Health Education Research, Vol. 18, No. 5, 580-591,
October 2003
© 2003 Oxford University Press
School differences in pupil smoking: a consequence of a trade-off between health and education agendas?
MRC Social and Public Health Sciences Unit, University of Glasgow, Glasgow G12 8RZ, UK
E–mail: jacki{at}msoc.mrc.gla.ac.uk
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Abstract |
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Current policy documents stress that raising standards in education and health are inextricably linked, with schools identified as well placed to advance both agendas. This paper considers these assumptions in the light of data derived from 27 staff interviews conducted in two secondary schools. These schools served relatively disadvantaged communities, but differed in their pupil smoking rates with one school being ‘high-smoking’, the other ‘low-smoking’. It explores whether this difference reflects the differential emphasis placed by each school on education or health. Analysis reveals that the ‘low-smoking’ school subscribes to holistic values and operates according to a child-centred bottom-up philosophy offering a differentiated programme of pupil support contingent on needs. In contrast, the ‘high-smoking’ school maintains a narrow focus on educational outcomes, and its high expectations are viewed as running counter to those held by pupils and parents. The contrasting school philosophies bring different unintended consequences. The holistic focus of the low-smoking school is associated with tempered educational expectations, thus conflicting with recommendations in education policies. The singular education focus of the high-smoking school leaves little room for a health agenda, and can overlook and disenfranchise the educationally disinclined. The school systems’ impact on pupil engagement may explain their different smoking rates.
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Introduction |
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One, if not the, principal purpose of schools is to educate. However, while attention to pedagogical matters unarguably represents a key goal of mainstream schools, policy documents in Great Britain for education and health also endorse schools’ role in addressing pupils’ more holistic health needs [e.g. (HM Inspectors of Schools, Audit Unit, 1996
; Scottish Office Department of Health, 1999; Department of Health, 1999; Department for Education and Employment, 1997)]. In Scotland and Wales, the recommended process by which such needs can be addressed is via the Health Promoting School (HPS) (Scottish Office Department of Health, 1999; Welsh Office, 1998), thereby placing emphasis on both the formal and hidden curricula. In England, the whole-school approach is formulated as the National Healthy School Standard (NHSS) (Department for Education and Employment, 1999) and, in this guise, the HPS has been introduced there as a mainstream concern in education. Guidance documents for both the HPS and the NHSS explicitly connect the health agenda with that of teaching and learning:
The Government is firmly committed to the twin aims of raising standards in both health and education. These twin aims are inextricably linked. [(HM Inspectors of Schools, 1999), p. v]
A healthy school understands the importance of investing in health to assist in the process of raising levels of pupil achievement and improving standards. It also recognizes the need to provide both a physical and social environment that is conducive to learning. [(Department for Education and Employment, 1999), p. 2]
Thus, the policy rhetoric presents educational and health agendas as not only harmonious, but also complementary. Correspondingly, assumptions of compatibility underpin recommendations as to how to progress a health agenda in schools. For instance, in Scotland, the HPS guidance issued to schools (Scottish Executive, 1999) explicitly builds on selected quality indicators outlined in the prior education-developed publication, How Good is Our School?, a document intended to support schools in raising achievement (HM Inspectors of Schools, Audit Unit, 1996). Yet despite processes common to the HPS and scholastically effective schools (e.g. the use of praise, parental involvement, good staff–pupil relationships), there are others that may not be so easily reconciled. One notable example is the emphasis on academic achievement, this being a long-established indicator for effective schools (Rutter, 1979; Smyth, 1999). By definition, the very notion of emphasis implies some process of prioritization, in turn requiring that a school’s finite attention and resources be correspondingly apportioned. This raises the possibility that an academic emphasis deflects resources from a health agenda; conversely, a school with a health priority may find its educational agenda necessarily compromised. One arena where such tensions are played out is in the curriculum, with competing pressures for time identified as a critical factor hindering schools’ health promotion practice (HM Inspectors of Schools, 1999).
