Background

• Voices and Choices: Health and Participation
• Voices and Choices: Historical Overview
• Voices and Choices: Foundational Models

Voices and Choices: Health and Participation

Voices and Choices: Planning for School Health is based on the principle that health is a prerequisite for learning. Healthy students in safe, health promoting school communities are ready to learn and learn more effectively than students who are ill, hungry, under stress, or chronically worried and pressured. Using a democratic process, Voices and Choices actively involves students in their school community, enabling them to have a greater influence over their health and school situation, and improve both their health and the health of their school environment.

Voices and Choices understands health as “a resource for everyday life” as defined by the World Health Organization (Ottawa Charter on Health Promotion, 1986). According to this definition, health is much more than the absence of illness. It is an important force in our daily lives that is influenced by life circumstances, beliefs, actions, culture, as well as social, economic and physical environments. Constant stress caused by the social environment, organization or structure of a school can be a source of illness, dropping out, personal violence, injury and poor lifestyle choices. These conditions can also disrupt social relationships with teachers, peers and family. Thus, school communities must develop strategies (program and policy) that address the physical, emotional and social aspects of health with a focus on not only the individual student, but also the environment in which students learn, work and play. 

The World Health Organization (WHO) recognizes schools as a key setting for health promotion (The Jakarta Declaration, 1997). Schools are uniquely positioned to influence several of the key determinants of healthy child and adolescent development, including education, social and physical environments, social supports, personal health practices, individual capacity and coping skills and accessibility of health and social services. Schools that establish positive social and physical environments that respect and support all students will be more likely to foster their healthy development, and experience both short and long-term benefits, including improved learning, spirit and morale, attachment and engagement, as well as reduced absenteeism, alienation and discipline problems. Furthermore, students will view their school as a positive place to be.

According to the Jakarta Declaration: “Every child has the right and should have the opportunity to be educated in a health promoting school” (WHO Statement on Health Promoting Schools, 1997). With this in mind, Voices and Choices builds on the principle that health is determined to a large extent by young people’s ability to take action and generate change in a socially responsible manner. It is also grounded in the articles of the United Nations’ Convention on the Rights of the Child. The Convention, an international treaty delineating the civil, political, economic, social and cultural rights of children (0-18), was adopted by consensus by the United Nations in 1989 and ratified in Canada in December 1991. It is one of six human rights treaties to which Canada is a party, and is the most comprehensive of all international treaties with near-universal ratification by countries of the world. Specifically, Article 12 of the Convention states that children should have a voice in all matters that affect them. Voices and Choices, therefore, is an effort to establish participatory structures and forums through which children may express their views; and encourage decision- and policy-makers to take these views into account. Thus, by providing an environment within which students, working together with their teachers and others, can gain a sense of control, achievement and influence over their lives, school communities can contribute to students’ learning, personal and social development, health and security.

Voices and Choices: Historical Overview

Since 1979, Health Canada has focussed on health promotion to deal with the nation's health needs. A Health Promotion in the Workplace Unit was established as part of this health strategy. Beginning in 1985, the Health Promotion in the Workplace Unit and the Addiction Research Foundation of Ontario (ARF) joined forces to design, implement, and evaluate a comprehensive corporate health model that would best respond to major needs of employees across Canada in all business sectors. Employee and company representatives worked together along with Health Canada and the ARF to test the model.

The Workplace Health System (WHS) is a comprehensive and integrated approach to health promotion in the workplace that is based on employee identified needs. The system supports the premise that people in safe, health promoting, supportive work environments are happier, more productive employees, and recommends that workplaces take action along three major avenues of influence on health simultaneously: the environment, health practices, and personal resources.

At the same time that the Health Promotion in the Workplace Unit was being developed, Health Canada formed an Education and Training Unit to work in collaboration with the health and education systems to promote health for children and youth in Canada. Beginning in 1987, this unit worked in collaboration with the newly formed Canadian Association for School Health (CASH) to develop the Comprehensive School Health (CSH) model. Over 30 national non-governmental organizations from the health and education sectors were involved in the development of the CSH model. Today, many of these organizations have signed a Consensus Statement endorsing Comprehensive School Health.

Voices and Choices: Planning for School Health came as a result of school boards that were using the Corporate Health Model (CHM) of the WHS while implementing the CSH model. What they came to realize is that the two models fit together very well. Many of these school boards requested that Health Canada, who had developed the CHM and participated in developing the CSH model, develop a student needs assessment tool that could be used along with the CHM to develop a complete Health Plan that involved students and staff.

Thus, Voices and Choices: Planning for School Health was developed in collaboration with the Addiction Research Foundation (ARF) as a practical way to help schools and school boards implement the CSH model.  It was developed as a systems approach targeted at the school level to help create healthier students in health promoting school communities that would facilitate learning. Voices and Choices provides a practical way for schools to identify the needs of their students within several of the CSH model paths.  It also provides a practical process by which students and staff can be empowered to act on these identified needs.

A Student Needs Assessment Questionnaire was developed using the adult questionnaire employed in the Corporate Health Model of the Workplace Health System and questions from WHO cross-national Health Behaviours in School-Aged Children Survey. It is based on scientific literature regarding specific influences on the health of young people and has undergone three separate rounds of pilot testing.  A Structural Equation Model was also developed.

