W tta' \\RLD I · ~ 1 . ~~ rl ~~ THE MAGAZINE OF THE WORLD HEALTH ORGANIZATION In this issue Health-promoting schools Hiroshi Nokajimo A health-promoting school starts with imagination Ilona Kickbusch 8. Jack Jones WHO's Global School Health Initiative Desmond O'Byrne, Jack Jones, Yu Sen·Hai 8. Heather Macdonald Eastern Mediterranean: an action-oriented curriculum Mohamed AI Khoteeb Innovation in a fast-changing Europe Vivian Barnekow Rasmussen, David Rivett 8. frio Ziglio New horizons in health 1 D Rosmarie Erben Health-promoting schools in the Americas 12 Maria Teresa Cerqueiro School health education in South-East Asia and Africa 14 Health can be "contagious"! 15 Sergio G. Meresman Ten steps to school health 16-17 Classroom health in Belize 18 Roman Magana Children versus mosquitos 19 Verity Beckles In London's East End 20 Kevin (orr Helping schoolchildren to help themselves 21 Chantos Penthisarn Greater awareness - better health 22 Jyotika Singh No junk food in the school canteen 23 Roy Donato D. Santos A Shanghai school shows the way 2 4 Coi Hong·Ying A school in Papua New Guinea 25 Buri Veneo 8. Pauline Doonar Sexuality and population education 26 0. J. Sikes Education International: an alliance with WHO 27 Fred von Leeuwen Intestinal worms 28 l. Savioli, K. E. Molt 8. Yu Sen·Hai Mental health promotion in schools 29 Rhona Birrell Weisen 8. John Orley Learning about HIV 30 Mariella Baldo World Health • 49th Year, No.4 July- August 1996 IX ISSN 0043-8502 Correspondence should be addressed to the Editor, World Heolth Mogozine, World Health Orgonizonon, CH-1211 Geneva 27, Switzerland, or directly to outho~, whose addresses ore given ot the end of eoch article. for subscripnons.see order form on poge 31. HEALTH Front cover: WHO/H. Anenden World Health is the officio! illustrated mogozine of the World Health Organization. It oppeors six nmes o yeor in English, french ond Sponish, ond four nmes o yeor in Arobic ond forsi. The Arabic edinon is ovoiloble from WHO's Regional Office for the Eastern Mediterranean, P.O. Box 1517, Alexandria 21 511, Egypt. The forsi edinon is obtoinoble from the Public Heolth Committee, Iron University Press, 85 Pork Avenue, Teheran 15875-4748, Islamic Republic of Iron. ©World Heolth Orgonizotion 1996 All rights reserved. Articles and photographs thot ore not subject to seporote copyright moy be reproduced for non-commercial purposes, provided thot WHO's copyright is duly acknowledged. Signed articles do not necessarily reflect WHO's views. The designonons employed ond the presentonon of moteriol published in World Health do not imply the expression of ony opinion whatsoever on the port of the Orgdnizonon concerning the legol stotus of ony country, territory, city or oreo or of its outhorines, or concerning the delimitonon of its frontiers or boundaries. World Health • 49th Year, No. 4, July- August 1996 3 Editorial Health-promoting schools The school is an extraordinarily effective setting in which to improve the health of pupils, staff, families and members of the community. It is a means of support- ing the basic human rights of both education and health. It offers op- portunities to achieve significant health and education benefits with the limited resources available to education and health agencies. It also offers highly visible opportuni- ties to demonstrate commitment to equity and to raising the social status of women and girls. Given the number of young people who do not attend school, it might be asked whether the school is really significant as a setting in which to promote health. The an- swer is a resounding "yes". Schools, worldwide, reach about 1000 million young people and, through them, their families and their communities. Primary school enrolments are in- creasing in nearly every part of the world. This is true in absolute num- bers as well as in enrolment rates . The only major exception is in sub- Saharan Africa, where enrolments are stagnating or declining. But there too, the school is the developing world's broadest and deepest channel for putting information at the dis- posal of its citizens. Even in countries which are struggling to provide the most basic education to their children, schools are doing more than most people ever imagine to bring about improve- ments in health. Schooling in itself has been shown to be a powerful way to influence health everywhere. Its impact is clearly seen in benefits to Dr Hiroshi Naka;ima, Director-General of the World Health Organization. More schools than ever before are considering whether their policies, practices and overall organization contribute positively or negatively to the health of students, teachers, families and community members. Those that continuously strive to maintain and improve positive contributions to health are what WHO calls "health- promoting schools". maternal and child health. Literate women tend to marry later and are more likely to use family planning methods. Mothers with even one year of schooling tend to take better care of their babies; they are also more likely to seek medical care for their children and to have them immunized. This issue of World Health shows the wide range of activities that schools are undertaking to promote health, along with efforts to prevent and protect against death, disease and disability. The increased attention to health promotion represents a new strategy. More schools than ever before are considering whether their policies, practices and overall organi- zation contribute positively or nega- tively to the health of students, teachers, families and community members. Those that continuously strive to maintain and improve posi- tive contributions to health are what WHO calls "health-promoting schools". This issue highlights some of the many ways in which schools are learning to promote health. We hope that these examples will inspire other schools to become health-promoting schools, too. • Hiroshi Nokoiimo, M.D., Ph.D. 4 World Health • 49th Year, No.4, July-August 1996 A health-promoting school starts with imagination Ilona Kickbusch & Jack Jones Brushing Ieeth together is fun - and it is one way to keep healthy. Wat are health-promoting chools? They are schools that do what they can to influence and promote health, even though their resources, support mechanisms and technical capacities may be extremely limited. This issue of World Health describes some of the imaginative ways in which schools are striving to improve the health of pupils, staff, families and communities. Administrators and programme managers think of school health in terms of infrastructure, systems, capacities and resources. Scientists, researchers and planners think of school health in terms of interven- tions, theories and technical factors. These are important means of devel- oping and improving school health programmes, but they do not suffice. Imagination is a universal re- source and can be found in abun- dance in each and every school throughout the world. So it makes an appropriate starting point in the quest to become a health-promoting school. Let us imagine a school in which pupils, parents, teachers and administrators work together to ensure that school policies and prac- tices promote health and fulfil the broad educational and developmental purposes of the school. Imagine a school in which the social environment is considered to be as important to health as the physical environment, and where pupils and staff work together to create policies and practices that reduce bullying, corporal punishment and other forms of violence, and increase equity, respect, caring, self- esteem and opportunities to experi- ence success in the classroom, the playground and the community. Imagine a school in which teach- ers, pupils, community leaders and parents work together on sensitive issues such as sexuality and gender, taking local values fully into account, and enable young people to acquire the knowledge, attitudes, values, beliefs, skills and services that they need to prevent HIV infection, sexu- ally transmitted diseases, unintended pregnancy, sexual abuse and discrim- ination. Imagine a school whose staff work with representatives from a variety of sectors (health, recreation, social services, law enforcement, transport, food and commerce) to find ways of combining their re- sources and potential to maximize their ability to meet the health, edu- cation and development needs of young people. To imagine what a school can do to become health-promoting is an excellent starting point. To share such ideas with others is to create a common vision, which in its turn can lead to effective collaborative action. We invite all readers to write to us (at the address given below) about their health-promoting ideas and activities- especially those that can enable schools with very few re- sources to promote health on their own. Next year, we will issue a report called Health promoting schools: the results of imagination, so that schools throughout the world will be able to share each other's visions and successes. Please send your letters to Jack Jones at the address below and mark them "Imagination". • Dr Ilona Kickbusch is Director of the Division of Health Promotion, Education and Communications, and Mr jack jones is a Health Education Specialist with the Health Education and Health Promotion Unit, World Health Organization, I 2 I I Geneva 27, Switzerland. World Health • 49th Year, No. 4, July-August 1996 5 WHO's Global School Health Initiative Desmond O'Byrne, Jack Jones, Yu Sen·Hai & Heather Macdonald In establishing the Division of Health Promotion, Education and Communication, the Director- General of WHO charged the Division with strengthening the Organization's capacities to promote health through schools. He recog- nized that many WHO programmes and Regional Offices support a wide range of health promotion, health education, and disease/injury preven- tion efforts in schools, but he also recognized that more needed to be done. To meet the Director-General's challenge, a School Health Team was established within the Health Education and Health Promotion Unit of the Division. The team serves as a secretariat for an interdivisional Working Group on School Health. Through the Team, the Working Group and its Regional Offices, WHO is committing its full organiza- tional capacity toward the develop- ment of a Global School Health Initiative. This Initiative is built on experi- ence, research and partnerships. In 1995, a WHO Expert Committee on Comprehensive School Health Education and Promotion reviewed the status of school health pro- grammes, the strategies used to strengthen them, and research that can be used to improve them. WHO programmes, UN agencies, universi- ties, and education and health organi- zations worldwide contributed information, insight, case studies and research to the Committee. The Committee's report and its back- ground papers provide the founda- tion for the Global School Health Initiative. The goal The goal of the Global School Health Initiative is to increase the number of institutions that can truly be called health-promoting schools. Although definitions and their implementation will vary among regions, countries, and schools according to need and circumstance, a health- promoting school can be characterized as a Working on the development of the Global School Health In itiative. school that is constantly strengthen- ing its capacity as a healthy setting for living, learning and working. A health-promoting school: • engages health and education officials, teachers, students, parents and community leaders in efforts to make the school a healthy place. • implements policies, practices and measures that encourage self- esteem, provide multiple opportu- nities for success, and acknowl- edge good efforts and intentions as well as personal achievement. • strives to provide a healthy envi- ronment, school health education and school health services along with school/community health projects and outreach, health promotion programmes for staff, nutrition and food safety pro- grammes, opportunities for physi- cal education and recreation, and programmes for counselling, social support and mental health promotion. • strives to improve the health of school personnel, families and 6 community members as well as pupils; and works with commu- nity leaders to help them under- stand how the community contributes to, or undermines, health and education. Implementing the Initiative WHO's efforts to achieve this goal are carried out through three broad health promotion strategies. Building capacity to advocate for improved school health programmes: The Initiative pre- pares technical documents , fact sheets and presentation kits that consolidate expert opinion about the nature, scope, effectiveness and potential of school health programmes. The materials are designed to help individuals in inter- national, national and local organiza- tions to argue effectively for increased support of health promo- tion through schools. They are also designed to help policy-makers and decision-makers to justify decisions to increase support for such efforts. Mobilizing public and private resources for developing "health- promoting" schools: WHO's Regional Networks of Health- Promoting Schools may represent the world's most comprehensive and successful international efforts to mobilize support for school health promotion. The first network was initiated by WHO's Regional Office for Europe, the Council of Europe and the Commission of the European Communities. This network has grown in five years to include 34 countries, 500 core schools, and 1600 affiliated schools together comprising some 400 000 students. In 1995, additional Regional Networks of Health-Promoting Schools were started by the Regional Office for the Western Pacific. This year, the Global School