| |
| |
|
Chapter
VI: Major Global Trends: Developments since Jomtien
|
| |
|
|
| |
Chapter IV described the status of the school health field leading
up to Jomtien. This chapter shows some of the major trends,
events, and activities that have happened over the last ten
years. With a scope as broad as a decade and a platform as enormous
as the world, only selected examples are given. Figure III,
in the appendix, lists selected online resources for school
health and additional information. Figure IV provides examples
of major trends and activities, barriers, and future actions
for the field of school health across regions and countries. |
| |
|
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.
|
| |
| To explain
more fully: |
| |
|
A defining characteristic of the 1990s has been the influence
of the HIV/AIDS pandemic on school health policies and programs.
The tragedy of this disease left many children as orphans and
many teachers and students dying. While this pandemic closed
the school door to many children and teachers affected or infected
by it, it also opened many doors to school health programs (Dick,
1999). |
| |
|
|
Because education to increase protective behaviors is one
of the few measures available to prevent HIV, and because
prevention ideally should begin before the onset of sexual
activity or alcohol and drug use, schools became a very important
setting for delivering life-saving interventions to children
and adolescents worldwide.
|
|
As educators and health workers began to plan and implement
school-based efforts to prevent HIV infection, many in the field
were asking what strategies were most likely to motivate people
to adopt protective behaviors. Such questioning, in the face
of the threat of HIV infection, led to reviews of lessons learned
from health education, sex education, family life, and reproductive
health education; increased calls for the implementation and
improvement of such programs; the innovative use of skills-based
methods; the cross-fertilization of ideas and strategies among
experts; and the involvement of young people in designing and
delivering programs. UNESCO, for example, launched a global
Program of Education for the Prevention of AIDS, which focuses
on integrating HIV/AIDS education into school curricula. Its
main goal is to put in place large national programs that draw
on the experiences of other projects and programs. UNESCO's
resource centers disseminate numerous materials and documents
on HIV/AIDS education, along with seminars and training for
ministerial staff and teachers (Dolan, 1999). |
| |
|
Since Jomtien, the following types of activities illustrate
how the complex and sensitive issues surrounding HIV/AIDS served
as an impetus for strengthening national, regional, and global
efforts to improve health through schools: |
| |
|
On a national level: In Zimbabwe, which has one of the highest
rates of AIDS cases on the African continent, the Ministry of
Education and Culture initiated an AIDS Action Program targeting
students and teachers in grades 4-7. More than 2,000 teachers
have been trained to use, not only specified AIDS education
materials, but also participatory life skills methods. National
programs fostered by UNICEF and focusing on life skills have
strengthened school health efforts by helping teachers: explore
their own attitudes and values about health, establish an open
and positive classroom climate, place education about HIV/AIDS
in the context of a general program on health, personal development,
and living skills, and use positive approaches that emphasize
an awareness of values, assertiveness, and other relationship
skills (Gachuhi, 1999). |
| |
|
On a regional level: In 1993, participants in the Inter-Country
Consultative Meeting on Comprehensive School Health Education,
convened by the South East Asia Regional Office of WHO, recommended
that in view of the physical, social, and psychological needs
of children, adolescents, and youth and the emerging health
problems such as AIDS/STD, drug and alcohol and tobacco use,
comprehensive school health education be given the status
of a separate subject in the school curriculum, in addition
to being integrated into other relevant subject areas. Furthermore,
the participants recommended that because comprehensive school
health education cannot be implemented effectively by teachers
without appropriate training, every member country in the
South East Asia Region should give priority to such training,
including adequate financial support for strengthening pre-service
and in-service training in health for teachers (WHO, 1993).
|
|
On a global level: In 1995, EI, WHO, UNESCO, and UNAIDS, in
collaboration with CDC and EDC, created an alliance to increase
the interest and involvement of teachers' unions in HIV/AIDS
prevention and in strengthening school health programs. In
July 1998, at EI's Second World Congress, teachers' unions
from around the world adopted a resolution on Health Promotion
and School Health. It calls on EI's member organizations to:
Play
an active role in the elaboration of school health education
policies in close collaboration with the ministries of education
and health.