Recent evidence indicates that secondary schools differ in relation to pupil health (Smyth, 1999) and health-related behaviours, particularly smoking (West and Sweeting, 2001), this variance remaining unexplained by socioeconomic characteristics and prior health behaviours at primary school level. One hypothesis is that such differences reflect the differential emphasis placed on education and health. This article explores this possibility by presenting qualitative analysis conducted in two schools, purposively selected on the basis of their differing rates of pupil smoking. To protect anonymity, the names of the two schools have been replaced with pseudonyms.
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Methods |
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Data on smoking behaviour and related issues were collected via questionnaires completed on a confidential basis by pupils in their Secondary 2 (S2) year (aged 13–14 years) and Secondary 4 (S4) year (aged 15–16) attending six schools. These schools served populations known to be relatively disadvantaged on the basis of the deprivation levels (DEPCAT scores) (Carstairs and Morris, 1991
) of the pupils’ home areas (Sweeting and West, 2000). To identify two schools differing in their prevalence of pupil smokers (regular or occasional), two criteria were deployed: (1) that there was evidence of within-school consistency such that a school with a relatively low or relatively high smoking rate at S2 displayed a similar pattern at S4, and (2) that there was consistency over time based on consideration of data collected in these schools 3 and 5 years earlier (West and Sweeting, 1996). Accordingly, our colleagues selected two schools, one (Highacres) characterized by its relatively high prevalence of pupil smokers, the other (Lowlands) by its relatively low prevalence. These differences were statistically different and notably unexplained by parental smoking. The fact that in Highacres, fewer pupils reported that one or both parents smoked than in Lowlands (Table I), points to school processes underpinning their differing rates of pupil smokers. This is further suggested by consideration of pupil characteristics indicating Lowlands to be the more disadvantaged of the two schools.
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The two schools are situated in adjacent local authorities, and therefore expected to experience broadly similar exposure to health campaigns and tobacco advertising. Lowlands has approximately 1400 pupils and serves predominantly urban neighbourhoods. With a roll of around 1100, Highacres serves both urban and rural town communities. As adolescents’ smoking rates in rural towns and villages are comparable with those in non-rural areas, and remote countryside areas actually experience lower rates of boys’ smoking (West and Sweeting, 2002
), the difference between the schools’ urban/rural composition does not provide a simple explanation for their smoking profiles. We aimed to interview staff members holding diverse roles and responsibilities. To achieve this we provided our link contact within the schools [both assistant head teachers (AHTs)] with a list indicating the number and designations of those we wished to interview. Decisions as to which individuals were then approached were governed by timetabling considerations. Two refused to participate, a janitor in Lowlands and a guidance teacher in Highacres, and in both cases an alternative was interviewed. Twenty-seven were interviewed (14 in Lowlands and 13 in Highacres). Interviewees comprised head teachers (HTs), AHTs, teachers (including those with ‘guidance’ remit; in Scotland, the term ‘guidance’ denotes a designated responsibility for pastoral care), support staff and school nurses (Table II).
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One-to-one interviews were conducted (by J. G. or K. T.) in private rooms. Although staff were informed that our primary interest was smoking, neither the interviewees nor ourselves knew the smoking status of the respective schools. Procedures for protecting anonymity and confidentiality were explained prior to interview. With permission all interviews were recorded, and subsequently fully transcribed and imported into NVivo version 1.2 (NVivo, 2000
). All data concerning school goals were considered, these being drawn from responses to direct questions concerning interviewees’ perceptions of the school goals and their feelings about these (e.g. ‘What do you see as the goals of your school?’; ‘How do you feel about these?’), questions about their personal goals (e.g. ‘What are you hoping to achieve with pupils?’), and all comments relating to their school’s focus and priorities that arose throughout the interview. Following thorough reading of accounts, key themes emerged which seemed to characterize and differentiate the two schools, leading to a decision to adopt a case study approach. Standard principles of qualitative analysis were used including identification of deviant cases, and triangulation to examine and check different perspectives [e.g. (Seale, 1999)]. |
Findings |
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Two schools, different priorities
Lowlands: the nurturing ethos
Lowlands was consistently described as a school that subscribed to a strong holistic value (i.e. concerned with the whole child), with great emphasis placed on pupils’ pastoral needs. This surfaced as a salient issue in the HT’s immediate response to his first interview question:
