AdobeStock by Kiattisak
<h2>Given the health and education challenges many New Zealand children face, it is surprising (and even depressing) how little crossover and collaboration there is between these two vital sectors.</h2>
<p>The inequities in <a href="https://www.curekids.org.nz/news/article/child-health-inequity-and-high-burden-diseases-worsening" target="_blank">health</a> and <a href="https://www.unicef-irc.org/publications/pdf/an-unfair-start-inequality-children-education_37049-RC15-EN-WEB.pdf" target="_blank">education</a> are both cause and symptom of the lasting socioeconomic disadvantage experienced by so many young New Zealanders. And yet the known interconnection between health and education rarely translates into policy or action, despite <a href="https://www.intechopen.com/chapters/62994" target="_blank">extensive evidence</a> of the reciprocal benefits.</p>
<p><a href="https://www.schoolnews.co.nz/latest-print-issue/" target="_blank" rel="noopener"><strong>Read the Term 4 edition of <em>School News</em> HERE</strong></a> </p>
<p>Meanwhile, increasing numbers of children are starting school with <a href="https://www.health.govt.nz/system/files/documents/publications/social-emotional-behavioural-difficulties-nz-children-technical-report-may18.pdf" target="_blank">social, emotional and behavioural</a> health needs. At the same time, <a href="https://www.curekids.org.nz/our-research/state-of-child-health" target="_blank">child health statistics</a> show conditions such as rheumatic fever, respiratory illness and skin infections remain unacceptably high.</p>
<p>Poor health affects <a href="https://www.nzccp.co.nz/assets/School-Attendance-NZCCP-Submission.pdf" target="_blank">school attendance</a>, <a href="https://onlinelibrary.wiley.com/doi/10.1111/j.1746-1561.2011.00632.x" target="_blank">limits learning opportunities</a> and contributes to <a href="https://archpublichealth.biomedcentral.com/articles/10.1186/s13690-020-00402-5" target="_blank">poor academic outcomes</a>. Correspondingly, education is a <a href="https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30144-4/fulltext" target="_blank">recognised determinant</a> of social wellbeing, and is a <a href="https://www.ncbi.nlm.nih.gov/books/NBK525273/" target="_blank">powerful precursor</a> of later good health.</p>
<figure id="attachment_29281" aria-describedby="caption-attachment-29281" style="width: 300px" class="wp-caption alignnone"><img class="wp-image-29281 size-medium" src="https://www.schoolnews.co.nz/wp-content/uploads/2023/12/AdobeStock_631902740-300x188.jpeg" alt="" width="300" height="188" /><figcaption id="caption-attachment-29281" class="wp-caption-text">Health and education outcomes are correlated. AdobeStock by Tatiana</figcaption></figure>
<p>But decades of neoliberal economic governance have led to the health and education sectors existing in silos, with no formal directive to collaborate. Introducing a more integrated approach would make a real difference to the long-term education and health prospects of young New Zealanders.</p>
<h2>Legal requirement to collaborate</h2>
<p>The lack of any legal requirement for the health and education sectors to collaborate runs counter to overwhelming evidence of the likely <a href="https://www.bmj.com/content/379/bmj-2021-067683" target="_blank">benefits</a>.</p>
<p>In the United Kingdom, for example, <a href="https://www.legislation.gov.uk/ukpga/2004/31/contents" target="_blank">specific legislation</a> stipulates the need for cooperation between key agencies such as education and health to promote child wellbeing. Responsibility sits with local authorities, and relevant agencies must cooperate.</p>
<p>While New Zealand’s <a href="https://www.legislation.govt.nz/act/public/2004/0090/latest/DLM317233.html" target="_blank">Care of Children Act</a> declares children’s welfare and best interests should be paramount, there is no formal requirement similar to the UK’s. Furthermore, the New Zealand <a href="https://www.legislation.govt.nz/act/public/2020/0038/latest/whole.html" target="_blank">Education and Training Act</a>, passed in 2020, does not set out any need for schools to actively collaborate with the health sector.</p>
<figure id="attachment_29282" aria-describedby="caption-attachment-29282" style="width: 300px" class="wp-caption alignnone"><img class="size-medium wp-image-29282" src="https://www.schoolnews.co.nz/wp-content/uploads/2023/12/kelly-sikkema-RYABMCLP7aM-unsplash-300x200.jpg" alt="" width="300" height="200" /><figcaption id="caption-attachment-29282" class="wp-caption-text">Photo by Kelly Sikkema on Unsplash</figcaption></figure>
<p>While there are school initiatives led by the Ministry of Health – mainly concerning <a href="https://www.education.govt.nz/news/promoting-healthy-food-and-nutrition-in-schools/" target="_blank">nutrition</a>, <a href="https://www.education.govt.nz/our-work/changes-in-education/healthy-active-learning/" target="_blank">physical activity</a> and <a href="https://www.education.govt.nz/news/new-mental-health-education-guidance-launched/" target="_blank">mental health</a> education guidance for teaching staff – they don’t amount to a coherent collaboration between sectors.</p>
<p>To compound matters, initial teacher education (ITE) programmes in New Zealand provide scant preparation for dealing with health issues. The programs are largely driven by Teaching Council requirements that graduates meet its professional <a href="https://teachingcouncil.nz/assets/Files/Code-and-Standards/Our-Code-Our-Standards-Nga-Tikanga-Matatika-Nga-Paerewa.pdf" target="_blank">code and standards</a>.</p>