Health Initiative will assist WHO Regional Offices to develop networks in the Eastern Mediterranean, Africa and Latin America. By 1997, it is hoped that every region of WHO will have established at least one network of public and private organizations World Health • 49th Yeor, No.4, July-August 1996 Schoolchildren in India bringing health information to the community. interested in working and learning together in collaborative interna- tional, national and local efforts to improve school health. Strengthening national capaci- ties: WHO is working with China, the Russian Federation and the United States of America to help health and education representatives to collaborate in improving school health pro-grammes. In 1996, as part of the development of WHO's Mega-Countries Health Promotion Network, WHO and the Centers for Disease Control and Prevention (USA) brought together persons responsible for health promotion and school health from seven countries, which include over half of the world's school-age children. All are interested in improving school health programmes on a large scale. The meeting enabled representatives to identify ways of improving their programmes by working and learn- ing from each other's experience. Successful efforts will be diffused through the regional networks. Partnerships and support WHO recognizes that the success of the Global School Health Initiative rests on the extent to which partner- ships can be formed at local, national and international levels. This will require organizations interested in promoting health through schools to identify individuals with responsibil- ity, time and authority to work in partnership with others. It will also require them to jointly develop mech- anisms which enable their organiza- tions to plan and work together, document their achievements and improve their programmes. The extent to which each nation 's schools become health-promoting schools will play a significant role in determining whether the next genera- tion is educated and healthy. Education and health support, com- plement and enhance each other. Neither is possible alone. Together, they serve as the foundation for a better world. • Or Desmond O'Byrne is Chief of the Health Education and Health Promotion Unit, in which Mr jack jones and Or Yu Sen-Hoi ore Health Education Specialists, Division of Health Promotion, Education and Communication, World Health Organization, l 2 l I Geneva 27, Switzerland. Mrs Heather Macdonald, formerly with the same Unit, is now Public Health Adviser to the Pacific Regional Team, AusAID's Centre for Pacific Development (ACPAC), I I l 0 Middle Head Road, Mosman NSW 2033, Australia. WHO wishes to acknowledge the following organizations which have contributed technical and/or financial support towards the development of the Initiative: the Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (USA); the Johann Jacobs Foundation (Germany); johnson and johnson European Ph ilanthropy Committee (UK); Education International (Belgium); the Education Development Center (USA); UNESCO, and UNICEF World Health • 49th Yem, No. 4, July-August 1996 7 Eastern Mediterranean: an action-oriented curriculum Mohamed AI Khateeb Dentists and teachers promote oral health at the /sa Town primary school in Bahrain. Pupils at this school can become "oral health leaders " and communicate to other children what they have learned. The importance of the health and well-being of children and youth is recognized by all countries in the Eastern Mediterranean Region, which consequently accord a high priority to school health education. Since globally there are close to 1000 million children in schools, the international community should see the school as a unique opportunity to promote Health for All. By reaching school-age children, health education can provide benefits to all dimen- sions of society: the individual, the family, the school, the community and the nation. In this Region, there is a long tradition of school health education. Ten years ago, WHO and UNICEF worked together on drawing up an action-oriented health curriculum for primary schools. By "action-ori- ented" the planners meant that the children should learn things that they could apply at school, at home and in the community. In 1988, a meeting was held in Cairo to initiate the Action-oriented School Health Curriculum for pri- mary schools. Five countries were chosen for participation in the first round of national implementation: Bahrain, Egypt, Jordan, Morocco and Sudan. In order to promote the programme and ensure effective interagency coordination, the Regional Directors of WHO, UNICEF and UNESCO visited each of those countries. The following year, an intercoun- try and interagency meeting took place in Cairo in which the partici- pants discussed strategies for imple- mentation. The Ministers of Education in the five countries se- lected subsequently gave their ap- proval to adopt the programme in their countries. Today there are 12 Member States in the Region which use the Action-oriented School Health Curriculum to mobilize and equip teachers and pupils to provide the community with knowledge on preventive health care. Many ministries and institutions are involved, such as the Ministry of the Interior, the Department of Traffic, the Ministry of Information, and municipalities. Health educators from the Ministry of Health partici- pate in the teaching, and parents are invited to attend. The schools also arrange for pupils to visit health institutions, shopping centres (where they learn about available foods , food safety and hygiene) and facto- ries. These visits teach them a great deal about health in relation to socio- economic development. In Bahrain, Jordan and Morocco, tests were developed to measure the knowledge and skills of students after the programme had been run- ning for some time. It was ciear that they had gained knowledge and skills regarding health, and knew how to practise what they had learnt about health-promoting behaviour. The main questions now are not so much about what to teach as how to teach it, and how to train primary- school teachers to put the prototype Action-oriented School Health Curriculum into effect. We also need to find ways to integrate the various health subjects in the school pro- grammes, and to find the resources necessary to support schools finan- cially as they prepare educational packages for the programme. The prototype Action-oriented School Health Curriculum (also the name of a publication available at the address below) is an innovative programme. It puts the school where it belongs, not in an "ivory tower", but at the heart of the community. It calls for parents, teachers and chil- dren to get together and take action. This can take many forms, such as improving the school environment, creating school health clubs, or undertaking special projects. Perhaps the most far-reaching signif- icance of this programme is that it outlines new roles for teachers and schoolchildren. • Dr Mohamed AI Khateeb is Regional Adviser for Health Education at WHO's Regional Office for the Eastern Mediterranean, P. 0 Box 1517, Alexandria 2 151 1, Egypt. 8 World Health • 49th Year, No.4, July-August 1996 Innovation in a fast· changing Europe Vivian Barnekow Rasmussen, David Rivett & Erio Ziglio A fast-changing Europe needs an innovative effort to create a climate of care and support in the schools. This network represents a sound investment for the future of Europe. The European Network of Health-Promoting Schools is a concrete example of an activity that has successfully incorporated the ener- gies of three major European agen- cies in the joint pursuit of their goals in school health promotion. Launched in 1991, the project is a tripartite activity of the Commission of the European Communities, the Council of Europe and WHO's Regional Office for Europe. The joint planning and management of the Network was one of the recom- mendations of the three agencies' Conference on Health Education held in Strasbourg, France, in September 1990, and it builds on the collaborative work done in the 1980s in the pilot project "Education for Health". Such pragmatic collaboration is essential to avoid duplication and provide a framework within which to foster and sustain innovation, dis- seminate models of good practice, and make opportunities for health promotion in schools more equitably available throughout Europe. The enthusiasm generated by this project is demonstrated by its rapid develop- ment, from a small pilot activity involving four countries in 1991, to the large complex of activities we see today, in which 37 countries partici- pate. Countries committed to this pan- European initiative are directing their energies towards the final goal of creating supportive environments for health within schools. This goal is being pursued by promoting within the curriculum positive views on health and safety, which in tum influence teaching and learning styles. This is an ambitious goal, but a fast-changing Europe needs this innovative effort to create a climate of care and support in schools. The health-promoting school seeks to achieve healthy lifestyles for the total school population by providing safe and health-enhancing social and physical environments in which to live, work and learn. Through its management structures, its internal and external relationships, the teach- ing and learning style it adopts and the methods it uses to interact with its social environment, the school will enable pupils and staff to control and improve their physical and emotional health. The health-pro- moting school should be seen by European countries as an investment. Places in which to live and learn Beginning as a small pilot project, the Network now includes over 500 project schools with 400 000 stu- dents in 37 countries. A further 2000 schools are linked through national or regional arrangements to the Network, which provides a unique platform for cross-country exchanges and partnerships. The Network does not belong to the international organizations but is supported by them, morally and technically as well as financially. It belongs to the participating schools, with the primary objective of im- proving and protecting the physical and emotional health and welfare of pupils, teachers, non-teaching staff and the wider community. The three sponsoring agencies have formed an international plan- ning committee, and a technical secretariat is hosted by WHO's Regional Office for Europe. Each country with pilot schools has a "Improving and protecting the physical and emotional welfare of pupils, teachers and the community". World Heolth • 49th Year, No.4, July-August 1996 national coordinator, and the coordi- nators meet at least once a year to discuss their experience, needs and challenges. The technical secretariat supports the coordinators with tech- nical guidance, and produces teach- ing and training resources and other material. Thanks to the commitment and eagerness of the project schools, a considerable variety of programmes have already been initiated. These programmes have the following features in common: active collabo- ration between pupils, staff, parents and the community in making the health-promoting schools a reality; environmental improvements which have affected the ethos of the school; school policy development in spe- cific areas; and the creation of a supportive atmosphere for teaching and learning. Twinning proiects From the very beginning, the project has aimed at including a European dimension, where twinning projects at both national and local level are ways of sharing experience and gaining international understanding and mutual respect. Several twin- ning programmes have started already, involving the sharing of information and the development of parallel health promotion activities, with the help of such tools as elec- tronic communication and video recordings, together with the ex- change of teachers as well as stu- dents. These are monitored on a regular basis and the results are published in newsletters and other media. Indeed the Network is now a large, complex, and truly European project and has been hailed as an exemplary model of collaboration between the three agencies that coordinate it. It is also beginning to gather real evidence of success. Some examples: • The project has from the very beginning focused strongly on collaboration between all the partners concerned. At the na- tional level, the formal agreement on a joint commitment to the project from both ministries of health and ministries of education has opened the way to a more effective approach to health promotion and education. • Several countries are already on the point of forming a national curriculum on health education based on the experience gained in the first phase of the project. • The mobilization of resources to provide technical support through specific tools and training has proved increasingly successful. • Exchanges and cooperation between countries and schools have strengthened the network and improved the quality of initiatives based on health- promoting schools. • The project is reported to have an increasing impact on democrati- zation in schools as well as in pre- service and in-service teacher training. • Some countries are reporting that the project has had an impact on policy development at national level. • In several countries, networks are now expanding to include more schools and thus the original idea of the pilot phase moving into the phase of dissemination and coun- trywide development is increas- ingly being fulfilled. The Technical Secretariat receives funding from WHO and the Commission for the Coordination of Project Activities in European Union member states. The Commission also gives member states funding for country support. Other countries within the Network, in particular countries of central and eastern Europe, receive funding from WHO as well as voluntary donations from countries such as Austria, the Netherlands and Switzerland. Particular problems are faced by some national coordinators, trainers and teachers in introducing new methodologies and practices into education and health systems. Many classroom teachers are not used to introducing new teaching methods and feel insecure about trying them 9 out. Many school administrators lack confidence in introducing change into school management structures. Trainers, although eager to learn new methods, require sub- stantial training themselves by competent group work experts. It is within this challenging context that the cooperation offered jointly by the sponsoring agencies is greatly appreciated by European countries. The introduction of changes on the scale required by a health-promoting school needs skilful management if the new elements are to be finally established as a legitimate part of school life. In the next phase of develop- ment, the Network will seek to reduce inequalities in health and education by introducing carefully targeted activities aimed at vulnera- ble groups, and at specific areas such as disadvantaged inner cities and rural districts. At the International Planning Committee meeting held in November 1995, a new development plan was endorsed by the three sponsoring bodies. It includes a working document setting out the strategy, aims and priorities for the future development of the Network. Europe can look forward to a strengthened and expanding Network of Health-Promoting Schools; it represents a sound invest- ment for the future of Europe. • Vivian Barnekow Rasmussen, David Rivett ond frio Ziglio are members of the Technical Secretariat, Health Promotion and Investment Unit, WHO Regional Office for Europe, 8 Scherfigsvej, DK-2 1 00 Copenhagen 0 , Denmark. 