K. T. When you think of Lowlands what comes to mind?
I think this school is very supportive to its pupils, that’s our aim anyway, to try and give every opportunity to every kid to try and achieve the best that they can, and we put an awful lot of effort into things like pastoral care and support for basic skills and those kinds of issues... There are other schools like us but I would suggest that perhaps our attitude, our own openness towards pupils is better than other schools, particularly over the last generation when schools are having to aim more for targets and for positions on league tables. Some schools have developed a culture which tries to avoid taking in problems or getting rid of problems whereas we have quite specifically or quite deliberately avoided that. Therefore we have a reputation particularly among social work fraternity, psychological services, and other organizations that support children that if they can get children with problems of one nature or another into this school they can normally be assured of more support. [HT]
There is therefore a suggestion that this pastoral emphasis was more pronounced than in schools typically. Later he explained how this pastoral focus was shared and fuelled by his Senior Management Team (SMT) and guidance staff:
I think that having been here for so long...then obviously the attitude which would come down through the Senior Management Team and into the Pastoral Care Team which therefore makes up a significant proportion of the school must then affect the ethos of the school. And people do understand that what we are looking for, if a kid discloses something or if somebody’s in trouble... I think it is one of these things that grows up in a school, that is a school. [HT]
The HT’s account suggests that not only did he personally value pastoral care, but also that his personal philosophy permeated the school to become a central feature of its culture or ethos. It is highly plausible that, as HT, his vision shaped school ethos and other staff accounts support this. For a start, both AHTs expressed a similar holistic concern, thereby suggesting SMT endorsement of the HT’s pastoral value. Furthermore, rather than exclusively describing Lowlands’ role in terms of providing reactive support to pupils’ difficulties, both AHTs indicated a school role in pupils’ psychosocial development, an altogether more positive and nurturing concept.
Clearly we would expect that those (non-SMT) teachers holding guidance responsibilities would similarly value pastoral activity. That is after all part and parcel of their designated role. Unsurprisingly this was the case: all those with a guidance remit stressed the primacy of pastoral care and holistic attention. In addition, these staff felt that such pastoral concerns were not the sole province of guidance, but were shared by non-guidance colleagues. Triangulated data from non-guidance teachers were consistent with this: all (non-guidance) teachers explicitly characterized the school in general, and themselves in particular, as operating according to a holistic agenda, one that attended not only to the educational needs of pupils but also to their psychosocial development:
To know things that are going on at home, to know them outside the classroom is essential. Definitely in this sort of environment anyway, to help the kids’ education and probably, development as a person as well. So I see that as a kind of major thing. [Teacher]
Stressing a commitment to pupil development that transcended a singular academic focus, this account typifies the views of all teachers interviewed and echoes the commitment to psychosocial development expressed by the SMT.
That an, if not the, official value of Lowlands was a caring one seemed to be more than just rhetoric: the school structure gave the guidance function prominent status with all AHTs holding a guidance remit. That is not to say that these empathic values were consistently applied: two staff made reference to some pupil management that ran counter to a caring ethos. However as such cases of non-empathic practice were explicitly described as conflicting with the school’s official ethos, the interpretations thus far are upheld: that Lowlands’ official and endorsed ethos is a caring one.