The Phase I pilot tests identified a need to adapt the Voices and Choices paths slightly to be applicable to students in schools.  The questionnaire needed to focus more on the school as a social system within which students learn and develop, and needed to consider the influence of the school climate on how students interact with the school setting. The Voices and Choices paths, the Student Needs Assessment Questionnaire, and the School Health Profile, by which student data are reported back to the schools, were further pilot tested and revised with the input of an expert advisory committee and the pilot schools (Phase II). A Guide to Implementation was also developed based on the experience of the expert advisory committee, the pilot schools and other partner organizations that had implemented the CHM and Small Business Health Model of the WHS.

The Phase II pilot tests identified a need to make Voices and Choices: Planning for School Health more accessible to school communities. During this phase, Health Canada had been responsible for analysing the data from the student questionnaires and producing the School Health Profile reports. Pilot schools found that it took too long for them to receive their reports and that the costs associated with interpreting the results therein were prohibitive to effectively implementing the Voices and Choices planning process. As a result, the internet was discussed as an alternative delivery mechanism for Voices and Choices, and a feasibility study was conducted in collaboration with the Ontario Institute for Studies in Education at the University of Toronto to determine whether there was sufficient technology to automate the needs assessment questionnaire and the data analysis process. The feasibility study demonstrated that the internet was a viable way to make Voices and Choices accessible to schools.

Therefore, in collaboration with the Canadian Association for Health, Physical Education, Recreation and Dance (CAHPERD) and CASH, Health Canada developed an on-line version of Voices and Choices: Planning for School Health, consisting of a web-based database and School Health Profile, computer software and on-line resources, including the Student Needs Assessment Questionnaire and the Guide to Implementation. The questionnaire and key concepts underlying Voices and Choices were focus-tested with a group of young people, and the name “Voices and Choices” selected based on their feedback. In order to help schools interpret the School Health Profile reports, the Profile itself was modified to include additional information and suggestions about how to do this, and the on-line database was developed to include the ability to anonymously make comparisons between schools, to national data and between selected questions. All of the on-line tools were then pilot tested and revised with the input of an expert advisory committee and the pilot schools (Phase III).

Voices and Choices: Foundational Models

Workplace Health System

The Workplace Health System (WHS) is a comprehensive needs assessment and planning model that is based on the premise that healthy people are happier, more productive employees.

In the CHM, there are three major avenues by which health may be influenced: the environment, personal resources, and health practices.

Environment

This refers to the home and work environment as it affects employee health: the physical environment (including air, noise, lighting conditions, and the quality of workspace, or equipment), and the social environment (including relations with supervisors and peers, people at home, etc.).

Health Practices

This refers to those aspects of an employee's lifestyle that affect health, including: exercise habits, smoking, drinking, eating habits, sleep, use of medications, and other drugs.

Personal Resources

This refers to employees' sense of control over their health, influence over their work, and the psychological and social support available to them from family, friends, and counselling professionals.

These three avenues are interconnected, as shown by the circle on the diagram.  This means, for example, that the environment affects personal resources and these in turn affect the ability of employees to look after themselves.  A comprehensive workplace health promotion strategy therefore addresses all three avenues simultaneously.

Comprehensive School Health

The Comprehensive School Health (CSH) model is a planning framework based on the premise that health is a prerequisite for learning.  Healthy students in health promoting schools will be ready to learn and learn more effectively than students who are ill, hungry, under stress, or chronically worried, and pressured.  This model consists of four components: instruction, psycho-social environment, physical environment, and support services.  The Comprehensive School Health (CSH) model is based on the premise that to develop healthy young people in health promoting schools, administration, staff, faculty, and students have to act on several fronts simultaneously.

Instruction

In order for students to grow up to be able to take on responsibility for their own health, they need the basic knowledge, skills, values, attitudes, and beliefs to undertake lifelong, positive personal health practices.  For these to develop, Canadian youth need age-appropriate instruction about health topics and issues by capable and competent teachers using up-to-date curriculum materials.  The instruction should be presented in a way that fosters the life skills of media literacy, decision-making, problem solving, and effective communication with others.  Effective instruction also allows students to develop life skills and a sense of personal competency and self-efficacy.

Psycho-social Environment

The psycho-social environment refers to the psychological and social support available within the school and in relation to the home and community.  This support can be informal (friends, peers, and teachers) or formal (school policies, rules, clubs or support groups).  This component also takes into account how the school operates and what policies are in place.  The psycho-social environment can help students grow into active contributing members of society if they are treated with respect and encouraged to participate.  It can also reinforce the classroom-based learning that takes place through instruction.

Physical Environment

A healthy, safe, violence-free physical environment is necessary for optimal growth and development of our young people.  It encompasses things like safe water, air, lighting, minimal exposure to toxic substances, and even the ergonometric aspects of chairs and desks, and the colours of the walls.  The physical environment can extend to travel to and from school and the ability to participate actively and safely in physical activity.  It can also reinforce the classroom-based instruction.

Support Services

Many students and their families already show evidence that they are experiencing difficulties.  Available and accessible support services are key to early identification and treatment of many problems that can cause long-term learning difficulties if not dealt with.   While many of these services are not the responsibility of the school, the school can be a convenient access point for many students and families and an economical delivery point for the services.  These supports may include health, social, and psychological services.