Fit advice

16th December 1994 at 00:00
Negotiating Health: primary school children at home and school, By Berry Mayall, Cassell Pounds 10.99, 0 304 32873 1. The Health-promoting Primary School, Edited by Ron Morton and John Lloyd David Fulton, Pounds 13.99, 1 85346 325 6

Adrian King on studies of health policy in the primary school. Berry Mayall breaks new ground in her exploration of influences at home and school on the health of five and and nine-year-olds. She argues strongly that children are a social group, subject to the forces of economic and political pressure that may affect any group, and yet are largely excluded and protected from the adult world they are deemed not yet ready to inhabit.

From this premise she seeks to show us, often quoting from children's own observations, how health in its widest sense is promoted or diminished and how children can, when permitted, negotiate and contribute to their own care. The complicated relationships between the health care and health messages given by teachers, mothers, health professionals and others is explored as is the young people's impressions of how these carers' efforts accord or conflict with children's own roles in maintaining their health.

Mayall underplays the huge potential of the health education curriculum to address many (but not all) of the issues raised in this fascinating and carefully written study, but reminds us effectively that the promotion of health is not achieved by chance and can be heightened and improved by collaborative endeavour involving the key players in children's lives. She calls for a radical shift in education's emphasis away from a social "product" and towards the interests of children as people.

Perhaps her most vital message is that as children develop autonomy in decisions and actions concerning their health, their voices need to be heard, not just in the classroom during health education lessons, but at all times when their health is under discussion. Their perceptions and their experiences have so much to teach us, though their capacity to contribute to their own well-being is frequently undervalued or ignored against the background of pressures to socialise them and coax them safely through the myriad hoops of daily life.

This book is firmly based upon consideration of primary age children. The ideas and principles it espouses, however, are not confined to the under elevens but are of value to all adults concerned with young people. Berry Mayall believes that only if adults listen to what young people can tell us and then involve them in the maintenance of their health at every stage of their development, can we hope to be entirely successful in nurturing them to become responsible, autonomous, healthy people. It is hard to disagree.

The Health-Promoting Primary School is far more conventional both in its style and the area with which it deals.

It is hard to fault it, for it sets out clearly the criteria for health and then carefully explores each of ten key factors, one per chapter, written by author-practitioners of high pedigree.

The subjects include the need for a whole-school approach to behaviour, how to involve the District Health Authority, the route to sexual health, and how to manage issues such as exercise, nutrition and smoking.

There's lots of good, solid stuff here, though I found it hard going. I particularly liked the breadth of Diana Veasey's excursion along the route of sexual health, but I balked at her apparently unquestioning acceptance of the DfE guidance to circumvent contraceptive advice-giving and her slightly sickly entreaty to "lead children safely" along the path towards sexual health.

What about the empowerment that leads to confident, informed choice-making? I found it in the very next chapter - Eileen Bruce's excellent journey through Child Protection, crammed full of real exercises to try with pupils. Here were young people, at last, and a chapter to buy the book for.

But this, surely is the crux. After reading Berry Mayall's book, I did not want to hear young people's voices, their contributions, their participation in the small print. I wanted to see them prominently in the theory, the policy, the planning and the execution of health promotion in every chapter. Instead, they were frequently relegated to an afterthought.

I have no doubt that if a school put in place all the components specified by John Lloyd in his lucid picture of a health-promoting school in Chapter One, it would be a flourishing and healthy place. The volume is packed with useful, balanced information about principles and practice; Norman Scott raises crucial points about the need for content to accord with principles when dealing with sensitive issues like drugs or smoking; so why didn't the book move me? I think it was because it failed to emphasise the need for us to stop considering children and their behaviour as mere performance indicators of our success at promoting their health, and start recognising them for what they can be: active, principal contributors, central to the practice of health-maintenance at home and at school.

Adrian King is health education co-ordinator, Berkshire Youth and Community Service.

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