Highacres: the educational focus
The Highacres HT expressed a strong and largely single-minded educational value. First, he talked at great length about the concerted efforts invested in raising educational achievements, these being largely directed towards, and reflected in, increased numbers moving into higher and further education, the proportion of school leavers doing so being higher than at Lowlands. (On the basis of the HTs’ accounts, 10% more school leavers at Highacres’ than Lowlands graduated to higher or further education establishments.) Although the HT also stressed a commitment to pupil safety, getting pupils involved in school activities and pupils’ self-confidence, these were located and valued within an educational paradigm. Thus, these latter three ‘planks’ were rationalized as key to improving attendance, strengthening pupils’ identification with the school’s values and raising career ambitions. This educational emphasis seemed to be more than just talk, the HT reeling off an extensive list of activities that support a scholastic agenda (e.g. parents’ nights offering advice on how to support their children’s learning, events to liaise with further education establishments, high profile prize-giving ceremonies, etc.). Additionally, considerations of educational costs and benefits underpinned the HT’s decision-making processes. Together these examples suggest that the HT translated his vision into wider school policy and practice.
Accounts provided by all other SMT and teaching interviewees in Highacres indicated that the HT’s steadfast educational vision was understood. For instance, the AHT identified the boosting of achievement as ‘the school’s raison d’être’, linking the improved record of examination successes to the HT’s appointment several years previously. Strikingly, the account of this AHT revealed a dissonance between his own goals and those of the HT (the personal goals of the former being consistent with his designated guidance responsibilities). Despite their differing perspectives, this AHT not only understood the official stance of Highacres (‘There is no health agenda in this school’), he operated according to it, concentrating on the educational (‘I have to deliver on things that people rate as high priority’) largely foregoing more holistic health-oriented work which he described as ‘desirable and well-intentioned’. Such values underpinned decisions regarding the curriculum:
The pressure’s really on the timetable. It’s not possible to do everything for everybody and we feel as a school that there is an increasing attention to exam results and a need to raise achievement. So we’re giving more time to examinable subjects. [AHT]
All teaching staff similarly described Highacres as a school that prioritized educational achievements:
Using their achievements, and raising their attainments, is a big, big factor in this school. [Teacher]
This singular focus was not just understood, but also shared by all but one of the non-guidance teachers interviewed. Crucially these non-guidance teachers did not make concessions for the wider psychosocial needs of the pupils despite the recognition that many experienced ‘problems at home’ or ‘come from bad backgrounds’:
K. T. What do you hope to achieve with your pupils?
Good grades... There’s some who come from a bad background. Those circumstances sometimes are horrendous, absolutely horrendous. I’ve got a great deal of sympathy for that, but there’s nothing really that I can do. [Teacher]
They’ve (pupils) got to be able to separate problems from their work... There’s no point getting them sort of trained up and then, ‘Oh, I’ve got problems at home, can’t go to work’. Even although they bring outside into your classroom, your job’s as a classroom teacher. That’s what you get paid for. [Teacher]
Insofar as the singular focus on education is expressed by the HT and understood throughout the school, it could be seen as the school’s official value. This is not to say that Highacres failed to consider and address pastoral needs, however. Interviews with guidance staff suggested that, like those holding equivalent positions at Lowlands, their concern for pupils was holistic and child-centred, also stressing that there were times when a teaching and learning agenda should take cognisance of, and even make allowances for the adverse circumstances experienced by some:
If a kid hasn’t had a cooked meal for a while...and if they don’t know where the uniform is because the laundry has not been done, it doesn’t make a lot of sense to give the child a row for not coming fully equipped... It’s easy to make these things into excuses but I think the reality for some children is that what the school expects of them has to be mediated or negotiated with someone who knows the whole picture, and that’s where guidance comes in. That’s why guidance is important. It’s got a mediating function between the valid expectations of the school towards the highest levels of aspiration and the knowledge of the pupil as an individual. [Guidance teacher]
Crucially, this interviewee cast guidance teachers as performing a mediating function, which in part involved advocating on a pupil’s behalf. This role of intermediary was linked to a perception that non-guidance teachers were reluctant to become involved in pupils’ holistic (non-education) concerns:
The bottom line maybe is teachers don’t want to know. They’ve got 30 weans (children). They don’t need to know that two of them are single-parent families, mother’s a drunk the other one’s a schizophrenic, you know what I mean? They don’t really want to know that. What they want is that 28 weans who are their major concern get on with their work. And for somebody to take they (those) two away and deal with them and that, kind of pass the buck. ‘Get them out of my frame, this is not the job of me as teacher’. [Guidance teacher]
With the exception of one member of staff who had a part-time remit for behaviour support, non-guidance staff similarly implied that only designated guidance staff had an obligation to attend to pupils’ welfare needs.
