Is schooling good for Aboriginal children’s health?

Merridy MalinAboriginal Health Council of S.A.

June 2009

Overview: Drawing on a micro-ethnography of one classroom, hypothesise about health promoting

pedagogy

Connections between western schooling and health Connecting the findings of family and classroom micro-

ethnographies Examine the classroom dynamics in one classroom looking at:

– What skills did the Aboriginal children bring from home to school– How did the teacher accommodate those skills in the classroom– What was the status of the Aboriginal children at the end of the

year in that classroom What does research suggest about

– what everyday situations might be stressful to children– the impact of stressful situations on the stress hormones in

children– the impact of stress on health– moderators of stress

Extrapolations on what might be healthful pedagogy

Social Determinants literature

“The health of populations is related to features of society and its social and economic organisation … health is a matter that goes beyond the provision of health services.” Acheson, in Marmot & Wilkinson 1999, p. xi; Carson, Dunbar Chenhall and Bailie 2007, p. 9.

This literature focuses on the social environment rather than health services and individual psychology or behaviour.

Social factors include: housing, transport, racism, employment, social supports, education, etc.

Connection between Health and Education

International literature (Caldwell 1991; Boughton 2000)

Parental education child survival

10% increase in literacy rates associated with

10% decrease in child mortality.Maternal education a child survival

Mothers with more confidence, higher expectations of

medicine, more assertive in seeking health carePopulation literacy levels (Marmot 1999)Years of schooling for self (Marmot 1999)

Australian research

3 proposed pathways: Education employment income health (Tsey)

Maternal employment child health (Ewald &

Boughton)

Education social and emotional well being

From: Terry Dunbar and Margaret Scrimgeour (2007)

Malin researchMalin research

Ethnography4 Adelaide families at home (2 Nunga, 2 Anglo

Australian)

3 classrooms across school year– Participant observation– Intensive interviewing– Videotaping

Reception – Year one classes Low income Adelaide suburban school

ScenarioScenario

Naomi, Jason and Terry were 3 physically

attractive, energetic, bright and curious

Aboriginal five year olds. Outside the

classroom,

they were articulate and confident but inside

the classroom, by the end of the year, they

were in the lowest academic group for their

age, considered troublesome by their teacher,

and were largely ostracised by their non-

Aboriginal peers.

Culture defined

System of standards for perceiving, believing, evaluating and acting

(Goodenough 1981)

Assumption: Culture variable & Assumption: Culture variable & constantly changingconstantly changing

People’s behaviours change with age, size of the family and gender

Different generations also vary

Commonalities, enduring traits within cultures eg middle class Australians versus middle class people from the USA

Enduring traits found in this research:

– Childrearing practices

– Communication styles

Parent preferences:Parent preferences: AutonomyAutonomy

Self regulationChildren will put on a jacket when coldWill get something to eat when hungryWill ask for assistance when it is needed

Self reliancePhysically tough, emotionally stoic, streetwise

Teacher response to autonomous childTeacher response to autonomous child

– Great practical competence, ingenuity, independence: Talents not ‘seen’ by teacher

– Not responding to teacher directives first time round:Child seen as disobedient, rebellious

– Not monitoring teacher’s presence sufficiently:Child caught out doing the wrong thing

– Wandering in mind and body while sizing up the situation:Child seen as vague: ‘on another planet’

– Not answering direct questions quickly enough:Child seen as not knowing

– Being assertive in settling disputes:Child seen as aggressive

Parent preferences:Parent preferences: AffiliationAffiliation

Collective responsibility - ‘Caring and sharing’– Sociability and social knowledge– Kinship knowledge– Acts of concern for others

– Sharing with, assisting, supporting another regardless of age

Parent preferences:Parent preferences: AffiliationAffiliation contcont

Nurturance – caring for younger sibling– Awareness of whereabouts– Offering to play, take them somewhere– Carry them– Show them something– Help, feed, give information to them– Draw the attention of another to them altruistically– Explain on their behalf to someone else– Show affection towards them– Express amusement at them in good natured way

Teacher response to affiliative childTeacher response to affiliative child

Sophisticated kin knowledge • Knowledge not ‘seen’ by teacher - invisibility

Monitoring peers for information Being aware of others’ whereabouts Being aware of others’ needs

• If seen, interpreted as being a ‘busy body’

