Introduction

This chapter traces the history of education policy in the UK before briefly discussing the international context. It then looks at the impact of policy developments, positive and negative.

A short history of UK education policy

Origins

In the UK, schools developed over the course of the late 18th and 19th centuries as a means to provide a basic education for the emerging class of industrial workers and a more advanced education for owners, managers and professionals. Their function was as much about sorting as about educating, and there were huge inequities in provision and participation. It was not until after the Second World War that free primary and secondary education was provided for all. But there continued to be massive inequities in the length and quality of schooling. The postwar system of secondary education was officially ‘tripartite’, comprising: ‘grammar’ schools teaching academic subjects; ‘technical’ or ‘central’ schools teaching applied skills; and ‘secondary modern’ schools providing basic secondary education. The technical schools did not take off, leaving a system made up of grammar schools for those who passed the ‘11+ ‘ academic exam and secondary moderns for everyone else. Gradually, this system was eroded with the rise of ‘comprehensive’ secondary schools, which admitted students regardless of prior attainment. The push for comprehensive schools was driven both by the demands of organised labour for better education and by the demands of the middle classes, fearful that their own children might not get into grammar schools.

Introduction

The previous chapter described the three toxic mechanisms through which secondary schools might harm student health: educational disengagement; lack of school belonging; and fear and anxiety. The identification of these mechanisms was informed by qualitative research, some of it carried out by me and my colleagues in English secondary schools and some by other author researchers around the world. This qualitative research provides rich insights into the lives of young people and their teachers, how young people understand their place in schools and how this is implicated in some of their decisions, including their decisions to become involved in various risk behaviours. These compelling stories allowed us to develop a detailed understanding of the mechanisms by which schools might harm some students’ health. However, it would be hard to conclude from these stories alone that English secondary schools have measurable impacts on the health of their students, or whether such effects also occur in other countries. So in this chapter, I examine quantitative, statistical evidence from the UK and beyond to see whether this supports the existence of worrying trends in young people's health, the possibility of school effects on health and the presence of the three toxic mechanisms.

Young people's health and risk behaviours

The first set of quantitative evidence I briefly review is evidence about trends and patterns in young people's health and risk behaviours.

Introduction

In Chapters 6 and 7, we saw how interventions aiming to increase engagement, belonging, and safety and support in schools can benefit students across a range of health and educational outcomes. This chapter explores how school context, country context and the specific health outcomes being addressed affect what schools need to do.

School context

Different schools have different cultures, different capacities for action, different pressures and different priorities. So when embarking on change, they are likely to need to start from different places and do different things.

Factors affecting delivery

Schools will vary in how hard they find it to deliver health interventions. With Lauren Herlitz, Laurence Blanchard and other colleagues, I have undertaken a couple of systematic reviews looking at what factors affect this. We know from these that implementation is much easier if school staff have the confidence to feel that they are able to deliver the intervention and if they believe in its value. Implementation is also more likely when an intervention has the support of committed colleagues and senior leaders and when it aligns with national policy. Implementation is likely to be sustained if staff can see a rapid positive impact on students’ engagement and wellbeing. Sustained delivery is also more likely if interventions can be adapted to existing school systems and routines.

Implementation is harder when there is a norm within a school of prioritising educational outcomes over student health and wellbeing. It is also harder where there are time and resource constraints, a lack of staff training and a high staff turnover.

Introduction

This chapter describes the toxic mechanisms that occur in secondary schools which can harm young people's health. The chapter draws mainly on qualitative research to explore three toxic mechanisms as they are experienced by students. Some of this qualitative research has been done by me and my colleagues. Some of it has been done by other researchers. As explained at the start of this book, qualitative research draws on interviews, focus groups and observations to try to understand how people experience the world. Interviews and focus groups involve researchers asking open-ended questions and then listening to people's stories in their own words. Qualitative research explores people's accounts of their experiences and the meanings they give to these as well as how they act and interact with others. It can explore how people's actions can be enabled and constrained by the institutions within which they find themselves (such as schools). And it can explore the immediate consequences of their actions.

Qualitative research is strong on understanding the details of social processes and how these are experienced by people. It can help us develop theories about cause and effect in the lives of people and across society.6 Qualitative research is less strong on testing the wider applicability of these theories. It generally draws on small samples of participants and contexts. It doesn't collect exactly the same sorts of data from each participant.

Introduction

Schools are increasingly required to address student health and wellbeing. This development seems to be somewhat in contradiction to the picture presented in the previous chapter of schools having become overwhelmingly focused on maximising individual educational attainment. However, it makes more sense when viewed as the system adapting itself to try to compensate for some of its own adverse consequences.

Types of school health intervention

A variety of health and wellbeing interventions are now delivered in schools. Some of these are ‘universal’ interventions, aiming to promote the health and wellbeing of all students. These can include health education classes, providing, for example, sex or drugs education. They can include social and emotional education lessons focused on learning to manage ones emotions and relationships. And they can include classes and other activities focused on meditation and mindfulness, also to help manage one's emotions and relationships. Relationships, sex and health education is now a statutorily required subject in all English schools.

As well as interventions delivered to all students to promote health and wellbeing, other interventions target students engaged in certain risk behaviours or experiencing certain mental or physical health problems. These include cognitive behavioural therapy and counselling for students with anxiety or depression as well as group interventions for students experiencing problems with substance use. In 2017, the government initiated a new programme of mental health services in schools, with a focus on cognitive behaviour therapy to address mild to moderate anxiety and depression, and created school mental health support teams to deliver these.

