Analyzing the No School No Pool Project in Burringurrah, Australia

This report analyzes the 'No School No Pool' video project in the remote Aboriginal community of Burringurrah, highlighting the crucial roles of education and healthy child development as social determinants of health. The project addresses the community's lack of knowledge regarding hygiene and swimming, and the lack of available services. It emphasizes how education and healthy development are key to improving health outcomes, reducing drowning rates, and enhancing social behavior. Furthermore, the report examines the application of primary health care principles, specifically community participation and health promotion, which guided the project’s implementation and success. The project also aligns with the Ottawa Charter's strategy of creating supportive environments. Cultural competence is identified as a vital component for effective engagement with the Indigenous community, ensuring the project is culturally sensitive and responsive to the unique needs of the community. The report concludes by emphasizing the project’s positive impact on health outcomes and the importance of addressing health inequities through a holistic approach.

1. Two social determinants of health that have established the need for the No
School No Pool video developed by Cunningham-Dunlop (2008), in the remote
community of Burringurrah, are education and healthy child development.
Education is a fundamental social determinant that could shape future outcomes
by providing knowledge and skills to individuals to solve problems and take
control of their life circumstances. Educational attainment is linked with health.
According to Raghupathi (2020), education improves knowledge, skills,
reasoning, effectiveness, and a broad range of other abilities that can be applied
to improving health. It could also enable physical, emotional, social, and
educational domains of development to be met, therefore making it an essential
social determinant of health. Hanh and Truman (2015) also stated that health
equity is promoted through programs as such, to close gaps in educational
outcomes between low-income or racial/ethnic minority populations and higher-
income or majority populations. Likewise, it was evident in the video that
education, as a crucial social determinant of health, significantly impacted on the
community involved. The community’s lack of knowledge of hygiene,
swimming and the lack of services introduced the need for the project.
Education was needed to aid the community and children with swimming and
resuscitation techniques, which are important to reduce rates of drowning in this
population, satisfying their physical and emotional wellbeing. The project has
guided the community to reduce mortality rates from drowning, which is a key
issue in these communities. The educational program was also able to improve
the social behaviour of the kids. Moreover, education influences the health

behaviours of individuals and is one of the most significant social determinants
of wellbeing.
Healthy child development is also a key factor as it plays a vital role in the
overall health of individuals and the community. For instance, healthy child
development enables the emotional, social, and physical development of young
children to be met. According to Moore (2015), there is evidence of worsening
or unacceptably high levels of problems in a minority of children across all
aspects of development, health, and wellbeing. These problems impacting
children developing in Australia are worse for Indigenous Australian children,
mainly due to socioeconomic variables because of health inequities. Thus,
healthy child development is an important determinant in the project, as it
enhances their current and future wellbeing. Likewise, in the video, No School
No Pool, developed by Cunningham-Dunlop (2008), it was evident that healthy
child development, as a crucial social determinant of health, was a determinant
that significantly impacted on the community involved. Due to the
environmental and social state of the community, children lack resources and
services that will improve and assist healthy child development. As quoted in the
video, ‘It’s pretty obvious when you first come out, the amount of scabies and
skin infections.’ The rural environment, as well as the community's social and
health inequity, endangers physical and emotional health. Thus, education and
healthy child development encouraged the need for the project in the video,
considering it enhances the quality of life and promotes optimised health in the
community.

2. Community participation and health promotion are two primary health care
principles that have guided the No School No Pool project in Burringurrah.
Community participation and health promotion are key ideas in the Alma Ata
Declaration (1978), which states that "people have the right and duty to
participate individually and collectively in the planning and implementation of
their health care.” Community participation is an essential primary health care
principle that encourages community members to contribute to deciding on their
health and for the needs of their community. According to Bath and Wakerman
(2015), ‘Community participation is a foundational principle of primary health
care, with significant reputed benefits including improved health outcomes,
relevance, quality, relevance, acceptability, service access and responsiveness.’
For instance, in an Indigenous community, projects aim to build strong
communities and support networks that are crucial to the effective functioning of
families and help them to provide a safe and healthy environment for their
children. Community participation assists individuals in the community to work
together to strengthen their bond through participation in school, or at the
swimming pool, where education, health and social interaction is promoted.
Participation was demonstrated through the planning and delivery of primary
care services, with the involvement of individuals within the community and
voluntary groups. Likewise, from the video, community participation played a
role in guiding the project. Members of the social project and community
members cooperated to identify the problems in the community, such as
infections in children, and strategies to address them to provide support towards

