Abbreviations

AIDS Acquired Immune Deficiency Syndrome

ALC Active Learning Capacity

CDC Centers for Disease Control and Prevention

CIDA Canadian International Development Agency

CRC Convention on the Rights of the Child

CTL Conditions of Teaching and Learning

DALY Disability-adjusted Life Year

DASH Division of Adolescent and School Health (at CDC)

DFID Department for International Development DOH Department of Health

EDC Education Development Center

EFA Education for All EI Education Internationa

l ENHPS European Network of Health-Promoting Schools

FAO Food and Agriculture Organization of the United Nations

FRESH Focusing Resources on Effective School Health

HBSC Health Behavior in School-Aged Children

HHD Health and Human Development Programs (at EDC)

HIV Human Immunodeficiency Virus

HPS Health-Promoting School

IBE International Bureau of Education IQ Intelligence Quotient

MLA Monitoring Learning Achievement

MOH Ministry of Health

MOE Ministry of Education

NGO Non-Governmental Organization

PAHO Pan-American Health Organization

PCD Partnership for Child Development

RAAPP Rapid Assessment and Action Planning Process

RH Reproductive Health

STD Sexually Transmitted Disease

STI Sexually Transmitted Infection U.N. United Nations

UNAIDS Joint United Nations Program on HIV/AIDS

UNDP United Nations Development Program

UNESCO United Nations Educational, Scientific and Cultural Organization

UNFPA United Nations Population Fund

UNICEF United Nations Children's Fund

USAID United States Agency for International Development

WCEFA World Conference on Education for All

WFP World Food Program

WHO World Health Organization

WPRO World Health Organization Regional Office for the Western Pacific

WWW World Wide Web

YRBS Youth Risk Behavior Survey

Ten major findings offer important guidance for the future:

1) School-based nutrition and health interventions can improve academic performance.

2) Students' health and nutrition status affects their enrollment, retention, and absenteeism.

3) Education benefits health.

4) Education can reduce social and gender inequities.

5) Health promotion for teachers benefits their health, morale, and quality of instruction.

6) Health promotion and disease prevention programs are cost-effective.

7) Treating youngsters in school can reduce disease in the community.

8) Multiple coordinated strategies produce a greater effect than individual strategies, but multiple strategies for any one audience must be targeted carefully.

9) Health education is most effective when it uses interactive methods in a skills-based approach.

10) Trained teachers delivering health education produce more significant outcomes in student health knowledge and skills than untrained teachers.

The suggestions are:

1) Major leaders and change agents in the field must come together around a common framework, relevant to the education sector.

2) To be successful, school health, hygiene, and nutrition efforts must be led by educators, supported and assisted by health professionals, and made an integral part of the efforts to improve education through policies and goals.

3) We must continue to deepen and expand collaboration, especially between the education and health sectors, with mechanisms that sustain and nurture joint planning, action, and learning over time.

4) More investment is needed in health services for children and adolescents that they can reach easily, without stigma.

5) Access to information as well as sustained support to use it (e.g., professional development, technical cooperation, and mentoring) must be improved for education and health workers.

6) Multiple targeted and coordinated strategies are needed to improve desired behavior patterns and health outcomes.

7) Indicators that provide universal measures of progress are needed to focus efforts and report changes that are possible to achieve by 2015.

8) Model programs should be developed for different levels of investment because countries vary in what they can afford.

School health efforts in 1990 can be characterized in the following ways:

1) Health initiatives in schools focused primarily on disease prevention.

2) There was confusion about the concept and definition of school health.

3) Single, uncoordinated intervention strategies dominated.

4) Few, formal mechanisms for multi-sectoral collaboration were in place.

5) Didactic, topic-by-topic teaching was the typical approach to health education.

6) Evidence of the effectiveness of interventions was not well known or disseminated.

7) Few tools to guide assessment and strategic planning were available.

8) Few donors earmarked school health programs as a priority for funding.

As the decade draws to a close, some of the major leaders and change agents at the world level are coming together to discuss how they might build on the frameworks since Jomtien and collaborate on a common framework for school health. WHO, UNICEF, UNESCO, and the World Bank are together developing "A FRESH Start: Focusing Resources on Effective School Health," launched at the Education for All Conference in Senegal in April 2000. The four essential components of the FRESH framework are:

1) Health-related policies in schools.

2) Safe water and sanitation facilities.

3) Skills-based health education.

4) School-based health and nutrition services.

Several major global trends over the past decade have dramatically influenced the scope and direction of school health work:

1) The AIDS pandemic stimulated a new demand and urgency for school health.

2) There was a gradual move from individual to multiple strategies and to integrated and coordinated approaches to school health programs.

3) New mechanisms for multi-sectoral collaboration have emerged.

4) Student and community participation has been an important factor in promoting school health.

5) Skills-based methods for health education have gained recognition and greater use.

6) The documentation and dissemination of evidence of effectiveness have increased.

7) New tools for assessment, planning, and monitoring have been tested.

8) Both, donor recognition of the field and investment have increased.

9) International conferences have addressed school health.

10) Various barriers still exist that can hinder future progress toward effective and sustained school health and nutrition interventions.