10 World Health • 49th Year, No.4, July-August 1996 New horizons in health Rosmarie Erben Used on the cover of various school health reports of the WHO Western Pacific Region, this drawing fries to symbolize how schoolchildren can work together for better health and welfare. To respond to the challenges of the 21st century, WHO in the Western Pacific Region has outlined in the document New hori- zons in health a coherent way of structuring plans and programmes in pursuit of the goal of health for all. This document identifies three themes for future work with Member States, namely, preparation for life, protection of life, and quality of life in later years. The central concepts in the document- health promotion and health protection - were taken up by the Ministers of Health of the Pacific island countries in March 1995 when they expressed their commitment to "healthy islands" in the Yanuca Island Declaration. The concept of health-promoting schools reflects the directions set out in New horizons in health. It is in relation to the first of the three themes, preparation for life, which focuses on health promotion issues particularly relevant to infancy, childhood and youth, that these schools have their most immediate application. Schools are also fea- tured as a priority in the regional health promotion programme which was endorsed by the Member States in 1993. In response to a proposal for the development of health-promoting schools, 27 countries and areas have expressed their interest in collaborat- ing with WHO in this project. In 1995, eight countries were actively involved: China, Lao People's Democratic Republic, Malaysia, Papua New Guinea, Republic of Korea, Singapore, Solomon Islands and VietNam. The concept was first discussed at a workshop on school health promotion for Pacific island nations and collaborating centres for health education and promotion, held in Australia in December 1994. This approach was given further support at a workshop in Singapore in January 1995 for countries from the northern part of the Region. These workshops were jointly orga- nized by WHO and the National Centre for Health Promotion, a WHO Collaborating Centre for Health Promotion in Sydney, Australia, and the Training and Health Education Department, Ministry of Health, a WHO Collaborating Centre for Health Education and Health Promotion in Singapore. Practical steps A WHO workshop for national coordinators of health-promoting schools from Pacific island coun- tries, jointly organized in October 1995 with the University of the South Pacific in Suva, Fiji, produced an outline for the practical steps involved (see box on next page). In the Pacific, the development of health-promoting schools is viewed as an important part of the Healthy Islands initiative. Later, a WHO working group on health-promoting schools was convened in Shanghai, China, in December 1995. Regional guidelines, entitled Development of health-promoting schools- a framework for action, have been prepared at the request of countries, as a basis for countries and areas in the Region to develop healthy lifestyles in the school setting in a comprehensive way. They are as relevant for China, the largest country in the Region, as for small Pacific island countries such as Niue. There are six major elements of a health-promoting school: school health policy, the physical environ- ment, the social environment, com- munity relationships, personal health skills and health services. A series of checkpoints shows whether action has occurred in relation to a particu- lar component and allows the school principal, teachers, students and parents to measure their progress. It also guides personnel at the local, regional and national level in the support and recognition of health- promoting schools. China was the first country to translate the guidelines and discuss their local adaptation during a National Conference on School Health Promotion, held in Beijing in December 1995, sponsored by WHO. Some 100 participants repre- senting health and education authori- ties from all provinces participated in the Conference and agreed on the development of health-promoting schools. Other issues in the series of booklets on health-promoting schools are the reports from the three workshops and the working group. An issue on research relating to these schools is in preparation. The series is an important means of sharing experiences and activating networks Working together Building alliances is crucial for the development of health-promoting World Health • 49th Year, No. 4, July-August 1996 schools. At country level, the collab- oration of the Department of Education and the Department of Health is a must. Within WHO an interdivisional theme group on preparation for life ensures that all relevant activities in programme areas such as nutrition, tobacco, and HIV I AIDS are considered. WHO has also made agreements to collabo- rate in developing health-promoting schools with organizations such as UNESCO, UNICEF, UNFPA, the South Pacific Commission and Education International. Besides supporting the Australian Sports Commission in strengthening the physical activities programme in several Pacific island countries as part of the Australia South Pacific 2000 Sports Programme, WHO is also collaborating with Australia in a healthy islands project for five Pacific island countries, which fo- cuses on health-promoting schools. The WHO Collaborating Centres for Health Education and Health Promotion have an important role. The one at Sydney University, for example, will support eight Pacific island countries in carrying out a study on health behaviour in school- children. Several university depart- ments have also become strong allies. From 1996 onwards, the Queensland University is offering short training courses for staff on health-promoting school projects. Other exciting developments are taking place in an increasing number of countries in the Region. Whether adopting the whole idea or using it in relation to specific health issues such as the control of helminth infections or substance abuse, countries and areas in the Region have responded enthusiastically to the concept of health-promoting schools. The biggest challenge, however, is to move from a given project to the nationwide establishment of health- promoting schools. It is encouraging to see that many countries have included the development of such schools in the activities funded through the WHO regular budget. The regional activities also con- tribute to WHO's Global School Health Initiative, which provides 11 A school garden in the Philippines: a safe place to ploy, sing and learn. valuable back-up for the countries in the Region, especially with regard to school health networking activities. To obtain copies of the two documents referred to, please write to the author at the address given below. • A network for the Pacific Cliff Benson Dr Rosmarie Erben is Regional Adviser in Health Promotion at WHO's Regional Office for the Western Pacific, United Notions Avenue, P.O. Box 2932, I 099 Manila, Ph ilippines. A network of health-promoting schools in the Pacific was formally established at the WHO W orkshop for National Coordinators of Health-Promoting Schools in the Pacific, held at the University of the South Pacific in Fiji from 2 to 6 October 1995. Attended by participants from 17 Pacific countries, as well as observers from Australia , this week-long gathering designated the Institute of Education at the University of the South Pacific as the focal point of the network, with its Fellow in Science Education, Sereana Tagivakallni, as Coordinator. The IOE is wel l placed to fulfil this role as it has regular contact with the Ministries of Education in the 12 member countries of the University. It also coordinates two other networks, one in teacher education and the other for women managers in higher education, which incorporate several non-member countries as well. Regular satellite meetings are convened to ensure continuity of the network. The University's satellite system is used, although not all countries in the Network are connected to this system. However, the Coordinator maintains contact with those countries and incorporates news from them in records of meetings. The Institute of Education also produces a Pacific health-promoting schools man ual for use by the national committees of health-promoting schools and in the schools themselves. Mr Cliff Benson is Director of the Institute of Education, University of the South Pacific, P.O. Box 1168, Suva, Fi;i. 12 World Health • 49th Year, No.4, July-August 1996 Health-promoting schools in the Americas Maria Teresa Cerqueira A teacher with her pupils in Argentina: the health-promoting team starts here. T he Health-Promoting Schools human development. initiative in the Region of the There are three principal areas of Americas stems from a proposal action for health-promoting schools. by the 14 countries which were The first consists of health education, represented at a consultation on which includes reshaping and updat- Health Education and Promotion in ing the school curriculum, improving the School Setting, held at the the training and skills of the teachers, Heredia National University, Costa and preparing appropriate educa- Rica, in 1993. The initiative called tiona! material. The second involves for the development and strengthen- making the school environment ing of health education, environmen- healthy through such measures as tal health, and health and nutrition ensuring adequate sanitation and safe services at school. This entailed a water supply, improving the physical commitment to involving not just the infrastructure, preventing violence school but also the community and (including corporal punishment), and local and municipal health services. finding ways to improve mutual The objective was to strengthen understanding between pupils, teach- the capacity of everyone concerned ers and parents. The third area is that to create an environment that would of health and nutrition services, and encourage better knowledge, atti- includes better coordination between tudes and health promotion practices, the health services, the parent- and would help to prevent risk fac- teacher associations, various non- tors for the younger generation. The governmental organizations and Healthy Cities and Municipalities community institutions. movement helped to strengthen local capacity to identify and respond to the requirements of this initiative. At Regional strategy the same time, the promotion of school health also held out the The regional strategy for carrying out promise of reducing school truancy the initiative is to promote a variety and examination failures, both of of cooperative activities including: which are risk factors for health and • disseminating the conceptual Latin America and the Caribbean have accumulated wide-ranging and fruitful experience in the field of school health, and ways are now being sought to apply the concept of school health promotion in a more integrated manner. framework and action guidelines of the initiative, and supporting the formation of a Latin American and Caribbean network of health-promoting schools to exchange knowledge and experi- ence about health promotion; • enabling the education and health sectors to formulate and put into effect joint policies; • helping to consolidate the mecha- nisms of intersectoral coordina- tion, which will include mixed commissions to harmonize and evaluate health promotion activi- ties in the schools; • strengthening the capacity of institutions to assess health needs; • promoting environments that are healthy both physically and socially, and reinforcing the community's social support systems; • coordinating the activities of local schools, health services and community organizations in the municipal context, and involving community leaders and local authorities