Social Determinants of Health in the 'No School, No Pool' Project

This report examines the 'No School, No Pool' project in the Burringurrah community, focusing on the social determinants of health (SDOH). The analysis highlights the importance of education, healthy child development, community participation, and health promotion. The project demonstrates how the implementation of primary health care principles, such as community involvement and cultural competence, can lead to improved health outcomes. The report references the World Health Organisation (WHO) and the Ottawa Charter for Health Promotion, emphasizing the role of community action and the creation of supportive environments. The 'No School, No Pool' project effectively increased school attendance and improved the health of the children, showcasing the impact of addressing SDOH. The project highlights the importance of cultural competence in achieving project success.

1. Social determinants of health (SDH) according to Foster et al. (2021), are non-
medical factors that influence health outcomes. The conditions in which people are
born, grow and work evidently shape the conditions of the individual’s daily life.
The World Health Organisation (WHO) has formally recognised that there are a
total of 10 social determinants of health that affect an individual’s ability to adopt a
healthy lifestyle (WHO, 1986). Education and a healthy child development,
components to the social determinants of health are evidently portrayed within the
‘No School, No Pool’ project video. Rochelle, a parent within the Burringurrah
community, located in the remote North Western Australia, has stated that “since
the pools have been up and they made the rule ‘No School, No Pool’ there’s more
attendance at the school” (Cunningham-Dunlop, 2008). Hence, the rule provides an
incentive for children, increasing the number of children attending school and thus,
receiving education. Hart et al (2017) elucidates that education plays a crucial
factor in conjunction with an individual’s health status, delineating that educational
programs provide an increase in knowledge of health and ways to access it and
thus, improving health outcomes. This is evidently analysed in the video,
communicating the value of education within the Burringurrah community where
the eldest custodians provide incentives for the children to receive an education.
According to Brady et al (2020), healthy child development is imminently a vital
social determinant of health, having a substantial role within shaping an
individual’s outcome with their future health. In reference to the video, the
Burringurrah community stated that before the introduction of the community pool,
the Burringurrah children were prone to various diseases and infections such as
scabies and glue ear. Evidently, the community started to see changes after less
than six months after the introduction of the pool where Mark, the teacher mentions

they have been “fortunate enough to look in ears from kids over the last couple of
years and you can see a great improvement” and have “noticed in the classroom
hearing the clean noses and clean skins”. Consequently, the increase in physical
health towards a healthy child development led the children to have a better health
outcome.
2. According to Clendon and Munns (2019), primary health care principles are
a guide in action towards illness prevention, health promotion and structural
and environmental modifications. Supporting health and wellness through
public participation in all aspects of life, provides a framework towards
equitable social circumstances, equal access to health care and community
empowerment. Hence, community participation is a central tenet towards a
primary health care approach that leads to improved health outcomes. It is
the cooperation within the community that establishes a mutual decision in
planning as a group to achieve an improved health outcome (Bath and
Wakerman, 2015). This not only enables individuals to enhance capacity for
developing social capital with mutual trust but also building a cooperative
network for better health and subsequently, strengthening the bond of the
Burringurrah community (Clendon & Munns, 2019). This is further depicted
in the video, where community participation is an integral primary health
care principle illustrated where Jack, a land custodian implements that “A
few of us custodians, the oldest, we sat out and decided what to do about the
kids who’s not going to school” (Cunningham-Dunlop, 2008). Subsequently,
the eldest custodians direct their focus on the factors that impact their health
status, improving quality community health development. Accordingly, the