Physical demonstrations of affection, touching, sitting close to

• … distracting

Teacher response to affiliative childTeacher response to affiliative child contcont

Stating achievements collectively “We made …” • …not acknowledged/ noticed

Speaking on behalf of other children• …being ‘busy body’

Drawing attention to others’ achievement• …being ‘busy body’

Lack of practical academic supportLack of practical academic support

Less time on task– Reading aloud at school individually– Instruction time given for individual & small group– Time left to work independently– Time spent in ‘time out’– Encouragement to read at home

Poor quality time– At end of lesson during classroom disturbance– Placement in group below child’s attainment level

Social exclusion by teacherSocial exclusion by teacher

Teacher displayed irritation or dislike of child and did not trust their ability to shoulder responsibility

Nunga students reprimanded and punished more often

Punishments were more severe

Jokes not acknowledged

Teacher did not share her personal stories

Assertions were doubled checked

Seen as behaviour problems

Excessively controlled in daily work

Social exclusion by teacherSocial exclusion by teachercontcont

Correct academic responses were not recognised

Good work received with surprise, scepticism

Their satisfaction at positive feedback interpreted as bragging

Punishments resulted in negative academic outcomes

Social exclusion by peersSocial exclusion by peers

After Nunga children were censured: Other students ostracised them

– Refused to play with them– Moved away from them – Made faces at them

Nunga children responded by:– Pleading for acceptance– Offering food or money– Expressing anger– Social withdrawal– Angry outbursts at teacher and peers– Seeking repeated affirmation of work from teacher

General outcomeGeneral outcome

Invisibility syndrome– Achievements not seen

Failures highly visible in – low expectations – not trusted– punishments

Evidence of distress– Seeking repeated affirmation of work from teacher– Angry outbursts with friends– Angry outbursts with teacher

Family, environment, stress & health Family, environment, stress & health during childhoodduring childhood – MV Flinn 1999

10 year ethnographic study of 264 children, aged

2 months - 18 years

Marker of stress was cortisol, obtained from saliva swabs taken randomly several times per day

Diary kept of events immediately before swab

Chronically stressed children had Chronically stressed children had higher levels of cortisol and higher levels of cortisol and

experienced more illnessexperienced more illness

“Chronically Stressed” - involved 2 or more events of – parental conflict, – mild abuse or neglect, – an anxious or inhibited temperament, – parent alcoholism, – few friends, – involvement in theft, fighting, running away,

punishment, quarrelling, embarrassment

Racism, Poverty, etc.

Daily Stress

DailyFlight-Fright response

Flight-Fright response

Sympathetico-adrenaline pathway:

• Increased heart rate• Increased metabolic rate • Increase blood pressure• Constriction of blood vessels• Increased perspiration.

In the longer term

Sympathetico-adrenaline pathway:

Affects immune system, blood clotting, inflammation & anincreased susceptibility to all major diseases

Adaptive for short lived stress (for flight) but

Hypothesised biological pathwayHypothesised biological pathway

Moderators of stressModerators of stress

Social support (Stansfield 1999, Syme 1998, Cobb 1976)

– Emotional support - Information to help resolve problems; Access to support networks; Boosting self-esteem by others

– Instrumental or practical support – resources, money Cultural factors (Jackson & Sellers 1998; Niles 1999: Syme 1998)

– Strong sense of cultural identity– Shared sense of spirituality– Family support– Associating with members of one’s cultural community

Individual temperament & personality

Education & social and emotional well Education & social and emotional well beingbeing

Hypothesis: Education will enhance the SEWB of children if offering:

Social support– Emotional support-Information to help resolve problems; Boosting

of self-esteem by others– Instrumental or practical support including sound teaching

methodologies

Cultural support / inclusion:– Strong sense of cultural identity– Family support– Associating with members of one’s cultural community

Sandi Hudspith’s research

Learning to Belong: An Ethnography of Urban Aboriginal Schooling. PhD thesis, Charles Darwin University 1996

School – Health connection hypothesisSchool – Health connection hypothesis

Health effects of schooling may be cancelled out in Australian contexts by marginalising processes of colonisation.

School failure is partly the result of marginalising practices.

