The Alleynian Review: Reconceptualising Our Perspective of Health

DUCKS PE teacher William Patz discusses the arguments to view health holistically and how schools play a key part in nurturing healthy students with a lifelong love of sport and activity.

Introduction

Physical inactivity is a key risk factor for non-communicable disease (e.g. cardiovascular disease), as well as poor mental health. Six of the top ten causes of death globally come from non-communicable diseases. Worryingly, more than 80% of the world’s adolescent population is insufficiently physically active. Finding new ways to promote physical activity is therefore a global priority.

The school, as an institution, can be at the forefront of taking on this challenge by tackling preventable and treatable health problems in young people, impacting on young people’s health, education, and family support. However, our perspective of health can often limit the focus and subsequent success of interventions and programs despite their best intentions. The purpose of schools and their methods for educating young people about health regularly spills into a public debate verging on ideological warfare. This debate on health has existed for over a century but has particularly come into focus in sport and physical education since the 1980’s when health-related fitness became a dominant part of the Physical Education curriculum. The science is strong for the benefits of school-based environments in health and physical activity promotion. This is in part due to the majority of a young person’s life being spent in school, with the access and opportunity to take part in a range of activities that comes with it.

Sport and physical education have an important role to play in guiding and encouraging young people to consider what health means to them and how they may engage in a physically active lifestyle into adulthood. Therefore, now is a good time to reconsider how we view health and how we educate young people about it with the support of exciting and innovative teaching methods.

Pathogenic versus Salutogenic

If we were to consider what health is, we may refer to what many medical dictionaries state “the human being’s normal condition in absence of medical deviations or disease”. Health has traditionally been regarded in this way, conceptualised in what is typically referred to as ‘pathogenic’. A pathogenic conception of health assumes that humans are inherently healthy and that a disease is a symptom of ill-health. From this perspective, treatments are reactive to the disease or condition and consider health to be an idealistic goal to achieve. Without good health, we are not capable of living a good life.

In contrast, we may consider the World Health Organisation’s (WHO) definition of health as “something ever-changing, in the process of becoming, created and lived by people within the setting of everyday life”. By reconceptualising health as ‘salutogenic’, our assumptions about health look at the potential of the body to be proactive or generate better health. It is assumed that humans are inherently flawed, and that health is something we should go and get rather than actually reach. It is a constant quest to gain, to grow and to discover how fully life can be lived. In other words, it is about continuous improvement and being in a constant state of becoming healthy.

Mikael Quennerstedt, a leading academic in health and physical education, reasons that activities, practices and rhetoric on health in Sports, Health and Physical Education (SHPE) has focused on eating habits, physical inactivity, body weight, 10,000 steps per day, and body shape; a pathogenic perspective. A pathogenic question would involve asking 'how do we use physical activity in order to prevent obesity, future diseases and premature death?'. The answer would be to increase energy expenditure and reduce risk of diseases such as coronary heart disease.

Readjusting our position to view health salutogenic would raise different questions: 'how do we use physical activity in order to strengthen young people’s health resources?'. The answers, in contrast, would involve meaningfulness, influence, social relations, and motor development among other things. With this in mind, it is important to reflect on whether SHPE globally is currently promoting a culture of continuously improved health.

Health in SHPE Curriculum

The perspective of health in the UK National Curriculum has until recently promoted ‘fitness for performance’ over ‘fitness for life’. In their study of secondary schools in England and Wales, Harris and Leggett found that school policies and teacher rhetoric expressed a desire to implement ‘fitness for life’ but instead demonstrated that teacher’s practice of health focused on ‘fitness for performance’ as per the curriculum. These performance practices specifically took the form of fitness testing, fitness training activities, body-as-machine learning outcomes, and instrumental forms of assessment which impacted significantly (sometimes negatively) on young people’s engagement with physical education.