Take
more account of the crucial role that the school system
and workers in education can play through health education
to prevent HIV/AIDS and STDS and drug abuse.
Become
more involved at every stage of the conception, implementation,
and evaluation of school health programs.
Take
action to ensure that all educational workers receive initial
and in-service training, enabling them to promote health
and health education. · Combat all forms of discrimination
and exclusion affecting students or workers in education
affected by HIV/AIDS or excluded because of their genetic
characteristics.
Establish
or develop contacts with parents and health professionals
at the local or national level.
Commit
themselves, especially in the framework of the Health Promoting
School, to make the school a healthy place that offers a
reliable infrastructure to guarantee protection from diseases,
violence, and harmful substances.
|
| |
| |
|
|
Such actions show an increased recognition of the need for and
value of working collaboratively to address HIV/AIDS while also
improving school-based efforts that address other issues affecting
health and learning. For instance, the use of tobacco and other
psychoactive substances has also stimulated interest and action
in the field of school health during the past decade, especially
in the Eastern Mediterranean and the Western Pacific regions.
Often, however, efforts were implemented as separate, vertical
programs (Chandra-Mouli, 2000). |
|
| |
| 2. There
was a gradual move from individual to multiple strategies and
to integrated and coordinated approaches to health education. |
| |
|
During the 1990s, frameworks evolved that included multiple
strategies-rather than individual approaches-to promote health
and nutrition through the schools. For instance, WHO's Health-Promoting
School model and its supporting tools (such as Local Action:
Creating Health-Promoting Schools) involve various participants
at the school level to foster health and learning with all the
measures at their disposal. In UNICEF's Child-Friendly Schools
Framework, the school culture, teaching behaviors, and curricula
content are all conducive to learning and learners. |
| |
|
In the United States, the book Health Is Academic outlines the
concept and components of coordinated school health programs
(http://www.edc.org/ HealthIsAcademic). It was developed by
EDC, with funding by CDC/DASH, and reviewed by more than 300
professionals before it was published in 1998. This book and
other efforts have had a marked effect on moving national school
programs toward a coordinated approach to school health. The
tendency toward more integrated and coordinated approaches to
school health is likely to continue and will balance content
from traditional disciplines. Health education can be coordinated
with or integrated into other subjects such as science, technology,
physical education, home economics, and social studies. |
|
| |
|
There are some notable examples of implementing coordinated
school health initiatives with multiple strategies, which
can both inspire and guide the field in the decade to come.
For instance:
The
Ministry of Health in Guinea, in collaboration with other
agencies, developed the following components for their Equity
and School Improvement Project (PASE), using data from baseline
studies and the World Bank's International School Health
Initiative's planning framework: teacher development in
the areas of helminth treatments, health education, and
referral for health services; and health services in the
schools to include antihelminth drugs, iodine, and iron
supplementation. Central to this project is community partnership
and partnership across sectors. A 1997 process evaluation
study revealed that the program was viewed positively by
99.3% of children and 100% of schools and had an impact
on enrollment, re-enrollment, and increased participation
by parents. Expansions are planned to include antimalarials,
vaccination, reproductive health, and HIV/AIDS/STD education,
campaigns to combat substance abuse, and measures to reduce
hunger (PCD, 1999g).
The
county of Lianjiang, China, launched a comprehensive approach
to creating Health-Promoting Schools in rural China, starting
with deworming. The project included guiding policy, collecting
baseline data, training staff, mobilizing the community,
two intervals of deworming services, improving the latrines
and safe water supply, and related health education activities.
Evaluations of this approach showed reductions in helminthic
infections and egg contamination in school environments
and positive changes in the students' knowledge and preventive
behaviors (Xu et al., 2000).
A U.S.
high school set up integrated services that included individual
and family counseling, primary and preventive health services,
drug and alcohol abuse counseling, crisis intervention,
employment counseling, training, and placement, summer and
part-time job development, recreational activities, and
referrals to health and social services. During the first
two years of the program, the number of births among the
students in this school dropped from 20 to 1, dropouts were
reduced from 73 to 24, and suspensions were reduced from
322 to 78 (Knowlton & Tetelman, 1994).
|
| |
| 3.