Commonplace practices can marginalise unintentionally and create stress

Socially supportive and ‘inclusive’ practices which facilitate child learning most probably promote child health

Concluding statementConcluding statement

Health does impact on the child’s accessibility to education

Western education is likely to be health promoting for Aboriginal and Torres Strait Islander children if it offers ‘social support’ and is ‘culturally and socially inclusive’

References

Boughton, B. 2000. What is the connection between Aboriginal Education and Aboriginal Health? Occasional Paper series, Issue 2, CRCATH, Darwin

Brunner, E.J. and Marmot, M.G. 1999. Social organization, stress and health. In M.G. Marmot & R.G. Wilkinson (eds), Social Determinants of Health. Oxford University Press, Oxford.

Caldwell, J & Caldwell, P. 1991. What have we learnt about the cultural, social and behavioural determinants of health? Health Transitions Review, vol. 1, no. 1, pp. 3-17.

Dunbar, T & Scrimgeour, M. 2007. Education. In Carson, B., Dunbar, T. Chenhall, R.D. & Bailie, R (eds.), Social Determinants of Indigenous Health. Allen & Unwin. Crows Nest

Flinn, M.V. 1999. Family environment, stress, and health during childhood. In C. Panter-Brick & C.M. Worthman (eds.), Hormones, Health and Behaviour: A Socio-ecological and lifespan perspective. Cambridge University Press, Cambridge, pp. 105-318.

References cont.

Gallaher, G, Ziersch, A, Baum, F, Bentley, M, Palmer, C, Edmondson, W & Winslow, L. 2009. In Our Own Backyard: Urban Health Inequities and Aboriginal Experiences of Neighbourhood Life, Social Capital and Racism. Adelaide: Flinders University.

Goodenough, W. 1981. Culture Language and Society. Reading, Mass: Addison-Wesley Modular Publications, No. 7.

Malin, M. 2003. Is Schooling Good for Aboriginal Children’s Health? Occasional paper series, no. 3, pp. 312-29.

Malin, M 1997. Mrs. Eyers is no ogre: A micro-study in the exercise of power. In G. Cowlishaw and B. Morris (Eds.), Race Matters: Indigenous Australians and 'Our' Society. Canberra: Aboriginal Studies Press, pp.139-158.

Tsey, K. 1997. Aboriginal self-determination, education and health: Towards a radical change in attitudes to education. Australian and New Zealand Journal of Public Health, vol. 21, pp. 77-83.

Contact Details

Merridy Malin

Aboriginal Health Council of South Australia

merridy.malin@ahcsa.org.au

Phone: 8132 6700

THANK YOU

Racism & Mental Health

Rollock and Gordon (2006) and Miliora (2000) found racism Generates internal stresses in individuals resulting in mental health

problems. Can lead to limitations in lifestyles ; can lead to depression, anxiety, substance abuse, and chronic physical health problems.

Gallaher, G, Ziersch, A, et al, (2009) survey of 153 Aboriginal people in Adelaide found:

– Substantially lower levels of trust in institutions among the Aboriginal people when compared with non-Indigenous people

– 93% of Aboriginal people reported experiencing racism at least sometimes

– 66% experienced it often

Responses to racism (Gallaher et al)

People believed that the experiences with racism impacted on both their physical and mental health.

94% reported they felt frustrated/angry or annoyed

69% avoided situations in response

Over 66% reported physical responses including headaches, stomach aches, pounding heart, shaking

More than 50% reported feeling ashamed, humiliated, anxious, fearful, powerless, hopeless, depressed

People who regularly experienced racism were more likely than not to have poor mental health

Upstream - Midstream- Downstream

Social determinants

EmploymentHousing

EducationRacismIncome

GovernmentPolicies

Economic, Welfare, Health

Housing, transport, taxation

Psychosocial Factors

NetworksSocial Support

Control

Stress

Culture

Beliefs

Values

Norms

Biological reactions

Hypertension

Adrenalin

Glucose intolerance

Physiological systems

Endocrine

Immune

Health Behaviours

Smoking

Alcohol

Addictive behavioursSuppressed immune

function

Global Forces

Self esteem

Isolation, anger

The control factor

Mapping the pathway from employment to ill health - Whitehall study

– The lower in the hierarchy the poorer the health of white, middle-class bureaucrats

– High demands at work and little discretion for how the demands are dealt with

In the industrialised world for almost every disease there is a stepwise gradient