Thus, in contrast to the position at Lowlands where the guidance values permeated the whole school to the point that these defined its ethos, at Highacres the guidance function operated according to a different set of values to those promoted within the school more widely.
Bottom-up versus top-down philosophies
Lowlands and its bottom-up child-centred approach
With the holistic needs of the child at its core, Lowlands seemed to operate within a bottom-up need-led philosophy, this being exemplified by the HT’s reflections on the implications of serving disadvantaged communities:
It would be a bit daft of me, or short sighted of me to ignore that...we can take national and local strategies and we can adapt them to suit local needs, and if we simply ignore the health issue of course we’re not exactly being terribly responsive. [HT]
Further evidence of the HT’s bottom-up values came from his repeated references to supporting pupils in achieving ‘the best they can’. Consistent with this, accounts of all subordinate levels of staff, including those in a support capacity, were peppered with terms that similarly implied an acceptance of the abilities and aspirations of individuals, e.g. ‘to give pupils the best opportunity’, to be ‘supportive and encouraging’, ‘responsive to pupils’ needs’, ‘to know what the pupils’ needs are and meet them as well as you can’, etc. Such perspectives suggest a child-centred bottom-up philosophy, rather than one unilaterally driven by an ‘outside’ agenda. Together with the school’s attention to pupils’ wider welfare, this proposition of a child-centred philosophy is supported by wider analysis on two counts. First, the school operated a differentiated needs-led programme of support. Lowlands provided sustained interventions not only for academically able pupils (in the form of homework groups), but also for those who were more vulnerable (e.g. support for those displaying behavioural problems) and intensive group support for those deemed to have low self-esteem, this latter programme relying on the withdrawal of pupils from modern language classes. Second, and axiomatic to the school’s holistic agenda and caring ethos, the child-centred focus was not only associated with some understanding and empathy for the children and the challenges faced on account of their backgrounds, staff also made concessions for these:
I remember there was two wee boys came to our school and they were very deprived wee boys and they were late every single day in life... They couldn’t afford the bus fare and they had to walk from a distance to the school. Now, they were never given into a row...and I had asked Mr X [the HT]. ‘When I was at school you know you were running up the road terrified to get into the class before the bell rang’, I says. ‘But when you were at school your parents worked. Everybody was up in the morning’, he says. ‘Some of these kids are the only one that are turning out. Their parents are unemployed. They live in really deprived areas, and their parents don’t have anything to get up for, nothing present or urgent to be doing in the day’. He says ‘The last thing that I want to do when these kids eventually get into school is to give them a hard time for being late. The fact that they’ve actually made the effort to come, I want to encourage them. Some education is better than none’. [Support staff].
