The disturbing link between education and health
We’re not making excuses. What we’re saying is this is the reality - this is what our children present with in the morning across the town.”
Andy Mellor is headteacher of St Nicholas Church of England Primary School in Blackpool. When pupils arrive through the gates, they are sometimes hungry or tired. Many of their parents are struggling to make ends meet and some have long-term health conditions, which means their children have to act as carers.
While St Nicholas has been rated as “outstanding” by Ofsted, educational outcomes for Blackpool as a whole are among the lowest in the country. At GCSE, just 47 per cent of students achieved a 9-4 pass in English and maths in 2018 - the second-poorest performing local authority after Knowsley.
Unfortunately, it’s not the only national table that Blackpool props up. According to the most recent figures available, male life expectancy at birth in the town is 74.2 years. That’s the lowest in the country, and almost a decade behind the local authority with the highest, 83.2 years, in Kensington and Chelsea.
And the link between the two statistics does not appear to be coincidental. Looking at the local authorities with the lowest educational outcomes, most have below-average life expectancy at birth. In Knowsley, it stands at 76.7 years for males, lower than the England average of 79.6. In Sandwell, which is the third-lowest performing local authority for GCSE passes in English and maths, it is 77.1.
“The connecting issue is poverty,” says Stephen Tierney, chief executive of Blessed Edward Bamber Catholic Multi Academy Trust, which runs three schools in Blackpool. “We have such a strong correlation, and I would argue causal link, between the level of poverty and educational outcomes.”
Health and education may be connected by poverty, but there’s a key difference between the two. In Blackpool, GPs aren’t held to account for low life expectancy. But Blackpool teachers - and those in other deprived areas - face constant official judgement for the educational outcome of their pupils (see box, opposite).
So what’s it like teaching in schools in parts of the country with the lowest life expectancy? Mellor has been a school leader in Blackpool for 20 years. “It is some of the most rewarding work you can do as a teacher or as a school leader,” he says.
Many of those who live and work there are uncomfortable with the fact that the area has become a case study of English deprivation, a reputation that has caused Blackpool further problems. Despite this, the town undoubtedly exemplifies some of the complex connections between poverty and other forms of deprivation.
Blackpool is not “your typical sort of place”, admits Mellor. “We have a large influx of people who, for one reason or another, have moved away [from somewhere else] and want a fresh start; we’ve got the highest number of children’s-home places in the country.”
The town is a “very seasonal place”, he adds, reliant on a tourism trade that lasts for about nine months and produces thin profit margins. “We have a large group of people in the town who are struggling,” he says.
Poverty doesn’t just manifest in hunger, but also in obesity and other health conditions. “If you haven’t got very much money, you can’t necessarily buy the sort of food that you might want to buy,” says Mellor. “You just have to buy what you can afford - and that isn’t always the best quality.”
Poor health feeds Blackpool’s low life expectancy. While male life expectancy at birth is 74.2 years, it is important to remember that this is an average figure for the local authority that conceals far lower life expectancy in some wards. Shockingly, in Blackpool’s Bloomfield ward, male life expectancy at birth is 65.8 years - the lowest in the country. Financial stress, coupled with physical and mental health problems, produce “high levels of pressure in the home”, which can sometimes flare into domestic violence, adds Mellor.
Tierney agrees. As a Blackpool head, every Monday morning he would receive “a whole load of domestic-violence reports from the police” involving families at his school. “Children [would be] coming to school having seen things that we would not want children to see,” he says.
‘Stressed children can’t focus’
All of this, of course, has implications for pupils’ capacity to learn. It is striking how often teachers working in deprived areas refer to Maslow’s hierarchy of needs - the pyramid that has “physiological needs” at the bottom and “self-actualisation” at the top - devised by the US psychologist in the 1940s.
Mellor mentions it in conversation, but so, too, does James Eldon, the principal of Manchester Academy in Moss Side. Previously, Eldon led Manchester Enterprise Academy, which serves a deprived, mainly white community in Wythenshawe. In this role, he encountered many of the challenges familiar to Blackpool teachers. “If you look on a basic level, children are less well fed or are hungry,” he says. “In winter, they are cold because heating houses, as we all know, is very expensive.”
The point about Maslow, Mellor explains, is that it is hard to get pupils to focus on academic studies when they’re being distracted by basic physical needs or concerns about home life. “For children to be able to access learning, they need to be in a position where they’re not stressed, where they’re able to focus, and many of our children aren’t in that position when they arrive in school,” he says. “We have to spend a lot more time settling them down.”
The sheer complexity of the issues that schools in areas of low life expectancy deal with is illustrated by the fact that, at Eldon’s old school, staff used a measure of deprivation to keep track of their pupils that had 16 categories of need: “We were able to say how many children in each year group had a parent with an addiction or an alcohol dependency, how many children in each group were young carers, how many children in each year group had parents with severe health issues.”
