1995
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CONTENTS Introduction Scope and purpose of the workshop Participating countries and organizations Proceedings Welcoming addresses Introductory statements Survey of pre-workshop questionnaires Reports from international agencies Country reports Additional reports from WHO collaborating centres Workshop process Conclusions and proposals Conclusions Proposals Concluding remarks Annexes Annex 1 List of workshop participants, observers representatives and secretariat Annex 2 Summary of pre-workshop worksheets 24 1 1 2 3 3 4 5 7 7 13 14 16 16 17 22
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INTRODUCTION Scope and purpose of the workshop The concept of health promoting schools has rapidly gained credibility over the last decade and now provides a widely-accepted basis for the development of schools into social institutions that active ly promote the health of students and teachers, and contribute to the health of the wider community. The intention of the workshop was to bring together representatives of many of the nations in the Western Pacific Region (particularly the island countries of the Western Pacific) to increase familiarity with the concept, to identify current practice in schools and to plan for further development. More specifically, the workshop sought to: § identify the current conditions in schools (e.g. physical facilities, trained staff, educational resources) and the current practice of health promotion in schools. This was achieved in part by summarizing pre- meeting worksheets completed by the official workshop participants and by presentation of country reports; identify the potential best practice of education and school-based health promotion that may be achieved over the next five years in each country; identify the most significant barriers to the development of health promoting schools and those factors in which change was most needed; identify the types of support and resources required to close the gap between current and best practice; and make recommendations that would support the further development of health promoting schools in the Region.
§ § § §
The workshop objective was to enhance the capabilities of participants in the implementation of school health promotion programmes by:
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1. exchanging experiences in the organization of effective school health promotion; 2. providing guidance for the development of school health promotion in the Western Pacific Region; 3. finding ways and means to link individual Member States in joint projects to promote health in schools; and 4. identifying priority areas for research in the development of health promotion in schools.
Participating countries and organizations The Workshop was attended by representatives of most of the WHO Member States from the south and east of the WHO Western Pacific Region, including Australia, Cook Islands, Fiji, Kiribati, Federated States of Micronesia, New Zealand, Papua New Guinea, Solomon Islands, Tonga, Vanuatu and Samoa. Rele vant WHO collaborating centres in the Western Pacific Region were represented and included: the Department of Public Health, School of Medicine, Juntendo University, Tokyo; Shanghai Health Education Institute, People's Republic of China; and the Department of Training and Health Education, Singapore Ministry of Health. Several international agencies and organizations were also represented. They were: the Australian National Catholic Education Commission, the New Zealand Ministry of Education, the University of the South Pacific and WHO (Western Pacific Region). A full list of the workshop participants and observers is attached as Annex 1. The workshop was funded by the following: Australian Agency for International Development (AusAID); National Centre for Health Promotion, Department of Public Health, University of Sydney; and World Health Organization, Regional Office for the Western Pacific.
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PROCEEDINGS Welcoming addresses Dr Tony Adams, Chief Medical Officer, Australian Department of Human Services and Health, formally opened the workshop, welcomed the workshop participants and extended a welcome from the Australian Federal Minister of Human Services and Health, the Honourable Dr Carmen Lawrence. Dr Adams pointed out that the Australian Government recognized that successful health promotion required attention to a broad range of factors including the family, the community, and the physical and social environments. In schools, emphasis should be placed on equity and on creating a fair and democratic environment. The activities in support of health promoting schools being undertaken by his department included: fostering closer links between the education and health sectors, a national nutrition education policy, a national HIV/AIDS education strategy, environmental health education initiatives and a national campaign against drug abuse. Finally, Dr Adams expressed his pleasure at the sharing and cooperative work between all countries in the Western Pacific Region in developing healthpromoting schools; he strongly supported the building and maintenance of an effective regional network. Dr Rosmarie Erben, Regional Adviser in Health Promotion, welcomed the participants on behalf of Dr S. T. Han, the Director of WHO's Regional Office for the Western Pacific. She thanked the National Centre for Health Promotion at the University of Sydney for organizing and hosting the workshop and the Australian Government for its generous support through the Australian Agency for International Development (AusAID). This workshop was the first joint activity in which, through the National Centre, different groups and networks in the field of health promotion in Australia would be linked to WHO's work. The workshop was also a first practical outcome of the joint work of WHO collaborating centres for health education and health promotion in the Region, and Dr Erben recognized the presence of representatives from the collaborating centres in Shanghai, China, Tokyo, Japan, and Singapore. She also welcomed the presence of representatives from the
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University of the South Pacific and the Australian Sports Commission. She conveyed the apologies of the South Pacific Commission for not being able to send their representative as foreseen, and read a message with their proposals for collaboration. Dr Erben outlined the health promotion programme of the Regional Office, which placed strong emphasis on school health promotion, and the policy direction advocated in the document New horizons in health. This document identified three themes for future work with Member States, namely preparation for life, protection of life and quality of life in later years. School health promotion was of specific importance in preparing young people for life by developing and strengthening their health potential. The workshop in Sydney was to be followed by a similar workshop for countries in the northern part of the Region, to be held 16-19 January 1995 in Singapore. It was expected that the workshop would stimulate the further development of school health promotion in countries in the Region, contributing to the global WHO School Health Initiative, which would in future provide policy support and strengthen intersectoral cooperation. Professor Nutbeam welcomed participants on behalf of the hosts of the meeting, the National Centre for Health Promotion, Department of Public Health, University of Sydney. He stated that this meeting was the first joint activity between the National Centre and WHO, and indicated that this would be the beginning of a more substantial collaborative relationship. Professor Nutbeam also welcomed colleagues from WHO collaborating centres in China, Japan and Singapore, and observers from the University of the South Pacific, the Australian Association of Health Promoting Schools? and the NSW Department of School Education and NSW Department of Health. He thanked AusAID and the NSW Department of Health for generous financial support which had made possible the organization of the meeting and the two-day symposium to follow. Mrs Palanitina Toelupe (Samoa) was elected as chairperson and Dr Michael Booth (University of Sydney) was elected as rapporteur.