The lowered educational expectations that seemed to be associated with this HT’s pragmatic stance were shared by others on his teaching staff. Moderate expectations, in acknowledgement of the disadvantaged backgrounds experienced by many and premised on assumptions of modest career trajectories for pupils, represented a recurring theme in the accounts provided by the AHTs and teachers. For example:
A number of them just don’t want to come to school, don’t see the relevance of it, and to be truthful with you, for some of these kids I have sympathy... If we’re being honest about it, the wee guy that wants to be a joiner, he’s no going to need French. [AHT]
Highacres and its top-down approach
The concessions made at Lowlands were not evident at Highacres. Rather the HT emphasized his commitment to raising expectations and setting pupils’ sights on a higher goal than they might hold if left to their own, and to their parents’ devices:
What has changed I think in the last N years [since he became HT] is the emphasis that we’ve placed on ambition. I’m not prepared to settle for the attitudes that people might have had several years ago, i.e. ‘I did this and therefore, as my son or daughter, you should do that’. [HT]
Here, the HT’s vision for pupils required that they conform to some educational ‘ideal’. Significantly, all levels of management and teaching staff stressed that the school was working to counter the low aspirations endemic to pupils and parents. The AHT described this conflict:
I deliver high levels of aspiration in terms of putting consistent messages across about the fact that children should give themselves a shake because if they don’t, if they do what their parents have always done, then they’re going to get what their parents have always got, which is a life with not a lot going for them. And sometimes you’ve got to rattle their cage to let them see that they need to break the cycle of the status quo if they want to improve themselves. [AHT]
The commonly articulated view that the school’s agenda conflicted with values traditionally held in the community was also highlighted by one teacher as not serving the best interests of those who fell short of the ideal promulgated by the HT:
I know people in this school for example who were talented musicians and were very good sports people, and were good artists, but because they were perhaps not good at Maths or English or didn’t get on well, they were excluded from a lot of things. And they weren’t all-rounders, and shiny and happy, so they’d get kinda vilified on one hand and maybe left aside. There are loads of kids in this school who might rub teachers up the wrong way because they come to school in their tracksuits. I know a fellow...who’s a fantastic artist. He’s banned from it because he knocked something over in science, or did some vandalism somewhere. Quite rightly so. These things shouldn’t happen. But to ban someone from practising what they’re best at, I don’t think serves people well. [Teacher]
The argument advanced here then is that in holding a myopic fixation on educational outcomes, the school favoured those who conformed to a certain ideal. The unintended consequence of this was in overlooking, and even reproaching, those who were more vulnerable, either through their lack of educational abilities or ‘because they come to school in their tracksuits’. As tracksuits commonly, but not exclusively, were sported by the rougher and tougher pupils (sic), and also tended to be worn by poorer pupils more generally, there was a further suggestion that the needs of the more disadvantaged were not addressed.
Support for the argument that Highacres did not prioritize and may even have failed to proactively attend to the needs of the more disadvantaged came from three areas. First, in contrast to Lowlands’ highly differentiated programme of support, the approach at Highacres was largely undifferentiated. This was signalled by the AHT commenting that ‘schools go for uniformity and conformity’, with the school system geared towards processing pupils as one homogenous mass. Later, he criticized the school for only reacting to individual needs on a case by case basis:
Maybe once in the course of the whole year does anybody say the ‘school’s not doing too well is it?’ I mean the focus is always on the individual, never Highacres should be looking at patterns or the way it operates or it should be looking at its policies. [AHT]
This implies that Highacres systems were not underpinned by a needs-led philosophy that addressed the broad diversity of pupils’ needs, those who were more vulnerable by and large not being proactively targeted. (The exception to this took the form of a newly introduced 0.5 full-time equivalent post offering behaviour support.)
The second dimension suggestive of the school’s tendency to overlook the needs of more disadvantaged pupils came from evidence that it was the academically inclined who were targeted for additional support. Finally, there was some suggestion that those experiencing material advantage were sometimes singled out for preferential treatment, an unintended consequence of the achievement values held by some, notably the HT:
The boss is very much a halo effect guy. He likes to be surrounded by attractive people. The kids that he promotes are always lovely and beautiful and clean and middle class and whatever, [and] he bends over backwards for them. A scruffy wean [child], comes in late, or wants to do something else, they don’t get the same chance. [Teacher]
Thus, at Highacres, the narrow educational focus could favour those pupils who were advantaged, not only educationally, but also economically. For this reason there was some evidence to suggest that Highacres’ systems, or at least the HT’s behaviour, could be inequitable.
