HPS as educational (and hence political) institutions whose programming is necessarily contested. Therefore, I will use the social justice lens to consider how HPS may be designed to more effectively engage Black students in their role as historically marginalized school stakeholders.

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The persistent marginalization of Black students (Hodge & Harrison, 2021; Finigan-Carr, 2017; Shockley & Lomotey, 2020) justifies the use of a social justice framework, whose emphasis on equality (Pérez & Martinez, 2008) can empower the students’ schooling upon addressing underlying governance and ethical issues. I am drawn to McPherson (2012), We all have a collective obligation to bring health and dignity to communities in need. Strong health systems and services, with anchoring primary health care foundations, are needed to ensure the human right to health. This represents a fundamental paradigm shift when talking about health system reform because the problem is not defined by availability of hospitals or physicians; rather it is defined by a violation of the right to those things that help keep us as healthy as possible and an associated lack of public service accountability for health human rights inactions and violations. (Emphasis in the original, p. 165)

McPherson reminded us of the political nature of public health enterprises as demonstrated by the use of such terms as “human right”, “dignity”, and “accountability”. Instead of science, McPherson’s work situates human health within the context of critical theory, which is pivotal to the discussion on equitable school participation because it problematizes the role of power in human relations (Brookfield, 2005). Black Lives Matter is a classical illustration of how the concept of social justice advances the critical theory discourse in practical ways that are palatable to ordinary people (Dunivin et al., 2022; Hodge & Harrison, 2021; Burke, 2014). Surely, a critical theory grounding of public health and education is needed to fight against the abuse of power in the highly unpredictable postmodern society. Social justice is essentially anti-oppression even though there is debate about whether or not it overrates and underrates collectivism and individualism respectively (Cisneros, 2022; Hayek, 1978; Burke, 2014; Reisch, 2002). Given this background, it is important for interventions to provide targeted support without seeking to dominate or disempower the non-marginalized lest the interventions become counter-hegemonic and oppression is reinvented. This book presents a critical theory-based intervention in an attempt to uplift the HPS participation of Black students, who face many injustices navigating school contexts. The intervention is founded on the argument that knowledge is culturally contested, suggesting a need to centralize minoritized students’ cultures in order to optimize their cultural proficiency, critical thinking, and social development (Ladson-Billings, 1995; Guy, 2002; Gay, 2010; Airhihenbuwa, 2007).

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Indeed, the uplifting of Black students ranges with the recommendation for all students to participate equitably in the democratic space of HPS (WHO, 1997; Anderson & Ronson, 2004; Griebler & Nowak, 2012). Student participation is a prized conversation in school health promotion as it is a reliable measure of the effectiveness of interventions. The work of Simovska (2004, 2007, 2008) suggests student participation is a political process of engaging in planned activities to gain vital knowledge, skills, and attitudes: Arguably, one of the key elements of a health promoting school is appropriate “space” for the students to participate genuinely in relevant aspects of decision-making processes at school. A participatory approach to health promotion implies more than the improvement of the health status of individuals in a given school community. Health promoting schools should provide resources and possibilities for students to develop, promote, exercise and exert their competencies to be qualified participants in democratic environments. (Simovska, 2004, p. 202)

I note how Simosvka used the word “democratic” showing an appreciation of the importance of equitably equal school and schooling. Though not shown in the above quote, Simovska identified two distinct modes of student engagement namely token and genuine. Whereas the latter is activistic and transformative, the former passively capacitates students’ ways of thinking, reflecting a conservative and less effective schooling strategy. Simovska and others (e.g., Kontak et al., 2022; Griebler & Nowak, 2012; Pan-Canadian Joint Consortium for School Health, 2023; Hart, 2008) do not specifically focus on minoritized students, but it is clear that student involvement in HPS is contestable. Thus, this book discusses how HPS can be made more equitable in relation to Black students in their role as historically marginalized school stakeholders. The term Black students is used in this book without geographical restrictions and applies to students of African heritage the world over. The following are the book’s sub-objectives: (i)

Chapter 1 describes stories of experience related to the development of the author’s interest in HPS and Black students’ health and schooling. ( ii) Chapter 2 discusses health promoting schools’ purpose, key components, underlying assumption, and history and development to ­highlight the approach’s Eurocentric origin and possibilities for Black students’ schooling.

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(iii) Chapter 3 reports on a literature review conducted to establish the state of knowledge related to the engagement of Black students in HPS across the globe in order to highlight knowledge gaps and key issues and concerns. (iv) Chapter 4 presents culturally relevant school health promotion, a comprehensive, race-based intervention that seeks to adapt HPS to Black students’ sociocultural needs. (v) Chapter 5 operationalizes culturally relevant school health promotion using the example of Zimbabwe, a southern African country keen on reviving its education system.

Conclusion As a school health researcher of Bantu lineage my understanding of the world is greatly influenced by the philosophy of Ubuntu, whose principles include collectivity, love, and friendliness. However, because oppression is enmity against democracy, educational transformation would need critical engagement with the HPS approach to ensure equitability. Thus, I use a social justice lens to consider how HPS may be designed to more effectively engage Black students in their role as historically marginalized school stakeholders. The concept of social justice situates HPS within the context of critical theory, which is pivotal to the discussion on equitable school participation because it problematizes the role of power in human relations. My thoughts, my imaginations, my contentions in this book are meant to free my soul and the souls of others seeking to resolve the HPS agenda for Black students. The reader will be the judge if I express myself freely, fearlessly, and selflessly.

References Airhihenbuwa, C. O. (2007). Healing our differences: The crisis of global health and the politics of identity. Rowman & Littlefield. Anderson, A., & Ronson, B. (2004). Democracy  – The first principle of health promoting schools. The International Electronic Journal of Health Education, 8, 24–35. Brookfield, S. (2005). The power of critical theory: Liberating adult learning and teaching. Jossey-Bass. Burke, T.  P. (2014, October 8). The origins of social justice: Taparelli d’Azeglio. Intercollegiate studies institute. Retrieved on August 23, 2022, from https:// isi.org/intercollegiate-­review/the-­origins-­of-­social-­justice-­taparelli-­dazeglio/

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Chibvongodze, D. T. (2016). Ubuntu is not only about the human! An analysis of the role of African philosophy and ethics in environment management. Journal of Human Ecology, 53(2), 157–166. Cisneros, C. (2022). Multivocality as practice of critical inquiry for social justice. The Qualitative Report, 27(8), 1529–1546. Coogler, R. K. (Director). (2018). Black Panther [Film]. Marvel Studios. Cooper, K., & White, R. E. (2012). Qualitative research in the post-modern era: Contexts of qualitative research (Vol. 1). Springer. Dunivin, Z. O., Yan, H. Y., Ince, J., & Rojas, F. (2022). Black Lives Matter protests shift public discourse. Proceedings of the National Academy of Sciences, 119(10), e2117320119. Enslin, P., & Horsthemke, K. (2004). Can ubuntu provide a model for citizenship education in African democracies? Comparative Education, 40(4), 545–558. Ewuoso, C., & Hall, S. (2019). Core aspects of ubuntu: A systematic review. South African Journal of Bioethics and Law, 12(2), 93–103. Finigan-Carr, N.  M. (Ed.). (2017). Linking health and education for African American students’ success. Routledge. Gade, C.  B. (2011). The historical development of the written discourses on ubuntu. South African Journal of Philosophy= Suid-Afrikaanse Tydskrif vir Wysbegeerte, 30(3), 303–329. Gay, G. (2010). Culturally responsive teaching: Theory, research, and practice. Teachers College Press. Gleddie, D. L., & Robinson, D. B. (2017). Creating a healthy school community? Consider critical elements of educational change. Journal of Physical Education, Recreation & Dance, 88(4), 22–25. Griebler, U., & Nowak, P. (2012). Student councils: A tool for health promoting schools? Characteristics and effects. Health Education, 112(2), 105–132. Guy, T. C. (2002). Culture as context for adult education: The need for culturally relevant adult education. New Directions for Adult and Continuing Education, 1999(82), 5–18. Hailey, J. (2008). Ubuntu: A literature review. Tutu Foundation. Hall, J. M., & Carlson, K. (2016). Marginalization. Advances in Nursing Science, 39(3), 200–215. Hart, R. A. (2008). Stepping back from “The ladder”: Reflections on a model of participatory work with children. In Participation and learning: Perspectives on education and the environment, health and sustainability (pp. 19–31). Springer Netherlands. Hayek, F.  A. (1978). Law, legislation and liberty (Vol. 2). University of Chicago Press. Henderson, D. X., Walker, L., Barnes, R. R., Lunsford, A., Edwards, C., & Clark, C. (2019). A framework for race-related trauma in the public education system

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and implications on health for black youth. Journal of School Health, 89(11), 926–933. Hodge, S. R., & Harrison, L. (2021). Feeling Black: A conversation about justice imperatives in education, disability, and health. Kinesiology Review, 1(aop), 1–8. Kontak, J. C., Caldwell, H. A., Kay-Arora, M., Hancock Friesen, C. L., & Kirk, S. F. (2022). Peering in: Youth perspectives on health promoting schools and youth engagement in Nova Scotia, Canada. Health Promotion International, 37(3), 1–14. Kwatubana, S., Nhlapo, V. A., & Moteetee, N. (2021). The role of principals in school health promotion in South Africa: A qualitative study. Health Education, 122(3), 304–317. Ladson-Billings, G. (1995). Toward a theory of culturally relevant pedagogy. American Educational Research Journal, 32(3), 465–491. Lee, A., Keung, V.  M. W., Lo, A.  S. C., Kwong, A.  C. M., & Armstrong, E. S. (2014). Framework for evaluating efficacy in health promoting schools. Health Education, 114 (3), 225–242. Lee, A., Lo, A., Li, Q., Keung, V., & Kwong, A. (2020). Health promoting schools: An update. Applied Health Economics and Health Policy, 18(5), 605–623. Letseka, M. (2012). In defence of Ubuntu. Studies in Philosophy and Education, 31(1), 47–60. Louw, D.  J. (1998, January). Ubuntu: An African assessment of the religious other. In The Paideia archive: Twentieth World Congress of Philosophy (Vol. 23, pp. 34–42). Macnab, A. (2013). The Stellenbosch consensus statement on health promoting schools. Global Health Promotion, 20(1), 78–81. Matolino, B. (2015). A response to Metz’s reply on the end of ubuntu. South African Journal of Philosophy= Suid-Afrikaanse Tydskrif vir Wysbegeerte, 34(2), 214–225. McPherson, C. (2012). A rights-based approach to primary health care: Increasing accountability for health inequities within health systems strengthening. In E.  A. McGibbon (Ed.), Oppression: A social determinant of health (pp. 150–165). Fernwood. Murove, M. F. (2012). Ubuntu. Diogenes, 59(3–4), 36–47. Nyika, L. (2003). Some perceptions about malaria among secondary school students (Unpublished BEd thesis). Bindura University of Science Education, Bindura, Zimbabwe. Nyika, L. (2017). African immigrant secondary school students’ participation in health promoting schools: Perspectives from Nova Scotia (Unpublished doctoral thesis). St. Francis Xavier university, Nova Scotia, Canada. Nyika, L., & Murray-Orr, A. (2014). Storying undergraduate university students identity construction in relation to sexual behaviours. Revue Phéneps/Phenex Journal, 6(1), 1–19.

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Ohinmaa, A., Langille, J., Jamieson, S., Whitby, R., & Veugelers, P.  J. (2011). Costs of implementing and maintaining comprehensive school health: The case of the Annapolis Valley health promoting schools program. Canadian Journal of Public Health, 102(6), 451–454. Pan-Canadian Joint Consortium for School Health. (2021). What is a comprehensive school health approach? Retrieved on September 27, 2021, from http:// www.jcsh-­cces.ca/about-­us/comprehensive-­school-­health-­framework/ Pan-Canadian Joint Consortium for School Health. (2023). Youth Engagement Toolkit. Retrieved on July 30, 2023, from http://www.jcsh-­cces.ca/ ye-­toolkit-­mod02/ Pérez, L. M., & Martinez, J. (2008). Community health workers: Social justice and policy advocates for community health and well-being. American Journal of Public Health, 98(1), 11–14. Rasberry, C.  N., Slade, S., Lohrmann, D.  K., & Valois, R.  F. (2015). Lessons learned from the whole child and coordinated school health approaches. Journal of School Health, 85(11), 759–765. Reisch, M. (2002). Defining social justice in a socially unjust world. Families in Society, 83(4), 343–354. Salm, T. (2015). School-linked services: Practice, policy, and constructing sustainable collaboration. In education, 21, 23–41. Samdal, O., & Rowling, L. (Eds.). (2012). The implementation of health promoting schools: Exploring the theories of what, why and how. Routledge. Samkange, S., & Samkange, T. M. (1980). Hunhuism or Ubuntuism: A Zimbabwe indigenous political philosophy. Graham Publishing. Sánchez-Hernando, B., Gasch-Gallén, Á., Antón-Solanas, I., Gea-Caballero, V., Juárez-Vela, R., Gállego-Diéguez, J., et al. (2022). A comparative study of life skills, lifestyle habits and academic performance in health promoting and non-­ health promoting schools in the Autonomous Community of Aragon, Spain. PeerJ, 10, e13041. Shockley, K. G., & Lomotey, K. (2020). African-centered education: Theory and practice (critical race issues in education). Myers Education Press. Shung-King, M., Orgill, M., & Slemming, W. (2014). School health in South Africa: Reflections on the past and prospects for the future. South African Health Review, 2013(1), 59–71. Simovska, V. (2004). Student participation: A democratic education perspective— Experience from the health-promoting schools in Macedonia. Health Education Research, 19(2), 198–207. Simovska, V. (2007). The changing meanings of participation in school-based health education and health promotion: The participants’ voices. Health Education Research, 22(6), 864–878. Simovska, V. (2008). Learning in and as participation: A case study from health-­ promoting schools. In A. Reid, B. B. Jensen, J. Nikel, & V. Simovska (Eds.),

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Participation and learning: Perspectives on education and the environment, health and sustainability (pp. 61–80). Springer. Storey, K. E., Montemurro, G., Flynn, J., Schwartz, M., Wright, E., Osler, J., et al. (2016). Essential conditions for the implementation of comprehensive school health to achieve changes in school culture and improvements in health behaviours of students. BMC Public Health, 16(1), 1–11. Tymchak, M. (2001). SchoolPLUS a vision for children and youth. Final report. Saskatchewan Instructional Development and Research. Vygotsky, L.  S. (1978). Mind in society: The development of higher psychological processes. Harvard University Press. Waghid, Y., & Smeyers, P. (2012). Reconsidering ubuntu: On the educational potential of a particular ethic of care. Educational Philosophy and Theory, 44, 6–20. WHO. (1997). Promoting health through schools: Report of a WHO expert committee on comprehensive health education and promotion. WHO.  Retrieved on September 1, 2022, from http://apps.who.int/iris/bitstream/handle/10665/41987/WHO_TRS_870.pdf;jsessionid=8E755C5AFF03993427 1A02382AE58092?sequence=1 WHO and UNESCO. (2021a). Making every school a health-promoting school: Implementation guidance. Retrieved on June 12, 2022, from https://apps. who.int/iris/bitstream/handle/10665/341908/9789240025073-­eng.pdf WHO and UNESCO. (2021b). Making every school a health promoting school: Global standards and indicators. Retrieved on June 12, 2022, from https:// iris.who.int/bitstream/handle/10665/341907/9789240025059-eng. pdf?sequence=1 Wilson, D., & Williams, V. (2013). Ubuntu: Development and framework of a specific model of positive mental health. Psychology Journal, 10(2), 80–100.

CHAPTER 2

Introduction to Health Promoting Schools (HPS): An Integrated Approach to Schooling

Abstract  The HPS approach has largely been applied in Eurocentric settings, but there is notable interest from the African continent in recent times. This chapter discusses health promoting schools’ purpose, key components, underlying assumption, and history and development to highlight the approach’s Eurocentricity and possibilities for Black students’ schooling. The chapter concludes by revisiting the connection between health condition and educational success using the theory of reflexivity as an alternative perspective to psychosocial theories that focus on motivation and relationships between students and school professionals. Keywords  Coordinated school health • Comprehensive school health • School health researchers • Educational success • Health promotion • Critical Realism

Introduction About three decades ago emerged an integrated school system that sought to optimize the health and schooling of school populations, such as students, teachers, and staff. This HPS approach has largely been applied in Eurocentric settings, but there is notable interest from the African continent in recent times (Tomokawa et  al., 2020; Reddy & Singh, 2017; Government of Zimbabwe, 2018). This chapter discusses health © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 L. Nyika, Advancing a Health Promoting Schools Agenda for Black Students, https://doi.org/10.1007/978-3-031-44702-0_2

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promoting schools’ purpose, key components, underlying assumption, and history and development to highlight the approach’s Eurocentric origin and possibilities for Black students’ schooling. It is important to discuss the structure and function of the HPS, as the book’s central phenomenon, to highlight opportunities and challenges related to the participation of Black students in HPS. The chapter begins by defining the term HPS.  This is followed by a discussion of the evolution of HPS to highlight the role of school health researchers in the formulation and advancement of the approach, which conversation appears to be dominated by the World Health Organization (WHO) (Turunen et al., 2017; Langford et  al., 2017; Lee et  al., 2014; Schools for Health in Ireland, 2013). The chapter concludes by revisiting the connection between health condition and educational success using Archer’s theory of reflexivity (2003, 2007, 2012) or introspection as an alternative perspective to psychosocial theories that focus on motivation and relationships between students and school professionals (Shaw et al., 2015; Basch, 2011; Ponsford et al., 2022). Archer’s theory draws from critical realism, which philosophy is renowned for distinctly separating individuality and social structure and ontology and epistemology.

