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Part
II Findings
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Chapter
I: Introduction: The Link Between Health and Learning
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The
Role of School Health and Nutrition at the Education For All
Conference
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In March 1990, world leaders gathered in Jomtien, Thailand,
for the World Conference on Education for All: Meeting Basic
Learning Needs. Its goal was to "launch a renewed worldwide
initiative to meet the basic learning needs of all children,
youth and adults and to reverse the serious decline in basic
education"(Inter-Agency Commission, 1990a). The conference organizers
chose a different approach: Rather than focus on the traditional
issues of how to provide school buildings, textbooks, and teachers,
they decided to address the process of learning and the needs
of the learners. Health and nutrition were included as important
contributors to the success of both the learner and the learning
process. |
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In preparation for the roundtable "School Performance, Nutrition
and Health" at the Conference, UNESCO published a key document¾Malnutrition
and Infection in the Classroom¾which presented the relationship
between the status of children's nutrition and health and their
performance in school. The paper argued that because nutrition
and health are so important in determining educational outcomes,
they should figure prominently in any efforts to improve the
quality of education and the ability of children to learn. In
the preface, the Director-General of UNESCO stated, "It is no
longer possible to ignore the fact that nutrition and health
can severely affect the ability of children to learn. We are
constructing the future with the precious resource of the present-our
children. It is essential that they be given the opportunity
to derive maximum benefit from the schooling they receive" (Pollitt,
1990). |
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Schools have unique access to this "precious resource." In 1998,
UNICEF estimated that out of 625 million children of primary
school age, 79% were in school. The vast majority was receiving
some basic education. It is also estimated that 70% of children
in the developing world complete at least four years of schooling
(UNICEF, 1999). Therefore, a school's potential to affect the
health status and learning ability of an enormous number of
the world's children stands before us. There are far more teachers
than nurses or health care workers in most countries. The teaching
corps around the world can deliver many health promotion and
health service interventions easily and effectively, with benefits
to the teachers themselves as well (Partnership for Child Development,
1999d). |
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At the Jomtien Conference, participants echoed the need to broaden
the perception of what contributes to basic education and to
consider the many factors that affect human development. They
called for an expanded vision of basic education, one that recognized
that "education does not work in a vacuum or in isolation from
other factors that have a bearing on society" (Inter-Agency
Commission, 1990a). Ultimately, the 1990 World Declaration of
EFA and its articles recognized the relationship among health,
education, and health/nutrition policies and programs, stating
that "education can help ensure a safer, healthier, more prosperous
and environmentally sound world" and "learning does not take
place in isolation. Societies must ensure that all learners
receive the nutrition, health care, and general physical and
emotional support they need in order to participate actively
in and benefit from education." To do so, "new and revitalized
partnerships at all levels will be necessary between education
and social sectors" (Inter-Agency Commission, 1990a). |
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This study reviews the main activities that have taken place
in the school health and nutrition field around the world since
Jomtien, identifies strategies and interventions that have proven
effective, and suggests actions for the decade to come. The
information presented in this study is essential to policy-
and decision-makers who are committed to achieving EFA because
the link between learning and health clearly shows that it is
unlikely that EFA can achieve its goals without significant
improvements in the health of students and teachers. |
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| A Call
for Action at Jomtien |
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Conference participants addressed the link between health and
education. For example, UNESCO and the World Food Program organized
a roundtable "School Performance, Nutrition and Health." The
discussants concluded that to learn effectively, children need
good health. Further, they asserted that malnutrition and poor
health may be important factors in low school enrollment, absenteeism,
poor classroom performance, and early school dropout (Hoffmann-Barthes,
1999). |
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The World Health Organization and other agencies presented
another roundtable, "Health in Education for All-Enabling
School-Age Children and Adults for Healthy Living." The paper
presented by WHO on this occasion contained a compelling call
for action:
1. "Health
education must be inseparably linked with the Education
for All Initiative.
2. Countries
must formulate and support clear policies on school health
education and ensure that the education and health sectors
have a joint strategy for their implementation.
3. Curriculum
development must be based on the health needs of the different
age groups and take into consideration the socio-cultural
background of the schoolchildren. Curriculum development
committees must include parents and community leaders.
4. Personal
and social development must, along with intellectual development,
be given due weight in schools in order to foster values,
attitudes, and behavior conducive to health and well-being.
5. The
teaching of school health education requires teacher preparation,
guidelines, teacher learning material and curriculum support.
Teacher training institutions must revise their courses
in the light of this need. Team training of all categories
of school personnel, including the health, administrative,
and general staff, is recommended for a comprehensive school
health program.
6.
The pivotal role of teachers in promoting health in the
school and community needs to be given high priority. The
support of teacher associations must be sought to increase
the health awareness of teachers and encourage them to assume
responsibility for being role models for health in the school
and community.