‘No School, No Pool’ project successfully guided the Burringurrah
community to achieving their goal of increasing school attendance to overall
build an optimal community health outcome. Accordingly, another primary
health care principle that influences the project is health promotion where
Keleher and MacDougall (2016) defines it as the process of enabling
individuals to take control over the factors that determine their health. Thus,
an individual or community must be able to identify and realise aspiration to
satisfy their needs in order to change or cope with the environment (WHO,
1986; Talbot & Verrinder, 2018). Consequently, throughout the video, the
Burringurrah community evidently expresses the various conditions such as
glue ear and scabies before the introduction to the pool. Evidently, the
Burringurrah community have seen a “great improvement” in the children’s
health over the last couple of years where without the education, children and
adults are unable to expand their knowledge about health preventions and
treatments. The community believes that due to the “healthier and cleaner”
water within the pool along with the chlorine present, it has imminently had a
major factor within the improvements of the Burringurrah children’s skin and
ear conditions. Furthermore, Mark, the teacher within the community, has
“noticed with some of the particularly the older ones, their outlook or attitude
and everything is a lot better” and therefore according to Annie from social
projects has “seen a huge difference in the social behaviours of the kids and
its flowing on the rest of the community”.

3. WHO (1986) defines health promotion as the process of enabling individuals
to increase control over their decisions in order to improve their health.
Therefore, to achieve an active community action, individuals evaluate and
implement systems and strategies in order to achieve an overall improved
community health. The Ottawa Charter for Health Promotion is a framework
guide for the planning of strategies for care and project planning. Overall,
there are five core strategies within the charter which are; building public
health policies, strengthening community action, developing personal skills,
creating supportive environments and reorienting health services in order to
enhance health promotion and therefore, ensuring a comprehensive approach
to improving an individual’s health outcome (Clendon & Munns, 2019).
Strengthening community action, implemented from the Ottawa Charter in
1986 evidently correlates for community health promotion clearly portrayed
within the “No School, No Pool” project video. This is evidently seen
through the eldest custodian’s desire for children to attend school and as a
result, working together as an active community that led to the introduction
to the community pool. In turn, this community pool provided the
Burringurrah children who didn’t attend school an incentive to actively
attend school and therefore, receive their education. Communities can
develop an optimal health outcome by implementing the Ottawa Charter’s
basic strategies that consists of advocating, enabling and mediating a health
promotion strategy (Talbot & Verrinder, 2018). Supporting empowered
communities strengthens Indigenous community action and participation
ultimately building a positive future and leading to a better optimal health
outcome for the Indigenous communities. This is evident where the eldest

custodians saw a problem within the community and thus, came together as a
community in order to fix the situation. Thus, strengthening community
action as the Burringurrah community are coming together and “Things are
starting to happen, you know like the fencing, the painting of the houses,
houses getting rebuilt” states Rochelle (parent), in order to fix their
community environment so that it can be safe for the community.
Consequently, the strengthening of community action seen within the “No
School, No Pool” project evidently aims to build an active and healthy
lifestyle for the community and therefore, improving their health situation.
Hence, the project evidently conveys that a strengthened community action
ultimately enhances the promotion of optimal health.
4. Cultural competence delineates an individual’s ability to effectively
understand, communicate and therefore interact with people across different
cultures (Elisha & Nagelhout, 2018). Thus, becoming inclusive to other’s
voices and being aware of one’s own world view, becoming a vital
component to provide high quality ethical care. To be culturally competent,
individuals must develop cultural awareness and cultural sensitivity through
moral reasoning providing respect whilst tailoring the care and understanding
the needs of the culture and providing equality across health services
enhancing patient satisfaction, improving health results. Accordingly, skilled
communication is a vital component in being culturally competent by being
openly aware of cultural differences that in turn affects and influences an
individual’s health lifestyle choices (Henderson et al, 2018). Hence, the
notion of cultural competence clearly determines the success of the project as

individual’s become culturally aware of the different cultures and ways to
effectively understand and communicate with people across different
cultures. In regard to the “No School, No Pool” project video, cultural
competence through cultural inclusion, encourages community participation,
a primary health care principle where it establishes a trust between the
Burringurrah community, and the other individuals involved in the project
such as Annie who was from social projects. Consequently, community
participation evidently illustrated within the Burringurrah community led to
the introduction of the community pool that provided an incentive for the
Burringurrah children that in turn led to the children receiving education, a
social determinant of health. It can also be interpreted that there was an
involvement of intersectoral collaboration where Annie was able to gain an
insight into the cultures of the Burringurrah community. Subsequently,
cultural competence is an influential component towards the determining
success of the “No School, No Pool” project that was implemented within the
Burringurrah community.

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