<p>Apart from a general commitment to “learner wellbeing”, they provide no requirement that ITE providers prepare student <a class="wpil_keyword_link" href="https://www.schoolnews.co.nz/2014/07/teachers-to-make-youth-employment-their-business/" target="_blank" rel="noopener" title="teachers" data-wpil-keyword-link="linked">teachers</a> for managing student health. Not surprisingly, teachers can find themselves unqualified to deal with real <a href="http://hdl.handle.net/10292/15909" target="_blank">problems in the classroom</a>.</p>
<h2>School as health entry point</h2>
<p>Primary schools in particular do not appear to be a focus of any central planning or policy for delivering accessible health care.</p>
<p>This is despite the effectiveness and potential shown by a programme such as <a href="https://www.nhc.maori.nz/wp-content/uploads/2022/08/220601-Mana-Kidz-evaluation-final-report.pdf" target="_blank">Mana Kidz</a>. Introduced in 2012, it provides primary health care services to roughly 34,000 children aged 5-12 in 88 low-socioeconomic schools and <a href="https://parents.education.govt.nz/primary-school/schooling-in-nz/different-types-of-primary-and-intermediate-schools/" target="_blank">kura</a> in Counties Manukau.</p>
<figure id="attachment_29285" aria-describedby="caption-attachment-29285" style="width: 300px" class="wp-caption alignnone"><img class="size-medium wp-image-29285" src="https://www.schoolnews.co.nz/wp-content/uploads/2023/12/cdc-BSozBCQn6oY-unsplash-300x198.jpg" alt="" width="300" height="198" /><figcaption id="caption-attachment-29285" class="wp-caption-text">&#8220;Access to health services in schools promotes improved outcomes for children&#8221;. Photo on Unsplash by CDC</figcaption></figure>
<p>International research has consistently shown that access to health services in schools <a href="https://onlinelibrary.wiley.com/doi/10.1111/josh.12311" target="_blank">supports collaborative partnerships</a> between the education and health sectors, and promotes improved outcomes for children.</p>
<p>While some health resources – usually public health nurses – are available to publicly funded primary schools in New Zealand, the provision is fragmented, has no national framework or service delivery standards, and fails to recognise the potential of school nursing to deliver services.</p>
<p>In an ideal world, regardless of the funding priorities set out in the Ministry of Education’s <a href="https://www.education.govt.nz/our-work/changes-in-education/equity-index/" target="_blank">equity index</a>, every primary school would be collaborating with local healthcare providers, with a recognised referral pathway (including for mental health).</p>
<p>Implementing a national, standardised school health services programme would include developing school nurses as a critical workforce. Many international studies have shown <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5348663/pdf/jcs-6-5.pdf" target="_blank">school nurses contribute</a> to student learning outcomes, and are accepted by school staff as the most appropriate health professionals to work with.</p>
<h2>Towards a holistic approach</h2>
<p>While the 2023 <a href="https://www.health.govt.nz/system/files/documents/publications/new-zealand-health-strategy-oct23.pdf" target="_blank">New Zealand Health Strategy</a> hints at greater collaboration between sectors, its fate under a National-led coalition government can’t be predicted.</p>
<p>And although the National Party’s <a href="https://assets.nationbuilder.com/nationalparty/pages/18436/attachments/original/1696286925/Better_Health_Outcomes.pdf?1696286925" target="_blank">policy manifesto</a> and its <a href="https://assets.nationbuilder.com/nationalparty/pages/18431/attachments/original/1696107664/100_Day_Action_Plan.pdf?1696107664" target="_blank">100-day action plan</a> grouped health and education together, the policy details were distinct. It seems likely the current approach won’t change.</p>
<p>But the siloed nature of the education and health sectors, as well as a lack of shared understanding of their interrelatedness, has made aligning and coordinating their work difficult.</p>
<p>To sustain real collaboration, directives and mandates from the respective ministries would require state-funded schools and health service providers to work together. And this less fragmented and more <a href="https://openrepository.aut.ac.nz/items/a5ba8c5a-260d-4d03-a073-905186ada34c" target="_blank">holistic approach</a> would be more cost-effective than the present system which sees too many fall through the gaps.</p>
<p><strong>Written by <a href="https://theconversation.com/profiles/sarah-williams-1476413" target="_blank">Sarah Williams</a>, Senior Lecturer in Nursing, <em><a href="https://theconversation.com/institutions/auckland-university-of-technology-1137" target="_blank">Auckland University of Technology</a></em> and <a href="https://theconversation.com/profiles/leon-benade-1265995" target="_blank">Leon Benade</a>, Associate Professor, School of Education, <em><a href="https://theconversation.com/institutions/auckland-university-of-technology-1137" target="_blank">Auckland University of Technology</a></em></strong></p>
<p>This article is republished from <a href="https://theconversation.com" target="_blank">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/health-and-education-are-closely-linked-nz-needs-to-integrate-them-more-in-primary-schools-217549" target="_blank">original article</a>.</p>

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