Introductory statements Professor Nutbeam provided an overview of some of the major concepts and principles which had guided thinking about health-promoting schools
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in many countries. He emphasized that health-promoting schools provided an integrated and mutually reinforcing range of experiences, for young people and for school staff, which were intended to promote and protect health. Such an approach to health promotion was based on a holistic concept of health which gives due recognition to the different physical, social and mental dimensions of health. Health-promoting schools also fully encompass the educational and social objectives of schools. Action to support the development of health-promoting schools was based on a number of fundamental principles. These included equity of access to school education among different population groups, and, between genders; emphasis on empowerment through the development of knowledge and skills among students; and inclusiveness, ensuring that the whole school community, parents and the wider local community are fully engaged in supporting school activities. Translating these concepts and principles into practice required a range of practical actions both by schools and for schools. Professor Nutbeam emphasized that the core of the workshop would be dedicated to identification of these actions which included: development of supportive health and educational policies, effective classroom teaching, provision of appropriate school health services, fostering family and community participation in school programmes, and attention to the school organization arid ethos.
Survey of pre-workshop questionnaires Dr Michael Booth, lecturer in public health, presented a summary of pre- workshop worksheets completed by the country representatives, which were intended to provide background information for the workshop. There were four sections in the set of worksheets: the first three addressed different components of the health-promoting schools concept (school health education, school health services and a healthy school environment) and the fourth section sought information on potential actions to strengthen school health programmes. A brief summary is provided here (a more extensive report is included as Annex 2). School health education had advanced significantly over the last two years, with most country representatives reporting the introduction of
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health into the formal school curriculum, in-service teacher training or the introduction of specialist teachers, and the development and introduction of new teaching and learning resources. The most important activity over the next two years would be to continue to build upon these changes with a more thoughtful development of the health curriculum, more comprehensive teacher training and a greater quality and quantity of teaching resources. There was a universal call from participants for more clearly developed policy and greater commitment to policy from the health and education ministries. A very broad range of international organizations, local nongovernmental organizations, community and professional organizations had provided support and the continued support of these organizations was welcomed. Of the actions that might be taken to support school health education in the future, all received moderate to high priority. Most notably, however, country representatives sought more effective use of existing resources and the provision of new resources. Most country representatives reported that health services were provided through their schools: immunization was almost universal, dental care and the treatment of minor ailments and injuries were very common and screening for vision, hearing and other health problems was also common. The most needed services were: improved screening and treatment services, improved facilities for water supply, sanitation and food preparation and counselling services for distressed or troubled students. The international agencies (the South Pacific Commission, UNICEF, UNESCO, the University of the South Pacific and WHO) had provided most support in the past and were seen as the best source for future development. Again, there was a strong call for health and education ministries to become involved in collaboration with each other and with other organizations. The most significant improvements in the school environment had been the provision of potable water, sanitation, the development of school gardens and improved safety of school buildings. The most significant contributors to these developments were the international agencies and government departments. The priorities for change were generally given moderate to low scores, with improvement and clarification of government policies and resource mobilization given the highest scores. There were frequent calls for greater coordination between organizations and for greater community participation and ownership of school development projects.
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Reports from international agencies Mr Cliff Benson, Director, Institute of Education, the University of the South Pacific, described the activities of his section and noted its particular emphasis on science education and environmental health, the development of teaching resources appropriate to the needs of schools in the South Pacific and fostering the development of regional networks in certain priority areas. Mr Benson provided participants with a set of background materials for further information.