This position is in sharp contrast to Lowlands where the highly differentiated programme targeted vulnerable pupils for proactive support, thereby operating more to a model of equity.
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Discussion |
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Before considering the findings and reflecting on their implications, it is worth noting three potentially significant methodological issues. First, as our study relied on the selection of schools with relatively high and low smoking rates, Lowlands and Highacres may be extreme, and therefore atypical schools. Second, the fact that both served relatively disadvantaged communities was likely to have shaped interviewees’ experiences, expectations and perceptions. Views about school goals may be very different in other types of schools, e.g. those in advantaged areas. Third, in order to capture and triangulate diverse experiences and perspectives, we selected for interview staff across a broad range of roles and responsibilities. Their accounts cannot be taken to necessarily be representative of those held more widely within the schools. Notwithstanding these caveats, the findings are useful for providing insight into school differences that in turn are suggestive of possible ways in which schools may impact upon pupils’ smoking.
Turning now to the emergent differences between the two schools, Lowlands was largely driven by a holistic and equitable agenda, accommodating and tailoring support to pupils’ needs. By comparison, Highacres’ values centred on educational outcomes, and by concentrating on the academically inclined and able, adopted a more inequitable approach. These differences prompt speculation on processes that might be associated with the schools’ smoking rates. Conceivably, Lowlands’ attention to all pupils, and concerted efforts to target those who were more likely to ‘have slipped on the other side of the line...and keep them on board’ together with its caring ethos and attention to pupil welfare may have combined to combat disaffection with school, and through this process reduce the likelihood of smoking among vulnerable pupils. Conversely, the systems and values at Highacres may have served to further alienate those already at risk of becoming disenfranchised (by dint of their lack of academic orientation, their more disadvantaged backgrounds, and the gulf between their own values and the achievement ones upheld by the school). In turn, such individuals may have rebelled by smoking. Consideration of the wider literature supports the plausibility of these related hypotheses: school satisfaction has been shown to be associated with pupils’ perceptions of staff as supportive and the school as fair (Samdal et al., 1998, 2000); pupils who hold negative perceptions of the school are not only those who are likely to be failing academically, they also have an elevated risk of adopting unhealthy behaviours such as smoking [e.g. (Nutbeam and Aaro, 1991; Nutbeam et al., 1993)]; the association between pupils’ perceptions of the quality of their relationships with teachers has been found to be inversely related to pupils’ smoking status not just at an individual level, but also at an aggregated school level suggestive of a school effect (West and Sweeting, 2001). Additionally, preliminary analyses of our pupil survey data also support the hypothesis that the goals and values advanced at Highacres may disenfranchise the less academic pupils, rendering them more vulnerable to adopting smoking behaviour. Insofar as an intention to stay on at school beyond age 16 years and an intention to advance to further education (college or university) can be viewed as two indicators of educational engagement, our survey data indicate that at Highacres such ‘disengaged’ pupils were more likely to be smokers than those ‘engaged’ with the school. In contrast, at Lowlands, no such difference emerged. Furthermore, Lowlands smokers were less likely to dislike school than their Highacres counterparts. We wonder whether this apparent lack of disaffection may be a consequence of its equitable and child-centred approach.
Our qualitative analysis of the interviews suggests that Lowlands’ staff rationalized their school’s holistic focus on the basis of pupil needs, whereas at Highacres the HT and non-guidance staff seemed to value certain psychosocial issues (e.g. self-confidence, pupils’ sense of safety) insofar as they supported its teaching and learning agenda. Whereas the holistic concern at Lowlands could be considered a parallel goal to education, at Highacres, acknowledgement of psychosocial health was a more subsidiary goal serving to bolster the school’s educational priority. This latter emphasis is broadly aligned with the NHSS (Department for Education and Employment, 1999), a development led by education not health, and which is more explicit than is the HPS in emphasizing the educational benefits to be accrued from investing in health. In turn this suggests that there may be lessons to learn from a comparison of these two whole-school approaches (HPS and NHSS) not just in terms of health processes and outcomes, but also educational ones.
