School Based Health Promotion in Sweden- Policy Discourses as Social Functions

• Health promotion (HP) is linked to democratic and social values including equity and societal cohesion (Akerman et al., 2019). Health literacy, the critical and empowering component of HP, has beenacknowledged as a health determinant across the life span (Carlsson, 2015; WHO, 2013). Schools are key arenas for HP (Paakkari & George, 2018). Apart from having positive implications for studentwellbeing and academic performance, HP in schools can be operationalized to address some social issues such as the humanely problematic health divide (Braveman et al., 2011; Cerda et al., 2021;Mannix-McNamara & Simovska, 2015). This study explores the articulation of school-based HP in Swedish education policies, in relation to democratic and social values (e.g., autonomy, empowerment, andequity). The study also investigates how far this articulation acknowledges health literacy as a core element in HP work. School-based HP can be a contested domain where different agendas compete. For example, some health discourses may encroach on personal autonomy, while others may depoliticize health (Malmberg& Urbas, 2019; Paakkari & George, 2018; Petersen, 1996). HP work in schools has been repeatedly problematized from moral and social perspectives including inquiries into how far it adheres to democratictenets and how well it fosters autonomy and empowerment (Danielsen et al., 2017; Jensen, 1997; Paakkari & George, 2018). It is informative to explore school-based HP from a sociological perspective to elucidate the links between ideologies, social values, and behaviors at the individual, group, and institutional levels. Scholars have repeatedly highlighted the relations between policy discourses and health-related activities or outcomes in schools (e.g., Danielsen et al., 2017; Wolpert et al., 2015), suggesting that educational policy discourses co-shape the manner in which health issues are addressed in school contexts. Swedish schools incorporate HP in the legally mandated student health services governed by local student health plans at both the municipal and school levels. However, there is a national guide that outlines the general aims, responsibilities, and potential areas for action across the whole country (Swedish National board of Health and welfare and Swedish National Agency for Education, 2017). In this study, four education policies were analyzed, the national guide for student health services in Sweden and three municipal student health plans. The analysis was informed by Fairclough’s (1992) model of critical discourse analysis. The findings indicate that policy articulations in the analyzed documents exhibit an awareness of the democratic and social dimensions of HP. However, tensions wereidentified between different discourses deployed in the documents including ethical, public health, biomedical and governance discourses. For example, there was a tension between the biomedical and public health discourses, where the former frequently focused on risk factors and framed students as passive recipients of care, while the more socially oriented public health discourse acknowledged the meaningfulness of the social determinants of health and the value of student empowerment. While the local policies mostly recapitulated the national guideline, they occasionally negotiated and recontextualized parts of the national discourse. This recontextualization was sometimes beneficial in the sense that it concretized key social values such as student participation. However, local discursive representations could also inadvertently undermine the democratic dimension of HP. For example, one municipal health plan used the floating term “norm-breaking behavior” which is potentially open to uncritical interpretations at the school level with possibly unfavorable implications for student autonomy as well as for equity. The differences between the three municipal documents may be related to differential interpretations of the national document but can also represent a local adaptation to the sociodemographic context in which the policy is to be deployed. The policies acknowledged health literacy in spirit rather than semantics

Ämnesord

SAMHÄLLSVETENSKAP  -- Utbildningsvetenskap (hsv//swe)

SOCIAL SCIENCES  -- Educational Sciences (hsv//eng)

MEDICIN OCH HÄLSOVETENSKAP  -- Hälsovetenskap (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Health Sciences (hsv//eng)

SAMHÄLLSVETENSKAP  -- Sociologi (hsv//swe)

SOCIAL SCIENCES  -- Sociology (hsv//eng)

Nyckelord

School health promotion

social

democratic

policy

education

Publikations- och innehållstyp

vet (ämneskategori)

kon (ämneskategori)