Overview of the book

This book is about how secondary schools can seriously damage the health of young people and can continue to affect them as adults. But it is also about how secondary schooling can be modified to avoid this damage and benefit young people's health and learning.

In human evolution and history, schools are a recent innovation and quite a strange one. If brought back to life, prehistoric hunter-gatherers or even medieval merchants would be amazed and probably baffled by our approach to socialising the young by separating them off from everyday society in special institutions, sorting them into classes by age and putting them under the guidance of a single adult at the front of the class. The historical norm for socialising the young was through participating in society, being attached to social groups mixing the old and the young, and learning through observing, copying and improving on what they saw others doing. Schools have developed gradually over the last couple of centuries, with initially only the European White male gentry going to school to prepare to become gentlemen and various sorts of boss. It was not until the second half of the 20th century that secondary schooling became the norm in Europe and North America, and this is only now becoming the norm across the rest of the world.

The current generation of young people is less mentally healthy than previous generations. Rates of bullying and other forms of violence remain at worrying high levels in the UK and elsewhere. Use of alcohol, tobacco and other substances has seen recent decline in high-income countries, including the UK. However, there is evidence that this is now levelling off and, for some substances, increasing again. Young people's sexual health is improving globally, but in the UK young people report high levels of risk behaviours and adverse sexual health outcomes. Young people, particularly in high-income countries, tend to have poor diets and engage in insufficient physical activity, with increasing rates of obesity.

Schools are not the only cause of these problems, but they do play an important role. Drawing on qualitative research, I have described the ways in which schools can harm young people's health through mechanisms involving educational disengagement, lack of belonging in school community, and fear and anxiety. Statistical evidence from different kinds of study supports the view that schools have an impact on risk behaviours and health outcomes via these mechanisms. The best evidence is from longitudinal studies that track students over time and examine statistical associations between various school-level characteristics and students’ health outcomes or risk behaviours, adjusting for potential confounders. These studies suggest that within education systems, some schools do a better job than others of protecting their students and avoiding the three toxic mechanisms.

Introduction

The pandemic resulted in long school closures worldwide, the duration of which varied between countries, affecting 1.6 billion learners. In England, schools were closed for 17 weeks across two lockdowns. School closures harmed student attainment as well as mental health and wellbeing. Effects were very variable across groups and countries. Harms to wellbeing particularly affected girls, disadvantaged and unsupported students, young children and older adolescents. Harms to attainment particularly affected disadvantaged students, who generally experienced worse online learning.

Post pandemic, schools face big challenges with attendance, behaviour, engagement, mental health and attainment. The interventions discussed in this book should help schools manage these challenges. Schools can use the approaches outlined in previous chapters without waiting for government policies to change.

The interventions described don't need schools to be any less focused on student attainment, and in fact some of the approaches have been shown to boost attainment. But a more supportive policy context would help schools to achieve more dramatic improvements. How should education policy change to support such work and make it easier for schools to disrupt the three toxic mechanisms of educational disengagement, lack of school belonging, and student fear and anxiety?

How policy should not change

I should be clear first of all what I am not calling for. I am not calling for a return to academic selection or for the introduction of different schools for different sorts of student. Comprehensive schools are likely to achieve the best overall results.

Introduction

Just because an intervention is effective in one place or time or with one population does not mean it will be effective elsewhere. There has recently been something of a crisis of replication in the fields of social science, medicine, psychology and economics, where the results of one study are not always confirmed by replications of the study in similar or different settings. However, in the case of school interventions, the evidence seems to suggest that interventions similar to Learning Together, which modify school organisation to promote engagement, belonging and support to benefit student health, have been effective in a very broad range of places, times and populations. Similar interventions have had broadly similar effects in a diverse range of countries, including Australia, India, Uganda and the US.

Interventions that informed Learning Together

Learning Together was strongly informed by the US Aban Aya and the Australian Gatehouse interventions and by the scientists who led the development and testing of these interventions, Brian Flay in the US and George Patton in Australia, both of whom sadly died in recent years.

The Aban Ayayouth project, led by Brian Flay, involved changes to the school environment coupled with social skills lessons. It was evaluated in Chicago middle schools serving largely Black, highly disadvantaged students. The intervention aimed to reduce risk behaviours by ‘rebuilding the village’ to enhance students’ sense of belonging and community and increase social support. It was strongly informed by theories suggesting that enhancing relationships and cultural pride could reduce aggression, substance use and other risk behaviours. Aban Aya involved a standardised process of institutional change.

Introduction

This chapter first describes the limitations of observational studies. Then it covers some theories that can help us understand the impact of schools on young people. The Learning Together intervention is described, and evaluation of programme delivery and impacts is discussed.

The limitations of observational studies

Chapter 3 described evidence of statistical associations between, on the one hand, various measures of school-level characteristics and, on the other, various risk behaviours and health outcomes among the students attending these schools. The best of these studies used longitudinal designs tracking students over time so that it was clear that the school-level characteristics in question were present before, and therefore could plausibly be a cause of, the student risk behaviour or health outcome. These studies also tried to adjust statistically for possible ‘confounding’ factors that could provide alternative explanations for why students in certain schools engaged in more risk behaviours or had worse health outcomes. These confounders might be characteristics of the students who attended the schools, their families or the neighbourhoods where they lived. Such studies provide quite plausible evidence that schools might influence their students’ involvement in risk behaviours and health outcomes.

However, these studies are still quite limited in what they can tell us about school effects and the three toxic mechanisms. Some of the studies were cross-sectional, and with these it is hard to know whether the school-level factor in question is the cause or the consequence of the risk behaviour or health outcome.