so as to ensure that health promotion is incorporated in local development planning; • encouraging health promotion at World Health • 49th Year, No.4, July-August 1996 the school level with the full participation of the community and parents' associations; • strengthening the human resources needed for health promotion in schools, which includes training teachers and health personnel, and providing reference materials and technical support for teachers; • finding ways to monitor practices that might endanger the health of schoolchildren; • making institutions better able to evaluate the whole process of creating health-promoting schools, and the impact of health promotion and education on the knowledge, attitudes, practices and lifestyles of the school com- munity. A range of experiences Latin America and the Caribbean have accumulated wide-ranging and fruitful experiences in the field of school health. In Latin America, ministries of education are carrying out various programmes of school health, especially in health education at the primary-school level. Most countries in the region can rely on the health services to detect problems in areas such as hearing, sight, pos- ture, malnutrition, and caries. Many health education programmes are built into the curriculum on subjects such as hygiene, diet, accidents and waste disposal. However, many of these programmes tend to take a vertical approach in which the lessons are not related to other as- pects of life. There is no system of surveillance for risky practices at school, and this makes it difficult to design strategies, activities and teaching materials to promote health. Certainly, environmental health is a priority area; others include im- proving human relations, preventing violence in the school and strength- ening the school's capacity for health monitoring and evaluation. Past experience has shown up a number of obstacles that prevent the concept of school health promotion from manner. In 1994, a conceptual framework and guide were produced, with the aim of making the health- promoting schools initiative a reality. The following year saw the launch of the Network of Health-Promoting Schools in the Region. Here are some examples of what is being done. In Bolivia, educa- tional reform calls for close coordi- nation between the health and education sectors in order to bring about the full integration of health promotion and health education. This reform is at present using the technique of "rapid diagnosis and analysis" to make a major evaluation of the country 's institutional capacity to undertake health promotion and health education at the primary- school level. On the basis of this evaluation, a plan will be drawn up to integrate these two activities in accordance with the principles of the educational reform. In Costa Rica, the process of strengthening institutional capacity to create health-promoting schools is making great strides. The Mixed Commission for Education and Health is already undertaking rapid diagnosis and analysis, has prepared a questionnaire to evaluate habits and practices that might endanger the health of schoolchildren and adoles- cents, and is coordinating the forma- tion of a national network of such being applied in a more integrated Planting trees Foro healthier Future in Mexico City. 13 schools. In Mexico, the national school health programme has the following aims: to promote a change in atti- tudes, habits and behaviour in order to inculcate a culture of health in the schoolchildren, their families and the community; to contribute to the early detection and prompt treatment of health problems; and to increase the effectiveness of health activities through the coordinated participa- tion of health-related and educa- tional institutions. The Caribbean island states also have extensive experience in this field. One school health project, for example, aims at teaching life skills in the English-speaking Caribbean, with particular reference to Dominica, Saint Kitts and Nevis, and the British Virgin Islands. It has been developed on the basis of the perceived need to improve the teach- ing of health education and sexuality in the schools. • Or Mario Teresa Cerqueiro is Regional Adviser For Community Participation and Health Education, Division of Health Promotion and Protection, World Health Organization Regional OHice For the Americas/Pan American Sanitary Bureau, 525 23rd Street N. W , Washington , DC 20037, USA. 14 World Health • 49th Year, No.4, July-August 1996 School health education in South·East Asia The whole subject of health edu,cation in schools in WHO's South-East Asia Region is closely linked with the development of the Healthy Cities initiative in that Region. This link has enabled a number of supporting alliances to be established between schools and their immediate community, as well as creating a favourable environment for further joint activities to be undertaken in the future. A wide range of intercountry seminars and consultations have been arranged in recent years deal- ing with many aspects of school health and health education in the classroom. In particular, representa- ti ves from the ministries of health and ministries of education have come together on a number of occa- sions to discuss methods of prevent- ing the spread of sexually transmit- ted diseases, especially HIV/AIDS. As long ago as 1992, the Regional Office in New Delhi drew up and distributed a series of recom- mendations and guidelines for carry- ing out and strengthening compre- hensive school education in the Region. Since then, several coun- tries have made efforts to reorient their health services in such a way as to ensure that health aspects receive their due emphasis in school curric- ula at all levels. India, Nepal and Sri Lanka, for instance, have been at pains to foster the development of school health education, not least through encour- aging "little doctor" programmes. These seek to ensure that whatever the children learn in school about hygiene, good sanitation and healthy lifestyles is carried back to their families and their communities. In many parts of the world, school- children have proved to be very good teachers to their elders who have not had the benefit of instruc- tion in the basic lessons in healthy living. • School health education in Africa The African Region is collaborat-ing with WHO headquarters in Geneva and drawing on experi- ences of other Regional Offices in order to put together a regional plan for developing health-promoting schools. The Regional Office for Africa in Brazzaville has devised a plan that will result in the creation of three subregional networks of such schools. The first of these networks will be launched in an intercountry consultation in Gaborone, Botswana, in November 1996, jointly planned by the Regional Office and WHO headquarters. One project already under way involves working with the Finnish International Development Agency (FINNIDA) to assist Namibia in planning school health programmes and out-of-school health activities for young people. Support for simi- lar schemes is being sought from other organizations of this kind. The spread of the AIDS pan- demic throughout the continent has served as a driving force, obliging governments to review the quality of school health curricula. Much more emphasis is now being placed on training teachers in health education and health promotion methods. A general reorientation of health ser- vices is now taking place in Africa, as ministries of education and min- istries of health look for strategies to attract investment in school health programmes, and for ways of main- taining such programmes in the future . Among country-specific activi- ties, the Regional Office is working with Benin, Cameroon, Ghana and Namibia to bring about improve- ments in school health, particularly through community action • In many African schools, more emphasis is now being placed on health education and health promotion. World Health • 49th Year, No. 4, July-August 1996 15 Health can be "contagious"! Sergio G. Meresman about in the classroom. Argentina's "Health-Generating Schools" experiment stems from an investi- gation into health promotion in schools, undertaken by the Institute for Research in Education Sciences at Buenos Aires University. Last year we drew up a pilot "Health is something wonderful", says the poster on healthy nutrition designed for the school by the children themselves. The final step was to evaluate and synthe- size the process, with maximum input from pupils and parents, making the local com- munity a part of the process. This com- pleted a cycle which went from information (research, problem- plan for five schools in urban and semi-urban areas of Buenos Aires and Quilmes. The programme was supported by the local office of the Pan American Health Organization and involved 25 teachers and auxil- iary teachers, more than 500 pupils in the 3rd to 6th grades of the San Cristobal, Villa Crespo, Ezpeleta and Berazategui schools, and a large group of parents, maintenance staff and school principals. In order for each school- pupils, teachers and parents- to be truly involved in the programme on the basis of its own needs and dynamics, we carefully avoided the idea of "outside assistance" which has char- acterized previous interventions in school health, because it tends to make the school a mere captive audience for the health professionals. Outside assistance has also resulted in intermittent activity, focused on a single issue, which only served to reinforce misconceptions and under- line the passivity of the educational community. Rather than being judgemental and pedagogical, we looked for an approach based on a positive concept of health. To do this, we used the formal and informal opportunities which the school offers for promot- ing healthy behaviour. We tried to foster a culture of care, so that health-related themes would infil- trate daily school activities and not just be an adjunct to the curriculum. Our objectives were as follows: to sensitize the educational community to its role in promoting healthy habits and health care; to improve the understanding of relations between health themes and other components of the school curriculum; to manage the school as a health-giving physical and social environment by making changes in the physical structure, the work pattern and the teaching- learning methods; and to optimize the links between school and health centre, thus encouraging joint initiatives. We "diagnosed" the health situa- tion of each school and its commu- nity, looking not only at problems but also at opportunities for health . We then chose a particular health theme for in-depth study, such as diet, hygiene or accidents. The pro- gramme managers sought ways of making changes in the school's daily life which presented pupils with objective facts to discuss and learn solving) through moti- vation (sensitization, involvement) to production (synthesis, communica- tion, change). The success of this pilot project carried out in 1995 encouraged us to extend the programme so as to form a network of health-generating schools. The emphasis was placed not on "the absence of illness" but rather on "a culture of health and care". This gave every participant, whether child or adult, the opportu- nity to make an exciting discovery: that health can be "contagious"! • Dr Sergio G. Meresman, of the Institute for Research in Education Sciences at Buenos Aires University, Argentina, is at present working at the Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 50A, UK. STEP ' TOS GHEALTH- Schools should be healthy places in which to work, help prevent and treat the common health problems of children and staff, and provide referral as needed to appropriate health institutions. AN ENTRY POINT FOR HEALTH PROMOTION AND INTERVENTION Skills-based health education can enable children to make healthy choices and adopt healthy behaviour throughout their lives. CRITICAL HEALTH AND LIFE SKILLS Schools must provide safe water and sanitary facilities and protection from diseases, violence and harmful substances. A SAFE LEARNING AND WORKING ENVIRONMENT Improving and expanding educational opportunities for girls is one of the best health and social investments a country can make. FULLEDUCATIONALPARTICWATION OF GIRLS Every Member State must provide education in school that meets the full range of children's learning and developmental needs. INVESTMENT IN SCHOOLING WHO Expert Committee on Comprehensive School Health Education and Health Promotion. HOOLHEALTH ~RO International support must be further developed to enhance the ability of Member States, local communities and schools to promote health and education. ThiTERNATIONALSUPPORT School health programmes must be well designed, monitored and evaluated to ensure successful implementation and outcomes. SUCCESSFUL SCHOOL HEALTH PROGRAMMES The community and the school must work together to support health and education. CO~ANDSCHOOLThiTERACTION Teachers and school staff must be valued and provided with the support necessary to enable them to promote health. TRAINING OF TEACHERS AND SCHOOL STAFF Policies, legislation and guidelines must be developed to ensure the mobilization, allocation and coordination of resources at all levels. POLICIES, LEGISLATION AND GUIDELINES Produced by the Division of Health Promotion, Education and Communication. 