Country reports Mrs Neti Herman of Cook Islands, reported that school health education was administered by the health education unit within the Ministry of Health with the goal of promoting the physical, mental, social and moral development of all individuals. Health was taught as a separate subject in primary schools (introduced in 1982) and covered a comprehensive range of content areas including safety, nutrition, hygiene, social, emotional and community health. In secondary schools, health was integrated into social science subjects and addressed issues of "growing up". An HIV/AIDS unit would be introduced in 1995. On school health services, Mrs Herman reported that each school was attended by a public health' and a dental nurse and physical examinations screenings were conducted by a physician. Immunization programmes were universal. The most pressing problems were the effective treatment and prevention of skin disorders, and fostering the greater involvement of parents and the wider community. Ms Jane Alymore reported that the main health concern in the Federated States of Micronesia (FSM) was with nutrition, particularly the correction of Vitamin A deficiency which was found to be prevalent among young people in the 1987/1988 National Nutrition Survey. Each class (in Grades 1 to 8) was asked to prepare a class health and nutrition action plan in which they: assess the situation of the community, identify the health and nutrition problems, organize a class health and nutrition committee, prepare a class action plan and implement and monitor activities. The programme emphasized the participation of teachers, parents and students. The main problems the programme sought to address were:
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• • • •
overweight in the adult population and children, dental caries, nutrition (particularly in nursing mothers) to prevent anaemia, balanced diet in the whole population with emphasis on the consumption of local staples.
Mrs Ilisapeci Movono attended the meeting in place of the original nominee from Fiji. She described the activities of two trial schools which were currently testing and developing the health promoting schools strategy: a Fijian girls' boarding school and a coeducational, multiracial school. Each school had established a committee (representing all sectors of the school) to identify target areas: diet, sexually transmitted diseases, smoking, the environment and physical activity/fitness. A "cross-curriculum" approach had been adopted with health issues being taught in biology, social science, home economics, English and geography. The trial school programme was initiated by the Ministry of Health, although there was a health/education liaison officer and the programme was supported by the Ministry of Education as well. Mr Timau Tiira described the education system in Kiribati where, as in most countries in the Pacific region, the education system was founded by missionaries. Although the Government had provided primary education (for ages 6 to 14 years) since 1977, Protestant and Catholic missions played a predominant role in the provision of secondary education. There were places for only 20% of students wanting to attend secondary schools. The primary school health education curriculum was integrated into the environmental science, home economics and community skills syllabuses, and included: Years 1-3: personal hygiene, home hygiene, good manners, leisure and nutrition; Years 4-6: sanitation, water-borne diseases, pollution, disease vectors, insect control and rubbish disposal; Years 7-9: population issues, transmittable diseases, sex education, the body, attitudes and morals, gardening and other community skills.
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Vitamin A capsules were distributed to schools in Kiribati under the supervision of trained nurses from the Ministry of Health. The home- based health programme network (a joint initiative of the ministries of health, education and of the environment and women's groups) had facilitated the formation of a national outreach network which trained teachers and other community members on various health-related topics. The network was an integral part of the formal and non-formal education systems. The school programme was well supplemented by more traditional education at the village level, which was conducted by nurses and youth workers. Mr Tiira described the most pressing needs as the training of national trainers and the provision of educational materials for school and out-of-school use. Mr Pepa Koka reported that, in response to national financial crises in Papua New Guinea, school health education had been reduced to about one hour per week and school health services had been dramatically reduced. However, substantial changes were planned for the near future. They included: • • • •
declaration of 1995 as the "year of health promotion", introduction of a stronger health component into the curriculum, the development and production of health education teaching resources, introduction of the child survival crash programme.
Mr Michael Sonitavea reported that Solomon Islands had a population of 379000 with a high growth rate of 3.5%. Almost 60% of the population was 19 years of age or younger. The school health curriculum was to be released in 1995 and would initially be for primary schools only. The two major projects likely to have an impact on the health of young people were the water and sanitation project (supported by UNICEF) and the schools gardening project. Mr Sonitavea identified the two main barriers to progress as: poor collaboration between sectors and the view of health as an unimportant asset and as a matter of purely individual responsibility. Mrs Susana Latu, Tonga, pointed out that the health status of the Tongan population was improving in relation to developed countries. On the basis of the 1993 population census, life expectancy at birth was 68 years and the infant mortality rate was about 14 per thousand live births. The two
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main disease groups that continued to increase were neoplasms and cardiovascular disease. Health education in schools was compulsory from Class 1 to Form 2 and covered many topics including nutrition, personal hygiene and home safety. The health education curriculum was the responsibility of the Ministry of Education and was being further developed with support from the Tongan Government and AusAID. Public health nurses, dental department staff and health inspectors currently provided many of the health services. Mrs Latu identified the main constraints to progress as: the absence of a clear policy, inadequate training of staff, high staff turnover, shortage of teaching resources and lack of coordination between the relevant ministries. Mrs Myriam Abel reported that Vanuatu was committed to the goal of achieving Health for All by the Year 2000, particularly through primary health care. The objective of this policy was to achieve the participation of all people in the decisions and actions intended to promote health. Emphasis was placed on education for all children so that they took responsibility for their own health and the health of others around them. Specific activities included: • • • •
declaration of a national health week e very year; declaration of a national children's day every year; integration of the principles and concepts of primary health care into public health teaching; collaboration between the ministries of health and education to produce teaching materials on health, nutrition and agriculture, supported by UNICEF; the development of a booklet for science teachers by the Curriculum Development Centre (Ministry of Education) on a range of health topics; the production of a special manual "Understanding STDs"; a nd the provision of teacher in-service training on sex education, sexuality and STDs/AIDS.
