School composition, school culture and socioeconomic inequalities in young people's health: Multi‐level analysis of the Health Behaviour in School‐aged Children (HBSC) survey in Wales

Abstract

Health inequalities emerge during childhood and youth, before widening in adulthood. Theorising, testing and interrupting the mechanisms through which inequalities are perpetuated and sustained is vital. Schools are viewed as settings through which inequality in young people's health may be addressed, but few studies examine the social processes via which institutional structures reproduce or mitigate health inequalities. Informed by Markham and Aveyard's theory of human functioning and school organisation, including their concept of institutional boundaries, critical theories of marketisation and the concept of micro‐political practices within schools, this paper presents analysis of student survey data (N = 9055) from 82 secondary schools in Wales. It examines the role of socioeconomic composition, social relationships at school and institutional priorities in mitigating or perpetuating health inequality. It finds that affluent schools were most unequal in terms of student health behaviours and subjective wellbeing. In relation to health behaviours, students from affluent families accrue a disproportionate benefit. For wellbeing, students from poorer families reported lower subjective wellbeing where attending more affluent schools. Student–staff relationships appear to be a key mechanism underpinning these effects: poor relationships with staff were predicted by a pupil's position within schools’ socioeconomic hierarchy and associated with worse health outcomes. That is, students from the poorest families reported better relationships with teachers where attending less affluent schools. Universal approaches engaging with these social processes are needed to reduce health inequalities.

Student health and well-being in secondary schools: the role of school support staff alongside teaching staff

“…However, this may lead to an oversight of the more deprived students who are attending more affluent schools who report poorer relationships with school staff (Moore et al, 2017). Thus, work should be undertaken to investigate any role that models for the distribution of well-being support roles within schools may play in mitigating or perpetuating inequalities.…”

“…Students’ relationships with their teachers and with other students in the school environment are consistently predictive of a broad range of health and well-being outcomes (Bonell et al, 2013; Moore et al, 2017; Suldo et al, 2009). Interventions such as INCLUSIVE (Bonell et al, 2014b), a school environment intervention to tackle bullying, attempt to work with the pre-existing functioning of school systems and better orient these school environments towards supporting health.…”

The mediating role of social capital in the relationship between socioeconomic status and adolescent wellbeing: evidence from Ghana

“…Nevertheless, social inequalities in adolescents' wellbeing are often measured by examining disparities in adolescents' socioeconomic status (SES) while social capital is largely overlooked. Socioeconomic status (SES) has been found to impact health and wellbeing directly [2,[8][9][10][11] and indirectly through psychosocial factors such as the poor's inability to establish bonds and networks for their benefits [6,7,11]. These psychosocial factors, however, can function as protective mechanisms to offset some effects of SES inequalities on wellbeing.…”

Associations between socio‐economic status (including school‐ and pupil‐level interactions) and student perceptions of school environment and health in English secondary schools

“…We sought to repeat and extend the analyses done by Moore et al . (). We found that pupils from less affluent families tend to report a lower sense of belonging and lower commitment to academic values but not worse relationships with teachers or participative school environment.…”

“…Moore et al's analysis provided evidence suggesting that pupil-staff relationships are a key mechanism underlying the worse health of disadvantaged pupils in more affluent schools: poor relationships with staff were predicted by a pupil's position within the school's socio-economic status (SES) hierarchy and associated with worse health outcomes (Moore et al, 2017). Students from the poorest families reported better relationships with teachers where they attended less affluent schools.…”