18 World Health • 49th Yem, No.4, July-August 1996 Classroom health in Belize Roman Magana Words of advice and encouragement are valuable but they are simply not enough in the fight against diseases. Poverty is probably the principal reason for some countries being ravaged by diseases. Belize, lying on the Caribbean coast of Central America, certainly suffers both from a poor economic situation and from widespread disease. At our school -Holy Redeemer Upper School in Belize City- the struggle to keep the children healthy is un- ceasing. We may lack the finance and technology needed to combat all the diseases that threaten our chil- dren, but our weapons of determina- tion, education and cooperation have helped us to make progress in this struggle. The school has received much help from international organizations like WHO, as well as from local institutions such as the Health Department. We have been provided with the technical advice and infor- mation needed to equip us for pro- moting health in the classroom. Occasionally, personnel from these organizations have visited our school to give lessons, stimulate discussion and encourage our children to take simple steps to prevent diseases. Some of the classrooms have become like little art galleries displaying charts that depict the causes, effects and ways to prevent such illnesses as cholera, AIDS and malaria. Over the years, we have set aside one day each year for nurses to come to the school to give our children lessons on sex education. We have seen how formerly timid students now want to learn more about them- selves and about the diseases that threaten their lives. As teachers, we believe that words of advice and encouragement are valuable but they are simply not enough in the fight against diseases. We do not have a particular time in the curriculum to teach health educa- tion, so this topic is included in the Through discussions and practical work, children quickly learn haw to promote health in the community. science lessons. Recently, one class was encouraged to do research on several tropical diseases and to make presentations in class. The results were astounding. The children produced charts and equipment to help them with their presentations. One student, Giovanni Santos, brought a stethoscope to listen to the heartbeat of his classmates. Sharnir Polanco brought an instrument to test the blood for sugar content, while Jamie Rosado illustrated- with the help of a plastic heart- how cholesterol can be deadly to us. These are only a few examples of what these children did themselves to acquire knowledge about sickness and good health. Hygiene is accorded great impor- tance, and our classrooms, our yard and especially our toilets are kept clean and tidy. The cost of maintain- ing the toilets is quite high but the results are satisfactory. Our school has won several first prizes for being the cleanest school in the city, and only last year we won an essay competition on "Keeping Belize City clean and beautiful." Holy Redeemer Upper School does not have all the resources necessary to provide comprehensive health to our children, but the tools we do have are time, motivation and dedication. Our ultimate goal is to see that our children eat well and have balanced diets. We are aware that a few children lack adequate nourishment; consequently one of our immediate aims is to generate the resources needed to ensure a healthier future for our school- children. • Mr Raman Magana is an Assistant Teacher at Holy Redeemer Upper School, 14 New Road, Belize City, Belize. World Health • 49th Year, No.4, July-August 1996 19 Children versus mosquitos Verity Beckles Pupils of the L. T. Gay Memorial School in Barbados separate garbage at the point of disposal. We in our small island nation know how important it is to fight against all types of diseases and environmental hazards, and to work for a healthier world. There is no better way to succeed in this than to educate our children at an early age. That is why the L.T. Gay Memorial Primary School near Bridgetown, the capital of Barbados, was pleased to become one of the many pilot schools in the Caribbean to be involved in community-based dengue prevention and control. Health education which leads to good health practices should be everyone's business. Despite the emphasis of primary school educa- tion on "the three Rs", with a concen- tration of effort on assisting pupils through the Common Entrance Examination at age eleven, our school has devoted much time to the Environmental Health and Vector Control Curriculum. We chose the integrated subject approach because weekly 45-minute sessions on health education proved inadequate. This "infusion" approach was used in social studies, mathematics and agricultural science, and it helped pupils to express themselves through art, poetry, composition and craft. The theme chosen was REDUCE, RECYCLE and REUSE. Since the mosquitos that transmit dengue may thrive in rubbish tips, our goal was to reduce the amount of garbage that was being collected daily by the sanitation workers. We introduced garbage separation, setting apart plastics, paper and non- combustibles. Combustible materi- als were incinerated and the ashes were applied to the garden beds as fertilizer. In the craft programme we used plastic drinks bottles as vases, aquaria, candle-holders and a variety of other household items. To avoid wasteful use of water, they were also used in the school garden as funnels to channel irrigation water down to the roots of the crop plants. Comments from parents revealed that their children had taught them many ways of controlling vectors and some important facts about dengue fever. Parents and teachers also said their children assumed the role of health inspectors, searching their surroundings and looking for mosquito breeding places. They often collected larvae for study, informed the local authorities, and eliminated breeding sites. District public health inspectors arranged visits to the local neigh- bourhood, and these gave the pupils first-hand knowledge of good and bad health practices in the commu- nity. The inspectors also gave in- struction to the janitors and school meals staff about vector control and safe food-handling methods. Two exhibitions at the school and the wealth of knowledge shown by the pupils on various health topics were proof of the dedication and hard work of the teachers. The pupils' pictures, poems and compositions showed how strongly they felt about things that affect their health. One of the difficulties which the school faced initially was the reser- vation expressed by teachers about adding a new topic to the already busy health programme. However, in time the project received the fullest support of the teachers. It is clear that, for maximum effect, health-promoting schools need to formulate long-term plans. • Mrs Verity Beckles is a teacher at L. T. Gay Memorial School, St Michael, Barbados. 20 In London's East End Kevin Corr l angdon is a large, multicultural comprehensive school of some 1800 students situated in a work- ing class area of London's East End. As a member of the European Network of Health-Promoting Schools, the school has focused on four development areas: the health education curriculum, bullying, smoking and healthy eating. The curriculum In order to develop the self-esteem of our students, we have put much emphasis on producing high quality teaching resources which help young people to take responsibility for their own health. Langdon's Personal, Social and Religious Department is building up new materials for drugs awareness and sex education, includ- ing worksheets, software, videos and games. Specifically targeted are family planning and contraception, menstruation, abortion, puberty and adolescence, and AIDS awareness. This has involved close coopera- tion with the local Personal, Social and Health Education Adviser as well as more involvement with theatre groups and with external community groups such as the Youth Awareness Programme. Dealing with bullying When students are asked for their opinions about the school's behaviour policy, a student counselling service was one of their requests, particularly to deal with the problem of bullying. In response, ten students and two staff members were specially trained to become mediators. The training was intense but very successful, and after much discussion and planning by the students the mediation service is now up and running, with two lunchtime sessions a week. Sessions take place in a mediation room and can be booked by placing a note in mediation "boxes". For students who do not want to tell a teacher about their difficulties, this provides an ideal opportunity to get something done about their problem. Our current mediators are from Year 11, but we will soon be training some Year 10 students, so they will be able to take over the job next term. Another aim is to create and preserve a play area for students who do not want to participate in the competitive games that can be seen in many playgrounds. Plans have been drawn up to decorate a section of the playground and plant flowers and shrubs. The London Dockland Development Corporation has pro- vided funds to buy new benches for this area. Football will not be al- lowed in this section. No-smoking policy The staffroom has been partitioned, leaving a small area for smoking, since there is increasing awareness among staff that smoking is accept- able only in a designated place. A large number of no-smoking signs are being fixed around the school building. This initiative will be linked to positive messages in Personal, Social and Religious Education lessons about the damag- ing effects of smoking. As the school's health education coordina- tor, I am at present drawing up a draft smoking policy, which will eventu- ally go into the school prospectus and the staff handbook. Linked to this, an "asthma pol- icy" has now been implemented; a large number of asthma cards, with treatment recorded and signed by the student's doctor, have been received and will be filed and updated in the Medical Centre. There is also a special storage cupboard where those World Health • 49th Yeor, No.4, July-August 1996 students who are asthma sufferers can keep a spare inhaler. Healthy eating A project to encourage a healthy diet has already started and culminated in European Food Week, held in June. A healthy eating promotion team has been established to oversee this task. The main focus was on a "Europe and her people's Food Evening" , , where food from different countries was put on display, including dishes from European minority groups. Thus alongside French food were North African dishes; alongside German ones, Turkish ; and beside English dishes, Indian. A number of local restaurants cooperated by giving demonstrations. There were also fitness displays and the launch of a book called The healthy taste of Europe. A large amount of written mater- ial was submitted by European embassies in London. Throughout the week several dimensions, includ- ing cultural and geographical ele- ments, were examined under different subject areas- physical education, food studies, geography, science, art, modern languages, and social and religious issues. As part of the European connec- tion, a school in Turku, Finland, contacted us through the European Network of Health-Promoting Schools and about 25 of its pupils visited us in May. Each of the visit- ing students later exchanged letters with a pen-pal in our Year 10 classes. • Mr Kevin Carr is the Health Education Coordinator at Langdon School, Sussex Rood, East Hom, London E6 2PS, England. World Health • 49th Year, No. 4, July-August 1996 21 Helping schoolchildren to help themselves Chantas Penthisarn Poor health always makes learn-ing more difficult. Health promotion, as part of general education, may be the best approach to solving this problem. Health- related knowledge and skill will not only improve the well-being of schoolchildren but help them to help themselves, their friends, their family and their community. Bangbua school in Bangkok, Thailand, selected some 40 fifth- grade boys and girls to take part in a training course called the Health- Promoting Leaders project. A cur- riculum proposed by the School Health Division is used to equip the participants with ade- quate knowledge to undertake a number of health activities. Each time, we record the treatment on individual files, and our health leaders play a major part in coordi- nating and collecting the data. A mobile medical unit comes to the school every year to provide diagnosis and treatment for the children and people living near the school. School-age children often have toothache, while others may be infested with lice. All children must participate in the tooth-brushing project: after brushing they must keep a fluoride liquid in their mouths for a few minutes. Those with lice Since most of our children come from poor families, they eat poor food, so their weight and height are below the standard. To help solve this problem, we set up a school lunch and growth-monitoring project. We measure the weight and height of all the children once a semester, and the results tell us that our chil- dren's nutritional status is gradually improving. Student leaders help to prepare immunization iniections Immunization is an important activity, and our school- children receive it at the beginning of the academic year. Once we have reviewed their previous immuniza- tion records and received permission from their parents, we ask the nearby public health centre to immunize them against poliomyelitis, measles and the other target diseases. If an epidemic occurs, we immediately ask for vaccination from the same centre. have to have treatment on three successive occasions. The health leaders take a major part in prepar- ing these activities. The school information service distributes general information and news about events such as wide- spread epidemics and the ways to prevent and treat infection. Every Thursday morning, the news is broadcast by the health-promoting leaders who take turns to do this and to distribute health documents. Since Bangbua school has 2130 children, 102 teachers and eight other workers and janitors, with more than 60 classrooms, environ- mental sanitation and food hygiene are high priorities. All members of the school must support these activi- ties, and our little health leaders regularly inspect the drainage, garbage disposal and other facilities, then report to their teachers who will try to solve any problems they have discovered. A timetable in the school nurse's room ensures that the health leaders take it in turns to come and work every morning and noon. They help each other to clean the room, prepare beds for patients and maintain the first aid equipment. When patients arrive in need of help, they take care of them, offering them first aid under the supervi- sion of the nurse teacher. Through these activi- ties we see the health- promoting leaders taking care of their school friends like brothers and sisters. Visitors may sense this lovely atmosphere at Bangbua school, especially in the nurse teacher's room, and we know that we are instilling both knowledge and responsibility in our children's minds. • Mr Chan las Penthisarn is a teacher at Bangbua Elementary School, 8 M 4 Paholyothin Rood, Chatuchak, Bangkok 10900, Thailand. 