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Core components of school-based and school-linked approaches
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Systems Science, Organizational Development

Several FRESH Partners have been part of the paradigm shift in school-based and school-linked health promotion and development that includes our traditional work on specific issues and programs within systems-focused strategies and actions designed to incrementally modify the core practices, structures and decision-making processes at all levels, across the several ministries and agencies that work with and within schools.

From Ecological Analysis and Systems Thinking to Action

Several prominent researchers have developed ecological and systems-based frameworks to explain how social and economic forces influence behaviour and health to guide health promotion, social development and educational programming. The term “ecological approach” is often used but in fact, many of these multi-layered depictions could be more accurately described as “ecological analysis”. 

While the theory of ecological models has evolved over a long period of time, the application for health promotion programming has been a recent development. The ecological perspective, according to Stokols (1992), is distinguished by four assumptions: (1) The health status of individuals and groups "is influenced not only by environmental factors but also by a variety of personal attributes. Consequently, health promotion should focus on the dynamic interplay among diverse environmental and personal factors as opposed to a framework that focuses "exclusively on environmental, biological, or behavioral factors. (2) The relative scale and complexity of environments may be characterized in terms of a number of components such as, physical and social components, objective (actual) or subjective (perceived) qualities, and scale or immediacy to individuals and groups. (3) The effectiveness of an intervention can be enhanced significantly through the coordination of individuals and groups acting at different levels. (4) The interdependencies that exist among immediate and more distant environments, and the dynamic interrelations between people and their environments need to be recognized.

Open system theory, another expression of ecology-based thinking, suggests that all systems have the same common characteristics. These common characteristics are structure, shared generalizations of reality, functions, functional as well as structural relationships between the units, flow and transfer of some material, exchange energy and matter internally and with their surrounding environment through various processes of input and output. Within its defined boundary the system has three kinds of properties: Elements that may be atoms or molecules, plants, or cows
  • Attributes - quantity, size, color, volume, temperature, and mass.
  • Relationships - are the associations that exist between elements and attributes based on cause and effect. The state or vitality of the system is defined when each of its properties has a defined value and are working together well.
  • Stasis: All systems will seek stability, homeostasis and equilibrium. All systems will seek to survive and reproduce themselves. 
Systems thinking implies:
  • A shift in attention from the parts to the whole: The part cannot be understood in isolation from the whole. Essential, systemic properties are properties of the whole, which none of the parts have.
  • Attention shifts back and forth between systems levels; systems are nested within other systems. Each level represents differing levels of complexity, but similar concepts may be applied to understand different levels. Systems thinking holds that the properties of the parts are not intrinsic to them, but can only be understood in the context of the whole; you will not understand the reactions of doctors unless you study their behaviour in the context of the health care reforms.
  • Knowledge is a network of ideas; ideas are a network or a juxtaposition of concepts, and so on... In systems thinking, knowledge is no longer seen as a building ("the structure of knowledge"), but as a network. While Cartesian thinkers held science to be objective, the systems approach holds that epistemology forms an integral part of natural phenomena. All knowledge is approximate and is viewed from a particular perspective. Science can never provide any complete and definitive understanding.
Shifting towards systems-focused strategies and actions that address the structures, processes and practices of complex, open, adaptive and bureaucratic systems can be achieved through the better use of systems science and organizational development tools and strategies. The science explaining systems has been established for many years but is only now being applied to school-based and school-linked programs. Similarly, well-recognized organizational development tools and practices can also be applied. Examples of their use includes:
  • addressing the concerns of middle and front-line managers who are expected to maintain organizational boundaries,
  • modifying organizational routines such as inter-ministry competition for a share of the overall budget by requiring joint submissions,
  • creating staff positions with responsibilities share or cross over between ministries or departments,
  • encouraging staff to develop expertise in coordination and cooperation across and within systems rather than rewarding only expertise in specific health or social problems,
  • organizational structures within ministries that have populations like school-age children, settings like schools or functions like health promotion rather than diseases and social problems,   

References and Resources
  • WHO (2017) Global Accelerated Action for the Health of Adolescents (AA-HA!), Guidance to Support Country Implementation Geneva, WHO, p.105;
  • World Bank (2013) The What, Why and How of the Systems Approach for Better Education Results Washington, Author, p 8;
  • UNESCO, WHO, UNODC (2017) Education sector responses to the use of alcohol, tobacco and drugs Paris, UNESCO, p 60;
  • FAO (2019)  Strengthening sector policies for better food security and nutrition results: Education, Rome, FAO, p 34
  • Stokols, D. (1992). Establishing and maintaining healthy environments. towards a social ecology of health promotion. American Psychologist, Jan;47(1), 6-22.
  • Carey G, Malbon E,Carey N, et al (2015) Systems science and systems thinking for public health: a systematic review of the field. BMJ Open, 2015, 5: e009002.doi:10.1136/bmjopen-2015-009002
  • Atkins, M.S., Rusch, D., Mehta, T.G., Lakind, D. (2016). Future Directions for Dissemination and Implementation Science: Aligning Ecological Theory and Public Health to Close the Research to Practice Gap, Journal of Clinical Child & Adolescent Psychology,45, Iss. 2,2016
  • Douglas McCall and Daniel Laitsch (2017) Promoting Educational Success, Health, and Human Development within Education: Making the Shift to a Systems Approach, in Ann Pederson, Irving Rootman, Katherine L. Frohlich, Sophie Dupéré, and Michel O’Neill (eds) Health Promotion in Canada, Fourth Edition New Perspectives on Theory, Practice, Policy, and Research, Toronto, ON, Canadian Scholars Press






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