The HPS Concept Present-day schools have become complex systems owing to the presence of wide-ranging interventions aimed at optimizing the health and wellbeing of school populations, either uncoordinatedly or coordinatedly. Coordinated school health or HPS can be described as the integration of health and educational services into a schooling entity whose goal is to ensure school populations are healthy and educationally successful (Salm, 2015; Lee et al., 2014). Indications are that a typical health promoting school would have four pillars or domains (Lee et al., 2020) of education, health-related programs, healthy school environment, and HPS policy (Pan-Canadian Joint Consortium for School Health, 2021; Salm, 2015; Lee et  al., 2014, WHO & United Nations Education Scientific and Cultural Organization (UNESCO), 2021a, b; Lee et  al.; Samdal & Rowling, 2012; Macnab, 2013). Spain’s community of Aragon requires due accreditation of HPS to distinguish these from non-health promoting schools on the following basis:

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A commitment of at least 3 years; the integration of education and health promotion on an ongoing basis; the creation of a work team, supported by the management; the interaction of the center with the services of the school environment; and the periodic evaluation of the actions carried out. (Sánchez-Hernando et al., 2022, p. 4)

While professional leadership is not typically recognized as a pillar, I believe it is vital to the functioning of HPS as suggested by Sánchez-­ Hernando et al. As well as being a promising Covid-19 school action plan, health promoting schools’ integrated approach is a potential community-­ builder. Notwithstanding, HPS are more exerting programming-wise by reason of their collaborated effort’s demand for thorough training of key implementers, such as principals, teachers, and school health professionals. The term HPS appears to have been introduced in the mid-1980s in Europe about the same time was proposed the American equivalent of comprehensive/coordinated school health (Young, 2005; Allensworth et al., 1997; St. Leger et al., 2022). Although the three terms of HPS, comprehensive school health, and coordinated school health may be used interchangeably (Kontak et  al., 2022; Ohinmaa et  al., 2011; WHO & UNESCO, 2021a), the reader is advised only the term HPS will be used in this text for convenience purposes. Of necessity, HPS tend to focus more on students, who are likely to encounter many injustices as they navigate school environments. Authentically engaging students can improve the quality of their school lives and ultimately help them learn better and succeed in school. This is the hallmark of HPS as an empowerment strategy—a concept which draws on the assumption that a connection exists between health condition and educational accomplishment (Allensworth & Kolbe, 1987; Symons et al., 1997). The idea of empowerment interlinks with pro-critical theory concepts that problematize the operations of power in human life (Brookfield, 2005), including social justice, democracy, and equity. In addition to questioning the integrity of status quo, critical theory seeks to find ways of overcoming oppression and advocates for emancipation of the oppressed. Foucault (1980) encouraged critical scholarship to challenge the legitimacy of knowledge (production, presentation, and distribution) because prejudices, biases, and stereotypes are produced and reproduced in discourse and in daily routines. Similarly, Freire (1998, 1973, 1970/2005) urged critical theorists to go beyond just theorizing about what can be and actively apply the critical theory ideology.

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HPS Components Figure 2.1 shows health promoting schools’ four pillars of education, health-related programs, healthy school environment, and HPS policy (Pan-Canadian Joint Consortium for School Health, 2021; Salm, 2015; Lee et al., 2014, WHO & UNESCO, 2021a, b; Lee et al., 2020; Samdal & Rowling, 2012; Macnab, 2013). However, professional leadership (which term refers to health promoting schools’ managerial personnel, who could be principals and/or coordinators/facilitators) is not an explicit domain in some models, but its contribution to programming is well-­ documented (Kwatubana, 2021; Shung-King et  al., 2014; Gleddie & Robinson, 2017; Rasberry et al., 2015; Storey et al., 2016). As indicated in Fig. 2.1, professional leadership is cardinal to the integration of the various domains, the establishment of productive partnerships, and maintenance of a whole-school focus. However, health promoting schools’ technicalities and complexities are likely to make it impossible for school leaders to implement the model without proper knowledge and training.

Healthy School Environment

Education

Professional Leadership (e.g., trained principals)

HPS Policy

Fig. 2.1  Generalized HPS model

Healthrelated Programs

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Education  Education can be described as the orderly acquisition of knowledge, skills, and attitudes (via a curriculum, pedagogy, and assessment) that intersects with diverse fields of study, including sociology, science, health, and psychology (Macnab, 2013; Jackson, 2011; Salm, 2015; Biesta, 2015). As a cultural construct, education is inevitably political and its operations may vary from place to place, depending on ruling regime politics (Raphael, 2008). However, in the context of HPS, education must emphasize the teaching of health education to empower stakeholders’ health literacy, decision-making, attitudes, and behaviors. Obviously, the teaching and learning of health education has important implications for teacher education and professional development.  Health-Related Programs  Health-related programs are the different schoolbased and school-linked services that are intended to protect and strengthen the health of stakeholders—health being defined as a confluence of biomedical and non-biomedical factors of body, psyche, and environment: “health is understood not merely as freedom from disease, but as a state of complete physical, mental, and social well-being” (WHO, 1997a, p. 5). The following are examples of health-related programs: health centers, student support services, nutritional programs, sexual health programs, and mental health services (Pan-Canadian Joint Consortium for School Health, 2021; Salm, 2015; Lee et al., 2014, WHO & UNESCO, 2021a; Macnab, 2013). It is important to maintain the school-parents-community link by incorporating outreach personnel into school-linked programming. Whereas health promoting schools’ wholesome approach targets all school participants, health-related programs may be selective. For example, Nova Scotia’s SchoolsPLUS is a health-related program that offers multiple services for students in the areas of mental health, sexual health, and educational and career support (Fleury, 2010; Province of Nova Scotia, 2022). Other prominent multifaceted programs are KaziBantu (South Africa), Love Kai (New Zealand), Apple Schools (Canada), and Comprehensive School Physical Activity Program (USA).  Healthy School Environment  This term describes the empowering school context composed of human and non-human elements. The human part being the social environment, which includes traditions, norms, values, and people-people relations. The non-human part being the physical environment, which includes infrastructure, graffiti, posters, plant life, and school safety (WHO & UNESCO, 2021b; Pan-Canadian Joint Consortium

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for School Health, 2021; Kwan et al., 2005; Amoran et al., 2017). It is my contention the representation within the school environment of the different school stakeholders’ cultures is important to equitable and authentic school participation.  HPS Policy  A health promoting school should have documents from government, province, school board, and school that describe the school’s constituent elements and schooling philosophy. The schooling philosophy describes the ethical and moral standards, value systems, ways of thinking, and ways of being the school upholds and seeks to perpetuate. These precepts guide teachers and school health professionals in the fulfilment of their roles as HPS agencies. Schooling philosophies make programming context-specific by professing to the kind of citizens the schools seek to promote; this validates Samdal and Rowling’s (2012) view of policy as backbone to HPS. As contended by McIsaac et al. (2017), programming varies from school to school in accordance with stakeholders’ needs and sociocultural situations as well as the cultural values and beliefs endemic to the school, community, and country. Thus, HPS may have similar components, but would operate differently owing to different cultural, philosophical, historical, and political conditions within and without the schools.  The model shown in Fig. 2.1 may look simplistic, but it can be challenging to identify a health promoting school for research purposes. There appears to be little discussion on the differences between HPS and non-health promoting schools to help researchers know how a health promoting school might actually look like (Kontak et al., 2017; Sánchez-­Hernando et  al., 2022), which leaves open the possibility of doing research in a wrong setting. How exactly are HPS different from non-health promoting schools? Is it enough to rely on information from websites of schools and school boards? Practical questions like these troubled me as I developed my doctoral research proposal and journeyed through the research landscape. Initially, I thought a school could be called a health promoting school because its website and school policies said so. Afterward, I reckoned a school does not become a health promoting school just because it has HPS policies and/or health-related programs. In my opinion, a school qualifies to be a health promoting school when it has the (four) pillars collaboratively managed by knowledgeable leaders, such as professionally developed principals (Sánchez-Hernando et al., 2022). It is interesting to

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further examine the practical significance of the differences between HPS and non-health promoting schools and how this may impact the quality of research. The advent of Covid-19 has caused many schools to revamp their health promotion activities and HPS have had to strengthen their disease prevention strategies to better protect and enhance stakeholders’ health. It can be seen how health promoting schools’ adaptability to emerging health challenges prompted the WHO and UNESCO (2021a) to advocate for all schools to be such. HPS are a valuable national investment, yet as educational institutions, their sustainability would vastly dependent on ruling regime politics (Salm, 2015; Raphael, 2008, 2013a, b). The HPS approach has been implemented round the globe since the late twentieth century with much of the knowledge being Eurocentric; however, the success story of Kenya is a notable development (Tomokawa et al., 2020; Akiyama et al., 2020). A brief history of HPS is provided in the following section to highlight the work of a few school health researchers.

A Brief History of HPS In 1986 the WHO organized the first international health promotion conference that brought attention to the role of factors outside the disease-­ oriented biomedical model. The resultant publication known as the Ottawa charter (1986) encouraged a comprehensive approach to public health with emphasis on relationships between human individuals, community, and environment. Regardless, the charter made little reference to the field of education in comparison to the World Health Organization’s technical report of 1997, which expanded the health promotion concept to include schools (WHO, 1997a). In addition to viewing HPS as viable and sustainable, the report suggested it was the right of all students to participate in the schools. Priority was given to community-driven strategies that enable schools and their communities to collaboratively shape the health of school stakeholders, such as students, teachers, and staff. Post-Ottawa conferences (WHO, 1997b, 2009, 2013) effectively situated health promotion within social constructivism, socioecology, and critical theory perspectives, signaling an urgent need for schools to eliminate unjust differences in stakeholders’ abilities to use educational, health, and health-related services. Henceforth, HPS are expected to help school populations interact profitably with the motely determinants of health, something pedagogy and the curriculum cannot do on their own, without

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supportive leadership, policies, programs, and school environments. A notable post-Ottawa development is the establishment in 1991 of the European Network for Health Promoting Schools, which consists of the Council of Europe, the European Union, and the WHO regional office for Europe, whose number of affiliates has burgeoned over the years (Burgher et  al., 1999; Rasmussen, 2005). Efforts to establish HPS in Africa appear to have begun in South Africa in 1994 at the request of that country’s health and education professionals, who sought to rejuvenate public education (Struthers et al., 2017). Generally, the HPS framework allows school-based and school-linked agencies to co-determine stakeholders’ health literacy, decision-making, attitudes, and behaviors. This settings approach (WHO, 1991, 1997b; Baric, 1993) resonates with the famous African proverb: It takes a whole village to raise a child, which draws from the philosophies of Ubuntu and social constructivism (Samkange & Samkange, 1980; Vygotsky, 1978). Though communities can naturally be trusted to determine school populations’ health on account of their vested interests, I believe for maximum equitability it is important to rigorously evaluate school health policies, programs, and programming. Evolution of the HPS Concept Although the Ottawa charter (1986) is renowned for encouraging the use of comprehensive approaches in public health, the strategy may have long existed within educational discourses. To begin with, the concept of collective empowerment has resemblances of the transformative power of education envisioned by Rousseau in the eighteenth century of “putting [the student] in the condition to be himself (sic) and in all things to do his will, as soon as he as one” (Bloom, 1979, p.  63). Rousseau considered students active participants in educational processes and placed them at the heart of educational thought. Additionally, Acheson (1990) traced the origin of holistic approaches to school and schooling to the nineteenth century in some parts of Europe. Within the same period, similar and ongoing school health activities were happening in the United States: Schools have been the site for health programming in the United States since the early colonial period. When public education became compulsory in the mid-nineteenth century, the strategic role that schools could play in promoting and protecting health became recognized; schools soon became

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the front line in the fight against infectious disease and the hub for providing a wide range of health and social services for children and families. (Allensworth et al., 1997, p. 1)

Allensworth et al. recognized schools as centers for addressing school populations’ health in correspondence with the HPS goal of bringing together various amenities at school aiming to accomplish health and educational prosperity of stakeholders. School health developments in the United States culminated in the development by Turner (1952) of a ground-­ breaking school model of four domains. In her work, School Health and Health Education (1952), Turner presented one of the first known integrated school models. Though the WHO published valuable school health documents between 1951 and 1966 (WHO, 1951, 1954, 1966), none of those documents described school health programming as quintessential as did Turner in 1952. The following is an overview of Turner’s model of four components: We are now ready to set up the framework of the School Health Program [of] (1) hygienic school management, (2) sanitation, (3) school health services, and (4) health education. The three first mentioned contribute to the protection and promotion of health directly, but they also contribute to the health education of the pupil through his [sic] indirect learning. Likewise, the health of the teacher, and the school employees as well as community health programs in which the schools participate, play a part in the health education of the child. (1952, p. 26)

The model by Turner mirrors current frameworks as evidenced by the inclusion of multiple stakeholders, such as students, teachers, and staff. Additionally, I note how Turner’s model appears to have a science bias and to place more emphasis on the student. Further, like Turner, the school health protocol of Allensworth and Kolbe (1987) made reference to pedagogy and the curriculum aspects of education and centralized the subject of health education. Elsewhere, Nyika et  al.  (2017) discussed how Allensworth and Kolbe’s framework extended Turner’s model by adding several health-related programs for students, teachers, and staff. Building on the work of Turner (1952) and Allensworth and Kolbe (1987), Tymchak (2001) refined the integrated school health model creating SchoolPLUS, a whole new comprehensive assembly of various human services, including education, health, justice, and social services. SchoolPLUS

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was implemented in Canada’s Saskatchewan province in recognition of students’ emerging health and educational needs in the context of a changing social environment. In a Task Force report, Tymchak explained why SchoolPLUS was needed: For some time, we have been asking schools to deliver more and more services and meet more and more needs of that “school” was never intended to meet. Yet, these needs of children and youth must be met and, more and more than ever before, it makes sense to meet them in association with schools. The Task Force believes that the answer to this dilemma of the role of school, and the apparent competition between public education and the other needs of children, should be met not by asking “schools” as they are presently constituted to do more and more but, rather, by creating a new environment altogether. (p. 44)

Despite SchoolPLUS’ discontinuation in Saskatchewan, its legacy of community-­building continues to influence school health projects elsewhere in Canada (Province of Nova Scotia, 2022; Salm, 2015). As with other school health researchers (e.g., Lee, et al., 2014; Macnab, 2013), Tymchak advocated for a deconstructed viewing of school because HPS is not a program, but an approach to schooling founded on the principle of collective empowerment. The principle must arguably be reflected by health promoting schools’ four pillars (i.e., education, health-related programs, healthy school environment, and HPS policy) both as individuals and together, showing the importance of a systems approach to programming as well. To this end, it can be said that a school is either a health promoting school or is not, depending on the integrity of its schooling process as determined by the coherence of the constituent elements (Sánchez-Hernando et  al., 2022). This view disputes the validity of the proposal to use a count of health-related programs to decide whether or not a school is a health promoting school (Macnab, 2013). Even though the interest in health-related programs is conceivable, the act of prioritizing one component over the others is contrary to the ordinances of collectivity. In fact, there appears to be a tendency by researchers to study health-related programs (or specific health issues) and education more than school environment and policy, yet it is important to study the domains separately and together to get segregated and holistic understandings of programming (Rasberry et al., 2015; Simovska, 2012; Kontak et al., 2022).

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Like earlier models of Allensworth and Kolbe (1987) and Tymchak (2001), current models (e.g., Pan-Canadian Joint Consortium for School Health, 2021; Victorian Government, 2018) draw from combinations of science and social theory in recognition of stakeholders’ diverse health and educational needs. The models portray the school as an entity aimed at enhancing collectively the health and wellbeing of school populations. Still, the models may not be uniformly implemented across school sites owing to different needs of stakeholders, funding opportunities, and issues of governance (Gleddie & Robinson, 2017; Macnab, 2013; Rasberry et  al., 2015), indicating the political and context-specific nature of HPS.  The WHO and UNESCO (2021a) continues to refine the HPS framework and recently developed a practical guide for implementation, evaluation, and sustainability. Nevertheless, the guide appears to address rather weakly the role of Black students as historically marginalized school stakeholders. Chapter 4 discusses how Black students can be engaged using a culturally relevant intervention that seeks to legitimize the students’ cultures. It would appear the evolution of HPS was impacted by the WHO and school health researchers with the former publishing key school health documents in the mid-twentieth century (WHO, 1951, 1954, 1966). However, Turner (1952) proposed what is likely the first HPS model, which informed later models by Allensworth and Kolbe (1987) and Tymchak (2001). Despite the WHO seemingly dominating the conversation on the genesis of HPS (Turunen et al., 2017; Langford et al., 2017; Lee et al., 2014; Schools for Health in Ireland, 2013), it is arguably not the sole (and even primary) progenitor as school health researchers also made significant contributions. Honor must be given where it is due to increase confidence in the field of HPS (or any other field for that matter) because erroneous representation of historical facts undermines the legitimacy of knowledge. In the following section I respond to a question that troubled me throughout doctoral education several years ago: how does health status relate to school success? The discussion, which relates to health promoting schools’ underlying assumption, is situated within Archer’s (2003, 2007, 2012) theory of reflexivity or introspection and the philosophy of critical realism.