•
• •
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Mrs Abel identified the problems as: • •
the Ministry of Health did not have an officer to coordinate school health education; and the available public health nurses were unable to deliver a comprehensive range of health services to schools.
Mrs Toelupe reported that Samoa had a population of approximately 160000, of whom 48% were of school age. The five leading causes of death were cardiovascular disease, suicide, pneumonia, malignancies and diabetes mellitus. Prior to the 1980s, school health was focused on personal hygiene, but it had undergone a change since 1982. The change was largely instigated by the Health Department with WHO/UNFP A support. Mrs Toelupe noted that the Department of Education did not identify the introduction of health education into schools as a high priority. In 1987 the Department of Education had developed a curriculum as a joint project with the Health Department-with the support of AusAID, SPC, UNICEF, UNFPA, UNESCO and WHO. Within primary schools health education was taught as a separate subject and in secondary schools and colleges it was integrated into the curriculum. Mrs Toelupe also noted that the development of the National Food and Nutrition Policy and the Tobacco Act and the Environment Act were significant reinforcing factors during the introduction of a newly developed curriculum on noncommunicable diseases. Finally, on school health services, Mrs Toelupe stated that these were provided by public health nurses from the Health Department. Although the service was not as comprehensive as it might be, it did operate effectively. Community participation in schools (including health) was traditionally an integral part of the community's responsibilities. For example, villages built local schools and the Department of Education provided professional staff. Mrs Rosie Pears and Dr John Faire from New Zealand, revealed that key education agencies currently involved in health education at different levels were: the Ministry of Education, the Education Review Office, the New Zealand School Trustees Association, as well as the School Boards
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of Trustees and schools. Health agencies involved were Crown Health Enterprises, the Ministry of Health, the Public Health Commission and a range of nongovernmental organizations. It was well accepted that schools had a key role in promoting the health of children and youth and that agencies other than schools also had important roles to play. Schools were required to provide health education and a safe and healthy physical and social school environment Health was a separate curriculum area, but was also well-integrated with the rest of the curriculum. A major review of the curriculum was under way and would include preparation of new teaching and learning resources. A "Healthy Schools: Kura Waiora" initiative had been launched in New Zealand. The Ottawa Charter had been used as the basis of the healthy schools framework by adapting the charter to suit schools and to health agencies working with schools. According to Professor Lawrence St Leger, health had been addressed in schools in Australia since 1910. Until recently, the approach had been fairly moralistic and simplistic. Recent advances had included the development of the national curriculum, and the impact of the national health goals and targets for children and youth. With the establishment of the Australian Association for Health Promoting Schools, a more holistic approach was being adopted. Resource development was well under way: teachers and other staff were receiving better training, and improved teaching resources were being developed and disseminated (with support from nongovernmental organizations, health foundations and the Government). There was still no universal agreement that health promotion was the most appropriate approach for schools, that attempts to change health behaviour may not be the core business for schools, that community expectations were very high (perhaps unrealistically so), and that teacher training, although improved, was not yet adequate. The challenges presently being addressed were: competition for curriculum space, improving the support for teachers and schools, identifying and acknowledging school achievements, and acceptance of the possibilities of health-promoting schools.
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Additional reports from WHO collaborating centres Dr Norio Shimanouchi of the WHO Collaborating Centre for Health Behaviour Research and Health Promotion in Tokyo, Japan, reported that the value and importance of school health promotion had recently been recognized in Japan and changes were beginning to occur. Health education comprised 20 hours of instruction in grades 5 and 6, 55 hours in junior high school and 70 hours in senior high school. Health guidance included school activities other than instruction, home-room projects and activities, and autonomous student projects. School health services included periodic health examinations for dental health, myopia, obesity, allergies and urinalysis for signs of chronic disease. Mrs Saroji ni Thanarajah of the WHO Collaborating Centre for Health Education and Health Promotion in Singapore, informed the workshop participants that health promotion efforts in Singapore had begun in the early 1960s, mainly concerned with infectious diseases, and public and environmental health. Today, health promotion efforts were aimed at reducing the incidence and morbidity of chronic degenerative diseases. The Training and Health Education (THE) Department of the Ministry of Health was responsible for health education and health promotion in Singapore. She also reported that the School Health Education Unit (SHEU) of THE planned and implemented health education and health promotion programmes which emphasized the importance of healthy living. The long-term -goal was to improve the health status of students through the implementation of the school health education curriculum, school-based health education programmes and the creation of a healthy environment. To achieve this, SHEU collaborated with the Ministry of Education and the School Health Service of the Ministry of Education. Mr Gan Xingfa of the WHO Collaborating Centre for Health Promotion and Education, Shanghai, China, stated that health education was not included in the national curriculum. However, a policy statement had recently been issued which recognized the value of and need for school health education. Targets had been set for school health education to increase health knowledge and to encourage the development of healthy
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behaviours. Manuals were available to guide lesson preparation and health education textbooks were being developed. Fifteen minutes per week were available for health education, but competition for curriculum space was critical. At present, emphasis was placed on detection of vision and hearing defects, and on nutrition. Some current projects included parental education and monitoring of health behaviours. The most critical current needs were: greater teacher training, inclusion of health education in the curriculum, and a more coordinated effort by the community, parents and I government.