22 World Health • 49th Year, No.4, July-August 1996 Greater awareness - better health Jyotika Singh Health experts from other Pacific island countries visit the Suva Grammar School in Fiji, to see how pupils learn about health and the environment. 5 uva Grammar School set up its "Health Environment Commit-tee" in 1995 to look into matters relating to health promotion in the school. This is a fully government- owned secondary school with just under 1500 pupils, making it one of the largest schools in Fiji. It is a coeducational day school with a multi-ethnic population, offering classes for pupils from Year 7 (Form 1) through to Year 13 (Form 7). The membership of the Commit- tee is drawn from all the school de- partments but is on a voluntary basis. Since becoming operational the Committee has undertaken a number of activities, aimed both at improving the physical environment of the school and at dealing with the health concerns of its pupils. A campaign to increase environ- mental awareness among pupils included a calendar poster competi- tion organized by the Curriculum Development Unit of the Ministry of Education. We ran clean-up cam- paigns in the classrooms and sur- rounding areas, and each form was allocated areas where they could plant trees and shrubs. All drains have been cleared to control mos- quito breeding areas. The Suva Waste Disposal Company and the Scrap and Metal Company both agreed to make waste bins available at no cost to the school. One of the first projects undertaken by the Committee was to make pupils aware of the litter prob- lem in the school. The juniors, with their science teachers, mapped the most polluted zones in order to make everyone litter-conscious. As part of a health education effort in the school, sanitation, waste disposal, toilet hygiene and personal hygiene have been continually highlighted in the classroom. An obesity survey was carried out in 1995, and this year we have de- cided to make obesity our priority project. Besides assisting the pupils by working out their recommended daily allowances of food and moni- toring them, we have introduced an aerobics class, twice a week, to help overweight pupils and teachers to work out a physical fitness programme together. The school tuck shop sells only fresh, locally produced fruits and drinks on desig- nated days. To improve the natural environ- ment, shrub and tree planting pro- jects have been carried out around the whole school, and there will be a special tree-planting ceremony this year to commemorate Arbor Week. In time for World Health Day, 7 April, we prepared vegetable gardens where only dark green leafy vegetables (such as spinach) and legumes were planted. Lack of finance is a major con- straint. However, we have not been deterred by this, and succeeded in securing sponsorship from a leading retailer to get our environmental campaign started. A lot more is needed for the purchase of more garbage bins, sanitary cleaning agents, mosquito control equipment, and so on. The challenge now is to maintain the enthusiasm and motivational- ready generated among staff and pupils. Active support from con- cerned authorities would give our efforts a big boost. For anyone wish- ing to put the health-promoting school concept into action, it is imperative to have the support of the school man- agement, the staff and the pupils - and to think of creative ways of over- coming the financial constraints. • Mr )yotika Singh is a teacher at Suva Grammar School, Suva, Fiji. World Health • 49th Year, No.4, July-August 1996 23 No iunk food in the school canteen Roy Donato D. Santos 5 choollife has never been health-ier at the General Gregorio del Pilar Elementary School in Bulacan, some 70 kilometres from Manila. Last year it was chosen to be the launching site of the Healthy School Initiative programme of the Department of Health, making it the premier health-promoting school in the Philippines. The results are becoming apparent not only in the changes on the school premises but more significantly among its stu- dents' health awareness and behav- iour. The school is not a fashionable or exclusive private one, but a typical public central school with 12 satel- lite barangay (neighbourhood) schools. Many of its 1499 students come from low-income or "no- income-at-all" families for whom health issues are often a secondary concern. The school had already embarked on a School Health Guardian Pro- gramme with components that include tree-planting, a herbal gar- den, supplementary feeding and school health services. The Healthy School Initiative strengthened that programme with the inclusion of health instruction, a safe and healthy school environment, useful commu- nity-school projects and regular health promotion activities. A big signboard on the main building proudly declares: "This school is chosen as the launching site of the Healthy School Initiative Programme" . On an adjacent build- ing is the bronze plaque put up when the programme was launched by representatives of the Department of Health, the Department of Educa- tion, Culture and Sports, and provin- cial and local governments. Two huge shelves in the library display a wide variety of materials on health, and trash cans are neatly At the General Gregorio del Pilar Elementary School, at Bulacan, Philippines, children from all social backgrounds have an opportunity to participate in the Healthy School Initiative Programme. placed in classrooms and corridors. Vegetables planted by the pupils provide a valuable source of nutri- tion. The school canteen offers only healthy food and bans junk food. There is a first-aid clinic with quali- fied health personnel. Health education has long been included in the elementary curricu- lum, but now health topics are given special emphasis by being incorpo- rated into other subjects. Science subjects include the study of herbal medicine; in the music class pupils sing about personal hygiene; in the art class, they draw herbal leaves and the healthy environment; essay assignments are often on various health topics ; and even in mathemat- ics, problem-solving exercises are often applied to health situations. The morning ritual of physical exercise and self-care includes brushing of teeth and washing of hands and face, followed by inspec- tion by the class teacher. One teacher says proudly: "Pupils now take the initiative in self-care. They have a better sense of being healthy and of what health is all about. They even inspect each other for traces of dirt on their hands, face, teeth, hair and clothing." The school programme enjoys much-needed support from the key sectors. At the request of the Parent-Teacher Association, the local government unit through the Municipal Task Force on the Healthy School Initiative is funding the construction of a toilet for every classroom, as the school has only one for each building. The Municipal Health Centre undertakes regular medical and dental check-ups and treatment. And the Department of Health gives technical assistance by providing educational materials, dental supplies and equipment, and financial support. Enthusiasm for continuous in- volvement among local executives, school and health officials and the schoolchildren themselves continues to grow as they assume responsibility for achieving the objectives of this innovative Initiative. • Mr Roy Donato D. Santos is Health Education Promotion Officer II with the Public Information & Health Education Service (PIHES), Department of Health of the Republic of the Philippines, San Lazaro Compound, Rizal Avenue, Santa Cruz, Manila, Philippines. 24 World Health • 49th Yeor, No. 4, July-August 1996 A Shanghai school shows the way Cai Hong·Ying Cleaning teeth to music - one of the many activities carried out at the )in Ling Road Primary School in Shanghai, China. tion on littering and spitting. Other standards relate primarily to behaviour at home. Boiling drinking-water is one example, and another is having adequate light for reading- an important consid- eration in a situa- tion where eyesight prob- lems among I n 1991 , even before the concept of health-promoting schools had been clearly developed in the Western Pacific Region, Jin Ling Road Primary School in Shanghai launched a health action project in cooperation with the local commu- nity authorities. The aim was for the school and the community to work together to improve health. The school has drawn up a set of health behaviour standards for pupils which are closely monitored by teachers. These include correct posture for reading and writing, carrying a handkerchief, washing hands before eating, and a prohibi- children are common. The schoolchildren also work on improving sanitation and physical environment by extending the school's "green belt". The neighbourhood authorities help the school in reinforcing with parents the importance of these standards. An event called "parents ' school" has been arranged once a year for the past four years, to pro- vide information about a range of issues, such as eye care, diet and child psychology. The health standards adopted by the school extend to social and per- sonal behaviour, such as cultivating a wide range of interests, taking part in Health-promoting schools in China social activities and showing friend- liness towards other pupils. The school is now exploring ways of linking some of these initiatives to the kindergarten level in order to influence health attitudes and behav- iour at an even earlier age. While it may be many years before the full fruits of these efforts can be appreciated, the short-term outcomes in terms of a range of health indicators have been very positive. For example, since the start of this programme there has been a marked decrease in dental caries and short-sightedness among pupils. In December 1995 the Shanghai Health Education Institute, a WHO Collaborating Centre for Health Promotion, designated Jin Ling Road Primary School as an experi- mental site for a health-promoting school. The school has been ap- praised as a model unit for two successive years, and its experience is now being shared with other primary schools. • Mrs Coi Hong-Ying is Chief Supervisor of the )in Ling Road Primary School, No. 86, West )in Ling Road, Shanghai 200020, China. Among several other projects currently under way in China involving health-promoting schools , one which was established last year by the National Health Education Institute invo lves four schools in each of three urban areas- Chifeng City in Inner Mongolia, Wuhan City in Yunnan Province and the W est City District of Bei jing. The project got off to a rapid start, particularly since the schools a ll had well-established foundations of health education and school-based health services. However the transition from that situation to one of working towards becoming health-promoting schools has involved some important shifts in the school culture. O ne such sh ift meant that the school staff had to reconsider their education objectives; they became aware how closely linked the main elements of health-promoting schools are with their own professional objectives of encouraging the comprehensive development of the students in their care . Another important shift has been the involvement of the schools w ith the local community on health issues. Students have helped in clean-up campaigns in their neighbourhoods. They arrange to visit older citizens, particularly those who do not have families around them, and help in community education campaigns on such health issues as non-smoking. The local community authorities in turn have been committed to working a longside the school and re inforcing the health messages promoted by the school. For example, junk food vendors have been ba nned from trading at the school gates at lunchtime, trees have been planted in the school grounds, and building rubble has been removed. World Health • 49th Year, No.4, Ju ly-August 1996 25 A school in Papua New Guinea Buri Veneo & Pauline Doonar Gomore Community School has been designated as a health-promoting school. This gives the board of management, the teach- ers, the children and members of the community new ways of looking at the school curriculum and its contri- bution to the village community. We are creating a new vision of health for our school and our village, and we have set out goals and objectives to achieve it. We have drawn up plans of action to tackle each of the health issues affecting the school. The top priority is to improve the standard of toilets in the school and the community. Parents and youth groups will be asked to dig the pits, and we shall look for donors to provide timber, cement and other materials. The financing will come