Community participation in rural Ecuador’s school feeding programme

It takes a community: exploring APPLE Schools' impact within and beyond school walls in Canada

Childhood is a critical stage to develop healthy behaviours, and the school years are an important developmental period in which children are learning and growing. School-based health promotion interventions are increasingly using the comprehensive school health (CSH) approach that has been found effective at improving health behaviours, while adapting to the school and community context to create and sustain a healthy school culture. The interconnected environments of school, home and community are key to the CSH approach, however, there is minimal research that has been conducted to determine the impact at the community-level. This research used a qualitative multiple case study design to explore the influence of a school-based health promotion intervention, APPLE Schools, on the school and community environments from the perspectives of school staff in Alberta, Canada. Twenty-two participants participated in walking interviews in five schools. The walking interview approach combined interviewing and field observation and empowered participants to share their local expertise and knowledge within the context of school and community environments. Interviews were transcribed and analysed using an inductive thematic approach. Four themes were identified: APPLE schools look different, APPLE Schools build champions, APPLE Schools builds community partnerships and APPLE Schools honours community culture. Health promotion practice in schools was uniquely adapted based on strengths and needs of each school and was broadly influenced by the community outside of school walls. In sum, it was found that school-based health promotion reaches beyond school walls and can influence the broader community environment.

In the name of COVID-19: legitimizing the exclusion of community participation in Ecuador's health policy

Global shifts toward a disease-oriented, vertical approach to health has involved limiting the right for communities to participate in decision-making. Ecuador's authoritarian legacy has forced civil society and social organizations to adopt 'coping strategies', while large protests recently derived into violent struggles. The country has been severely hit by the COVID-19 pandemic amid corruption scandals involving hospital and food purchases by government during the response. This study critically examines how Ecuador's government took into consideration 'community participation' as a value and tenet of health promotion. Our systematic textual analysis focuses on 53 consecutive resolutions by the National Emergency Operations Committee (EOC) leading the decision-making processes, which, explicitly requires community participation. Results show that the 'lifecycle' of the central government's evolving policy framing centered on law enforcement and the private sector, followed by the social sector. Further, there is no evidence of stakeholders from civil society or organizations taking part in decision-making. Having legitimized the exclusion of community participation in Ecuador's response to the COVID-19 pandemic, it is possible that the government will fail to consider the wider social implications of its impact. In particular, the limits to local governments becoming informed and making decisions without mediation by the National EOC will further impede community participation in health decision-making in the future. This implies that local knowledge and experiences will also not inform health policy.

Do Israeli health promoting schools contribute to students' healthy eating and physical activity habits?

The Israeli Health Promoting School Network (HPSN) is actively committed to enhancing a healthy lifestyle for the entire school population. This study aimed to explore the contribution of school participation in the HPSN and students' individual characteristics to healthy eating and physical activity habits among Israeli school children aged 10-12 years. A cross-sectional survey was conducted among 4166 students in grades 4-6 from 28 schools. The schools were selected from a sample of HPSN affiliated and non-HPSN schools. The contribution of individual characteristics (grade, gender and subjective self-reported health education activities at school) and school characteristics (school type, population group, deprivation score) to healthy eating and physical activity habits was analyzed using multi-level hierarchical models. Multi-level analysis indicated that student's individual characteristic was significantly associated with healthy eating and physical activity habits. The subjective self-reported health education received at school was statistically significant factor associated with students' health behaviors. The school's affiliation with the HPSN was not associated with higher healthy eating and physical activity scores after adjusting for individual factors. These findings suggest that Israeli HPSN schools do not contribute to children's health behaviors more than other schools. Therefore, health promoting activities in HPSN schools need to be improved to justify their recognition as members of the HPS network and to fulfill their mission.

The rural school meal as a site for learning about food

The aim of the article is to contribute to the understanding of the school meal as a site for learning about food, nutrition and the wider determinants of health in three small rural schools of Ecuador. Based on a year-long qualitative fieldwork, the multiple case study associates Vygotsky's sociocultural theory of learning with Noddings' theory of care to analyze the findings. In the study, elements of care in the relationships between children and adults seemed to promote dialogue and, in this way, adults were able to model what is required to care for others and oneself. This entails that a focus solely on food or limitations on social interaction during the school meal may reduce its learning opportunities. The study concurs with the research that the food is better received when it is more aligned with the students' expectations. In addition, the findings support the view that rural school meal programs should address the views of parents and teachers because of their influence on how the meal is prepared and provided. The article proposes that schools work within a flexible framework emphasizing attention to the caring aspects of the meal, as a means to develop this dimension of the school meal. The study also contends that a collaborative reshaping of conditions formally set by school food policy is consistent with a critical approach to food and nutrition. In connection with this, the study concludes by highlighting the value of revisiting Noddings' perspective of care as deriving from the practice of opening up and meeting the other.