Workshop process In addition to the exchange of information between countries, the major part of the meeting was taken up by meetings in small groups to consider the issues described in the scope and purpose and workshop objectives. Three working group sessions and two plenary feedback meetings were held. The working group sessions were directed towards the following objectives: Group work 1 explored the concept of the health-promoting school in the context of the Western Pacific island nations. Participants exchanged views on the concept and principles of a health-promoting school and considered the special opportunities and problems associated with such a concept: Group work 2 focused on the definition of priorities and identification of major barriers/challenges to progress, as well as identification of potential resources. Having had the opportunity to explore some of the principles which underpinned the health promoting school concept, discussions at this workshop focused on the practicalities of health promotion in the school setting. This involved a further exchange of experiences which illustrated practical problems and solutions in the development of a health- promoting school; consideration of actions which can be taken by individual schools to make progress in becoming a healthpromoting school, and actions which could be taken by health and education ministries and nongovernmental organizations which could support schools in becoming health-promoting schools; and identification of priorities for school health promotion, and the type of support (resources, training, research, etc) needed to take action in relation to those priorities.
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Group work 3 focused on the development of potential solutions; the development of support networks; methods of obtaining resources; and definition of research priorities. This final work group session was concerned with what would happen next. What participants could do in their own countries, how countries could support each other, what might be reasonably expected from nongovernmental organizations, international organizations, and aid agencies. It was devoted to determining the main t conclusions and recommendations for the meeting. This included prioritization of the actions required by individual schools, health/education ministries, national nongovernmental organizations, international organizations, and aid agencies to support the development of health- promoting schools in the Western Pacific island countries; identification of key research questions which, when addressed, would support development of the health-promoting school; and consideration of the practicalities of developing an international network of health-promoting schools in the Western Pacific Region as part of the global network of health-promoting schools.
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CONCLUSIONS AND PROPOSALS Conclusions Participants at the workshop welcomed WHO's initiative in supporting the development of health-promoting schools in the Western Pacific Region, and recognized that the WHO document New horizons in health provided t a broad framework for health action in the Region. It was clear from the contributions of individual participants that there was considerable experience and expertise among the countries in the Region in school- based health promotion. The meeti ng offered an opportunity to consolidate that experience and to plan for further developments of special relevance to Pacific island countries. The concept of health-promoting schools was based on a commitment by schools to provide integrated and mutually-reinforcing experiences for schoolchildren which promoted and protected their health. Such experiences not only included classroom education, but also the creation of a safe and healthy school environment, the provision of appropriate school health services, and the involvement of the family and wider community in efforts to promote health. As the country reports testified, participants in the meeting had experience in all of these actions. What also became clear was that the concept of a health-promoting school find comfortably with the framework of primary health care which was central both to the organization of health care in most of the Pacific island countries and to their commitment to the WHO strategy for health for all. The concept also fitted comfortably with supporting schools in the creation of the conditions for the achievement of their primary goal - effective learning. Participants also recognized the strong coincidence of interests between health, education and economic development in the Pacific island countries. The evidence to support this relationship was presented in the 1993 World Bank Development Report, Investing in health, and provided participants
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Conclusions and proposal
with a powerful reminder of the need to refer to this economic rationale when making a case to support the development of health-promoting schools. However, participants were also keen to ensure that governments recognized the limitations of action to promote health through such schools. Schools could not compensate for all of society's problems any more than they could act in isolation from the community they served. With these issues in mind participants made the followi ng proposals.
Proposals 1. Understanding the needs of school students It is necessary to have a clear understanding of the physical, emotional and social needs of children to ensure that any programme or strategy addresses their needs. To this end it is recommended that where appropriate, individual schools, regions and/or countries undertake regular studies of the health status and health needs of young people, and that the results of the studies be widely disseminated. 2. Effective teaching for health Effective health education requires appropriately trained teachers and support staff, and thoughtfully and expertly prepared teaching and learning materials. To this end it is recommended that: (a) an individual is nominated in every school to be responsible for fostering the development of a health-promoting school, and to act as a point of contact for a wider national and international network of schools; these nominated individuals are offered opportunities for appropriate in-service training; existing educational resource materials for health within the Pacific island countries are made more widely available (see network proposals below). Any new materials should be developed in a culturally sensitive manner;
(b)
(c)
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(d)
adequate time be made available for health-related teaching in the school curriculum. This might be achieved by integrating health teaching across the curriculum, and/or by dedicated teaching time. In some situations it may be appropriate to recommend that health be an examinable subject in schools. boys and girls should have equally fair access to education for health; where possible pre-service training of teachers should introduce the concept of the health-promoting school, and key components of health teaching
(e) (f)
3. A healthy school community The health of students is influenced not only through classroom teaching, but also through the wider set of experiences and activities encountered during their school life. To this end it is recommended that: (a) teachers, principals and other members of the school community should be encouraged to act as appropriate role models; all members of the school community (including staff and students) be encouraged to participate in school decision-making, particularly with regard to activities that influence their health; school policies and practices should be consistent with the concept of a healthpromoting school, for example, healthy food in canteens, and all students should be encouraged to participate in physical activities; the school ethos should be supportive of students' emotional and social health needs.