Eldon says the school used the information to plan “therapeutic interventions”.
As well as being linked by poverty, the other connection that life expectancy and educational outcomes share is that they are both influenced by the wider social infrastructure - social services, the NHS and welfare. And, as austerity has sent these services into retreat, schools in areas with low life expectancy have been forced to try to plug the gaps themselves.
When Eldon started at Manchester Enterprise Academy in 2011, there was an “incredibly popular and well-used” walk-in health centre next to the school, as well as a “fully functioning police station”. During his tenure, the health centre closed and the police station was downgraded to a “fairly skeletal administrative centre”. A strong group of Sure Start centres shut or had their provision reduced, and youth services were “massively cut”.
“If you’re making parallels with health, there’s an acceptance that wraparound services are all contributory factors to people’s wellbeing and health,” he reflects. “Therefore, if they are affected in any way, that may have a knock-on effect. But interestingly, it’s never seen that way with education. Schools are seen as islands.”
They are not, of course. “Reduction in services, in some cases decimation of services, obviously trickles through to families, which trickles through to children,” says Eldon.
Areas of deprivation can acquire a stigma that just makes education more challenging. “What we have in our Blackpool secondary schools is a historical view of the performance,” explains Mellor. “Parents who are more affluent and have more opportunities to ship their children out to neighbouring Lancashire high schools will do so. They tend to be the higher-performing kids.”
For those who are educated in the town, negative headlines about low life expectancy are a further hurdle to overcome. “That’s just another aspect of the job that we are trying to manage and support the kids through,” says Mellor.
He thinks that the Department for Education has in the past been complicit in denigrating poorer towns, though he says the tone it is currently taking is “far better now than it was”.
“There’s been a lot of damage done to places like Blackpool, Morecambe, Scarborough and Hastings by badmouthing them publicly and saying that standards aren’t high enough,” he believes.
Demographic accountability
This takes us back to the accountability system, which school leaders in deprived areas believe is hindering rather than helping their cause. The DfE might object that it has reformed the system to focus on progress rather than crude educational outcomes, such as the old five A*-C GCSE measure.
However, to some extent, even progress measures seem to be correlated with life expectancy and poverty. Blackpool has the second-lowest Progress 8 performance in the country. Most of the local authorities at the bottom of the life-expectancy table have negative Progress 8 scores.
If you look at the other end of the table, the nine local authorities with the highest life expectancy all have positive scores (see data graphic, page 49). Mellor thinks it is simply “cruel” to judge places such as Blackpool to the same standards as schools in affluent areas that don’t have to grapple with similar social problems.
The most pernicious aspect of the current system is that it adds to the existing stigma of deprived areas and makes recruitment even more difficult. “It’s a bizarre system where there’s less incentive to go into the areas that are most in need of good leadership,” says Eldon, wearily.
But the problem for those arguing for a greater appreciation of context in the accountability system is that they quickly run into accusations that they are peddling the “soft bigotry of low expectations” - a term popularised in England by Michael Gove when he was education secretary. Ofsted’s new inspection framework suggests it intends to move in a more nuanced direction - the inspectorate has said its focus on the quality of the curriculum will enable it to look beyond just school results.
But the organisation still seems to be facing in two directions on the issue. In December, Amanda Spielman, Ofsted’s chief inspector, said she would make “no apology” for not giving schools in deprived areas “an easier judgement”. “The moment we allow for a different quality of education based on demographics is the moment we concede defeat in the battle for equality of opportunity,” she added.
So is there a solution to the accountability conundrum? Mellor thinks the DfE could move toward looking at data for “families of schools” - comparing schools that have a similar demographic make-up. This would contextualise results, but would still allow those at the bottom of the cohort to be held to account.
Geoff Barton, the general secretary of the Association of School and College Leaders, also wants to see a more “inclusive” system of accountability.
While he thinks the DfE should continue to collect a core set of academic data, he would like to see the creation of a “dashboard” that would allow schools to flag up achievements not related to exams - such as the number of children playing in the school orchestra or taking part in other enrichment activities.
“What that does is recalibrate things so that those schools get a kind of recognition for doing things that are important, and we start broadening the notion of what education is,” he says.
Teaching in an area in which socioeconomic factors limit life chances - and even the amount of time someone can expect to live - comes with huge challenges. But it’s not all doom and gloom. The last word is best left to Mellor.
“There’s an element of social justice about what we do,” he reflects.
“There is nothing more powerful than working in an area where you’re trying to rebalance social inequality. It is rewarding and it’s more than just a job.”
@whazell
This article originally appeared in the 15 March 2019 issue under the headline “A matter of life and death”
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