New mechanisms for multi-sectoral collaboration have emerged. |
| |
|
|
During the 1990s it became increasingly apparent that in order
for schools to improve health, international, national, provincial,
and local agencies, education and health professionals and parents
and communities will need to work together on behalf of young
people (Kolbe et al., 2000). A recent survey of donors and agencies
found that "there is a move towards inter-agency school health
planning, monitoring and evaluation, particularly in the U.N..
This reflects a move by the U.N. system and bilaterals towards
a sector-wide approach to funding, and away from a project approach"
(Dolan, 1999). For instance, a situation analysis that includes
assessments of adolescents' needs and responses was developed
as an interagency activity by UNDP, UNESCO, UNFPA, WHO, and
PCD and has been evaluated by WHO in Ghana, Zimbabwe, Botswana,
Uganda, and Kenya (Dolan, 1999). The World Bank's International
School Health Initiative has helped to create global partnerships
that focus on a common school health agenda (Bundy, 2000). Agencies
and donors have also expressed interest in a school health Web
site and mailing list, as is currently being developed by PCD
with the World Bank, which will provide a vehicle for greater
collaboration (Dolan, 1999). |
| |
|
The Partnership for Child Development has established programs
that emphasize the development of national collaborations as
a part of locally managed programs, the core of which is the
essential partnership between the health and education sectors.
There are now PCD research programs or activities in more than
14 countries around the world that are supported by a broad
range of international agencies (UNDP, WHO, UNICEF, World Bank),
bilateral agencies (USAID, UKDFID), and charities (Rockefeller
Foundation, Edna McConnell Clark Foundation, James S. McDonnell
Foundation, Wellcome Trust, and Save the Children Federation).
The Partnership was set up to develop the intersectoral collaborations
necessary to establish or strengthen school health programs.
This international initiative helps to provide technical assistance
and support so that low-income countries can monitor and evaluate
the costs, processes, and impact of these programs (PCD, 1999f).
|
| |
|
|
A major new global partner is Education International. Established
in 1993, EI represents more than 25 million teachers and workers
in the education sector, and more than 250 teachers' unions
in 150 countries are affiliated with EI. EI has adopted resolutions
to promote health and nutrition for its membership and has also
participated extensively with WHO, UNAIDS, UNESCO, and HHD/EDC
in providing professional development on health promotion for
members and HIV prevention initiatives. |
|
| |
|
Stimulated by WHO headquarters, WHO regional offices, and others,
networks have emerged as a means of communication and technical
support. Regionally, networks of persons responsible for school
health from both the education and health sectors have been
created to share experience and foster collaboration across
sectors. One of these networks is the European Network of Health-Promoting
Schools, a consolidating initiative between the health and education
sectors (European Commission et al., 1996). WHO's Mega Country
Health Promotion Network serves as a new mechanism to foster
cooperation between the ministries of education and health in
the 11 most populous countries, which face the common problem
of size. In the E-9 Initiative, sponsored by UNESCO, UNICEF,
and UNFPA, leaders of the 9 most populous developing countries
pledged to universalize primary education and reduce illiteracy
in their respective countries. However, such intra- and intercountry
networks do not yet involve every country.. |
| |
|
On a national level, collaboration between the health and education
sectors has been critical to program development. National intersectoral
coordinating committees have been formed in a number of countries,
including Samoa, Cambodia, Indonesia, and Laos (Lin, 1999).