(b)
(c)
(d)
4. Creating a supportive school environment The school physical environment should be safe and should support the health of students. To this end it is recommended that: (a) all facilities on school sites minimize the danger of physical harm to students and all members of the school community, for example, by being physically safe (including travel to and from schools), free from dangerous substances, and having safe play equipment;
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Conclusions and proposal
(b)
adequate facilities are available to allow the maintenance of good personal hygiene, for example, adequate sanitation and clean water; where possible, the facilities actively support the health of students, for example, through the provision of school gardens and cooking facilities.
(c)
5. Reorienting school health services Most countries offer some form of school health service. In many cases these are established to offer relevant health screening and care to school- age students. In some countries these services are either underdeveloped or may not be using existing resources in an optimal way. To this end it is recommended that: (a) all countries offer, as a minimum, basic school health services which address local health needs. These might include universal immunization, screening for common health problems (vision, hearing, physical and learning disabilities) and dental services; all countries recognize the desirability of providing counselling and support for emotionally or socially distressed students.
(b)
6. Engaging families and the community Whatever experiences students have at school have to be placed into the wider context of their family and community lives. A critical indicator of a health-promoting school is the way in which it fosters family and community involvement in the life of the school. This means more than IC working with the community to raise resources for the school, but rather concerns active support for the health-promoting activities of the school. It is essential that these supportive efforts be coordinated and that not all responsibility for student health be placed on the school. To this end it is recommended that: (a) schools regularly communicate with parents to provide information on healthpromoting school activities, and to seek feedback and advice from parents. This might be achieved through the creation of a school committee, through regular meetings or other forms of communication
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(b)
wherever possible, schools should encourage parents to reinforce school health education through their own example and interaction with their children; wherever possible, schools encourage parents to participate in health-promoting school activities, for example, improving the physical facilities of the school; schools involve local community groups with an interest in or responsibility for the health of young people in supporting school activity to promote health, and in turn schools seek to playa role in community events and activities.
(c)
(d)
7. Health-supportive public policy Commitment by both health and education ministries to health-promoting schools is essential to the successful implementation of the above recommendations. This might best be achieved through a joint policy statement which is compatible with existing health and education policies. Such a policy statement should both provide a mandate for schools to take actions such as those recommended above, and should facilitate the provision of the resources needed to do so. In addition, such a policy statement might also define minimum and high standards for health- promoting schools for reference and review. Beyond such a policy statement, governments must also recognize that policies from other sectors may undermine the capacity of schools to protect and promote the health of the school community; for example, policies concerning the availability and promotion of tobacco and alcohol products. Governments must develop appropriate mechanisms to account for such policy inconsistencies. In addition to developing a national policy, governments should also consider ways in which they can foster improved working relations between sectors of the government, and with nongovernmental organizations, agencies and associations. Furthermore, the importance and potential value of incorporating the health promoting schools initiative into existing national and regional structures and programmes should be taken into account.
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Conclusions and proposal
To this end it is recommended that: (a) all governments develop a joint health/education national policy statement for school health which: •
provides a set of benchmarks indicating the minimum acceptable standards for the promotion of health in schools, and the highest standards that might be aspired to; and provides a mandate to pursue the development of health-promoting school through the above recommendations;
•
(b)
countries establish or develop a national intersectoral group which provides advice on all policies with an impact on the health of the school community, acts as an advocate for the health of school students, and as a coordination and reference point in the development of a national network of health-promoting schools. Such a group could include both government and nongovernmental agencies and associations. The work of such a group would be greatly supported through the appointment or a country coordinator; health and education ministries consider establishing health promoting schools to test and refine different approaches to student health promotion which are relevant to the different social and cultural situations that exist across the Western Pacific Region. It is essential that the experience gained from such schools be widely disseminated; government and nongovernmental organizations identify ways in which information on successful practice and useful resources can be widely disseminated.
(c)
(d)
8. International support and network development This workshop has demonstrated clearly the value of international cooperation in promotingthe health of school communities. International agencies and donor agencies have a crucial role in supporting implementation of all of the actions recommended above. To this end the workshop urges WHO to: (a) provide technical advice to- governments on the formulation of national policy statements on health-promoting schools;
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(b)
Support the preparation of guidelines on the establishment, improvement and maintenance of health promoting schools. These guidelines would include recommendations on benchmarks for health-promoting schools and would indicate minimal and optimal standards; provide the leadership and coordination necessary to establish and maintain a healthpromoting schools network in the Western Pacific Region. It might do this in cooperation with its collaborating centres, other international organizations and institutions such as the University of the South Pacific and the South Pacific Commission.