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Introducing the Multilayered Philosophy of Critical Realism Critical realism is founded on Bhaskar’s (1975, 1998) perception of a world governed by that which can be accessed by study, events that happen whether or not humans experience them, and underlying mechanisms. To critical realists, reality is a stratification of empiricism, human individuals, and the natural environment (Elder-Vass, 2010), suggesting human life is fundamentally influenced by factors internal and external to the human individual. The work of Bhaskar (1975, 1998) suggests an exhaustive understanding of underlying mechanisms would require studying individual strata separately and going beyond empirical outcomes to seek deeper meanings. Additionally, Bhaskar and Danermark (2006) argued that theory-based investigations capture generative mechanisms insufficiently indicating a need for ontological rigor and the use of in-­depth and analytical research approaches. Despite critical realism’s emphasis on both human individuals and structure, the absence of deep exploration of broader social factors is an important limitation. While it is important to consider personal and immediate social influences (e.g., cognition, family, and friends), it is hard to ignore the role of macro factors such as politics, power, and marginalization. In the context of this text, HPS are political institutions because their operations are strongly influenced by ruling regimes, who endeavor to control what counts as acceptable knowledge and behaviors (Salm, 2015; Raphael, 2013a, b). Critical realism has also been criticized for overemphasizing deeper explanations and for uncertainty about suitable empirical methods to unveil the deeper explanations (Alvesson & Sköldberg, 2009; Angus & Clark, 2012); however, its potential in health research is indicated. I am persuaded that a critical realist view of HPS can provide an encompassing view of the relationship between an individual’s health context and educational achievement.

A Reflexive View of Health Promoting School’s Underlying Assumption The over-30 years’ history of HPS appears to lack a clear understanding of the relationship between health condition and school success, yet such knowledge can help refine the HPS concept with its great promise of helping close the education achievement gap (Basch, 2011). Though it can be

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assumed an undernourished student, for example, will have difficulties learning, the mechanism of such a process may not be simple and straightforward as the student’s responses may depend on various individual and environmental factors. Guided by critical realist thought Archer (2003, 2007, 2012) developed a theory of reflexivity or introspection that says one’s cognition interweaves with the social environment to influence decision-making and the ability to act. Archer’s positioning of reflexivity within mental-cultural discourses supports a comprehensive definition of health as a confluence of body, soul, and milieu (WHO, 1997a). In this section I discuss health promoting school’s underlying assumption that a connection exists between health status and educational accomplishment (Allensworth & Kolbe, 1987; Symons et al., 1997), using Archer’s theory of reflexivity as framework. Archer (2012) identified four ways by which youths in western cultures engaged in internal self-examination as a result of cultural changes caused by monumental breakthroughs in technology: communicative reflexives (CR), autonomous reflexives (AR), meta-reflexives (MR), fractured reflexives (FR). Each reflexive type has a unique pattern of behavioral, attitudinal, familial, and employment characteristics as follows: (i) CR view the world as would their families and friends, (ii) AR feel they have freedom to make their own choices and unlike CR are capable of making enabling decisions, (iii) MR are divorced from their familial roots and welcome opportunities for change, and (iv) FR do not relate quite well with their families and are doubtful about their careers. As contended by Archer (2012), CR struggle to navigate the fluid contemporary life due to their inability to adapt their mental-cultural identities. Whether CR will persevere in postmodernity is uncertain, but there sure are many believers of tradition, of culture, of status quo, such as Ubuntists and social constructivists (Samkange & Samkange, 1980; Vygotsky, 1978). From an education perspective, Durkheim (1956) used the term homogeneity or sameness in describing the learning process as a preserve of particular traditions and beliefs. Contrary to CR, meta-­ reflexives’ high critical thinking relates to Plato’s (Bloom, 1968) perspective of education as an enabler of students’ transitioning through society. Typical of critical theorists, MR are wary of status quo and want to fight for their independence, indicating an epistemological view of knowledge as contested: “What these [weak] parental relationships have induced are young people who have to disengage from them in order to re-engage with the social order in terms of their own concerns” (Archer, p. 248). It

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is rather surprising how fragile familial bonds cause MR to develop strategies that enable them to gainfully interact with the fluid postmodern world. Because they are highly resilient, AR can easily cope with pressure from peers and dating partners. Thus, AR are capable of leading productive lives owing to flexible relationships with their home situations. Archer (2012) believed that unlike CR, AR have better chances of success in a changing social environment. It looks like AR correlate with a conservative and transformative education focus, reflecting both Durkheim’s “cultural heritage” and Platonian transcendary perspectives. In contrast to AR, FR are completely disconnected from their families and home friends and struggle to make sense of the world around them: “Equally regularly [FR] admit to huge difficulties in making decisions in defining courses of action to be constantly pursued and above all, in engaging in anything more than the survivalists’ day-to-day planning” (Archer, p. 249). Fractured reflexives’ seemingly negative and distracted maneuvering through life is a potential mental health condition. While failure to establish viable lifestyles unifies CR and FR, the latter are further weakened by total separation from their families. FR seem to be incompatible with either Durkheim’s preservation of cultural heritage or Plato’s transcendary views of education and may need specialist (psychological or spiritual) support to participate positively in the ever-changing contemporary world. Despite being criticized for overemphasizing individual agency and for citing unconvincing examples of social structure (King, 2006; Yeoh, 2011; Porpora, 2007), Archer (2003, 2007, 2012) adds a strong voice to educational discourses by consenting to students’ active involvement in determining their own lives. In support of the argument for teachers to lead implementation, health promoting schools’ principles of empowerment and community correspond with the educational theories of Plato, Rousseau, and Durkheim, to which Archer adds the concept of reflexivity. The work of Archer points to the association of CR with community-­ driven philosophies of Ubuntu and social constructivism, MR with critical theory perspectives, AR with combinations of Ubuntu or social constructivism and critical theory, and FR with psychological or spiritual strategies. I suppose the reflexively weak FR, who are impeded by their brokenness and low self-esteem, can benefit from interventions that emphasize psycho-­ spirituality. Also, it appears that community-based and critical theory-­based interventions would favor CR and both MR and AR, respectively. MR and AR, which resemble transformative education, are regarded

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by Archer as being more compatible with a changing world than CR and FR. However, it remains to be seen if reproduction of status quo, which is characteristic of CR, will become redundant. From an Archerian viewpoint, school and schooling is a function of a student’s mental-cultural context, which must be negotiated before the student can be educationally successful. This makes it a mental-cultural issue how well students use school and schooling provisions, such as student support services, breakfast programs, and Covid-19 prevention strategies. Therefore, the goal of HPS is to encourage positive school involvement by providing amenities that appeal mental-culturally to students in the immediate to lifelong instances as measured by such outcomes as school attendance and completion, critical citizenry, health literacy, and employment (Simovska, 2012; Lee et al., 2013). Figure 2.2 illustrates the connection between the school context, reflexivity, and school success. As indicated in Fig. 2.2, health condition is to school success a mental-­ cultural barrier, whose addressing or lack thereof affects school engagement; hence, school is more rewarding to students whose mental-cultural needs are provided for. Thus, health promoting schools’ underlying assumption can be explained by saying that a student is likely to succeed when school and schooling is in sync (Sheared, 1999) with the student’s mental-cultural circumstances. By considering students’ mental-cultural contexts a hindrance to school engagement, the theory of reflexivity deviates from psychosocial theories’ focus on motivation and relationships between students and school professionals (Basch, 2011; Ponsford et al., 2022). Either way, the connection between health and educational success is a complex matter that demands multi-pronged and adaptable interventions. School sevices & environments •e.g., health centres, breakfast program, and student support services

Health status •mental-cultural context

Fig. 2.2  Reflexivity in school and schooling

Educational prosperity •short to long term outcomes (e.g., grades, health literacy, critical citizenry, and employment)

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A well-coordinated school system would, through various agencies within the four pillars, attend expediently to each student’s mental-­cultural situations to help each student interact fruitfully with the school context. Schools may already have school-based and school-linked mental health programs, what may be missing is centralization of students’ mental health issues or culturally relevant mental health promotion (Kalra et al., 2012). Culturally relevant mental health promotion could have saved the life of Karyn Washington, founder of the For Brown Girls web site, who committed suicide several years ago (Cokley et al., 2014). Then there is Rehtaeh Parsons, whose tragic story has “haunted” me ever since doctoral education: Rehtaeh was 15 when she was allegedly sexually assaulted by four boys. One of the boys took a photo of the incident, which spread through the school via the internet. Months of cyberbullying from her peers followed, culminating in her suicide. (BBC News, 2014, para. 6)

Growing awareness of mental health-related issues among young people endorses the role of mental health promotion as an example of one aspect of health that may be associated with school health. Rehtaeh ended her life after being bullied on social media. Her parents went public with her story and were instrumental in raising awareness of the need to develop culturally relevant mental health promotion in schools. These advocacy thoughts inspired Chap. 4’s development of an intervention that accounts for Black students’ identities, ways of thinking, and aspirations. Insofar as HPS are arguably political, context-specific, and mental-­ culturally  seated, school health researchers must extensively examine school populations and school health environments using in-depth and analytical approaches, such as grounded theory, participatory action research, and ethnography. The sort of questions to ask include: (a) What is the nature of relationships between the school’s service providers, stakeholders, and leadership? (b) How do the different stakeholders see themselves within the school? (c) In what ways is the sense of community made manifest in the school? (d) How useful to stakeholders are school-based and school-linked programs in terms of relevance, equitability, and accessibility?

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Conclusion HPS can be described as integrated school systems designed to optimize the health and schooling of school stakeholders, such as students, teachers, and staff. It is noteworthy that HPS are community-oriented institutions with a shared responsibility for students’ wellness and educational success. However, health promoting schools’ complexities demand strong collaboration by knowledgeable leaders with good liaison skills to integrate multiple domains into a coherent unit, to establish productive and sustainable partnerships, and to ensure programming maintains a wholeschool focus. Despite the WHO seemingly dominating the conversation on the genesis of HPS, it is arguably not the sole (and even primary) progenitor as school health researchers also made significant contributions. My reflexive exploration of the relationship between health status and educational success highlighted the importance of culturally relevant mental health promotion to HPS, which has important implications for Black students’ health and schooling.

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CHAPTER 3

Being Black in Health Promoting Schools (HPS)

Abstract  This chapter reports on a literature review related to Black students, whose schooling needs may be unknown or poorly understood in the context of HPS. The purpose of the review was to establish the state of knowledge related to Black students’ participation in HPS across the globe to highlight knowledge gaps and key issues and concerns. A critical theory-based framework undergirded the review to better understand HPS as educational (and hence political) constructs, whose programming is inevitably disputable. Several themes were developed from the review, including race and racism in HPS, teachers and school health professionals, HPS leadership, funding, and successful HPS implementation. The chapter concludes by discussing how HPS may be modeled in relation to Black students using critical race theory as a framework. Keywords  Coordinated school health • Comprehensive school health • Blacks • Racial oppression • African

Introduction Health promoting schools’ goal of making stakeholders healthy and educationally successful demands that HPS have adaptable programs, services, and environments since stakeholders will always have manifold health and educational needs. This chapter reports on a literature review related to © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 L. Nyika, Advancing a Health Promoting Schools Agenda for Black Students, https://doi.org/10.1007/978-3-031-44702-0_3

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Black students, whose schooling needs may be unknown or poorly understood in the context of HPS. The purpose of the review was to establish the state of knowledge related to Black students’ participation in HPS across the globe to highlight knowledge gaps and key issues and concerns. The term Black students is used here without geographical restrictions and applies to students of African heritage the world over. My research question was as follows: What is the state of knowledge related to HPS and Black students? The review, which was conducted solely by the author, seeks to give an overview of existing bodies of knowledge, but with less emphasis on methods and methodologies. The initial plan to conduct a scoping review was constrained by difficulties in finding suitable co-­ reviewers due to circumstances beyond my control. Hence, the appraisal uses elements of scoping review (Jesson, 2011; Arksey & O’Malley, 2005; Peters et al., 2022), with the author being the sole reviewer, which would necessarily decrease the appraisal’s rigor. The three terms of HPS, comprehensive school health, and coordinated school health may be used interchangeably (Kontak et  al., 2022; Ohinmaa et  al., 2011; World Health Organization (WHO) & United Nations Education Scientific and Cultural Organization (UNESCO), 2021a); however, the reader is advised only the term HPS will be used in this text for convenience purposes. Cooper and White’s (2012) critical theory-based framework undergirds the review to better understand HPS as educational (and hence political) constructs, whose programming is inevitably disputable. The protocol of Cooper and White centralizes the role of power in qualitative research, power being problematic because it operates in composite and insidious ways to drive injustices. Epistemologically, the protocol frames knowledge production and representation as contextual and contested. I begin the chapter by describing the review procedure as guided by standard frameworks (Nishio et al., 2018; Robinson & Young, 2019; McIsaac et  al., 2016). This is followed by a discussion of the themes that were developed from the review. The chapter concludes by discussing how HPS may be modeled in relation to Black students using critical race theory (CRT) as a framework.

Review Procedure Various online databases and search engines were used to review literature from within the last ten years ending July 31, 2022. The period of ten years was preferred as this appears to be a standard time-frame for

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knowledge that can be considered “recent” (Paul & Criado, 2020; Racine et al., 2012; Aoun et al., 2013) and to my knowledge it is standard practice to assess recent work when doing literature reviews. However, while the intention was to appraise recent literature, seminal publications were considered as well and these could go beyond ten years. Of the many databases and search engines searched, the following were found to contain relevant publications: ERIC, African Journals Online, Science Direct, Oxford Academic Journals, SAGE Journals online, and JSTOR. Between October, 2021 and July, 2022, I, the author, searched for peer reviewed and substantial grey literature written in English using two inclusion criteria. First, eligible publications had to relate to the concept of HPS, which is not a program, but an approach to schooling (see Chap. 2). Second, eligible publications had to relate to Black students in their role as historically marginalized school stakeholders. Search and Selection Processes The following search terms were used adjustably to the different online data sources: HPS (or comprehensive school health, coordinated school health, whole-school health) And Black, African students (and American or Canadian or European or African or Caribbean) Or Africa (or Cameroon or Central African Republic or Chad or Congo or Democratic Republic of the Congo or Equatorial Guinea or Gabon or Burundi or Djibouti or Eritrea or Ethiopia or Kenya or Rwanda or Somalia or South Sudan or Sudan or Tanzania or Uganda or Benin or Burkina Faso or Cape Verde or Cote d’Ivoire or Gambia or Ghana or Guinea or Guinea-Bissau or Liberia or Mali or Mauritania or Niger or Nigeria or Senegal or Sierra Leone or Togo or Algeria or Egypt or Libya or Morocco or Tunisia or Angola or Botswana or Lesotho or Malawi or Mozambique or Namibia or South Africa or Swaziland/Eswatini or Zambia or Zimbabwe). My searches yielded a total of 598 records (i.e., 586 from databases and 12 from other sources, as guided by expert opinions and random manual searches). After adjusting for duplicates, the initial screening by title resulted in the exclusion of 556 records to remain with 42. The 42 records were further screened by assessing the abstract, introduction, conclusion, and full text. This process resulted in the further exclusion of 25 records to remain with 17, which were subsequently included in the review as shown in Fig. 3.1.

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Records identified through Records identified

other sources, e.g., expert

from database searches

advice

(n = 586)

(n =12)

Records after duplicates

Records excluded after

removed

screening by title

(n = 598)

(n = 556)

Full texts assessed for Full texts excluded

eligibility

(n = 25)

(n = 42)

Records included in review (n = 17)

Fig. 3.1  Summary of review process

The eligible publications came from two main jurisdictions as follows: Africa (South Africa 8, Kenya 3, and Nigeria 1) and North America (Canada 1 and United States 4). Development of Themes Drawing on the work of Robinson and Young (2019), I organized the eligible publications (n  =  17) into a table with the following sections:

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author(s), year, country, key findings, and conclusion (see Appendix). Following this I sieved through the table for common threads/ideas and sorted them into codes. The codes were then manually grouped into broad themes, which were refined into final themes using elements of basic content and thematic analysis (Braun & Clarke, 2019; Hsieh & Shannon, 2005; Thompson, 2022). This procedure produced five overarching themes: race and racism in HPS, teachers and school health professionals, HPS leadership, funding, and successful HPS implementation, which were interpreted in the context of health promoting schools’ four pillars of education, health-related programs, healthy school environment, and HPS policy (Pan-Canadian Joint Consortium for School Health, 2021; Salm, 2015; Lee et al., 2014, WHO & United Nations Education Scientific and Cultural Organization (UNESCO), 2021a, c; Lee et  al.; Samdal & Rowling, 2012; Macnab, 2013).