Fitness has become a byword for health which has led to health being normalised, assessments becoming generic, and young people being classified as either fit or not fit. Research over the last 20 years has shown this can often take away the enjoyment of SHPE in school, which has also led to a decline in participating in physical activity outside of school. These experiences for young people in health and physical education is not only limited to the UK. In New Zealand, school messages have often resembled a blunt ‘eat less, exercise more’ stance to SHPE.

Meanwhile, in the USA, recent changes in SHPE curriculum have included wider aspects of health with two out of their five standards stating health can be addressed in physical, cognitive, affective and social domains of learning. To support this, only 13 of the 49 states determine that fitness tests are used to measure and assess health. A range of alternative methods of assessment of health are instead being designed and implemented.

Australia has also recently redeveloped its national SHPE curriculum. There has been a greater focus in Australia on how young people learn and their complex and diverse learning needs, specifically in the physical, cognitive, affective and social domains of learning. Research has suggested that these four areas of learning can have a significant impact on the future of young people’s engagement in SHPE lessons, enjoyment of physical activity, and understanding about health.

Practical considerations

If we reflect on two questions:

1)    Is alcohol good for people’s health?

2)    Is sport good for people’s health?

The answer, as Quennerstedt explains, is that it depends. It depends on if we look at the issue from a salutogenic or pathogenic perspective. To say that SHPE is good for young people’s health without first understanding our personal assumptions about health could alienate many young people from taking part in physical activity. One alternative would be to provide young people with their own agency, to define their own bodies and health, to engage in carefully created practices that cater for their complex and diverse learning needs. A salutogenic perspective describes health as involving physical, social, psychological and spiritual aspects of living a good life. Taking part in activities from yoga and gymnastics to orienteering could ensure young people learn in all four of these aspects. Furthermore, young people could feasibly participate in these activities and more, regardless of age, gender or ability.

Providing a diverse curriculum of activities and increased student agency could be the key to success in the reconceptualization of health. For example, three phases of learning usually take place in a fitness components unit of work: 1. Define and understand what the fitness components are, 2. Test and measure the students, 3. Rank students according their performance in the tests against norms to show where improvement is needed.

A salutogenic perspective would involve a different approach. It would involve students: 1. Finding out about the science behind the fitness components and how it is applicable to their lives, 2. To achieve a task or series of progressive tasks set out by the teacher rather than being tested, 3. Students may hypothesise who is likely to have better endurance, or flexibility, or speed.

Once hypothesised through self-directed research, they can devise ways to test each other and can figure out what sports or physical activities they may find success in based on their combined attributes. Collaboration, decision-making and reflection would be key components of the learning process. By investigating fitness components in small groups, using and having access to technology, students may find that they are more successful, engaged and empowered from the unit of work. This is a practical example of health being reconceptualised from a pathogenic perspective to a salutogenic one.

Conclusion

Reconceptualising our perspective of health from a predominantly pathogenic view (health as the opposite of disease or risk) and begin to view it as salutogenic (health as involving physical, social, psychological and spiritual aspects of living a good life), then we may be able to have a real impact on the health of young people. It is necessary that we do reconceptualise our perspective of health to one that is salutogenic as young people are becoming more creative, resistant and critical of the messages being sold to them as part of a health agenda in society. Resistance in SHPE is usually seen through the reluctance to take part in physical education lessons in school and disengagement in physical activity outside of school.

Research has consistently shown in recent years that SHPE can only promote healthy and active lifestyles by providing personally relevant, interesting and enjoyable activities that positively influence young people’s motivation to participate in these activities inside and outside of school.

If the school as an institution is to achieve more success in preventing non-communicable diseases of the future, the reconceptualisation of health, wider use of technology, and increased student agency are a major first step towards providing a more engaging, enjoyable and rewarding experience for young people’s health and lifelong physical activity.

Thank you to William Patz, DUCKS Physical Education teacher, for contributing this thought-provoking piece to The Alleynian Review.

Acknowledgements

My thanks to Dr Victoria Goodyear for her review of an early draft copy of this article.

References

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