(c)
Donor agencies should support implementation of the above recommendations in a number of specific ways: (a) (b) (c) training within and between countries to build local capacity and expertise; sponsorship of projects to establish health promoting schools in individual countries; sponsorship of a country coordinator position to foster development of a network of health promoting schools in individual countries; support for the development of a clearing house for support materials for school health promotion; support for research in countries which supports countries and individual schools in defining health priorities and needs.
(d)
(e)
Concluding remarks The first consultation of Pacific island countries on the health-promoting schools initiative represented a significant step forward in implementing activities that would translate into practice the policy directions outlined in the document New horizons in health. Participation by several Pacific island countries ensured very useful pooling of information and ideas leading to increased understanding of those countries' specific contexts for school health promotion.
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Conclusions and proposal
The additional participation by several observers from the Pacific, including Australia and New Zealand, added an important dimension. The Australian and New Zealand delegates provided insights into health promoting schools in action, which enhanced participants' awareness of what the initiative had to offer and successful approaches and strategies to use in implementing the health-promoting schools concept. Participation by WHO's collaborating centres for health promotion and education was also important. Their presence underlined the crucial role of networking in successful school health promotion. Finally, WHO acknowledged the substantial input of the National Centre for Health Promotion of the Department of Public Health at the University of Sydney, which was a significant contributing factor to the success of the workshop. The meeting marked a significant step forward in the establishment of health-promoting schools in the Pacific island countries. It also made an important contribution to advancing WHO's worldwide school health initiative, which will greatly support the achievement of the target of "Health for all by the year 2000".
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School Health Promotion
Annex 1 List of workshop participants, observers, representatives and secretariat 1. Participants Dr Michael Booth Lecturer in Public Health National Centre for Health Promotion Department of Public Health A27 University of Sydney, NSW 2006 Australia Professor Lawrence St Leger Associate Professor in Public Health School of Nutrition and Public Health Deakin University 662 Blackbum Road Clayton 3168 Victoria Australia Mrs Neti T. Herman Health Educator Ministry of Health P.O. Box 109, Rarotonga Cook Islands
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Annex 1
Mrs Ilisapeci Kuruosali Movono Head of Department (Languages) Adi Cakobau School Ministry of Education Private Mail Bag, Marela House, Fiji Mr Timau Tiira Senior Education Officer Ministry of Education, Science & Technology Bikenibeu Kiribati Mr Amram Mejbon School Health Specialist Ministry of Education P.O. Box 3 Republic of the Marshall Islands Majuro Marshall Islands 96960 Ms Jane S. Elymore National Food and Nutrition Programme Manager Coordinating School Health and Nutrition Curriculum. Department of Health Services Federated States of Micronesia P.O. Box PS 70, Palikir. Pohnpei FM 96941 Federated States of Micronesia Mrs Rosemary Ann Pears Policy Analyst, Policy And Planning Public Health Commission P.O. Box 1795, Wellington New Zealand
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School Health Promotion
Mr Pepa Koka Assistant Secretary Health Promotion and Communication Department of Health P.O. Box 3991 Boroko Papua New Guinea
Mrs Palanitina Toelupe Chief Health Educator Department of Health Apia Western Samoa
Mr Michael Sonitavea Assistant Health Education Officer (Training) Health Education Division, Honiara Town Council P.O. Box 342 a Honiara Solomon Islands
Mrs Susana Liava'a Latu Assistant Health Education Officer Ministry of Health P.O. Box 59 Nuku'alofa Tonga
Mrs Myriam Abel STD/ AIDS Program Manager and Coordinator of all Preventive Programs Ministry of Health Port Vila Vanuatu 26
Annex 1
2. Observers/Representatives Dr Tony Adams Chief Medical Officer Department of Human Services and Health GPO Box 9848 Canberra 2601 Australia Capital Territory Australia Bruce E. Allen Associate Professor Department of Public Health SchoolofMedicine Juntendo University WHO Collaborating Centre for Health Education and Health Promotion 2-1-1 Hongo Bunkyo-ku, Tokyo Japan Cliff Benson Director Institute of Education University of the South Pacific P.O. Box 1168 Fiji Colin Brown Aussie Sport Program Consultant Australian Sports Commission P.O. Box 176 Belconnen ACT 2616 Australia Michael D' Arcy Australian Sports Commission Leverrier Crescent, Bruce ACT 2617 Belconnen ACT 2616 Australia 27
School Health Promotion
Gawaine Powell Davies Director of Health Promotion South West Sydney Area Health Service Locked Mail Bag 17 Liverpool 2170 Australia Janet Davy Chief Education Officer PD/H/PE Key Learning Area Private Mail Bag 3 Ryde NSW 2112 Australia John Faire Curriculum Facilitator Ministry of Education 45-47 Pipitea St., Box 1666 Wellington, New Zealand Yasushi Fukuwatari Professor, Department of Public Health School of Medicine Juntendo University WHO Collaborating Centre 2-1-1 HongoBunkyo -ku, Tokyo Japan Rhonda Galbally Chief Executive Officer Victorian Health Promotion Foundation Drummond Street Carlton Victoria 3053 Australia Jennie Lyons Director National Health Advancement Department of Human Services and Health GPO Box 9848 Canberra ACT 2601 Australia 28
Annex 1