Themes This section discusses the review’s themes of race and racism in HPS, teachers and school health professionals, HPS leadership, funding, and successful HPS implementation. Race and Racism in HPS Literature from mostly North America stressed the importance of race and racism in HPS.  From a study of Black immigrant students to Canada, Nyika (2022) concluded that: “By confirming [HPS] as racially contested settings, findings from the study provide empirical evidence of the significance of race and racism, and the need to address these as part of comprehensive school health programming” (p.  13). Author’s work provides much-needed evidence for the presence of racial oppression in HPS contexts. Additionally, Cokley et al. (2014) contended Black students needed culturally relevant programs to fight race and racism, such as employing role model Black teachers and school health professionals. Further, Henderson et  al. (2019) and Lewis and Teasdell (2021) described how fault-oriented views of Black people was a driver of racial oppression: “Drawing attention to deficits in black youth, their family, and neighborhoods as predictors of poor health outcomes negates the effects of racism” (Henderson et al., p. 926). The work of Henderson et al. and Lewis and Teasdale encouraged the use of culturally appropriate language, for example, minoritized and marginalized versus disadvantaged and at risk.

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Funding Reviewed literature showed a need for adequate funding to establish and sustain health-related programs and services (WHO & UNESCO, 2021b; Macnab et al., 2014; Ekenedo & Ekechukwu, 2015; Shung-King et al., 2014; Reddy & Singh, 2017). A South African study by Shung-King et al.’s (2014) underscored the importance of funding as notable limitation to successful implementation: The school health service does not have specific nor sufficient budget allocations in national, provincial or district [level] budgets. School health competes against many other priorities, and although some staff and transport costs are covered, the shortfall remains significant. (p. 68)

As suggested by Shung-King et al., government funds make it possible for schools to buy material resources needed by stakeholders, showing the important role of government in the establishment of HPS. HPS Leadership The review underscored the value of professionalism in the management of HPS.  Kwatubana et  al. (2021) commented that “principals play an important role of facilitating, strengthening and sustaining collaborations and partnerships. Collaborations and partnerships are a cornerstone of school health promotion” (para. 30). The comment by Kwatubana suggests trained or professionally developed school leaders are needed to integrate health promoting schools’ various domains into a compact unit. This view is supported by Shung-King et al. (2014), whose work highlighted a need for knowledgeable HPS leaders: The lead government departments responsible for school health differ across countries, with health assuming the primary responsibility in some and education in others. On this matter, the review emphasised the need for close collaboration between health and education, regardless of which department led the service. It further stressed the integral role that educators could play in school health service interventions. (p. 65)

I note how Shung-King et al. acknowledged the importance of teachers in HPS programming as discussed in the following section.

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Teachers and School Health Professionals According to the review, successful HPS programming is associated with the nature of relationships between students, teachers, and school health professionals (Reddy, 2019; Henderson et al., 2019; Shung-King, 2013; WHO & UNESCO, 2021b; Reddy & Singh, 2017; Macnab et al., 2014; Tomokawa et al., 2020). I refer to the work of Mashamba et al. (2022): Taken together, the case studies illustrate the role of competency building among both educators and students to implement HPS programs in secondary schools that result in capacity and motivation to transform the educational environment in South Africa into an environment that enables educators and learners to achieve their full health potential. (p. 13)

Mashamba et al.’s comment highlights the centrality of students in HPS and the significant role of professionally developed teachers. Additionally, the work of Cokley et al. (2014), Caldwell et al. (2009), and Nyika (2022) puts into perspective the importance to school professionals of the ability to relate to Blackness, Black identity, and Black culture. Successful HPS Implementation The potential for HPS success is indicated by the work of Tomokawa (2020) and Akiyama et al. (2020): The results of this study indicate that a comprehensive school health project in Kenya contributed to improving not only health-related knowledge, attitudes and practices, and self-evaluated physical and mental health status, but also a sense of school belongingness, self-awareness of health control, recognition of the importance of learning about health in school, and ­absenteeism. Subjective happiness, however, did not improve significantly. (Tomokawa et al., 2020, p. 8)

I note how Tomokawa et al. acknowledged the poor addressing of “subjective happiness”, showing a need to still revise programming. Although not shown in the above quote, Tomokawa et al. mentioned that teachers had been professionally developed as part of programming. It is possible the training of educators may have factored into Kenya’s success story. The review underscored the important role of teachers along with calls to

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standardize their role through professional development (Mashamba et al., 2022; Reddy & Singh, 2017; Henderson et al., 2019; Cokley et al., 2014), in support of the argument for teachers to lead implementation.

Discussion It is encouraging to have reports of successful HPS programming involving Black students, even though the studies came from one jurisdiction of Africa. What can be seen from the reports is the clear involvement of teachers and especially professionally developed teachers (Akiyama et al., 2020; Tomokawa et al., 2020). It is interesting to have follow up studies and also to use assorted evaluation methods. Teachers are important to HPS for several reasons. First, teachers teach health-related subjects (e.g., health education, life sciences, biology, and physical education), these have a considerable impact on students’ health knowledge, attitudes, and behaviors (Laschke et  al., 2023) Second, teachers naturally assume the role of parents as students would look up to them for guidance and counselling (Dowling & Doyle, 2017). Third, teachers have in-depth understandings of the relevant learning processes and of child development (Kambouri, 2016). The significance of teachers and principals evidenced in this review supports the argument for conceptualizing HPS in relation to education perspectives (Simovska, 2012; Samdal & Rowling, 2012). This suggests teachers need to be knowledgeable about the HPS approach, whose principles must seep into the curriculum and teachers’ pedagogical strategies. The role of teachers interlinks with students as part of health promoting schools’ two pillars of education and health-related programs, suggesting the importance of professional development to ensure proficiency and especially in relation to Black students. This review underscores a need to consolidate the role of teachers and the curriculum in HPS, whose programming should arguably draw from educational theory and education professionals. I believe it is prerequisite for the education sector, as the backbone of school and schooling, to lead implementation with the support of applicable fields of study. This perspective has implications for teacher education and professional development. Moreover, the pivotal role of teachers in programming underlines the value of revising teacher education since school and schooling is arguably linked to educational (and social) theory. It is interesting to further explore the role in HPS of teacher education and the professional development of school professionals, including principals, teachers, and school

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health professionals. As mentioned in Chap. 2, professional leadership may not be recognized as a HPS pillar, however its contribution to programming is indicated (Kwatubana et al., 2021; Shung-King et al., 2014; Gleddie & Robinson, 2017; Rasberry et al., 2015; Storey et al., 2016). Teachers may be critical to effective programming but additional chores assigned to them as a result of school health promotion (Reddy, 2019; Reddy & Singh, 2017; Tomokawa et  al., 2020) do not help teachers’ already overloaded schedules. It is difficult for teachers to cope with the ever-increasing demands of human health and education, whose burden is often placed on the shoulders of the teacher with little or no training. Such unproductive moves have only resulted in more teacher strikes and half-­ hearted teaching (Sulz et al., 2016; The Educator, 2022). Thus, it is reasonable to call for the introduction of a new group of school professionals with training in pedagogy, health, and educational leadership, who can effectively dialogue with, motivate, and build teamwork between key stakeholders (Wasonga et al., 2014). Health education is key to HPS and so too should be the training of health education teachers. Building on the work of the government of Papua New Guinea (2009), teacher education can be broadened to include HPS, social justice education, and health equity as well as critical theory perspectives of CRT, disability studies, and feminism. Some post-secondary schools may already be doing this, but more needs to be done about the training of health education teachers in the context of HPS. Consistent with prior research (Simovska, 2012; Macnab, 2013; St. Leger et  al., 2022), this review confirmed that funding is a major hindrance to HPS programming and especially concerning health-related programs, showing the importance of strong financial support from central authorities. As national leaders, governments must pay more than lip service to health promotion as they are responsible for the development and sustenance of public health and education. Being custodians of public health, governments the world over have an obligation to address and eliminate health inequities, which are intimately connected to social determinants of health (SDoH) and marginalization (Beckfield et  al., 2013; Medvedyuk et al., 2018). Surely, there is no justification whatsoever for any viable government to not fund school health promotion in the era of Covid-19 and beyond. From a CRT viewpoint, it is disconcerting the review’s African literature makes little reference to race and racism in comparison to the North American literature where the discussion is center stage. At this point in

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the history of human health and development the need for global attention to racial oppression is apparent, we saw this happen after the death of George Floyd in 2020 (Tedam & Cane, 2022; Weine et al., 2020). Insofar as the world has arguably become more connected in space and time, it is crucial for HPS conversations to centralize the issue of race and racism within health promoting schools’ four pillars of education, health-related programs, HPS policy, and healthy school environment (Pan-Canadian Joint Consortium for School Health, 2021; Salm, 2015; Lee et al., 2014, 2020; WHO & UNESCO, 2021a, c; Samdal & Rowling, 2012; Macnab, 2013). If anything, the understatement of race and racism in the reviewed African literature should not be taken to indicate its absence from or prevent its occurrence in the continent of Africa. Race and racism is an ancient social creation with deep roots in politics and scholarship (Lynn & Dixson, 2013; Delgado & Stefancic, 2012), the injustice will not disappear just because the world has become more aware of it. The increased awareness of racial injustices is definitely a good sign, yet express and deliberate actions are still needed. For example, it is necessary to increase the school leadership of Black people by training and hiring suitably qualified Black education and school health professionals, who act as role models to Black students. As reflected in this review, deficit-­ oriented descriptions of Black students are culturally unfriendly, belittle Blacks, and perpetuate anti-Black racism (Henderson et al., 2019; Lewis & Teasdell, 2021). Deficit-oriented terminology (e.g., voiceless, minority, at risk, disadvantaged, and vulnerable) tend to make Black students the problem which is incorrect because the problem is actually oppression. Hence, it is more appropriate to use culturally relevant words like racialized, minoritized, and marginalized. I urge the WHO and UNESCO (2021a) to not merely call for every school to become a health promoting school, but to also call for every health promoting school to be racially equitable. However, the entanglement of race and racism with other SDoH to co-influence health status must be acknowledged (Henderson et  al., 2019; Cokley et  al., 2014; Nyika, 2022; Nyika & Murray-Orr, 2017), this signals the value of multidimensional whole-school interventions. While the need for culturally relevant programming is a recurring suggestion in this review (Lewis & Teasdell, 2021; Henderson et  al.; Cokley et  al., 2014; Shung-­King, 2013; Nyika, 2022), there is scant empirical evidence of how Black students conceptualize HPS and their

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role in it. Future research must address this knowledge gap to help us better understand and consider how HPS may be designed to more effectively engage Black students. The following section discusses how HPS may be modeled in relation to Black students using a race-based framework. It is the goal of the section to make the students look forward to the next day of school because the day brings genuine hope of a better present and future.

HPS for Blacks: A CRT Perspective For centuries on end, humanity was encouraged to take for granted White supremacy by accepting White people as natural leaders and in every way perfect. As contended by Harris (1993), the White condition was created to guarantee perpetual advantages to the White race. This means that being White would translate to material wealth, even social capital (Durkheim, 1956) or cultural superiority. These ordinary, but infectious, views of skin coloration spurred the creation of race and racism by making people accept as normal White dominance and non-white inferiority. To which politics is complicit because ruling regimes have (sovereign, hierarchical, and legislative) power over the proliferation of societal ways of thinking, attitudes, and behaviors (Apple, 2006; Brookfield, 2005; Foucault, 1980). The normalization of race and racism triggered the formation of the politically left CRT at the end of the 1970s to confront racial injustices and White supremacy (Lynn & Dixson, 2013; Treviño et al., 2008). Thus, CRT can be defined as an interpretive framework that focuses on and advocates for justice, freedom, and empowerment of the racially marginalized, such as Black, Indigenous People of Color (BIPOC). CRT is compatible with the HPS concept as both frameworks are empowerment-­driven, moreover CRT centralizes the issue of race and racism, a social determinant of health which affects Black students’ HPS participation as discussed earlier. It is of essence to position race and racism within the context of slavery (West, 2001), which stretches back to old civilizations. Hollander (1963) was of the opinion that slavery in the ancient days was somewhat democratic because of its condemnation of prolonged slavery without the slave’s consent. This suggests slavery became more oppressive with the onset of capitalism resulting in centuries of exploitation and abuse of BIPOC round the world.

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Introducing CRT Race and racism is ordinary, it is constructed, regulated, and reinforced covertly or otherwise in discourse, in social structures, and in everyday interactions. The seed for CRT arguably began to be sown by Karl Marx in the mid-19 century. Marx’s (1887) view of eco-political power as a tool for oppressing ordinary citizens correlates with Dubois’s (1903) observation of a world divided by prejudiced views of skin coloration, causing the unjust empowerment and disempowerment of White people and BIPOC respectively. Dubois’ seminal work, The Soul of Black Folk (1903), concretely situated oppression within race discourses and most definitely foregrounded the emergence of CRT: The problem of the twentieth century is the problem of the color-line — the relation of the dark to the lighter races of men in Asia and Africa, in America and the islands of the sea. It was a phase of this problem that caused the Civil War; and however much they who marched South and North in 1861 may have fixed on the technical points of union and local autonomy as a shibboleth, all nevertheless knew, as we know, that the question of Negro slavery was the real cause of the conflict. (p. 9)

Du Bois argued that race is political and a notable determinant of human health and wellness, however he discussed rather poorly the legislative implications of race and racism. This shortcoming was addressed by Bell and others (Bell, 1980; Crenshaw et al., 1995) leading to the formation of CRT between the end of 1970s and early 1980s, as a philosophical framework that focuses on the worldviews of the racially oppressed. The following characteristics of race and racism are indicated in the literature (Lynn & Dixson, 2013; Ladson-Billings, 1998; Delgado & Stefancic, 2012; Crenshaw et al., 1995): • Race and racism is produced in discourse. • Race and racism is socially constructed. • Race and racism is political. • Race and racism is common. • Race and racism is a SDoH. • Race and racism intersects with slavery, capitalism, and other SDoH.

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The emergence of CRT as a legal movement marked the beginning of hope for BIPOC the world over. CRT recognizes, celebrates, and advocates for the emancipation and empowerment of the voices of the racially oppressed. Even so, the critical race theorist desires more than just giving a voice and wishes for racially marginalized people to have hope. Thus, critical race theorists have issues with identity, racial identity, with the soul, with how BIPOC see themselves, how they prosper, and how they transform society (Cerezo et al., 2013). The intention, as suggested by Maynard (2017), being to disengage (and be free) from prejudiced conceptions of who they are, who they are not, who they can or cannot be, who they must and must not be. CRT recognizes the ability of educational institutions to influence people’ ways of thinking, showing the importance of counter narratives in denouncing prejudiced views of BIPOC.  The work of Treviño et  al. (2008) is relevant here: Critical race scholars have in the past dozen or so years turned to writing in the form of narrative, or “storytelling,” not only as a rhetorical device for conveying their personalized racialized experiences but also as a way of countering the metanarratives— the images, preconceptions, and myths— that have been propagated by the dominant culture of hegemonic Whiteness as a way of maintaining racial inequality. (p. 8)

As suggested by Treviño et  al., knowledge (production and representation) plays a key role in the sustenance of racial injustices. For example, central authorities tremendously shape ordinary people’s worldviews by determining the kinds of knowledges found in the media, at school, and other public spaces (Van Dijk, 2015). This discursive power has for centuries succeeded to perpetuate normative perceptions of race that unjustly exulted White people at the expense of every other race (Cerezo et  al., 2013; Maynard, 2017), suggesting White supremacy is the root cause of racial oppression with the two terms being mutually inclusive. Counter stories seek to empower BIPOC by helping them confront, reflect upon, and consider their role in and how to overcome racial oppression. Likewise, this book is a counter-story. To my knowledge this is the first known book written from an African viewpoint in health promoting schools’ over 30 years of existence. The African viewpoint is a valuable alternative to a schooling approach that is dominated by Eurocentric ideologies (Clift & Jensen, 2005; Samdal & Rowling, 2012; Knisel, 2019;

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WHO & UNESCO, 2021a), more so with the world becoming more aware of race and racism. Nonetheless, writing this book has increased my appreciation of the fact that race and racism interweaves with other social constructs (e.g., gender and sexual orientation, disability, and socioeconomic status) to co-determine Black students’ health and wellbeing. It is my hope readers will be encouraged to look inside themselves and decide how HPS can be made more inviting to Black students in the postmodern era, especially considering the entanglement of race and racism with other SDoH.  There appears to be little discussion on CRT and HPS, but I (Nyika, 2022) recently used the example of African immigrant students to demonstrate the significance to HPS research of a philosophical blend of CRT and social constructivism. CRT, HPS, and Black Students CRT is compatible with culturally relevant interventions that target historically othered members of society aiming to enhance their cultural proficiency, critical thinking, and social development (Ladson-Billings, 1995; Guy, 2002, Gay, 2010; Airhihenbuwa, 2007). As mentioned before, one goal of CRT is to increase hope and confidence of the racially marginalized, which can be achieved by employing more Black teachers and school health professionals. Race and racism interconnects with other SDoH (e.g., disability, gender and sexual orientation, education, and socioeconomic status) to co-influence the health conditions of Blacks, showing the value of comprehensive, but race-based interventions (Henderson et al., 2019). It is one thing to give voice and another to engage Blackness through food, poetry and art, sports, and music. “Hey yo?!” It is well with hip hop, spoken word, and basketball if it causes Black students to return to school the next day knowing they can be who they are, who they want to be, and who they will be without fear or being feared (Greason & Jerry, 2023; Maynard, 2017). With reference to Black students, I believe culturally relevant interventions can be enhanced by the philosophy of collectivity known as Ubuntu. As discussed in Chap. 1, Ubuntu is uniquely African and its power of love makes it applicable to education, health, and health promotion (Letseka, 2012; Wilson & Williams, 2013). Culturally relevant interventions have important implications for teacher education and the professional development of school professionals. The CRT framework supports the matching of the Black voice with appropriate material structures at school within each of health promoting

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school’s four domains of education, health-related programs, healthy school environment, and HPS policy. Black students’ voice must be matched with culturally appropriate health-related programs and services. Nyika (2022) made the following comments from a recent Canadian study of African immigrant students: There was some degree of unease about [youth health] centres as some participants perceived these locations as “not for them” because of poor representation of the Black race in daily services, environments and programmes. In contrast, involvement in physical activity and support by the African Nova Scotian student support worker proved to be empowering. (p. 12)

As indicated by Author, Black students felt marginalized at youth health centers, but this was not the case with the African student support program which served as a source of inspiration, keeping the students hopeful and motivated at school. It can be assumed the sporting activities were also culturally appropriate given that race and racism pervades all dimensions of postmodern life, including sports and entertainment (Kwenda, 2022; Leonard, 2017). Additionally, the Black voice must be matched with culturally relevant legislation and policies, schooling philosophies, leadership, and pedagogy (Brown-Jeffy & Cooper, 2011). Drawing on the work of Henderson et al. (2019) and Lewis and Teasdell (2021), anti-­ deficit viewing of Blacks should be emphasized in support of anti-racist education. There is no place whatsoever for deficit viewing of BIPOC, it is racial aggression and an injustice to use such terms as disadvantaged, at risk, and vulnerable. Alternatively, the beholder can use culturally relevant words like marginalized, minoritized, racialized, and oppressed.