from the parents, the provincial government and the local community. The second priority will be to demonstrate how to plant and make a garden to improve nutrition for the schoolchildren. This will also gener- ate cash for the school. Parents, teachers, children, the women's fellowship and the youth group will clear the ground and plant the seedlings, and look after the garden. Seedlings and tools will be provided by the community, the board of management and the local authori- ties. An awareness campaign will be run by the teachers, the children and others, and signboards will be made and put up by parents and members of the community. Next will come our plan to im- prove the environment of the school. We intend to plant trees for more shade and to grow grass on the school grounds so that they will look green and beautiful. Besides flower gardens, there will be carvings placed around the school as well as playground equipment such as see- saws and slides. The board of man- agement and the parents will provide manpower, timber, seedlings and carving tools, while teaching advice and personnel will come from the Department of Home Affairs and Social Services. Again the finance will come through donations, fund- raising and grants from the national, provincial and local government. School gardening- a way to guarantee healthy nutrition in Papua New Guinea. Our longer-term projects include tanks to improve the supply of safe water for teachers and children. A fence is to be erected around the school to make it safer, since it is on a main highway. The teachers are being urged to provide a savings box so that every- one can contribute to improving the health of the school. They will draw up a set of health rules for children to follow, and inspect the children daily for general cleanliness, oral hygiene, proper treatment for cuts and sores and other health needs .. The community as a whole is looking forward with enthusiasm to all these long-term improvements. Clean houses and yards, the school grounds looking neat and tidy, and improved toilets will all contribute to a better and healthier life for the village community as a whole. • Reverend Buri Veneo is Chairman of the Health- Promoting Schools at Gomore Community School in Central Province, Papua New Guinea, and Pauline Doonar is Chairwoman of the National Coordination Committee for School Health in Papua New Guinea. 26 World Health • 49th Year, No.4, July-August 1996 Sexuality and population education O.J. Sikes Each new generation of children faces health chal- lenges, but those faced by today 's school-age group seem particularly daunting. Chil- dren are con- fronted at an early age by situations that require know ledge for behaviour. Children learn to care about what happens to others as a result of irresponsible behaviour, to care about what happens to the environment, and so on . decision-making How to become healthy adults: this is the great challenge for todoy's young people. Experience has shown that it is possible to introduce some of the most and skills for preventive action. Very often adoles- cents find themselves under strong peer pressure to engage in highly risky behaviour which can have serious implications for. their lives. Early pregnancy, for instance, clearly limits girls' education and employment opportunities. When drugs, alcohol and tobacco are also involved, early pregnancy involves an added danger of birth defects . Although its association with higher risks of maternal mortality has been widely known for years, the problem of early pregnancy persists. The spread ofHIV/AIDS among adoles- cents is a more recent phenomenon, but is growing in importance, while the traditional problem of sexually transmitted diseases among adoles- cents continues to increase. In 1994, the International Conference on Population and Development drew attention to these problems and urged countries and the UN system to assign high priority to the reproductive health needs of adolescents. It also endorsed the goal of Education for All, with spe- cial emphasis on the education of girls. Since then, a number of other major international conferences, such as the Fourth World Conference on Women, have drawn attention to the health and education needs of adolescents. Such bodies as UNESCO, UNICEF, WHO and UNFPA are working on these issues with min- istries of education around the world. UNFPA is funding projects on popu- lation education in over 70 develop- ing countries, while other donors are funding related activities, and gov- ernments around the world are build- ing these activities into their school curricula. Population education devotes considerable attention to family life, sexuality and human ecology. Educators have long realized that traditional methods of instruction do not sufficiently prepare young people to meet challenges that have such an important bearing upon their lives. Population education stresses partici- patory teaching techniques that encourage students to reflect on the issues, and to think about the impli- cations of the issues and of their own important concepts in the area of reproductive and sexual health without arousing controversy. These include respect for others (especially persons of the other sex); self- esteem; the possibility of planning families and understanding that children are ideally born as the result of a conscious decision by loving and responsible parents; the impor- tance of postponing the first preg- nancy; and the abi lity to withstand peer pressure. A key ingredient in the success of these projects is the involvement and support of parents and the community. Health systems, and health educators in particular, can play an important role in ensur- ing that support. • Mr 0). Sikes is Chief, Education, Communication & Youth Branch, United Notions Population Fund (UNFPA), 220 E. 42nd Street, New York, NY I 00 17, USA World Health • 49th Yeor, No.4, July-August 1996 27 Education International: an alliance with WHO Fred van Leeuwen A health education play being performed at a school in India. Teaching children and adoles-cents how to become responsi-ble citizens should be a fundamental mission for today's schools. This involves making them aware of the major problems, espe- cially the health problems, which they will face from childhood on- wards. The school and the education system in general must train young people not only for employment but for life as citizens of the 21st century. This means preparing them to be- come women and men with equal rights, who are both self-sufficient and mutually supportive, have a well-developed critical intelligence, and can make decisions with a full understanding of what is at stake. Health education calls for an inclusive approach because it means not merely conveying knowledge but also influencing or changing atti- tudes and behaviour in the context of daily life. It means making young- sters responsible for their own health, for better or for worse. It has long been recognized that young people's health directly affects their training, their school attendance and their academic achievement. So all-round health programmes have to be developed in the school setting. Studies made by WHO and the World Bank have concluded that such programmes (for instance, combining health education with the health services to run case-finding or vaccination campaigns) are among the most cost-effective investments that a nation can make to improve its health. The yield can be measured in long-term economic and social developmentand the well-being of the whole population. This is one of the principal con- cerns of Education International, an organization of teachers and other educational workers which was created in 1993 and has affiliates in 140 countries, representing about 23 million individuals. It is at present developing many promising partner- ships. In July 1995 an International Con-ference on Health Education and Prevention of HIV I AIDS was held jointly with Education International, WHO and UNESCO in Harare, Zimbabwe. It brought to- gether more than 260 educational workers from 112 countries. Among its objectives was to make school staff more aware of the importance of school health programmes and the special role they can play in improv- ing public health generally. The Conference was a successful event but we will measure its longer-term impact by the effectiveness and sustainability of the follow-up activi- ties. Education International greatly values its partnership with WHO, which it considers to be essential for effective work on these issues. This is why we participated in the Expert Committee on Comprehensive School Health Education and Promotion, which laid the ground- work for WHO's Global School Health Initiative and defined the broad lines of action that should be followed between now and the end of this century (see page 5) . Building up this collaboration and sharing the available resources and know-how seem to us the most pro- mising ways to improve the effec- tiveness of the efforts being under- taken in this field. • Or Fred van Leeuwen is Secretary-General of Education International, 155 boulevard Emile jacqmain, 1 2 1 0 Brussels, Belgium. 28 Intestinal worms L.Savioli, K.E.Mott & Yu Sen Hai Controlling intestinal worm infection in a school in the Seychelles. Worm infections are among the most widespread health problems in the world, especially in developing countries. WHO estimates that about 1400 million people worldwide are in- fected with at least one of the three kinds of intestinal helminths- round- worm, whipworm or the hookworms. Of these, some 200 million suffer from diseases associated with infec- tion. The hookworms are particu- larly debilitating, causing iron- deficiency anaemia by blood loss. Despite the success of control pro- grammes, schistosomiasis is still a serious public health problem in more than 70 countries throughout the world, affecting some 20 million people. At least 40% of the world's school-age children- about 400 million - are infected with intestinal worms. In this group, adverse effects on growth, nutrition and learning ability are most evident. School- children also bear the greatest burden of schistosomiasis, which is an important determinant in the even- tual development of liver cirrhosis and cancer of the bladder. The harm- ful effects of intestinal helminths and schistosomiasis on the growth, devel- opment and health status of this vulnerable age group are much greater than doctors have previously suspected. Over the last 15 years, several health programmes have proved successful in improving child sur- vival but have done little to improve the quality of life of school-age children. Yet improving the health of schoolchildren is a crucial investment in the human resources that will determine a nation's future develop- ment. A major collaborative study con- ducted recently by a team from Johns Hopkins University (USA), WHO, the United Republic of Tanzania and USAID has found that low-cost treatment significantly reduces the amount of blood loss caused by in- testinal worms. A single 500 mg dose of mebendazole, at a cost of 2. 7 US cents a dose, given regularly three times a year, was shown to improve the nutritional status of school-age children significantly despite intense transmission, reinfection and incom- plete deworming. Regular treatment saved the loss of almost a quarter of a litre of blood per child annually at a cost of about 15 US cents, including drug distribution. Control of worm infections in school-age children through chemotherapy may also have broader consequences by generating a benefi- cial collaboration between Ministries of Health and Ministries of Education in endemic countries. Personnel of the peripheral health World Health • 49th Year, No.4, July-August 1996 care system and schoolteachers may collaborate to deliver health care, in partnership with parents. Experience in many countries has shown that schools provide a cost- effective means of reducing and preventing health problems in school- age children. Schools practising the "health-promoting school" concept are in an excellent position to intro- duce worm control. Community- based control calls for efforts to improve inadequate sanitation and water supplies both at school and in the community. The challenge now is to use chemotherapy and integrate it with other health interventions in school-age children, especially mi- cronutrient supplementation, to improve their health. To help schools to do this, WHO has prepared a document entitled Strengthening interventions to reduce helminth infections through schools, which is available from the Health Education and Health Promotion Unit, World Health Organization, 1211 Geneva 27, Switzerland. • Dr L. Sovioli and Dr K.E. Molt ore with the Schistosomiasis and Intestinal Parasites Unit of WHO's Division of Control of Tropical Diseases, and Dr Yu Sen Hoi is with the Health Education and Health Promotion Unit, Division of Health Promotion, Education and Communication, World Health Organization, 121 1 Geneva 27, Switzerland. World Health • 49th Year, No.4, July-August 1996 29 Mental health promotion in schools Rhona Birrell Weisen & John Orley W en people think of mental health, a negative picture of madness or depression tends to come to mind. However, just as physical health creates an image of strength and vitality, men- tal health should be associated with strength of mind and vitality in the way that individuals interact with others and as they deal with the challenges of everyday life. When children have the opportu- nity to attend school, education provides them with information, instruction and exercises to assist the development of knowledge and practical skills. They may also be lucky enough to learn about health and healthy lifestyles. Unfortunately, only