Affordable Health Initiative Health Promoting School Model

Theoretical Framework

Reasoning

AHI claims that, in early life, good family functioning and a higher parental level of education encourage children to develop positive socio-psychological attributes (attachment, family/friendship ties, community engagement, self-esteem, and resilience). This may balance against the harmful effects of experiencing poor social conditions. Thus, adopting sound social and healthy behaviours leading to an improvement in cognitive development and health capital; to higher education achievement and good health status in adolescence. This fosters wellbeing and, later in life, to better job opportunities, higher income, and upward social mobility. AHI acknowledges that genetic endowment plays an important role in good health capital and that this is not modifiable. Therefore, AHI focusses on key modifiable protective and risk factors to promote health in accordance with the salutogenic approach. The AHI reasoning is based on the fundamental cause theory (1), the life course framework (2) and the salutogenic approach (3,4).

The fundamental cause theory (1):

The fundamental cause theory argues that social conditions are the fundamental cause of diseases. This theory explains the persisting association between socioeconomic status and disease/mortality by reference to personal resources such as knowledge, money, power, prestige, and social connections, as well as disparate social contexts related to these resources. Social conditions:

•Influence multiple outcomes

•Affect disease outcomes through multiple factors.

•Determine access to resources to avoid risk, and minimise consequences of disease.

•Reproduce over time, because higher socio-economic groups are better equipped to benefit from new knowledge.

The life course framework (2):

The life course framework offers policy makers the means to understand the interaction between nature and nurture. This conceptual framework illustrates that an individual’s biological resources are influenced by their genetic endowment, their pre-natal and post-natal development and their social and physical environment in early life. Adversity in childhood becomes ‘embodied’ at an early age, and its full impact may manifest later in life. Moreover, health at any one stage of life is influenced by previous experiences and therefore risk exposure at different stages of life can have different impacts on health. Furthermore, health is a dynamic process connecting biological and social elements which are dependant on the past and can be changed by present circumstances. Biological characteristics can influence the life trajectory in the same way as the environment influences biological resources. In addition to providing the means to understand the interaction between nature and nurture, the life course framework provides the timing for interventions so as to prevent disadvantage and mitigate early disadvantage in life.

The salutogenic theory (3,4):

The principle of salutogenesis is incorporated into the World Health Organisation Ottawa Charter and offers an effective health promotion resource to promote resilience. This focusses on determinants of health rather than on disease (pathogenesis) such as biological, material, and psychosocial factors that make it easier for people to perceive life as understandable, structured and consistent. This has an affirmative effect on the perceived physical and mental state, quality of life and wellbeing of people both as individuals and at a societal level.

AHI THEORETICAL MODEL

The AHI HPS theoretical model includes the traditional biological, behavioural and materialistic pathways. In addition, it includes socio-psychological factors as key determinants of health. The AHI model differs from the dominant paradigms: first, it adopts a salutogenic approach; and second, while dominant models focus on a unique pathway and disregard the role of others, the AHI model focuses on the interaction between the biological, behavioural, materialistic and social-psychological pathways. The flowchart above shows the theoretical background that supports the AHI model of HPS. This has the potential to break the chain of risk that leads to the reproduction of inequities throughout generations.

The salutogenic model acknowledges that change, chaos, and stress are a constant in life and therefore “natural” conditions of it; thus, human beings are in a state of heterostatis rather than homeostasis. The question is: how we can survive this state of disequilibrium? Over time, greater consideration has been given to the nature of the stress agents, and it is well stablished that poor social conditions cause great levels of stress. The AHI model of HPS pays attention in diminishing the impact of stressful events on health by placing importance on protective factors as an instrument to achieve homeostasis rather than focusses on constant factors associated with disease. The life course framework (2) provides the means to understand the interaction between nature and nurture: an individual’s biological resources are influenced by their genetic endowment; their pre-natal and post-natal development; and their social and physical environment in early life and throughout the life course. This provides guidance to identify health protective factors.

Education, income and health

AHI claims that education is the fundamental health protective factor. Health, education, and income are strongly interconnected throughout the life course. In early life, healthier children achieve better results at school. Children with chronic diseases experience more school absenteeism and difficulty concentrating in class, which prejudices their school achievement. Later in life, educated people are more likely to understand their health needs; follow health instructions; advocate for themselves and their families; and communicate effectively with health providers. Furthermore, poor health and a low level of education are associated with a lack of job opportunities. More educated workers tend to have a higher income. This has a major positive effect on health as a higher income enables a healthy lifestyle whereas a lower income prevents an individual from adopting a healthy lifestyle. Families with higher incomes can afford to purchase healthy foods, they have time to exercise regularly and pay for quality health services. Conversely, low wages and lack of assets can make individuals and families vulnerable, particularly during long periods of economic austerity. This can lead to periods of poor nutrition, poor housing conditions and unmet health needs. Furthermore, low income and fewer resources force people to live in socially deprived neighbourhoods. These areas are often marginalised economically and are associated with risk factors for health such as lack of safe drinking water; lack of sanitation; fewer high-quality schools; less access to sources of healthy food; an oversupply of fast-food restaurants and outlets that promote unhealthy foods; higher levels of toxins, such as air and water pollution, hazardous waste, pesticides, and industrial chemicals; and higher crime rates. This understanding of the combined effects of education and health outcomes over the life course provides the foundation for the AHI HPS model.