In Viet Nam, the School Health Insurance was introduced in 1995
as a joint effort of the Ministry of Health and the Ministry
of Education and Training. This collaborative achievement enabled
the government to respond to two major concerns of Viet Namese
parents: the protection of their families against adverse consequences
of their children's ill health, and the creation of school conditions
and programs that are conducive to health and that help children
and their families stay healthy (Carrin et al., 1999). |
|
| |
| 4. Student
and community participation has been an important factor in
promoting school health. |
| |
|
|
During the 1990s, many publications and actions have recognized
and strongly supported youth and community involvement as important
for effective school health and nutrition programs. WHO's Adolescent
Health Program concluded that youth involvement ensures project
relevance, acceptability, dedication to project objectives,
long-term effectiveness, and personal development for the young
participants (WHO, 1997d; WHO/UNFPA/UNICEF, 1995). A paper prepared
for the Conference on Comprehensive Health of Adolescents and
Youth in Latin America and the Caribbean in 1996 states that
"involvement of youth is critical at every step along the way"
(Burt, 1998). |
| |
|
The European Network of Health-Promoting Schools (ENHPS) has
published many case studies that show how students have been
involved in planning, implementing, and evaluating various school
projects. In Gandrup school in Denmark, students have been involved
in planning. The pupils, who claimed that they learn more when
they are able to influence the choice of subjects, discussed
the WHO definition of health and then identified conditions
they wished to change in their school life, the community, or
their own lives (Jensen, 1997a). In another project at the same
school, students were involved in implementing programs. Fourth-grade
pupils taught second-graders. This project showed that "pupil
participation is a key prerequisite of sustaining their involvement
and motivation" (Jensen, 1997b). In a school in Finland, students
were actively involved in the evaluation of a school democracy
project in which they evaluate themselves, their actions, and
their progress twice a year. "This is important to the young
people because they can compare themselves with the prevailing
norms and then decide themselves in which ways they want to
improve or change." Feedback from teachers, pupils, and others
has proved that this project is worth continuing (Poentinen,
1998). |
| |
|
Family and community involvement has also been strongly supported
during the past decade. A recent U.N. study included community
and family involvement as a vital factor for "programs that
work." Community members must be recognized as central actors
rather than passive beneficiaries. In Tanzania, for instance,
severe malnutrition disappeared during a program whose feature
was growth monitoring in the community (UNICEF, 1998). |
| |
|
Active community participation has also played an increasingly
prominent role in effective collaboration. An extensive analysis
of the progress in the development of education in Africa found
that "the role of communities as providers of education is becoming
more complex and more substantive. ... Communities are becoming
involved in matters previously regarded as within the domain
of professionals and ministries. Communities are currently involved
in the recruitment of teachers, the negotiation of teacher salaries,
teacher management (Guinea, Cameroon, Senegal, and Tchad), school
management (Côte d'Ivoire, Zanzibar, and Tchad), the selection
of school curricula (Zanzibar), school mapping (Côte d'Ivoire,
Gambia), financial management (Madagascar, Tanzania), and the
establishment and management of preschools (Zanzibar). There
appears to be a partial shift of the locus of action and control
from the central ministries to the communities" (ADEA, 1999,
p. 64). |
|
|
| |
|
|
Local expertise is also indispensable to effective programs
and to identifying and solving local problems. Africa, for example,
has a wealth of community associations, including parent-teacher
associations, that can channel community participation and responsibility.
The early involvement of such organizations in developing a
program maximizes the community's commitment and the program's
sustainability. In Ghana, communities "revealed not only their
interest in alleviating the health and nutrition problems of
their school-age children but also a willingness to help pay
for these services" (Del Rosso & Marek, 1996, p. 36). |
|
| |
|
| 5. Skills-based
methods for health education have gained recognition and greater
use. |
| |
|
|
Research has demonstrated the effectiveness of skills-based
approaches in promoting healthy choices and in preventing or
delaying risk behaviors. Such skills include refusal, communication,
critical thinking, and other life skills. Interactive methods,
which give young people in the classroom the opportunities to
practice these skills with regard to important health issues,
are the most critical factor in achieving success. Increasingly,
schools are giving priority to teaching life skills. Numerous
products have emerged to support skills-based approaches. Many
countries (e.g., Zimbabwe, Cameroon, Colombia, Costa Rica) have
carried out skills-based health education projects. Uganda,
for example, launched a very well planned, comprehensive school
health initiative. Along with creating a network of health educators
at the district level for health education activities, skills-based
health education was integrated into the basic science curriculum
and also became part of the examination process (Hubley, 1998).