Conclusion A notable highlight of this chapter is a need to consolidate and strengthen the role of teachers in HPS. Teachers are natural school leaders and their function needs to be strengthened because they have relevant working knowledge of child development, spend more time with students, and are relatively familiar with the politics of school and schooling. Strong collaboration is needed across and within education and health sectors, showing the importance of knowledgeable (trained or professionally developed) principals, teachers, and school health professionals. Yet, as political

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institutions, HPS cannot truly engage Black students without addressing the issue of race and racism, suggesting the importance of a race-based positioning. Writing this chapter increased my own understanding of oppression, I was able to look inside myself and began to wonder how HPS can be made more inviting to Black students considering the entanglement of race and racism with other SDoH, such as gender and sexual orientation, education, and disability. With these advocacy thoughts in mind, I decided to develop an intervention that can be used to uplift the HPS participation of Black students as the proceeding chapter will show.

References Airhihenbuwa, C. O. (2007). Healing our differences: The crisis of global health and the politics of identity. Rowman & Littlefield. Akiyama, T., Njenga, S. M., Njomo, D. W., Takeuchi, R., Kazama, H., Mutua, A., et  al. (2020). Implementation of Kenyan comprehensive school health program: Improvement and association with students’ academic attainment. Health Promotion International, 35(6), 1441–1461. Aoun, S. M., Bentley, B., Funk, L., Toye, C., Grande, G., & Stajduhar, K. J. (2013). A 10-year literature review of family caregiving for motor neurone disease: Moving from caregiver burden studies to palliative care interventions. Palliative Medicine, 27(5), 437–446. Apple, M.  W. (2006). Educating the “right” way: Markets, standards, god, and inequality. Routledge. Arksey, H., & O’Malley, L. (2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology, 8, 19–32. Beckfield, J., Olafsdottir, S., & Bakhtiari, E. (2013). Health inequities in global context. American Behavioral Scientist, 57(8), 1014–1039. Bell, D. A., Jr. (1980). Brown v. Board of Education and the interest-convergence dilemma. Harvard Law Review, 518–533. Braun, V., & Clarke, V. (2019). Reflecting on reflexive thematic analysis. Qualitative Research in Sport, Exercise and Health, 11(4), 589–597. Brookfield, S. (2005). The power of critical theory: Liberating adult learning and teaching. Jossey-Bass. Brown-Jeffy, S., & Cooper, J. E. (2011). Toward a conceptual framework of culturally relevant pedagogy: An overview of the conceptual and theoretical literature. Teacher Education Quarterly, 38(1), 65–84. Caldwell, L. D., Sewell, A. A., Parks, N., & Toldson, I. A. (2009). Guest editorial: Before the bell rings: Implementing coordinated school health models to influence the academic achievement of African American males. The Journal of Negro Education, 78, 204–215.

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CHAPTER 4

Culturally Relevant School Health Promotion: Fighting Black Students’ Marginalization and Disproportionate Schooling Abstract  Although the viability of culturally relevant interventions is indicated, their application in health promoting schools (HPS) appears to be scant, especially at the whole-school level. This chapter presents a model of culturally relevant school health promotion that seeks to adapt HPS to Black students’ sociocultural contexts. The model was developed from the concept of social determinants of health, which considers cultural constructs (not disease!) a constraint to people’s health, such as race and racism, politics, and disability. The social determinants of health framework is compatible with the HPS approach as both concepts fundamentally interrogate underlying issues of power and equity; hence, the chapter takes a critical theory positionality. Keywords  Coordinated school health • Comprehensive school health • Minoritization • Blacks • Culture

Introduction Marginalization (or minoritization) is an injustice that happens when prejudices cause fellow citizens of this world to be othered, ignored, and silenced (Hall & Carlson, 2016). Black students, for example, are marginalized prior to the beginning of school owing to endemic racism in human © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 L. Nyika, Advancing a Health Promoting Schools Agenda for Black Students, https://doi.org/10.1007/978-3-031-44702-0_4

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cultures (Caldwell et al., 2009). The continued marginalization of Black students (Schroeder, 2016; Hodge & Harrison, 2021; Shockley & Lomotey, 2020) may be indicative of the inadequacy of the commonly used science and inclusion-based schooling frameworks (Viljoen et  al., 2005; Lee et al., 2020; World Health Organization (WHO) and United Nations Education Scientific and Cultural Organization (UNESCO), 2021a), suggesting the importance of culturally relevant frameworks that seek to authenticate the students’ ways of being. Although the viability of culturally relevant interventions is indicated (Crooks et al., 2015; Decuir-­ Gunby et al., 2010), their application in Health Promoting Schools (HPS) appears to be scant, especially at the whole-school level. As evidenced in Chap. 3, comprehensive, race-based interventions are needed to authentically engage Black students in HPS. The three terms of HPS, comprehensive school health, and coordinated school health may be used interchangeably (Kontak et  al., 2022; Ohinmaa et  al., 2011; WHO & UNESCO, 2021a); however, the reader is advised only the term HPS will be used in this text for convenience purposes. This chapter presents a model of culturally relevant school health promotion that seeks to adapt HPS to Black students’ sociocultural contexts. The model was developed from the concept of social determinants of health (SDoH), which considers cultural constructs (not disease!) a constraint to people’s health, such as race and racism, politics, and disability (Raphael, 2009; Bryant et  al., 2011; WHO, 2022). Still, it must be remembered the Ottawa Charter (1986) is a key document in shifting the narrative to focus on health promotion, rather than traditional biomedical views of health. Indeed, the SDoH framework is compatible with the HPS approach as both concepts fundamentally interrogate underlying issues of power and equity; hence, the chapter takes a critical theory positionality. The chapter begins by introducing critical theory, a philosophical framework that problematizes the operations of power in human life (Brookfield, 2005). This is followed by the introduction of SDoH to show their relevance to marginalization as implicit contributors to the exacerbation of health inequities. It is health inequities that cause unjust differences in people’ abilities to lead healthy and prosperous lives, with ordinary people coming out the worst (Braveman & Gruskin, 2003; Beckfield et al., 2013). The chapter concludes by discussing the limitations of using culturally relevant school health promotion as an intervention.

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Critical Theory: Unraveling the Injustices of Human Life As an injustice, marginalization cannot be fully understood without considering how power operates in complex and obscure ways to drive inequities, exploitation, and abuse of ordinary members of society. This brings into perspective the significance of critical theory, an anti-oppression interpretive framework that problematizes the role of power in human life and being human (Brookfield, 2005). It is arguable that issues of power and oppression, whose embryonic conceptions are traceable to the work of Marx (1887, 1968), underpin many human interactions and fields of study, including education, health, and health promotion. As far back as the nineteenth century, Marx and Engels (1848) noted the oppressive nature of human cultures, with governments using eco-political powers to sustain corrupt status quos. Society today is plagued with various forms of oppression owing to governments’ control of key social constructs (e.g., education and politics) that regulate knowledge and influence what counts as acceptable behaviors and practices (Raphael, 2008; Apple, 2006). The critical theory ideology deems it mandatory for research to emancipate people, even Black students, giving them power to make better their lives. Rather than working toward the goal of understanding how the world works as do interpretivists, critical theorists want to unravel the injustices that constitute human life (Cooper & White, 2012), thereby supporting an epistemological view of knowledge as contested. The fact that prejudices, biases, and stereotypes are produced and reproduced in discourse and in everyday experiences makes it pre-eminent to vigilantly challenge the taken for granted (Freire, 1973, 1998, 1970/2005). I am drawn to the story of a French politician named De Tocqueville, who questioned the role of his government in colonial Algeria in 1846: The African question, complicated and important as it is, may be summed up in these words: ___ How shall we succeed in raising a French population, with our laws, our manners, and our civilization, and at the same time treat the natives with the consideration to which we are bound by honor, by justice, by humanity, and by our real interests?… I assure you that I go to Algiers perfectly unprejudiced as to the man whom I shall meet, and the things which I shall see. (De Tocqueville, 1862, pp. 83–84)

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De Tocqueville’s writing reflects the positionality of a researcher who is wary of status quo, a critical scholar who approaches the research process with an analytical mind to learn about the different ways people understand the world around them in relation to power and oppression. Typical of critical theorists, De Tocqueville entered the research arena knowing his interactions with people will be influenced by such constructs as politics, race and racism, gender and sexual orientation, and socioeconomic status (Brookfield, 2005). To the extent that power can be used to marginalize Black students, critical theory is one way of ensuring the creation of equitable HPS programming by questioning the sincerity of HPS knowledge production, presentation, and distribution. Moreover, critical theory-­ based interventions are needed to counter marginalization which greatly inhibits Black students’ school participation and to maximize equitability (Schroeder, 2016; Henderson et  al., 2019; Hodge & Harrison, 2021). The following section discusses the role of the critical theory-based SDoH as disproportionate drivers of human health and wellbeing.

An Introduction to SDoH Raphael (2009) described SDoH in relation to community and production: “Social determinants of health are the economic and social conditions that shape the health of individuals, communities, and jurisdictions” (p. 2). Bryant et al. (2011) referred to SDoH as sociological elements or “Societal factors that shape the health of individuals and populations” (p. 45). The WHO (2022) used the term “non-medical factors” in recognition of the impact on being healthy of human-created contexts, including economics, politics, and culture. What can be deduced from these definitions is the nature of SDoH as human-created, context-driven, and political. Following this line of thought, I define SDoH as cultural constructs that disproportionately affect people’s health. Like culture itself, the creation of cultural constructs is susceptible to the dynamics of power and domination, these being typically skewed in favor of the most powerful to the disadvantage of the common person (Bhabha, 1998). The SDoH lists developed over the years include several power-laden concepts of education, politics, race and racism, disability, gender and sexual orientation, and socioeconomic status (Bryant et  al., 2011; Dahlgren & Whitehead, 1991/2007; Mikkonen & Raphael, 2010; the Toronto Charter, 2002; Wilkinson & Marmot, 2003; WHO, 2022; Dennis et al.,

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2019; McGibbon, 2012); however, it is difficult to compose an exhaustive list as they are necessarily political. Starting with education, I introduce each key social construct in turn. Education Education can be described as the orderly acquisition of knowledge, skills, and attitudes (via a curriculum, teaching and learning, and assessment) that inevitably draws from societal beliefs, norms, and values: “Education is a socially facilitated process of cultural transmission whose explicit goal is to effect an enduring change for the better in the character and psychological well-being (the personhood) of its recipient” (Jackson, 2011, p.  95). Jackson associated education with culture and normativity, suggesting it is disputable and largely influenced by dominant groups, who are powerful politically, economically, and discursively. This view supports Marx’s (1887) perspective of education as a driver of elitist culture, which would make culture more or less predictable. It has long been observed that the interconnection between education and health is vital to human life, especially as it relates to health decision-making, employment opportunities, and healthy living (Ross & Wu, 1995). As the bedrock of school and schooling, education can certainly be considered forerunner to the HPS concept, which justifies the call for HPS conversations to prioritize educational perspectives (Simovska, 2012; Samdal & Rowling, 2012). The world today is increasingly dependent on and driven by knowledge, whose chief source is education. Oftentimes, education interlinks with other social constructs (e.g., politics, socioeconomic status, and race and racism) to influence people’s abilities to use public health systems. Knowledge (and lack of it) influences decision-making and the ability to act; hence, it is no surprise health literacy is gaining traction in the fields of health and health promotion (Nutbeam et al., 2018; Cranton & English, 2009; Fleary et al., 2018). However, it can be said, the knowledge any education seeks to provide is likely to be more effective if it is relevant, accurate, and accessible to especially marginalized students. Politics Education and politics are key contexts of people’s health and wellbeing on account of their enduring impacts on knowledge creation, utilization, and regulation. The work of Marx (1887) suggests education is inherently

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political because it is controlled by dominant groups or classes, who have (economic, hierarchical, and sovereign) power over the school system directly or indirectly. Politics can be used as a tool to unjustly advance the interests of ruling regimes at the expense of the public or at least some sectors thereof. Apple (2006) described how liberal/neoliberal politics’ markets-driven philosophies compromised young people’s quality of (school) life: “Many groups of varying religious and political sentiments express the concern that children are ignored in [the American] society, they are simply seen as present and future consumers by people who only care whether a profit is made of them” (p. 196). Unlike the people-minded social democrats, the business-minded liberals/neoliberals are less culturally friendly as their quest for financial glory sidelines the ethic of justice. Although an emphasis on “profit” would encourage competitive service delivery, the culture of business mostly favors the financially powerful. More often than not the public spectates when governments as national leaders make decisions about the funding of education, yet such decisions greatly affect the public’s livelihoods. It is Raphael’s (2008, 2013a, b) contention ruling regime politics influences the success of health promotion, whose programming is strongly mediated by political power. Race and Racism From her work, The Afrocentric school [a blue print] (2021), Dove made the following remark: “Race has influenced not only our thinking but also the ability of people to survive” p. 3. The comment by Dove aligns with Dubois’ (1903) proposition race and racism is a major hindrance to the wellbeing of Black, Indigenous People of Color. Dubois’ work portended the birth of critical race theory decades later in the early 1980s (Delgado & Stefancic, 2012; Crenshaw et al., 1995); however, it was a few more decades before the world became more aware of the importance to human life of racial oppression. The impetus being the death on 25 May 2020 of a Black man named George Floyd in racialized police-related circumstances. George’s passing (and incidentally, on Africa Day) awakened humanity to a giant SDoH called race and racism (Tedam & Cane, 2022). Many people, many races, many places have since begun to seriously interrogate the place of racial injustice in various aspects of postmodern life, including school, health, sport, and entertainment. The disproportionate school involvement of Black students does not seem to be receding and can be remedied using comprehensive whole-school culturally appropriate

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interventions (Henderson et  al., 2019; DeCuir-Gunby et  al., 2010). Moreover, Gebhard et  al.’s (2022) work reinforced the importance of stronger advocacy for and development of anti-racist professionalism, policies, and practices, these being core determinants of knowledge and what are seen as acceptable ways of being. Disability Similar to race and racism, the emergence of disability studies in the 1960s to 1970s (Roulstone et al., 2012) endorsed the significance of disabilities as an antecedent to people’s health. Disability is not disease, but a discursive concept that is scripted in human conversations, in practices, and in everyday life: Disability is now regarded in policy circles as not simply a medical issue but also a human rights concern. A major catalyst for this development has been the social model emphasis on the material and structural causes of disabled people’s disadvantage. This has led to the introduction of numerous legislative measures and policy initiatives to address the various economic and social deprivations encountered by disabled people across the world. (Barnes, 2012, p. 23)

Barnes’ view of disability moves the focus away from (and deemphasizes) science, biomedicine, and other deficit-oriented perspectives of disability preferring instead the sociocultural view, which is critical of biases, prejudices, and stereotypes. As noted in Chap. 3, deficit-oriented terminology (e.g., at risk, vulnerable, and disadvantaged) serve only to make marginalized persons the problem when in fact the problem is actually oppression. Deficit-oriented views are created from a position of privilege, consciously or not, intentionally or not, the views are discriminatory, oppressive, and culturally unfriendly (Henderson et  al., 2019; Lewis & Teasdell, 2021). It is advisable to use such culturally relevant terms as minoritized, marginalized, and oppressed. The school participation of people with disabilities (e.g., blind, autistic, and deaf) is a topical issue worldwide as many nations grapple to provide an education that equitably engages this diverse group. Given the likelihood of disability interweaving with other social constructs, such as race and racism (Loutzenheiser & Erevelles, 2019; Hodge & Harrison, 2021), comprehensive schooling approaches would be preferable.