Eamonn Murphy Curriculum Officer K-12 Catholic Education Commission P.O. Box A169 Sydney South NSW 2000 Australia Janice Plain Manager Food and Nutrition Program Health Advancement Division Department of Human Services & Health GPO Box 9848 Canberra ACT 260 1 Australia Louise Rowling Senior Lecturer in Health Education Teaching and Curriculum Studies President Australian Association of Health-promoting Schools Faculty of Education A35 University of Sydney New South Wales 2006 Australia Norio Shimanouchi Associate Professor Department of Health Science School of Health and Sports Science Juntendo University WHO Collaborating Centre for Health Behaviour Research and Health Promotion I-1 Hiraga gakuendai, Imba-mura Imba-gun-Chiba Japan
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School Health Promotion
Sarojini Thanarajah Secretariat Director WHO Collaborating Centre for Health Education and Health Promotion Training and Health Education Department Ministry of Health Hyderabad Road Singapore Gan Xingfa Deputy Director Shanghai Health Education Institute WHO Collaborating Centre for Health Promotion and Education 122 Shanxinan Road Shanghai. 200040, China
3. Secretariat Dr Rosmarie Erben Regional Adviser in Health Promotion World Health Organization Regional Office for the Western Pacific United Nations Avenue Manila. Philippines Professor Don Nutbeam Professor of Public Health Centre for Research and Training in Health Promotion Department of Public Health The University of Sydney, Sydney, NSW 2006, Australia
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Annex 2
Annex 2 Summary of pre-workshop worksheets Prior to the workshop, participants were provided with worksheets. The purpose of these worksheets was to provide background information on the different conditions of school health education, school-based health services, policies and practices that influence health, and support for health-promoting schools in the countries. The completed worksheets are summarized here in point form under the headings used in the worksheets. Only the information considered useful to the Workshop 'is presented.
School health education Most important accomplishments in last two years • • •
Introduction of health into the curriculum Training of teachers or introduction of specialist teachers Development and introduction of new teaching and learning resources
Most important changes to be achieved in the next two years •
More clearly developed policy/ greater commitment to policy from health and education ministries More consistent and thoughtful development of health curriculum .More comprehensive teacher training Greater quality and quantity of resources, particularly those that support skill development
•
•
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School Health Promotion
Which organizations HAVE BEEN of greatest assistance in the development of health promoting schools in your country? •
A very broad range of organizations were identified: SPC, UNICEF, USP, World Bank, WHO, health and education ministries, parent groups, community organizations, public health professionals
Which organizations MIGHT BE of greatest assistance in the future ? Same as those identified above What actions have priority for the future ? It should be noted that almost all of these priorities received high rankings (that is, were considered high priorities). From the comments provided, it was clear that few of the country representatives wanted more resources, but sought mobilization and more effective use of currently available resources. •
Highest ranking Policy support Resource immobilization Teacher training
•
Slightly lower Materials and resources School/community projects
•
Lowest Employ more teachers
Most important issues currently being addressed • •
Nutrition Hygiene
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Annex 2
• • • • •
Family planning/human sexuality HIV / AIDS Communicable diseases Alcohol/tobacco Noncommunicable diseases
School health services What services are currently being provided? •
Immunization appears universal; dental care, treatment of minor ailments/injuries are very common Screening for vision/hearing and other health problems are common but not universal
•
What services are most needed? • • •
More screening and treatment services Improvements in facilities: water, sanitation and food preparation Counselling and social support for distressed or troubled students
Which organizations HAVE BEEN of greatest assistance in the provision of health services in schools? •
South Pacific Commission, UNICEF, UNESCO, University of the South Pacific and WHO were consistently identified Community groups, public health professionals
•
Which organizations MIGHT BE of greatest assistance in the future provision of health services in schools? •
The same organizations were again identified, but there were consistent calls for health and education ministries to become involved in collaboration with each other and with other organizations 33
School Health Promotion
•
Nongovernmental organizations and parent organizations
What actions have priority for the future? •
Highest ranking was given to policy support from health and education ministries and to resource mobilization There was considerable variation among the remaining identified priorities suggesting that they should be dealt with on a country- by-country basis There were several calls for counselling services and improved coordination between service providers
•
•
Healthy school environment Most important accomplishments in the last two years • • •
Provision of water supply and sanitation Development of school gardens Improvement of buildings: removal of lead paint and PCBs
Which organizations HAVE BEEN of greatest assistance ? •
UN agencies, Government departments, NGOs (Rotary, Heart Foundation, Cancer Council
Which organizations MIGHT BE of greatest assistance? •
The involvement of government ministries in a coordinated way was seen as very important
Priority actions • •
In most cases, priorities for change were given only moderate ranking Policy support and resource mobilizations generally ranked highest 34
Annex 2
• •
There were frequent calls for greater coordination between service providers There were also frequent calls for greater community participation/ ownership
Potential actions to strengthen school health programmes Specific actions in the next two years § § § Improved teacher training Improved teaching resources Advocacy for greater policy support
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