In September 1999, the Pan American Health Organization convened
a conference with Latin American and Caribbean countries to
plan how to strengthen skills-based health education in the
region. |
|
| |
|
| 6. The
documentation and dissemination of evidence of effectiveness
have increased. |
| |
|
|
The past ten years have seen an explosion in the number of documents
published by international organizations to report on the effects
of single interventions, such as treatments for intestinal worms
or nutritional deficits to reduce health problems and improve
learning. Others, such as Promoting Health Through Schools,
Report of a WHO Expert Committee on Comprehensive School Health
Education and Promotion (WHO, 1997a) and Class Action: Improving
School Performance in the Developing World Through Better Health
and Nutrition (Del Rosso & Marek, 1996), have synthesized the
findings of hundreds of studies to inform and convince policy-makers
and practitioners that the status of a child's health is a critical
variable in achieving the goals of Education for All. One of
the greatest innovations of the past decade is the use of the
World Wide Web for global knowledge sharing. The Web, relatively
untapped for school health in 1990, is broadly disseminating
evidence of the best practices worldwide in timely and cost-effective
ways. For instance, the Partnership for Child Development and
the World Bank are currently developing a Web site and moderating
an e-mail discussion list for donors, agencies, and governments
in order to share school health-related experiences, research,
programming, and related issues: http://www.ceid.ox.ac.uk/schoolhealth
(Dolan, 1999). |
|
| |
|
| 7.
New tools for assessment, planning, and monitoring have been
tested. |
| |
|
|
Several tools have been pilot tested, including those for:
(1) Situational
Analysis, developed by the Partnership for Child Development
in collaboration with other agencies, including UNICEF, the
Edna McConnel Clark Foundation, WHO, USAID, PAHO, and the
World Bank (http://www.ceid.ox.uk/ schoolhealth/download%20documents.htm).
The goal of the situational analysis is to guide the design
and evaluation of school-based health and nutrition programs.
(2) Rapid
Assessment and Action Planning Process (RAAPP), initiated
by WHO, PAHO, HHD/EDC, EI, and national agencies in Indonesia,
Bolivia, and Costa Rica. Consistent with the HPS framework,
RAAPP includes instruments, data collection, analysis procedures,
and strategic planning tools. Its purpose is to assess and
strengthen a country's infrastructure to support school health
programs (Vince-Whitman et al., 1997). Rapid Assessment Tools
have also been used by various other WHO programs recently
(e.g., WHO, n.d.).
(3) UNESCO/WHO
Survey on National School Health Policies, administered by
UNESCO in December 1999, includes items to assess which ministries
are responsible for school health issues and the existence
of national policies relating to the school environment, school
health services, and the teaching of health in primary and
secondary schools. Preliminary findings were presented at
the World Education Forum 2000 (UNESCO, n.d.; Birdthistle,
2000)
(4) Health
Behavior in School-Aged Children (HBSC), developed by WHO/EURO
and adopted by more than 25 countries to monitor health and
health-related behaviors and social influences on young people
(Wold & Aar, 1990; Wold, 1993; http://www.uni-bielefeld.de/gesundhw/hbsc/intpub.html).
(5) Youth
Risk Behavior Survey (YRBS), developed by the Division of
Adolescent and School Health of the U.S. Centers for Disease
Control and Prevention and piloted in more than 10 countries,
including China and the Russian Federation. The YRBS collects
data through schools that describes the prevalence of high-risk
behaviors among young people (http://www.cdc.gov/nccdphp/dash/yrbs/index.htm).
Its purpose is to monitor whether these behaviors change over
time (Kolbe et al., 1993).
(6) The
joint UNESCO-UNICEF International Assessment Survey Project
helps countries to collect empirical data describing health-related
learning outcomes and health-related teaching and learning
conditions in schools. Two prototype instruments have been
developed:
(1)
Monitoring Learning Achievement (MLA), which has a specific
section labeled "life skills" containing questions about
health-related knowledge; and
(2)
Conditions of Teaching and Learning (CTL), which contains
questions about school facilities and health, safety, and
security measures taken by schools. The surveys provide
nationally representative data obtained from fourth-grade
students (stratified random samples). They have been adapted
and implemented in approximately 40 countries as part of
the EFA 2000 assessment (Chinapah, 1997).