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Gender and Sexual Orientation Issues of gender and sexual orientation may relate different with health, yet both are arguably influenced by societal norms and values. Whereas gender relates to how society defines what the different sexes mean, for example, what it means to be male and to be female, sexual orientation relates to who someone is attracted to romantically or sexually (Lau et al., 2020; Goldman et  al., 2020; Madsen et  al., 2017). The sociocultural understandings of gender-related terms (e.g., role of male and role of female) and sexual orientation-related terms (e.g., gay, lesbian, and heterosexual) is contested territory. Drawing from feminist perspectives, Sen et  al. (2007) described gender in sociocultural terms in support of the critical, people-oriented interpretation as opposed to the less critical, science-­oriented perspective: Sex and society interact to determine who is well or ill, who is treated or not, who is exposed or vulnerable to ill-health and how, whose behaviour is risk prone or risk-averse, and whose health needs are acknowledged or dismissed. (p. xii)

As indicated by Sen et al. the socially constructed nature of gender is problematic because it causes disproportionate health outcomes. It may be considered controversial that feminism supports lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual, and more (LGBTQIA+), whose roles conflict with well-established moral, ethical, and divine principles. However, in my opinion, the controversy does not make gender and sexual orientation a lesser SDoH, but attests to the political nature of human-created constructs. The inequitable school participation of especially LGBTQIA+ is indicated (Snapp et  al., 2015; Clark & Kosciw, 2022; Jarpe-Ratner et al., 2022), showing the presence of gender-­ related and sexual orientation-related marginalization at school. Of a surety, schools need to do more than wave the inclusion banner and employ radical approaches to fight against the marginalization of not just females and LGBTQIA+, but all non-mainstream school populations. Socioeconomic Status The use of socioeconomic status to divide people is not alien to discourses of human health and development. As humans, we are endlessly rated,

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judged, and classified according to economic factors at the various levels of human organization, including the individual, family, community, national, and international. The impact on quality of life of socioeconomic status has long been observed by Marx and Engels (1848), who suggested that eco-political power can be used to subdue and exploit the common person. Even access to basic human needs may depend entirely upon an individual’s financial status, such as shelter, education, food, and health-­ care. One salient developmental factor is the movement of people across borders. This migration whether or not it happens willingly also has socioeconomic implications for many countries, including Canada, USA, United Kingdom, South Africa, and China. It is possible for socioeconomic status to interconnect with other SDoH and cause, compound, and prolong many health inequities. From his work on Race Matters (2001), West commented: Post-modern culture is more and more a market culture dominated by gangster mentalities and self-destructive wantonness. This culture engulfs all of us— yet its impact on the disadvantaged is devastating, resulting in extreme violence in everyday life. Sexual violence against women and homicidal assaults by young black men on one another are only the most obvious signs of this empty quest for pleasure, property, and power. (p. 10)

West uses the example of Blacks to illustrate how human-created constructs (e.g., gender and sexual orientation and socioeconomic status) combine with race and racism to influence people’s health and wellness. The intersecting of social constructs to affect the school participation of minoritized stakeholders is recognized in the field of education (Loutzenheiser & Erevelles, 2019; Hodge & Harrison, 2021). Of the social constructs described in this chapter race and racism appears to have peaked in recent times, judging by the year 2020s worldwide condemnation of and activism against racial injustices, never before seen happen in the middle of a pandemic. Feminists demonstrated against gender-related oppression back in the nineteenth century (Snowden, 1900) and the possibility of such a scenario recurring cannot be dismissed. In view of this chapter, SDoH can have subcategories, for example, socioeconomic status can be subdivided into employment, shelter, health-care, citizenry, and nutrition. The literature on SDoH and HPS appears to be scarce, even though I (Nyika, 2022a) have used the concept of SDoH as a lens to study African immigrant students’ participation in HPS in Nova Scotia.

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I believe there is compatibility between SDoH and the concept of cultural relevancy, which describes the centralization of minoritized cultures aimed at optimizing minoritized people’s cultural proficiency, critical thinking, and social development (Ladson-Billings, 1995; Gay, 2000, 2010). From his work on Healing Our Differences: The Crisis of Global Health and the Politics of Identity (2007), Airhihenbuwa stated that “[c]ultural sensitivity in health communication, health promotion, education, and development programs can be realized only when we centralize the cultural experiences of those who have hitherto been marginalized in the production of knowledge and cultural identity” (p. 167). As suggested by Airhihenbuwa, cultural relevancy is about social justice achieved through providing targeted support to traditionally oppressed members of society. Regardless, cultural relevancy should not be confused with inclusion as the two frameworks work differently to enhance school participation. Inclusion seeks to optimize the engagement of every learner by giving everyone equal learning opportunities (Ainscow et al., 2006) and cultural relevancy seeks to legitimize the cultures of marginalized learners specifically. Exemplifying cultural relevancy is Nova Scotia school boards’ program called African Nova Scotian student support worker (ANSSSW), which provides educational support services to Black students (Nova Scotia Department of Education, 2011). I had an opportunity to work with African Nova Scotian student support workers during my doctoral research several years ago. The following is a field note about my first encounter with the ANSSSW at Alex’s (pseudonym) school: Today, 22 February, I visited Alex’s school where the school principal introduced me to an ANSSSW. The ANSSSW in turn introduced me to potential study participants and advised how best to schedule individual interviews since we had agreed to use her office as a venue. It was my first time to see this kind of school space, which was busy the few hours I was there. This was a place where students of African descent came to hang out during their free periods and scheduled breaks, under the watchful eye of the ANSSSW. Being in this location felt like being in a school within another school. (Field note, 22 February 2016)

As reflected by the field note, the African Nova Scotian student support worker’s room was famous with Black students at Alex’s school. My recent work (Nyika, 2022a, b) gives more details about the empowering role of the ANSSSW program.

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A Model of Culturally Relevant School Health Promotion Unlike the disease-oriented biomedical model, the people-oriented SDoH framework supports the Ottawa Charter (1986) by situating human health within the context of human organization, power, and advocacy, thereby challenging the hegemony of biomedicine by demanding an interpretation of health as culturally disputed terrain. This signifies the importance to HPS of accounting for SDoH so stakeholders can interact equitably with the school context. As noted in Chap. 3, race and racism interconnects with other social constructs to co-influence Black students’ health and schooling, indicating the value of comprehensive, but race-based interventions. Drawing on the epistemological argument that knowledge is culturally contested (Ladson-Billings, 1995; Guy, 2002, Gay, 2010; Airhihenbuwa, 2007), I present a model of six key SDoH (i.e., race and racism, education, politics, disability, gender and sexual orientation, and socioeconomic status) to help fight Black students’ marginalization and disproportionate schooling. This “culturally relevant school health promotion” is a multidimensional whole-school model that can be used to guide policy, programming, and evaluation. The model, shown in Fig. 4.1, presupposes that marginalization as an injustice can be reduced and prevented by attending to SDoH as an underlying cause of marginalization. It must be stressed that culturally relevant school health promotion is not a HPS model, but an intervention that seeks to adopt HPS to Black students’ sociocultural contexts aiming to enhance the students’ health and schooling. Thus, the intervention can be used as a framework to develop HPS policies, to professionally develop principals, teachers, and school health professionals, and to design health-related programs and services. Culturally relevant school health promotion has ties to health promoting schools’ four pillars of education, health-related programs, healthy school environment, and HPS policy (Pan-Canadian Joint Consortium for School Health, 2021; Salm, 2015; Lee et al., 2014, WHO & UNESCO, 2021a, b; Lee et al., 2020; Samdal & Rowling, 2012). This is because the model developed from Chap. 3’s literature review, whose discussion was framed within health promoting schools’ four pillars. I have expanded each social construct to include subcategories in order to give insight into how each construct operationalizes. For convenience purposes, I present the social constructs in alphabetical order and not in order of priority as follows:

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Disability

Socioeconomic status

Education

Race and racism

Gender and sexual orientation

Politics

Fig. 4.1  Culturally relevant school health promotion: Empowering Black students’ HPS participation

• Disability: centralizes issues of blindness, deafness, mental health, mutism, academic-related disabilities, and the handicapped. • Education: centralizes the provision of knowledge that is relevant, accurate, and accessible to Black students. • Gender and Sexual Orientation: centralizes the role of female and LGBTQIA+. • Politics: centralizes the contribution of government to school health promotion in terms of funding, leadership, and training. • Race and Racism: centralizes the cultures of Black students and anti-racism. • Socioeconomic Status: centralizes issues of citizenry, employment, health-care, nutrition, and shelter.

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This somewhat simplistic model emphasizes the much-needed critical thought in support of the empowerment and equitable school involvement of Black students in HPS.  In so doing, the model highlights the importance of critical theory as a framework for fighting marginalization since critical theory problematizes issues of power and prejudice, which issues undergird SDoH as precursors to marginalization. Thus, culturally relevant school health promotion goes beyond inclusion and seeks to uplift the HPS participation of Black students by legitimizing the students’ cultures. As a multidimensional, whole-school model culturally relevant school health promotion is not limited to one HPS pillar or health issue and can be used to frame the four HPS pillars individually and together. For example, the training or professional development of teachers and principals (as part of education) must use culturally relevant school health promotion as a framework and involve school health experts of African ancestry. Professional development grounded in culturally relevant school health promotion would enlighten education professionals and encourage them to develop instructional and leadership strategies that are sensitive to and genuinely engage Black students. The impact of the model can be assessed using standard indicators, such as school participation, school attendance and completion, health literacy, life skills, health attitudes and behaviors, and happiness (Akiyama et  al., 2020; Tomokawa et al., 2020; Simovska, 2012; Lee et al., 2013, 2020). Regardless, a notable limitation of the model is that it was developed from the perspective of one school health researcher with his accompanying biases, assumptions, and limitations.

Challenges to Culturally Relevant School Health Promotion A major challenge to culturally relevant school health promotion is implementers, who are school professionals designated to apply the intervention, including principals, teachers, and school health professionals. As discussed in previous chapters, principals, teachers, and school health professionals are responsible for coordination, education, and health-related programs/services respectively. Culturally relevant school health promotion may be practicable, but it cannot be guaranteed how school professionals will respond to it. It is one thing to be trained or professionally developed on an intervention and another to be motivated to enact it.

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While the employer has the right to choose who to employ as a school professional, I (Nyika, 2022a) recommend the employment of equity-­ savvy professionals with genuine interest in social justice and empowerment of the marginalized. Culturally relevant school health promotion is radicalistic as it would cause positional shifts, which may be resisted by stakeholders who are used to their positions of power, including government, some parents, and some students. Whether in actuality or perceived, the possibility of power shifts due to the intervention is decisive as it may negatively affect implementation. It is possible some stockholders may not know or care that culturally relevant school health promotion is a social justice and ethical issue. Throughout this book I have described HPS as political constructs whose operations are dependent on ruling regime politics. The termination of SchoolPLUS in Canada’s Saskatchewan province (Salm, 2015) demonstrated what can happen when government is not ready or willing to support school health interventions. Even so, Gebhard et  al. (2022) reminded us how the history of colonization teaches humanity that fighting oppression is tough, doable, and inevitable. It was tough for the musical group N.W.A (or Niggaz Wit Attitudes) to please an anti-hip-hop American society in the 1980s, yet the public and government resistance only succeeded to bring out the best of hip hop music (Gray, 2015), which today is big business. It is reasonable to wonder if it is not favoritism to target the issues and concerns of only Black students. What about the rest of the students, what do they get out of it? Will they not lose out? The reader is reminded that culturally relevant school health promotion is not about favoritism, but about social justice, whose purpose is to bridge the empowerment gap between members of society aiming to achieve equality (Airhihenbuwa, 2007). It was mentioned in Chap. 1 how targeted support should be provided without seeking to dominate or disempower the non-marginalized, lest interventions become counter-hegemonic and oppression is reproduced. Hence, thorough professional development and training of implementers is needed to increase acceptability and ensure the intervention empowers without being hegemonic. From my view of social justice, White students (for example) do not lose out because they are already empowered by belonging to a historically privileged group of White. I reiterate that culturally relevant school health promotion is different from and should not be confused with inclusion. Whereas the latter seeks to optimize the school engagement of all students

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(Ainscow et  al., 2006), the former seeks to authenticate the cultures of marginalized students specifically (Ladson-Billings, 1995; Guy, 2002, Gay, 2010; Airhihenbuwa, 2007). Regardless, the use of culturally relevant school health promotion will require adjusting to the idea of a school context that is deliberately uplifting Black students; hence, school stakeholders need to be informed of the meaning and implications of the intervention. As well as other students of color, White students may have health and schooling issues too, but that discussion is beyond the scope of this book. This book sought to help uplift the school participation of specifically Black students in the spirit of social justice. I elected to focus on marginalization because I believe it greatly inhibits school participation at the whole-school level. Another researcher may choose to focus on a different factor altogether, such as teachers, school health professionals, or professionalism. My model of culturally relevant school health promotion appears to be the first of its kind and I do not know of any literature on its application. Nonetheless, the final chapter demonstrates how culturally relevant school health promotion can be used to evaluate school health policies, using the example of Zimbabwe a southern African nation keen on re-building its education system.

Conclusion Critical theory-based interventions are needed to maximize equitability since marginalization greatly inhibits Black students’ school participation. My critical theory-based intervention seeks to adapt HPS to the sociocultural contexts of Black students in their role as marginalized stakeholders who face many injustices navigating school landscapes. As argued in the chapter, race and racism interconnects with other key SDoH (i.e., disability, gender and sexual orientation, education, politics, and socioeconomic status) to co-influence Black students’ health and schooling, indicating the value of a comprehensive, but race-based intervention. This culturally relevant school health promotion is a multidimensional whole-school model that is not limited to one HPS domain or health issue. The model presupposes that marginalization as an injustice can be reduced and prevented by attending to SDoH as an underlying cause of marginalization. Thus, culturally relevant school health promotion goes beyond inclusion and seeks to uplift the HPS participation of Black students by legitimizing the students’ cultures.

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CHAPTER 5

Culturally Relevant School Health Policing in Zimbabwe

Abstract  Using the example of Zimbabwe, this chapter shows how the model of culturally relevant school health promotion can be used to evaluate school health policies in support of equitable programming for Black students. Because currently used frameworks address the role of oppression only sparingly, culturally relevant school health promotion offers a critical theory-based alternative that enhances the methodological rigor of school health policy evaluation. Moreover, unlike a traditional HPS framework, the model expressly attends to the role of Black students as historically marginalized school stakeholders. The chapter concludes by making recommendations in relation to Zimbabwe’s school health policy and culturally relevant school health promotion. Keywords  Coordinated school health • Comprehensive school health • Health promoting schools • Equity • Intervention • Southern Africa

Introduction Culturally relevant school health promotion is a comprehensive whole-­ school model of six key social determinants of health (SDoH) (i.e., race and racism, socioeconomic status, disability, education, gender and sexual orientation, and politics) designed to uplift the HPS participation of Black students. The three terms of HPS, comprehensive school health, and

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coordinated school health may be used interchangeably (Kontak et  al., 2022; Ohinmaa et  al., 2011; WHO & UNESCO, 2021), however the reader is advised only the term HPS will be used in this text for convenience purposes. Using the example of Zimbabwe, the chapter shows how the model of culturally relevant school health promotion can be used to evaluate school health policies in support of equitable programming for Black students. Because currently used frameworks address the role of oppression only sparingly (e.g., Lee et al., 2014; United Nations Education Scientific and Cultural Organization (UNESCO), 2014a, b, c; Viljoen et al., 2005), culturally relevant school health promotion offers a critical theory-based alternative that enhances the methodological rigor of school health policy evaluation. Moreover, unlike a traditional HPS framework (Pan-Canadian Joint Consortium for School Health, 2021; WHO & UNESCO, 2021; Salm, 2015; Lee et  al., 2020) the model expressly attends to the role of Black students as historically marginalized school stakeholders. Policy is so fundamental to programming that Samdal and Rowling (2012) described HPS as “a policy approach” (p. 51) in recognition of the strong legislative basis. As a developing nation, Zimbabwe may not be the example of choice for HPS discussions, but it is included here for various reasons. First, Zimbabwe provides an interesting political scenario from British colonization to a promising post-colonial education, to economic meltdown, and an attempt to revive an education system. Second, Zimbabwe exemplifies the alternative and often marginalized story of developing countries in the African continent. Third, as a Zimbabwean citizen and health and education professional I have vested interest in my country’s health promotion plans. I am neither ashamed nor intimidated to use Zimbabwe as an example as it gives me contentment to showcase Zimbabwe’s school health story from my perspective as a Zimbabwean, African, and Black school health researcher. The chapter begins with a brief history of Zimbabwe to put into perspective the country’s sociopolitical context. This is followed by a description of the review method and presentation of review findings. Following this is a discussion of review findings. I conclude by making recommendations in relation to Zimbabwe’s school health policy and culturally relevant school health promotion.

