A crisis concentrates the thinking. This is another of those sayings that we have heard with some frequency over the last few weeks. The nature of that crisis has changed over time – from its existential threat to survival, impact on physical and mental health to the possibly devastating effect of poverty as jobs are lost. And now, increasingly, we are looking to mitigate the long-term impact of the lockdown on young people, on a growing attainment gap between the most and least disadvantaged. A crisis can also mean that over time, we default to the safety of the known. An aviation executive said recently that it will be 3 years until we return to the frequency of flights that we knew before the arrival of the COVID-19 virus. Hang on a moment – is that really what we want to happen? To reset the status quo? In schools, do we just redouble our efforts to ensure learning is caught up, or has the greatest pandemic in living memory shed new light on what is most important in the curriculum, including how we address matters of health in schools?
Schools on the Front Line
The pandemic and lockdown have highlighted (as if we didn’t know it) the central role that schools play in the welfare of children – the safety of the classroom and its routines, the teacher as consistent and reliable carer, the provision of a hot meal. Now, as children and young people return at different times, schools have a vital role to play in helping them to make sense of their experience, to share their story. Every story will be different. Some will have experienced real trauma; others will have had positive experiences. Some of course will have been in school since March. Relationships are key as young people connect with each other and with teachers, who, as ever, will need to be both empathic and flexible as children’s different needs come to the fore over time. For some, support from external agencies will be urgently needed.
It is a coincidence that as many more children return to school in September, as is planned, so the teaching of physical health and mental wellbeing will be compulsory in all schools (with some leeway granted because of the school closures). The content of this curriculum will not be new to most schools and a number of early adopters have begun implementation from September of last year, but it is hugely to be welcomed that important parts of PSHE are now acknowledged as having equal status within the National Curriculum. Much of its content has increased relevance because of recent experience, addressing for example the normal range of emotions, benefits of physical exercise on mental health, good sleep and simple self-care techniques as well as ‘personal hygiene and germs including bacteria, viruses, how they are spread and treated, and the importance of hand washing.’
Rethinking Medicine
So, very timely on the face of it. But there is a danger with all prescribed curricula that the body of knowledge (‘Students should know how to…) becomes just that – knowledge rather than something that motivates, inspires and leads to change in attitude and behaviour. As schools take on the requirement to teach this defined content, what can we learn from health professionals who aim to foster this same sense of ownership and agency in their patients (us!)? There has been a shift from the old top down medical model, with all its investment in the notion that doctor knows best and the dictum that we are led by the science (does that ring any bells?), to something encapsulated in ‘person centred care’ – that those using health and social care services are equal partners in planning and developing their care to make sure it meets their needs. This is altogether a much more collaborative process. There are values at the heart of it (dignity, compassion, respect). It recognises that we are all different, that an approach that works for one may not be right for someone else. Above all, it involves helping people to make decisions for themselves, building strengths that lead to greater control and independence.
This rethinking of medicine involves more than challenging the prevailing biomedical model. It’s about understanding power. All relationships in medicine involve an exchange between those with more power and knowledge and a generally compliant receiver of care. Information is increasingly being shared so that patients are entrusted with managing more complexity, rather than being ‘done to.’ The implications here are great – the myth that everything can be healed quickly using drugs or surgery (or, soon, genetics) is exploded, and the greater importance of lifestyle and inequalities come into sharp focus. By building knowledge and insight (health literacy) we make prevention a realistic option and step back from interventions that could be avoided.
Rethinking Health Education
There is, of course, a range in the level of investment in this approach amongst medical professionals. It’s complicated, not an exact science (that’s the point!) and each encounter between doctor and patient is different. But there is common ground here between GP surgery and classroom.
When we have an appointment with our GP, we have a high level of engagement in the exchange. It’s about us, our condition, our health and sometimes, our illness. A health curriculum that allows us to include exploration of the child’s interests, led by their natural inquisitiveness about illness, their own experience and their family’s – how motivating that can be! It acknowledges the reality that we all get ill, it’s part of our experience, and most of the time, most of us get better from most illnesses without the need for an intervention. This is even true of COVID-19, notwithstanding the reality that for those presenting the most serious symptoms, vital care is needed. We can embrace a wider sense of normal which includes illness, rather than maintaining the illusion that perfect health is attainable. That range of what we consider normal includes, of course, the fluctuations of our emotional and mental health.
This is not straightforward for us as teachers. It means that (like GPs) we do not have all the answers. We are not medical experts, but the best teachers have never shied away from ‘finding things out together’, sharing the learning. More than that, it means relinquishing some of our control by opening up the agenda. The gain here is that we are helping children to understand that they own their health. Exploring health and illness (not just wellness) is a safe and healthy thing to do. It is our experience through devising, implementing and evaluating a Facts4Life health curriculum for early years, primary and secondary age children, that this responsibility need not be painful or difficult, but is a key aspect in developing resilience.
These are exceptional times and we need approaches to health in school that have the flexibility to go off-road rather than simply stay on the tracks of what is prescribed. We can provide opportunity for young people to understand COVID-19 as a virus in the community that changes our social and health behaviours, but more than this, we can also help children find the language to express its impact on them as individuals and their families, reaffirming self-care strategies that work for them. This is true not just for exceptional times – adverse experience comes in different forms and children will always need these skills to face an uncertain future.