(7) School
Health Policies and Programs Study (SHPPS), developed by the
U.S. Centers for Disease Control and Prevention to monitor
improvements in eight components of the school health program
throughout the United States (http://www.cdc.gov/nccdphp/dash/shpps;
Kolbe et al., 1995).
|
|
| |
|
|
|
The use of each of these tools has been fairly limited. Still
needed are instruments to monitor progress worldwide, based
on common and comparable data items and data collection methods. |
|
| |
|
In the coming decade, FRESH partners plan to work collaboratively
to strengthen the monitoring and evaluation of school health
efforts, using and adapting the tools mentioned above. |
|
| |
|
| 8. Both,
donor recognition of the field and investment have increased. |
| |
|
Donors and philanthropic agencies appear to have an increased
commitment to providing financial and technical support for
improving health through the schools. A survey of donor and
agency support for school-based health and nutrition programs
found that increased donor interest and investment in the
health and nutrition of the school-age child was most apparent
in the U.N. system but also appeared in some of the bilateral
organizations and increasingly among NGOs (Dolan, 1999). Some
samples include:
UNICEF
currently supports a range of school health programs in
water, sanitation, and hygiene; life skills/AIDS; child-to-child
and extracurricular activities; and health and nutrition,
including the provision of micronutrients, anthelmintics,
and malaria tablets.
·The
World Bank's investment has primarily been through educational
projects, but also through health, nutrition, and social
protection credits. The Bank has created a specific school
health thematic group and has a specific school health initiative
for Africa. An increased investment in school health is
also expected through a partnership on this issue with PAHO
for Latin American countries (Bundy, 2000).
The
Canadian International Development Agency is a leading donor
in nutrition programming. Since 1992, CIDA has contributed
more than $87 million to nutrition projects and an additional
$120 million to integrated projects that combine nutrition
with health, basic education, and income generation activities.
CARE
supports a range of school health and nutrition projects,
including school health education in Kenya using Child-to-Child
approaches; a school nutrition project with community-based
activities in Laos; and a Children's Health and Environment
magazine project in Thailand (Dolan, 1999).
|
|
|
|
|
For more detail about a broad range of school health and nutrition
programs carried out and financed by donor agencies, refer to
the "School Based Health and Nutrition Programs: Findings from
a Survey of Donor and Agency Support, Carmel Dolan, 1999" (http://www.ceid.ox.ac.uk/schoolhealth/download%20documents.htm).
|
|
| |
|
| 9. International
conferences have addressed school health. |
|
| |
|
|
During the past decade, many major international conferences
brought together important leaders and change agents and gained
international attention. School health issues were addressed
in various contexts as part of these conferences. Figure V gives
an overview of selected conferences and the school health issues
they addressed. |
|
|
| |
|
| 10.
Various barriers still exist that can hinder progress toward
effective and sustained school health and nutrition interventions. |
|
| |
|
|
Despite the encouraging global trends of the past decade,
barriers, controversies, and missed opportunities continue
to impede the implementation and effectiveness of school programs
at the national and local level. Significant work is still
needed to make the hope of a Health-Promoting and Child-Friendly
School a reality for most schools. Country and regional representatives
around the world reported the following national barriers:
The
absence of political concern and national legislation to
support school health programs.
The
lack of a well-defined national strategy and policies for
the promotion, support, coordination, and management of
school health programs. · Limited funds allocated for school
health programs or the inequitable distribution of existing
resources.
Weak
links between the health, education, and other relevant
sectors.
The
failure to escalate pilot projects to large programs.