the community. Therefore, successfully guiding the project to achieve its goal of
building an optimal community health outcome.
Health promotion is also a significant primary health care principle which
directed this project. Health promotion aims to reduce the risk of diseases and
illnesses from development by engaging and empowering individuals and
communities in strengthening factors which help make individuals, families, and
communities healthier. This strategy promotes health by providing information,
education for health, and enhancing life skills. Defined by the World Health
Organisation, health promotion includes social, environmental, and political
processes that promote education, the development of life skills, and enable
individuals to have an increased control over their own health. Percival et al.
(2016), stated that the desire to close the health and life expectancy gap between
Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians
has led government and non-government organisations to invest considerably in
the development of health promotion. Through the video, No School No Pool, it
is evident that the desire to develop health promotion guided the project. It
indicates that health promotion plays a role in directing this project, through
constant references to Indigenous health issues. As stated by Mark, the pool
manager, children were suffering from severe skin, ear, eye, and respiratory
infections. The use of health promotion strategies, such as advocating through
education, to encourage health, enabling people to have equal access by
collectively including community members, and mediating through
collaboration of organisations to achieve equity in health. Inequities were
because of inadequate hygiene, exposure to a dusty and dirty environment, and

insufficient health services. Community participation and health promotion
therefore guided the program to ensure the community gains optimal health
outcomes.

3. Creating supportive environments is a strategy established by the Ottawa Charter
that strongly links to the project in the video. The Ottawa Charter defines health
promotion as' the process of enabling people to increase control over, and to
improve their health’. The implementation of creating supportive environments
is one of the main strategies of the Ottawa Charter, because of the obvious link
between people’s health and their environment. As stated by Fry and Zask
(2016), creating supportive environments is defined as developing physical and
social environments in ways which support health and protect against physical
hazards and socially and psychologically damaging practices, which can be done
by changing physical or social environments, by organisational change, or by
offering additional infrastructure, programmes, or services. In reference to the
video, the project’s overall aim, to offer participants an opportunity to engage in
social activities and improve their health, relates to this strategy. This strategy
enabled several social benefits associated with having a swimming pool in the
community, such as improved social cohesion and promotion of good behaviour,
such as increased school retention rates, as stated by Rochelle in the video, that
is also flowing on to the rest of the community. The video relates to the strategy
of creating supportive environments, as it reflects on healthy lifestyle choices
and assists in reducing illness associated with their physical environment, such
as skin infections. Through creating supportive environments, it allows social
justice principles to be addressed, by emphasising the importance of health.

4. Cultural competence is the key component of the attitudes, skills, and policies
that enable individuals to understand and communicate effectively with people
from intercultural settings. According to Grosser (2020), cultural competency is
the ability to become aware of the cultural differences that exist, appreciating
and understanding those differences and accepting them. It also means being
prepared to guard against accepting your own behaviours, beliefs, and actions as
the norm. It is a vital component in increasing a patient’s wellbeing, quality of
care and satisfaction. Cultural competence is significant when dealing with
Indigenous Australian health services and communities, and is essential to
reducing the institutionalised racism that maintains current Indigenous health
standards.
Due to the cultural differences in the community of Burringurrah, which consists
of a remote Aboriginal community. It is important that the project can adapt to
the contemporary Indigenous cultural context, to improve the outcome of the
project and improve the wellbeing of people in the community. Regarding the
video, cultural competence is displayed through the organisation’s ability to
understand and respect the Aboriginal culture, to understand the needs of the
community. The project’s team created strategies, such as involving ensuring
full participation of Indigenous community members, ensuring services are at a
cost the community can afford, for example, a swimming pool free to the
community to educate and improve social wellness, and possessing knowledge
about their culture. According to Curtis et al. (2019), lack of awareness about
culture, or being culturally incompetent, can cause poor communication, a lack

of partnership through participation/decision-making, a lack of respect, trust,
and most importantly, a huge factor in driving health care inequities. Cultural
competence is therefore important in determining the success of the project, as
the lack of cultural competence is consequential to the wellbeing of the
community and their safety.

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