One unintended consequence of Highacres’ focus on its educational agenda and, correspondingly, on its more educationally inclined pupils, was the inequity that characterized its systems. Its sink or swim approach that overlooked the needs of the more vulnerable runs counter to the vision expressed within education guidance documents in Scotland, England and Wales, all of which reject any notion that ‘less should be expected of some pupils’ or that ‘some are destined to fail’ [(Department for Education and Skills, 2001), para. 2.33]. Notwithstanding Highacres’ inequitable approach, its top-down imposition of an educational value realized through raising expectations is, however, consistent with the consensual view in education policy of an uncompromising stance that ‘high expectations for all pupils...regardless of their circumstances, simply cannot be relaxed’ [(National Assembly for Wales, 2001), p. 11].
Lowlands’ bottom-up approach was based on the community’s values, operated from a holistic perspective, accommodated pupils’ backgrounds and adjusted its expectations accordingly. While lowering of expectations may perpetuate inequalities (and subsequent lowering of educational achievement) in the longer term, the differences between the two schools suggest a philosophical division between a top-down educational philosophy and the bottom-up values of the HPS. In turn, this prompts speculation as to whether the HPS and the educational model represent two polar extremes of one axis (a tension theory) or can better be characterized as two intersecting axes thereby offering the possibility of a win–win situation in which educational and health goals can be simultaneously addressed (a compatibility theory). Current national policies implicitly endorse the latter notion. Informal discussions with senior policy makers again support the compatibility theory, one convincingly arguing that a school that produces impressive levels of educational achievement at a cost of poor pupil mental health, is a school that has failed. Additionally, as educational achievement may offer a route out of deprivation, the polemical synergy between education and health agendas would appear upheld.
Perhaps, however, the practice of combining health and education agendas, while being a well-intentioned ideal, involves some balancing of competing values and priorities. This balancing act takes place within the context of limited resources and inevitably some ‘costs’ will be incurred as one priority wins out over another. One manifestation of this tension is a trade-off between education, on the one hand, and health-related activity, on the other. Within the schools we studied there was support for this. For example, Lowlands withdrew pupils considered to have low self-esteem from modern language classes (an educational, certainly modern language, ‘cost’ with an intended self-esteem benefit) and in Highacres there was frequent talk of prioritizing educational matters over ‘well-intentioned’ health-related issues within the curriculum. This education–health trade-off is consistent with the schools’ education results: routinely collected data on educational outcomes indicate levels of achievement on national examinations to be higher at Highacres than Lowlands. (Based on Scottish Executive produced reports detailing examination results for 2000 and 2001, Highacres pupils consistently performed better than Lowlands pupils. For example, for 2000 and 2001, the percentage of the S4 roll gaining at least three awards at level 6 or better at the end of S5 differed by 4%. We have noted a difference rather than actual figures as these data are in the public domain and therefore disclosing these would violate issues regarding the schools’ anonymity.) Furthermore, the notion of a trade-off with associated costs and benefits is consistent with the finding that schools that are academically effective are not necessarily effective in personal and social development (Smyth, 1999).
We suspect that the two schools we studied are quite extreme in their positioning on a health–education axis and that most will lie somewhere in the middle. Notwithstanding their particular characteristics, the Lowlands–Highacres comparison is useful for stimulating debate on how schools should allocate their resources in addressing pedagogical matters, on the one hand, and wider holistic considerations, on the other. These decisions will carry opportunity costs.
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We would like to thank Patrick West and Helen Sweeting for their comments on earlier drafts of this paper. Thanks too to our colleague Robert Young for exploring the quantitative aspects of the study and to Mary Robins for help in accessing references. The study reported here is funded by the UK Medical Research Council.
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Received on July 16, 2002; accepted on October 11, 2002
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