The
lack of data, particularly relevant disaggregated data,
helpful to program planning.
|
|
|
|
Obstacles to effective partnerships for school health were
identified by participants in the World Education Forum in
Dakar, Senegal:
Different
mind-sets and ways of thinking about conceptual frameworks
Cultural
barriers
Competition
for funding
Hostility
toward partnerships
A lack
of clear guidance in creating effective partnerships
|
|
|
|
Obstacles repeatedly identified at the local and school levels
include: ·
A lack
of awareness and support for school health programs.
An
inability to sustain the quality and even the existence
of school health programs.
The
overcrowding of pupils in schools and of content in the
curriculum.
A scarcity
of trained people (including teachers) to implement school
health programs.
The
inadequate supply and production of teaching and learning
materials and resources, including supplies, books, and
equipment.
Limited
or no funding to support health activities.
A lack
of monitoring and evaluation of current school health programs.
The
deterioration of the initial positive effects of many school
health interventions due to unsupportive conditions in the
school and its surrounding environment (e.g., the availability
of drugs, tobacco, and alcohol; messages in the media that
contradict messages promoted at school).
|
|
|
|
Finally, many schools still exemplify unhealthy living, where
teachers and sometimes students smoke, where the only food choices
are unhealthy, dirt is prevalent, and harassment is unchecked.
There is an urgency and opportunity to use the knowledge, momentum,
and international commitment gained since Jomtien to tackle
the operational challenges that impede progress within both
countries and schools. |
|
|
| |
|
|
To overcome these barriers, strong and genuine partnerships
at all levels-i.e., between different sectors, between governmental
and nongovernmental agencies, between teachers and health workers,
between school and parents and the larger community-are critical
to successful school programs. To make partnerships work, it
is important to remember the common denominator that connects
the various sectors, disciplines, and specialists: the larger
social development agenda and the welfare of children. |
|
|
| |
|
|
The FRESH framework is a good example of how international
agencies can work together. To achieve similar cooperation
at national and local levels, the following WHO publications
may provide useful guidance:
Improving
School Health Programs: Barriers and Strategies. WHO/HPR/HEP/96.2
Local
Action: Creating Health-Promoting Schools. (Both are available
at: www.who.int/hpr/gshi/docs/index.html; or from WHO, Dept.
of Health Promotion and NCD Prevention and Surveillance,
20 Avenue Appia, CH-1211 Genève 27, Switzerland.)
|
|
|
|
| Regional
Trends |
|
| |
|
|
Progress in school health and nutrition has varied dramatically
across regions and nations. Figure IV shows major regional
trends and accomplishments in school health and nutrition
in Africa, the Americas, Europe, the Middle East, South and
East Asia, and Australia during the past decade. This figure
also lists barriers to school health experienced in these
regions and activities planned for the future. For example:
In
Central and Eastern Europe, many of the formal mechanisms
that were in place in 1990 providing social services to
young people, including those through the educational system,
have deteriorated. This change occurred when the communist
system fell apart and with it the numerous structures that
were reaching out to young people.
In
the Western Pacific, extensive accomplishments have taken
place to create Health-Promoting Schools, supported by national
policy frameworks and a regional technical assistance network.
·
Countries
like Guinea and Indonesia have systematically developed
comprehensive school health programs with incentives and
awards for local schools, and countries in Africa, such
as Uganda and Zimbabwe, have made excellent progress with
skills-based health education.
|
|
|
|
During the past decade, we have seen the best thinking about
education and health coalesce into several frameworks that identify
the core principles shared by professionals and practitioners
around the world. Definitive research results proliferated,
and collaborative efforts expanded. Even failures and the tragedies
of HIV infection have taught us profound lessons that can guide
us in future efforts. |
|
|
| |
|
|
The access to and attainment of education and health must therefore
drive all development policies, and many countries may need
to rethink their social and economic priorities. Education for
All should be seen as the foundation for access for each and
every person to each and every level and form of education,
and the quality of education should be seen, not only in terms
of educational standards, but also of relevance. The direct
links to health are clear: education has a fundamental role
to play in personal and social development, and it is unlikely
that the goals of education will be achieved without significant
improvements in the health of both students and teachers. |
|
| |
|
|
---------------------------
|
|
| Return
to contents |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