7. Schools
must be health-promoting institutions. In addition to emphasis
on the development and implementation of health education
curricula, attention must be paid to ensuring that teachers
and other staff and the school environment support and facilitate
healthful living.
8. School
health education must be planned and implemented in the
context of the pupils' support, families and the wider community
to which they belong. It must relate to the life of the
child in and outside of school. Involving schoolchildren
in community activities and the community in school activities
will bring about greater understanding and encourage mutual
support" (WHO, 1990).
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Note that recommendations seven and eight present "school health"
as a concern for everyone in the school as well as members of
the community. |
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Although the roundtables on school health and education gave
strong and clear guidance for improving school health programs
as a means of achieving Education for All, those recommendations
were not given priority in the final report or in the Framework
for Action following Jomtien. Furthermore, no specific goals
for school health and nutrition or indicators were established
for the decade 1990-2000. |
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| A Growing
Body of Evidence-The Link Between Learning and Health |
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In the decade since EFA, many publications and studies have
elaborated on the link between learning and health status
(e.g., WHO/UNESCO/UNICEF, 1992). A WHO report stated, "As
long ago as 1950 it has been noted that nutritional deficiencies
and poor health in primary-school-age children are among the
causes of low school enrollment, high absenteeism, early dropout,
and poor classroom performance. Health is thus a key factor
in school entry as well as continued participation and attainment
in school. Moreover, education that provides children with
basic academic skills and specific knowledge, attitudes, and
skills related to health is vital to their physical, psychological,
and social well being. This is not only true in the short
term; such education lays the foundation for a child's healthy
development through adolescence and across the entire lifespan"
(WHO, 1997a).
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As numerous studies show, education and health are inseparable:
Nutritional
deficiencies (protein-energy malnutrition, iron, Vitamin
A, and iodine deficiency) and health problems such as helminth
infections (especially schistosomiasis and infections with
roundworm and other intestinal parasites) and malaria affect
school participation and learning. A 1990 analysis of nine
studies on the relationship between nutritional anthropometric
indicators (such as height-for-age and weight-for-height)
and school indicators (such as age at enrollment, absenteeism,
achievement test scores, IQ, and performance on selected
cognitive tasks) showed that better nutritional status was
consistently linked to higher cognitive test scores or better
school performance (Pollitt, 1990).
Violence,
unintentional injuries, suicidal tendencies, and related
lifestyle behaviors, such as the use of alcohol and other
drugs, interfere with the learning process. Children exposed
to violence may become highly aggressive, use psychoactive
substances, or show other dysfunctional ways of dealing
with anxiety (Singer et al., 1995). This behavior, in turn,
may reduce attendance at school, impair concentration, and
detrimentally affect cognitive development (WHO, 1998d).
Sexual
behaviors, especially unprotected sex that results in HIV
infection, other sexually transmitted diseases, and unwanted
or too-early pregnancies, affect both students' and teachers'
participation in education. These behaviors place at risk
students who have successfully reached secondary school.
Too-early pregnancies negatively affect the education of
young girls, who often must drop out of school. HIV/AIDS
has already had a devastating impact on children in sub-Saharan
Africa, where over 90% of all AIDS orphans live, most of
them will never complete a basic education (UNICEF, 1999).
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It is important that most of these issues can be addressed effectively
through health, hygiene, and nutrition policies and programs
for students and staff. Figure I in the appendix shows examples
of effective school-based interventions that prevent or reduce
specific health conditions. |
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The
Purpose of This Thematic Study
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The Thematic Study on School Health and Nutrition explores what
has happened in the field of school health and nutrition since
1990. Drawing on the contributions of researchers, practitioners,
and policy-makers around the world, this study aims to learn
from the promising developments of the last ten years, stimulate
dialogue, and move those involved to a shared vision and plan
of action for the next decade. Specifically, |
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Chapter
II presents research highlights of strategies that have
been found effective;
Chapter
III suggests actions to guide EFA 2015;
Chapter
IV reviews the status of the school health and nutrition
field leading to Jomtien;
Chapter
V describes conceptual frameworks that were developed through
the 1990s;
Chapter
VI reviews major global trends during the past decade.
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The authors have written this study for a broad readership:
those who work at different levels and in a variety of roles
in the education, health, and other sectors. |
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To prepare
this paper, the authors drew on:
telephone
interviews with and electronic questionnaires from approximately
40 respondents in agencies at the world, regional and national
levels;
the
collection and review of research articles, country reports,
and publications from many world, regional, and country
offices;
Web
searches of agencies of the United Nations and other organizations;
· their own firsthand knowledge of the field.
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Many talented and dedicated people have worked tirelessly to
move school health and nutrition policies and programs forward
in the 1990s. The authors are deeply grateful to so many who
contributed ideas to this timely review and to the many more
who have advanced the field of school health and nutrition through
their work since Jomtien. |
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| Return
to contents |
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