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A Brief History of Zimbabwe Zimbabwe is a southern African country that used to be a colony of Britain, whose representatives came to Zimbabwe around 1888 pretending to be miners, yet they were colonizers. Subsequently, Zimbabwe became a British colony after the Africans were deceived into signing away their land in exchange for military ware and luxuries for the Africans’ chieftaincy (Hensman, 2007; Ndlovu-Gatsheni, 2008). Nonetheless, Zimbabwe returned to independence nearly a century later in 1980 after two spells of war as the Africans fought against White minority rule. The first war happened in the late nineteenth century followed by the second war beginning 1966 until 1979 (Hove, 2012). Zimbabwe’s second war was supported internationally by social democratic and/or communist countries, such as China, Romania, and Yugoslavia as well as African countries, particularly Mozambique and Tanzania. Independent Zimbabwe was led for many years by Robert Mugabe and his social democratic party of Zimbabwe African National Unity-Patriotic Front. The government of President Mugabe introduced educational reforms that significantly raised the literacy levels of Black Zimbabweans in a free Zimbabwe (Kanyongo, 2005; Matereke, 2012). In no time, the colonizer’s racist education vanished with the onset of Black majority rule. Regardless, over the years Zimbabwe has experienced an economic downturn due to governance and political issues, which have negatively affected public health and education. All the same, the present government of Emmerson Mnangagwa, who seems to have renewed interest in Zimbabwe’s education system, recently developed what might be the southern African nation’s first school health policy (Government of Zimbabwe, 2018). I will review the Zimbabwe school health policy (ZSHP) to highlight its strengths and weaknesses using culturally relevant school health promotion as a framework (see Table 5.1). As shown in Table 5.1, the equitability of ZSHP will be determined by how it addresses the impact of oppression in relation to six key SDoH and their subsets.

Review Method Drawing on basic qualitative research and thematic analysis (Merriam, 2009; Wengraf, 2001; Braun & Clarke, 2019) I repeatedly read the ZSHP to get a deep sense of its contents. During this process I made notes and began the task of identifying possible key ideas as guided by my review framework. The key ideas were color coded for easy identification. I

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Table 5.1  Culturally relevant school health policy review framework (i)  Disability- considers the attention given to academic-related disabilities, blindness, deafness, mental health, mutism, and the handicapped. (ii)  Education- considers the relevance, accuracy, and accessibility of knowledge to Black students. (iii)  Gender and Sexual Orientation- considers the attention given to the role of female and lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual, and more (LGBTQIA+). (iv)  Politics- considers the contribution of government to school health promotion in terms of funding, leadership, and training. (v)  Race and Racism- considers the attention given to the cultures of Black students and anti-racism. (vi)  Socioeconomic Status- considers the addressing of issues of citizenry, employment, health-care, nutrition, and shelter.

continued to develop review threads comprising my comments and applicable policy statements. The threads were then grouped into an appropriate category (i.e., education, politics, race and racism, disability, gender and sexual orientation, and socioeconomic status) and critically assessed for their contributions to equitable programming. As shown in Table 5.1, each social construct was expanded to include subcategories to enable a broader assessment of how the social construct was addressed, partly addressed, or not addressed.

Review Findings In accordance with the review framework shown in Table 5.1, I present review findings under six headings of disability, education, gender and sexual orientation, and race and racism, socioeconomic status. The review findings are summarized in Table  5.2, whose structure is based on the standard health policy review protocol of Cheung et al. (2010). Socioeconomic Status The policy makes clear references to school safety, nutritional health, community outreach, and health promotion for workers. Exemplifying this is the issue of nutrition, whose: “services [were to] be an integral part of the broader School Feeding Programme and shall incorporate approved meals that meet the nutritional requirements of all learners while upholding optimal food hygiene and safety standards” (Government of Zimbabwe, p. 14). All the same, there is an absence of career support plans for Black students.

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Table 5.2  Summary of review findings Category Disability Mental health Blindness Deafness Mutism The handicapped Academic-related disabilities Education Relevance of knowledge to Black students Accessibility of knowledge to Black students Authenticity of knowledge to Black students Gender and sexual orientation The role of female LGBTQIA+ Politics Funding Leadership Training Race and racism Cultures of Black students Anti-racism Socioeconomic status Citizenry Employment Health-care Nutrition Shelter

Addressed

Partly addressed

Not addressed

X X X X X X X X X

X X X X X X X X X X X X

Disability The policy speaks to many issues of disability and the intention to provide: “support to individual learners with visual, speech and hearing impairment, physical disabilities, emotional and behavioural problems as well as different degrees of intellectual challenges” (Government of Zimbabwe, p. 14).

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Education The policy refers strongly to the HPS principle of collective empowerment (see Chap. 2), especially regarding educational aspects of pedagogy and the curriculum. Students are identified as the priority population, but clear reference is made to teachers and staff: “While the policy is primarily focused on learners, it also seeks to promote health enhancing behaviors among teaching and non-teaching staff as part of the workplace health and safety requirement” (Government of Zimbabwe, 2018, p. 15). Africans of Bantu lineage’s philosophy of collectivity known as Ubuntu (see Chap. 1) appears to be Zimbabwe’s schooling philosophy. Applicable local and international literature (e.g., Government of Zimbabwe, 1999; UNESCO, 2014b) was used in discussing the relevance of school health promotion to Zimbabwe. Most of the terms used in the ZSHP were defined and appropriate references were given, however it looks like the policy is available in electronic and print forms in English language only. Gender and Sexual Orientation Gender and sexual orientation discussions are limited to the cause of female and male persons: “The policy will ensure that the concerns and experiences of girls and women as well as of boys and men are an integral part of the school health programme design, implementation, monitoring and evaluation” (Government of Zimbabwe, 2018, p.  4). The policy is silent about LGBTQIA+ persons. Politics There is no commitment from central government to fund Zimbabwe’s school health promotion, whose funding was left to charity: “The United Nations agencies, other developmental partners and private sector shall provide technical and financial support towards the implementation of the Zimbabwe School Health Policy” (Government of Zimbabwe, 2018, p. 17). It is doubtful the political United Nations will provide meaningful school health guidance to Zimbabwe in comparison to the International Union of Health Promotion and Education (IUHPE) (2022), for example. The policy proposes cross-sectorial partnerships between the departments of education and health (with the department of education designated to lead implementation), however there is little discussion of

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the training or professional development of key implementers, such as principals, teachers, and school health professionals. Also, the policy seems to emphasize the evaluation of health-related programs and HPS policy, two of health promoting schools’ four domains. Race and Racism Although there is reference to race and ethnicity, Zimbabwe school health policy’s discussion of racism is blurry. The policy speaks of “ensuring that all people are accorded rights inherent to all human beings, whatever the nationality, place of residence, sex, national or ethnic origin, colour, religion, language in line with the constitution of Zimbabwe” (Government of Zimbabwe, 2018, p. 5).

Discussion There is a close connection between ZSHP and the HPS approach. The policy makes a strong case for health-related programs but is deficient regarding funding, gender and sexual orientation, employment, training, and schooling philosophy. As presented, Zimbabwe’s school health policy is ontologically weak because its schooling philosophy of Ubuntu, though applicable, lacks much-needed critical edge. Whereas Ubuntu emphasizes familiarity or love (Ewuoso & Hall, 2019), critical theory emphasizes the role of oppression (McGibbon, 2012), the latter being more likely to favor the creation of equitable school and schooling. Despite a poor emphasis on activism critical theory does well to question the taken for granted, seeking to quell social injustices. Surely, a contemporary world rife with greed and corruption needs critical theory’s will to fight against the abuse of power by people entrusted to justly govern public health systems. It is worrisome the Zimbabwean government does not finance the country’s school health process. Not only is it financially risky to rely on charity for whole-school reforms like HPS, but such an arrangement is also prone to reification as donors may have hidden motives. Without trying to sound paranoid it should be remembered that Zimbabwe got colonized when the British defrauded Zimbabweans into accepting military supplies at the expense of the Africans’ land (Ndlovu-Gatsheni, 2008). HPS is a worthy national investment, the Zimbabwean public earned it by participating actively in the war against White minority rule between 1960s and 1970s. Besides, health inequities have desolated many a life in

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Zimbabwe and globally (Umuhoza & Ataguba, 2018; Beckfield et  al., 2013), showing a need for governments to support such restorative interventions as culturally relevant school health promotion. The success of health promotion depends heavily upon ruling regime politics with liberalism’s insistence on individuality unlikely to augment health promoting schools’ community focus (Raphael, 2013a, b), hence the social democratic Zimbabwean government should find it easier to uphold the HPS concept. Consistent with the principle of collective empowerment (Lee et  al., 2014; Pan-Canadian Joint Consortium for School Health, 2021; Schools for Health in Ireland, 2013) ZSHP priorities the health of students, teachers, and staff. However, the policy is weak on the subject of racism despite speaking fervently to nutritional health, health-care, disabilities, and school safety. School health policies must speak strongly to all forms of injustices, including disabilities and racism, especially now with the world being more sensitive to racial oppression. Still, Zimbabwe school health policy’s English version would be less accessible to many Zimbabweans, who speak as their firsts African native languages, such as Ndebele, Nambia, Tonga, and Shona. Although the exclusion of LGBTQIA+ discussions from ZSHP may be reflective of Zimbabwe’s Christian background and a constitution that criminalizes homosexuality (Government of Zimbabwe, 2013), the country needs to clarify its position on LGBTQIA+ and school health promotion. It is only just for all stakeholders to participate equitably in the democratic space of HPS, the same stakeholders can help build a culture of concern for Black students’ success. Yet, such collectivity demands knowledgeable, dedicated, and efficient leadership to establish and maintain effective dialogue with all stakeholders (Gleddie & Robinson, 2017; Rasberry et al., 2015; Storey et al., 2016). Policies are arguably as good as their implementation (i.e., coordination, supervision, and evaluation), suggesting the importance of trained or professionally developed school leaders to coordinate programming. Zimbabwe school health policy’s assigning of the education sector to lead implementation is good since educational theories foreground the HPS approach (Simovska, 2012; Samdal & Rowling, 2012). Therefore, it is inefficient for the policy to emphasize rather weakly the training and professional development of key implementers (e.g., principals, teachers, and school health professionals) as this is pivotal to effective implementation. In addition to speaking to career programming for Black students, ZSHP

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must speak to the issue of remuneration for teachers to avoid the all-too-­ common teachers’ remuneration woes in Zimbabwe (Education International, 2022). I acknowledge the policy’s provision for the evaluation of health-related programs and HPS policy, however to maximize equitability it is necessary to evaluate all four HPS domains, including education, health-related programs, healthy school environment, and HPS policy. Implications for Zimbabwe School Health Policing In the context of this review, equitable HPS programming for Black students is attainable in Zimbabwe, but the recommendations that follow should be considered. (i) Because oppression obstructs true democracy, critical theory based schooling philosophies are needed to ensure equitability in the fluid social order. For Zimbabwe, I recommend a blended schooling philosophy of critical theory and Ubuntu. (ii) The government of Zimbabwe must make a commitment to financially support the country’s school health promotion and begin to consider implementation at small scale (Macnab, 2013), perhaps beginning with rural areas. (iii) Zimbabwe’s school health policy must emphasize the professional development and training of school professionals, remuneration for teachers, and career support for Black students. It is expedient for education professionals to lead implementation, especially principals with expertise in HPS, social justice, and leadership, who can dialogue effectively with all stakeholders. (iv) ZSHP should expressly speak to the issues of racism and LGBTQIA+. (v) In addition to English, ZSHP must be written in native African languages to increase accessibility to the public, for example Tonga, Ndebele, and Shona. (vi) To maximize equitability the policy should promote the evaluation of all four HPS domains of health-related programs, HPS policy, education, and healthy school environment. The model of culturally relevant school health promotion was successfully used to evaluate Zimbabwe’s school health policy in an effort to fight against Black students’ marginalization and disproportionate schooling.

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This evaluation shows the viability of a health promoting school policy developed in an African context as a way of challenging the Eurocentric prevalence of the HPS approach. Nonetheless, I believe it is important to extensively field-test the model of culturally relevant school health promotion since this text represents its first known presentation. Book Limitations This text is based on the views of one school health researcher of African heritage with his accompanying biases, assumptions, and limitations, hence many other opinions are needed from across the globe to enrich the conversation on equitable school health promotion.

Concluding Remarks This book used the example of Black students to discuss the relevance of HPS to marginalized school populations in an effort to promote equity in school and schooling. As argued in the book, race and racism interconnects with other key SDoH (i.e., disability, gender and sexual orientation, education, politics, and socioeconomic status) to co-influence Black students’ health and schooling, indicating the value of a comprehensive, but race-based intervention. This model of culturally relevant school health promotion seeks to fight against Black students’ marginalization and disproportionate schooling, which can encourage the students to look forward to the next day of school because the day brings genuine hope of a better present and future. However, the intervention is radicalistic as it would cause positional shifts, which may be resisted by stakeholders who are used to their positions of power. Moreover, culturally relevant school health promotion will require adjusting to the idea of a school context that is deliberately uplifting Black students, hence school stakeholders should be informed of the meaning and implications of the intervention. This book showed the viability of a health promoting school policy developed in an African context as a way of challenging the Eurocentric prevalence of the HPS approach. Nevertheless, it is important to elect equity-savvy (government, school, and community) leaders with genuine interest in social justice and empowerment of the marginalized. HPS need to be well-funded and to have professionally developed or trained principals, teachers, and school health professionals. I am convinced the role of

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teachers must be consolidated if HPS are to work more efficiently. If teachers cannot cope with ever-increasing workloads perhaps it is time to train specialist teachers, who can coordinate programming and teach health-related subjects like health education, life sciences, physical education, and biology. Surely, HPS needs the strengthening of education perspectives and my future work will shed more light on the role of key implementers, such as principals, teachers, and school health professionals.

References Beckfield, J., Olafsdottir, S., & Bakhtiari, E. (2013). Health inequities in global context. American Behavioral Scientist, 57(8), 1014–1039. Braun, V., & Clarke, V. (2019). Reflecting on reflexive thematic analysis. Qualitative Research in Sport, Exercise and Health, 11(4), 589–597. Cheung, K. K., Mirzaei, M., & Leeder, S. (2010). Health policy analysis: A tool to evaluate in policy documents the alignment between policy statements and intended outcomes. Australian Health Review, 34(4), 405–413. Education International. (2022). Zimbabwe: Strike action by teachers as government leaves them in a financial crisis. Retrieved on December 31, 2022, from https://www.ei-­ie.org/en/item/26294:zimbabwe-­strike-­action-­by-­teachers-­ as-­government-­leaves-­them-­in-­a-­financial-­crisis Ewuoso, C., & Hall, S. (2019). Core aspects of ubuntu: A systematic review. South African Journal of Bioethics and Law, 12(2), 93–103. Gleddie, D. L., & Robinson, D. B. (2017). Creating a healthy school community? Consider critical elements of educational change. Journal of Physical Education, Recreation & Dance, 88(4), 22–25. Government of Zimbabwe. (1999). Report of the presidential commission of inquiry into education and training. Government Printers. Government of Zimbabwe. (2013). Constitution of Zimbabwe Amendment No. 20 ACT 2013. Retrieved on September 22, 2021, from https://www.constituteproject.org/constitution/Zimbabwe_2013.pdf Government of Zimbabwe. (2018). Zimbabwe school health policy. Retrieved on September 24, 2018, from http://www.mopse.co.zw/sites/default/files/ public/downloads/ZSHP%20final%20signed%20March%202018.pdf Hensman, H. (2007). Cecil Rhodes: A study of a career. Kessinger Publishing, LLC. Hove, M. (2012). War legacy: A reflection on the effects of the Rhodesian security forces (RSF) in south eastern Zimbabwe during Zimbabwe’s war of liberation 1976–1980. Journal of African Studies and Development, 4(8), 193–206. IUHPE. (2022). What are we doing? Retrieved on July 21, 2022, from http:// www.iuhpe.org/index.php/en/

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Kanyongo, G. Y. (2005). Zimbabwe’s public education system reforms: Successes and challenges. International Education Journal, 6(1), 65–74. Kontak, J. C., Caldwell, H. A., Kay-Arora, M., Hancock Friesen, C. L., & Kirk, S. F. (2022). Peering in: Youth perspectives on health promoting schools and youth engagement in Nova Scotia, Canada. Health Promotion International, 37(3), 1–14. Lee, A., Keung, V.  M. W., Lo, A.  S. C., Kwong, A.  C. M., & Armstrong, E. S. (2014). Framework for evaluating efficacy in health promoting schools. Health Education, 114(3), 225–242. Lee, A., Lo, A., Li, Q., Keung, V., & Kwong, A. (2020). Health promoting schools: An update. Applied Health Economics and Health Policy, 18(5), 605–623. Macnab, A. (2013). The Stellenbosch consensus statement on health promoting schools. Global Health Promotion, 20(1), 78–81. Matereke, K. P. (2012). ‘Whipping into Line’: The dual crisis of education and citizenship in postcolonial Zimbabwe. Educational Philosophy and Theory, 44(sup 2), 84–99. McGibbon, E. A. (2012). Oppression: A social determinant of health. Fernwood. Merriam, S. B. (2009). Qualitative research: A guide to design and implementation. Jossey-Bass. Ndlovu-Gatsheni, S. J. (2008). Nation building in Zimbabwe and the challenges of Ndebele particularism. African Journal on Conflict Resolution, 8(3), 27–56. Ohinmaa, A., Langille, J., Jamieson, S., Whitby, R., & Veugelers, P.  J. (2011). Costs of implementing and maintaining comprehensive school health: The case of the Annapolis Valley health promoting schools program. Canadian Journal of Public Health, 102(6), 451–454. Pan-Canadian Joint Consortium for School Health. (2021). What is a comprehensive school health approach? Retrieved on September 27, 2021, from http:// www.jcsh-­cces.ca/about-­us/comprehensive-­school-­health-­framework/ Raphael, D. (2013a). The political economy of health promotion: Part 1, national commitments to provision of the prerequisites of health. Health Promotion International, 28(1), 95–111. Raphael, D. (2013b). The political economy of health promotion: Part 2, national provision of the prerequisites of health. Health Promotion International, 28(1), 112–132. Rasberry, C.  N., Slade, S., Lohrmann, D.  K., & Valois, R.  F. (2015). Lessons learned from the whole child and coordinated school health approaches. Journal of School Health, 85(11), 759–765. Salm, T. (2015). School-linked services: Practice, policy, and constructing sustainable collaboration. In education, 21, 23–41. Samdal, O., & Rowling, L. (Eds.). (2012). The implementation of health promoting schools: Exploring the theories of what, why and how. Routledge.