a minority of children will be taught how to deal with the demands of everyday life: for example, how to cope with stress, how to commu- nicate with others, how to solve problems, how to express their feelings or how to think critically. Sadly, there has been a long-stand- ing assumption that people just acquire these "how to" skills for life as a natural process while they are growing up. As witnessed by the scale of mental health problems of both children and adults, the "how to" of life is often a rather weak component of human competence. Life skills education in schools enables children to protect and promote their own health and well- being. They must have the opportu- nity to practise such skills in the classroom as well as in homework assignments. Teaching methods therefore need to be interactive for learning such skills, rather than just acquiring knowledge. The ideals are defined in the UN Convention on the Schoolchildren in El Salvador. A supportive environment encourages children to relax and enjoy one another's company. Rights of the Child: "the education of the child shall be directed to ... the preparation of the child for a respon- sible life in a free society, in the spirit of understanding, peace, tolerance, equality of the sexes, and friendship amongst all peoples .. . " Unfortunately, schools do not always match these ideals, and for many children the school is experi- enced as a harsh and unsupportive environment. As part of the broader WHO Global School Health Initiative, WHO's Mental Health Programme is urging all schools to become mental health-promoting and. "child friendly" by promoting coop- erative and active learning, life skills education, tolerance, caring, creativ- ity and - above all - the self-esteem of children. Such schools will pro- vide an education that is relevant to children's lives, will work in close consultation with parents, and will work to prevent all forms of vio- lence, especially bullying. When all schools are health- promoting in this way, a major im- provement is anticipated in the mental health status of children, and of the adults that they will become. By that time, "mental health" should lose its negative image and the real significance of mental well-being for human societies will be acknowl- edged. • Documents and other materials on mental health promotion in schools are available on request from the Division of Mental Health and Prevention of Substance Abuse, WHO, Geneva. Mrs Rhona Birrell Weisen is a consultant with the Programme on Mental Health and Or john Orley is Manager of the Programme in the Division of Mental Health and Prevention of Substance Abuse, World Health Organization, 1211 Geneva 27, Switzerland, Geneva. 30 learning about HIV Mariella Baldo A healthy school ensures a friendly environment. ~olescents and young people oday inherit a world in which elationships may present a new and frightening problem: sexual intimacy, far from enriching the lives of partners, may result not only in a curable disease or an unwanted pregnancy, but in infection with HIV, for which there is no cure. In this decade and at least the next, develop- ing a healthy sexuality is a matter of survival. So it is encouraging to see more and more young people attending primary and secondary school, par- ticularly in developing countries. But do schools actively promote sexual health? Societies expect schools to be healthy and safe places to live and work, for pupils and staff. Yet in the playground as much as in the staff room, psychological pressure or physical violence may force individ- uals into behaviour that is known to be risky. Bullying, offering drugs and sexual harassment have a common aspect of intolerance. A health- promoting school is one in which such forms of intolerance are moni- tored and rigorously dealt with, and where individuals relate to one another with understanding and compassion. A health-promoting school does not discriminate unfairly between people, and will therefore welcome the student or the teacher who is living with HIV or AIDS, in the knowledge that HIV is not can we do to promote health education programmes in schools that: '"~''u"''"' sexual health young people to avoid HIV infection down the epidemic? World Health • 49th Yeor, No.4, July-August 1996 spread by casual contact and that normal standards of hygiene protect everyone in case of accidents. In the age of AIDS, it seems unethical to deny young people information on disease prevention that may save their lives. Yet most students still go through their school years without meeting a caring adult who discusses sexual health with them. In a world obsessed by fitness and sex, schools manage to avoid teaching about sexuality, sexually transmitted diseases and AIDS. The attributes of a health-pro- moting school should include the following: parents who encourage curricula that cover sexual health, to complement the sex education they provide at home; a community that supports such curricula; and students who learn not only the facts about sexually transmitted diseases, HIV and AIDS but also the skills they will need in real life, when the time comes to be assertive about making healthy choices. Such skills include negotiating for safe sex, and stand- ing up for a friend or relative who is living with AIDS. For effective school-based pre- vention of HIV infection, health education and a supportive environ- ment are both necessary, and for them to be practised in schools, coherent policies are needed. The board of directors should develop them for the school, just as policy- citizens: participate in community action on health and HIV, for example, by being active in the local schools to encourage a policy shift from prejudice to education; promote policies that mobilize education systems into effective, research-based prevention activities; overcome inhibitions about sex education in the family as well as in school, and become supporters of sex education; religious leaders: contribute towards developing programmes for responsible behaviour; young people: assert the right to know, and to live in a caring , responsible world . World Health • 49th Year, No.4, July-August 1996 makers who care about their country's youth should develop them nation- wide. Such policies should always include the human rights aspect (non- discrimination), as well as the instruc- tion component (information and skills needed for prevention). Evaluation studies have shown that sex education does not encourage early sexual experimentation, and may reduce sexual risk-taking among students. However, they show that programmes must be skill-based and well designed if they are to have an effect on behaviour. Otherwise they just increase the level of knowledge. Curricula should always be devel- oped on the basis of the students' needs: the situations of risk that girls and boys find themselves in most frequently should be researched, and become scenarios for classroom activities. These might include role playing, discussions or group work, and will be reflected in the students' learning materials and used in teacher training. Students are the best source of convincing stories and scenarios which can be used to pre- sent difficult choices between re- sponsible behaviour (such as Ufe skills in Zimbabwe protected sex or avoidance of sex or drugs) and fear (for instance of violence, or of losing a friend, or of being rejected). Students should learn about the full range of options for prevention, from abstinence to condoms and risk-reduction techniques for inject- ing drug users. Responsible behav- iour takes many forms according to age, circumstances and the nature of a relationship; unsafe sex and drug- related behaviour leading to HIV infection are largely a matter of social interaction. Everyone, whether ordinary citizens, policy-makers, parents, religious leaders or young people themselves, should do what they can to promote school health education programmes that include sexual health. This will help young people as individuals to avoid HIV infection and at the same time slow down the epidemic. • Dr Marie/fa Baldo was a Scientist with WHO's Global Programme on AIDS. Her present address is Via Bacchiglione 18, 361 00 Vicenza, Italy. All students in Zimbabwe aged between l 0 and l 8 are gradually being reached through a weekly session with trained teachers and age-specific learning materials . The programme focuses on life skills and HIV prevention, and the lessons pose a series of scenarios that help students to explore feelings, examine alternatives , think through situations of risk and take decisions. The scenarios and stories are about growing up, friendship and love, dating ; sexual abuse is addressed in a very open way, including instances of rape by members of the family or approaches by adults or even teaching staff. Teenage pregnancies and related social norms are discussed, while a series of projects to be undertaken in the community complete the lessons. The programme is run by the Ministry of Education with assistance from UNICEF . In the next issue Photo Credits Front cover & pages 3,4,5: Page 6: Page 7: Page 8: Page 10: Page 11 : Page 12: Pages 13 & 14: Page 15: Pages 16 & 17: Page 18: Page 19: Page 21 : Page 22: Page 23: Page 24: Page 25: Page 26: Page 27: Page 28: Page 29: Page 30: Bock cover: WHO/H. Anenden AKF/ H. Roy © WHO/ Ministry of Health, Bahrain WHO /Regional Office for Europe WHO /Regional Office for the Western Pacific WHO/ R.D.D. Santos WHO/ A. Diez Still Pictures/M. Edwards © WHO/W. Becherelli Design ond photos by WHO/H. Anenden WHO/A. Diez WHOjV. Beckles WHO/Bongbuo School. Thailand WHO/R. Erben WHO/R.D.D. Santos WHO/K. Douglas WHO/B. Christensen WHO/H. Anenden AKF/ H. Roy © WHO/ H. Anenden WHO/Ministry of Public Health ond Social Welfare, El Solvodor Still Pictures/E. Porker © WHO/ J. 8. P. Hubley Do you have something to say? As from the first issue of 1997, World Health will include corre- spondence from readers . If you have comments, ideas or sug- gestions on any of the topics cov- ered in the magazine that you would like to share with other readers, please write to the Editor, World Health , World Health Organization, 1211 Geneva 27 , Swi tzerland. Letters should be not more than 250 words in length. The Editor reserves the right to edi t all such material received . Since the time of Hippocrates, eth ical issues related to the practice of medicine have preoccupied mankind Today, the great strides made by science and biology, as well as the spread of diseases old and new, place ethics more than ever in the foreground of human affa irs The SeptemberDctober issue of World Health will consider some of the ethical aspects of public health that should be of concern to us all. • Did you enjoy this issue? Why not toke out a subscription to World Health ond enjoy reading about the world 's major health issues six times o yeor2 1996 subscription prices ore listed below. WHO also offers its popular "Health Horizons" subscription, a combined subscription (at a reduced rote I to World Health and the quarterly World Health Forum. Order form Cord number------------- 0 World Health ( 1996 subscription) at Sw. fr. 30.-/US$ 25.00 Expiry dote ____ Dote of order------ 0 Health Horizons ( 1996 subscription) Signature-------------- at Sw. fr. 88.-/US$ 70.00 0 Payment enclosed 0 Please charge to my credit cord Nome----------------------------- Address-------------- 0 Visa 0 American Express _______________ _ 0 Eurocard/Mastercard/ Access World Health Orgonizonon, Oistribunon and Soles, 1211 Geneva 27, Switzerland. 31 Printed in Great Britain by GreenShires Print limited, Kettering, Northamptonshire, England. Ten Steps to Help Schools Become 11Heal~ SchOOisn Dr Lloyd Kolbe, Chairman, WHO Expert Committee on ComptYihensive School Health Education and Promotion . If we nurture the health, hopes and skills of young people, thejr P.Otential to improve the world is unbounded. If they are healthy, they can take the best advantage of e~ opportunity to learn. If they are educated, they cah 'ive fulfilled lives and contribute to building the future for everyon~. In 1995, WHOeonvened an Expert Committee on Com,...hensiveSChOol Health Education ancf Promotion to assess what is known about promoting health through s~ls. The Committee was made up of ~J.On$ from ministries of educatton and health, nongovernmental orft'llhi%otions, universities and ~arch institutions. The Committee reviewed r~rch from both developing and developed countries and concluded that, without question, school health programmes can simultaneously reduce common health problems, increase the efficiency of the education system, and tlu.Js advance public health, education, anq cia/ and economic development in all nations. - The Committee set out ten steps which, if implemented, will enable schools throughout the world to become "health-promoting schools" . The recommendations are listed on pages 16-17 of this issue. They are important steps to a better future- for everyone. The WHO Expert Committee on Comprehensive School Health Education and Promotion comprises: Ms I. Copoor, Director, Centre for Health Education Training and Nutrition Awareness, Ahmedodbod, Indio; Dr D. Hopkins, Institute of Education, University of Cambridge, Cambridge, England; Dr L.J Kolbe, Director, Division of Adolescent and School Health, Notional Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA; Dr D. 0. Nyomwayo, Director, Health Behaviour and Education Deportment, African Medical and Research Foundation, Nairobi, Kenya; Mrs K. Songuror, Notional Coordinator for School Health and Environment Education, Ministry of Education, Manama, Bahrain; and Dr Ye Guong:}un, Director, Institute of Children's and Adolescents' Health, Beiiing Medical University, Beiiing, Chino .
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