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Schools for Health in Ireland. (2013). Framework for developing a health promoting school. Retrieved from http://www.healthpromotion.ie/hp-­files/docs/ HPM00840.pdf Simovska, V. (2012). What do health-promoting schools promote? Processes and outcomes in school health promotion. Health Education, 112(2), 84–88. Storey, K. E., Montemurro, G., Flynn, J., Schwartz, M., Wright, E., Osler, J., et al. (2016). Essential conditions for the implementation of comprehensive school health to achieve changes in school culture and improvements in health behaviours of students. BMC Public Health, 16(1), 1–11. Umuhoza, S. M., & Ataguba, J. E. (2018). Inequities in health and health risk factors in the southern African development community: Evidence from world health surveys. International Journal for Equity in Health, 17(1), 1–15. UNESCO. (2014a). Monitoring and evaluation guidance for school health programs thematic indicators appendices. Retrieved on September 22, 2021, from https://healtheducationresources.unesco.org/sites/default/files/resources/ FRESH_M%26E_Appendices.pdf UNESCO. (2014b). Monitoring and evaluation guidance for school health programs thematic indicators core indicators. Retrieved on September 22, 2021, from https://healtheducationresources.unesco.org/sites/default/files/ resources/FRESH_M%26E_CORE_INDICATORS.pdf UNESCO. (2014c). Monitoring and evaluation guidance for school health programs thematic indicators. Retrieved on September 22, 2021, from https:// healtheducationresources.unesco.org/sites/default/files/resources/ FRESH_M&E_THEMATIC_INDICATORS.pdf Viljoen, C. T., Kirsten, T. G., Haglund, B., & Tillgren, P. (2005). Towards the development of indicators for health promoting schools. In S.  Clift & B. B. Jensen (Eds.), The health promoting school: International advances in theory, evaluation and practice (pp. 75–85). Danish University of Education Press. Wengraf, T. (2001). Qualitative research interviewing: Biographic narrative and semi-structured methods. SAGE. WHO and UNESCO. (2021). Making every school a health-promoting school: Implementation guidance. Retrieved on June 12, 2022, from https://apps. who.int/iris/bitstream/handle/10665/341908/9789240025073-­eng.pdf



Appendix



Being Black in Health Promoting Schools

Author(s)

Year

Country

Key Findings

Conclusion

Akiyama et al.

2020

Kenya

The comprehensive school health model was successfully implemented in Kenya.

Author

2022

Canada

Improved health and wellbeing of school populations, successful implementation of HPS in Kenya. Authentically represent Blackness using culturally relevant pedagogies. Race and racism intersects with other social determinants of health, e.g., education. Authentic representation of Black people and the Black race. HPS programming is racialized.

Race and racism is an important context of HPS programming.

(continued)

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APPENDIX

(continued) Author(s)

Year

Country

Key Findings

Conclusion

Caldwell et al.

2009

USA

Comprehensive approachshould emphasize mental health, cultural characteristics of Blackness (being Black) in HPS programming.

Cokley et al.

2014

USA

Race and racism underlying factor in HPS programming. Consider social determinants of health, mental health issues for Blacks. Culturally relevant health education. Professional development for teachers and school professionals. Race and racism, anti-racism model. Consider the competency of teachers and school health professionals. Race and racism, Blackness. Intersection of race and racism with other social determinants of health, especially class. Highlights psychosocial and philosophical/ theoretical underpinnings of mental health for Black students. Positivist lenses is culturally unfriendly to Black students. Teachers lack cultural intelligence (teacher knowledge). Well-coordinated school-linked mental health services needed, increase access to culturally relevant mental. Health services Biomedical and “deficit-­ based” models are inadequate.

Race and racism influences school health programming, use culturally relevant mental health programming. Cultural competence of teachers and school health professionals is important.

(continued)

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99

(continued) Author(s)

Year

Country

Key Findings

Conclusion

Ekenedo & Ekechukwu

2015

Nigeria

Henderson et al.

2019

USA

Kwatubana, Nhlapo, & Moteetee

2021

South Africa

Lewis & Teasdell

2021

USA

Emphasizes teacher Study highlights the professional development. importance of funding and teacher education. Deficit viewing of Black Create culturally relevant people aggravates race school health contexts to and racism. better engage Black Race and racism an students. important underlying factor in HPS programming. Intersection of race and racism with other social determinants of health, especially class and gender. Increase school, family, and community networks. Teachers, school health professionals, and policies relevant. School (health) professionals and parents talk about race and racism. Create opportunities for stakeholders to communicate. Professional development for teachers and school professionals. Employ role models, authentic race representations to champion culturally relevant programming. Professional development Study provides evidence for for HPS leaders/ the presence of coordinators. knowledgeable HPS leaders in South Africa. Significance of prejudiced Study highlights the views of Blackness and importance of culturally Black students. relevant pedagogy. Deficit viewing of Black people is an injustice. (continued)

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(continued) Author(s)

Year

Country

Key Findings

Conclusion

Macnab, Stewart, & Gagnon

2014

Sub-­ Saharan Africa

Research highlights the importance of leadership and governance issues.

Mashamba et al.

2022

South Africa

Reddy

2019

South Africa

Reddy & Singh

2017

South Africa

The importance of effective (multi-sectoral) collaboration/ interactions/partnerships between key stakeholders. Shortage of human resources and finances. Highlights the importance of leadership and governance issues. Effective collaboration between key stakeholders is vital. HPS should prioritize student participation and teacher professionalism. More and genuine government and stakeholders’ support needed for successful implementation. Active and authentic involvement of all stakeholders in programming is crucial. Health and health-related resources a limiting factor. Evidence for lack of human (school health professionals), financial, and material resources. Collaboration issues raised at the level of administration/ governance/ministerial level. Lack of finances, material resources, time, and supervision. Teachers overwhelmed/ teacher attrition, the critical role of the teacher in HPS programming.

Study underscores the value of consolidating the roles of teachers, students, and good governance in HPS programming.

Study highlights the importance of prepared/ trained school (health) professionals in HPS programming, including teachers and nurses as well as adequate financial and material resources.

Research underscores the importance of funding and material resources in HPS implementation.

(continued)

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(continued) Author(s)

Year

Country

Key Findings

Conclusion

Shung-King

2013

South Africa

Comprehensive school health programming should create enduring stakeholder partnerships.

Shung-King, 2014 Orgill, & Slemming

South Africa

Tomokawa et al.

2020

Kenya

Wasonga et al.

2014

Kenya

Collaboration between key stakeholders is important. Employ culturally relevant protocols. It is important to ensure school health professionals and education professionals work efficiently. HPS in South Africa has limited financial support. There is a need for efficient, knowledgeable, capable school leadership. Increase/enhance/elevate the role of teachers in HPS programing. Teachers professionally developed as part of programming. “Weak” collaboration between the fields of education and health.

WHO and UNESCO

2021b South Africa

HPS concept not emphasized, there is inadequate financial support and issues with teacher knowledge, and the role of school health professionals. Marked differences between the needs of students in rural and urban settings. Political support present, so is the leadership of the ministry of education.

Comprehensive school health needs research/ evidence driven programming led by capable leadership.

The HPS model was successfully implemented in Kenya. There is need to provide adequate resources and promote inter-sectorial collaboration. HPS programming less emphasized, there are issues with financial support, teacher knowledge, and the role of school health professionals.

Glossary

Culturally Relevant School Health Promotion  a comprehensive, whole-school intervention that seeks to adapt health promoting schools to Black students’ sociocultural contexts. Health Inequities  unjust differences in people’ abilities to interact profitably with health-related contexts. Health Promoting Schools (or Comprehensive/Coordinated School Health)  integrated school system designed to optimize the health and schooling of school stakeholders, such as students, teachers, and staff. Health Promotion  comprehensive approach to public health with emphasis on relationships between human individuals, community, and environment. Marginalization (or Minoritization)  is an injustice that happens when prejudices cause fellow citizens of this world to be othered, ignored, and silenced. Social Determinants of Health  cultural constructs that disproportionately affect people’s health. School Health Promotion  optimization of the health and wellbeing of school populations, either coordinatedly or uncoordinatedly.

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Index

A Africa, 8, 10, 26, 43, 44, 48, 50, 68 African, 3, 7–10, 19, 26, 43, 49, 50, 53–55, 72, 75, 77, 84, 85, 90–92 Anti-racist, 55, 69 Approach, 89, 90, 92 Archer, M. S., 20, 29, 31–33 At risk, 50, 55 B Bantu, 8, 9, 13 Biology, 6, 9, 48, 93 Biomedical, 2, 23, 25, 73 Black, 3, 4, 7, 8, 10–13, 29, 34, 41–56, 63–77, 83–86, 90–92 Black Lives Matter, 11 Blackness, 47, 54 Black students, 64–66 Breakfast programs, 3, 33

C Canada, 2, 4, 6–8, 10, 28, 44, 45, 71 Class, 3, 5 Collective empowerment, 26, 28, 88, 90 Collectivity, 8, 9, 13 College, 2 Colonial, 65 Color, 7, 77 Comprehensive school health, 2, 21, 42, 64, 83 Conclusion, 43, 45, 55–56 Conversation, 12, 20, 29, 35, 92 Coordinated school health, 2, 20, 21, 42, 43, 64, 84 Covid-19, 4, 21, 25, 33, 49 Critical Race Theory (CRT), 42 Critical realism, 20, 29, 30 Critical theory, 11, 13, 21, 25, 32, 49, 64–66, 75, 89 Critical thinking, 11, 31, 54, 72 Culturally appropriate, 9, 45, 55, 68

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INDEX

Culturally contested, 11, 73 Culturally friendly, 68 Culturally relevant, 29, 34, 35, 45, 50, 54, 55, 63–77, 83–93 Culture, 4, 6, 31, 47, 66–68, 90

G Gender, 70 Gender and sexual orientation, 10, 54, 56, 66, 70, 71, 73, 74, 77, 83, 86, 88, 89, 92

D Decision-making, 7, 23, 26, 31, 67 Democracy, 10, 13, 21 Diaspora, 10 Disability, 49, 54, 56, 64, 66, 69, 73, 74, 77, 83, 86, 87, 92 Disadvantaged, 45, 50, 55, 69 Discourse, 11, 21, 52, 65 Discussion, 24, 29, 42, 48–51, 77, 84, 89–92 Disease, 25, 64, 69 Disproportionate, 63–77, 91, 92 Dominant, 67, 68

H Health condition, 20, 21, 30, 33 Health promoting school (HPS), 1, 24, 28, 50 Health promoting school policy, 92 Health promotion, 9, 25, 49, 54, 65, 67, 68, 72, 84, 86, 90 Health-related programs, 2, 20, 22–24, 27, 28, 46, 55, 75, 89, 91 Health services, 27 Health status, 29, 31, 35, 50 Historically marginalized, 10, 13, 29, 43 Holistic, 26, 28 Hospital, 2, 6 Human immunodeficiency virus/ Acquired immunodeficiency syndrome (HIV/AIDS), 6, 7 Human life, 8, 21, 30, 64–66, 68

E Education, 1, 2, 4–6, 9–11, 20, 22, 23, 25–32, 34, 48–50, 54–56, 65–69, 71, 73–75, 77, 83–86, 88, 90–93 Educational theory, 48 Empowerment, 21, 32, 52, 53, 75, 76, 92 Equality, 11, 76 Equity, 21, 49, 92 Evaluation, 29, 48, 73, 84, 89–92 F Familiarity, 9, 89 Feminism, 49, 70 Food, 3–5, 9, 71 Framework, 10, 11, 26, 27, 29, 31, 42, 51, 52, 64, 73, 75, 85, 86 Funding, 29, 45, 46, 49, 68, 74, 88, 89

I Identity, 47, 53 Implementation, 29, 32, 45–48, 76, 88, 90, 91 Implementers, 75, 76, 89, 90, 93 Inclusion, 27, 70, 72, 75–77 Inequities, 10, 49, 89 Injustices, 42, 50, 51, 53, 65, 68, 73, 77, 89, 90 Integrated, 1, 19–35 Interventions, 11, 29, 34, 54, 76, 77, 90

 INDEX 

K Knowledge, 42, 48, 51, 53, 55 L Lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual, and more (LGBTQIA+), 70, 74, 88, 90, 91 Limitations, 92 Lobola, 8 Love, 8–10, 13, 89 M Marginalization, 10, 11, 30, 49, 63–77, 91 Mental, 23, 34 health, 23, 34, 74 health condition, 32 health promotion, 34, 35 Minoritized, 10–12, 45, 50, 55 Minority, 3 Model, 83, 84, 91, 92 N Non-health promoting schools, 24 Non-white, 51 O Oppression, 7, 10, 11, 13, 21, 45, 50, 52, 53, 56, 65, 66, 68, 69, 71, 76, 84, 85, 89–91 Ottawa charter, 25, 26 P Participation, 11–13, 66, 69–72, 75, 77, 83 Pedagogy, 23, 25, 27, 88

107

PhD, 6 Politics, 25, 30, 50, 51, 55, 64–68, 73, 74, 76, 77, 83, 86, 88–90, 92 Post-colonial, 84 Power, 5, 9, 11, 13, 21, 26, 30, 42, 51–54, 64–66, 68, 71, 73, 75, 76, 89, 92 Prejudice/prejudiced, 52, 53, 75 Principals, 48, 55 Privilege/privileged, 69, 76 Programming, 21, 23, 24, 26–28, 35, 42, 47–50, 68, 73, 84, 86, 90, 91, 93 R Racism, 7, 10, 45, 49–52, 54–56, 63, 64, 66–69, 71, 73, 74, 77, 83, 86, 89–92 Reflexivity, 20, 29, 31–33 Researcher, 1–13, 66 Review, 41–50, 84–89 Risk, 45 S School and schooling, 5, 12, 26, 33, 48, 55, 89, 92 School environment, 2, 20, 22–24, 28, 55, 91 School health policy, 84, 85, 89, 91 School health professionals, 75, 77, 89, 90, 92, 93 School health promotion, 12, 49, 63–77, 83–85, 88, 91, 92 School health researchers, 20, 25, 28, 29, 34, 35, 75, 84, 92 School setting, 4 Science, 1, 2, 5, 11, 27, 29, 64 Secondary school, 2, 5 Setting, 24 Social constructivism, 9, 25, 26, 32

108 

INDEX

Social constructs, 10, 65, 67, 69, 71, 73, 86 Social determinants of health (SDoH), 49, 83 Social justice, 10–13, 21, 49, 72, 76, 77, 91, 92 Socioeconomic status, 10, 54, 66, 67, 70–74, 77, 83, 86, 92 Status quo, 21, 31, 33, 66 T Targeted, 11, 72, 76 Teachers, 2–6, 19, 21, 24, 25, 27, 32, 35, 45, 47–49, 54, 55, 75 Teaching and learning, 23, 67 Themes, 42, 44–48 Totem, 8

U Ubuntu, 2, 8–10, 13, 26, 32, 88, 89 W Wellbeing, 8, 20, 29, 66–68 Wellness, 5, 6, 35, 52, 71 White, 3, 4, 7, 51–53, 76, 77, 85, 89 White supremacy, 7, 51, 53 Whole-school, 22, 35, 43, 64, 68, 73, 75, 77, 83, 89 Whole-school interventions, 50 Z Zimbabwe, 2–8, 10, 43, 77, 83–93 Zimbabwe school health policy (ZSHP), 85