lmproving health through schools

10 World Health • 48th Y eor, No. 2, Morch- Aprill995 lmproving health through schools Jack Jones, Ilona Kickbusch, & Desmond O'Byrne The school presents an ideal setting for children to acquire healthy lifestyles ond ski lis in maintaining good health. 1 f we consider what it takes to create health , the school emerges as an ideal setting for action. The Ottawa Charter for Health Promotion ( 1986), a product of the First International Conference on Health Promotion in Industrialized Countries, states that health is created by people in the settings in which they live. It also suggests that health is created by caring for oneself and others, by being able to make de- cisions and have control over one 's !ife circumstances, and by ensuring that society creates conditions that allow the attainment of health by ali its members. (Box 1) Schools can help young people to 1. Life skills improve lifestyles acquire basic skills needed to create health. Such skill s, sometimes called life ski lis, include deci sion-making, problem-solving, critical thinking, communication, self-assessment and coping strategies. When people have such skills they are more likely to adopta healthy lifestyle. If we consider how best to invest in health, school health programmes emerge as very good investments . Last year, the World Bank and WHO compared the cost-effectiveness of various public health programmes. They concluded that among the most cost-effective investments in health are programmes to: expand immu- nization and micronutrient supple- ln Mexico, a study of a sex education programme, based on life ski lls , Planeando tu vida, which is taught in over 200 schools, showed thot adolescents, especially boys, who look part in the programme before they became sexua lly active were much more likely to use contraceptives in later relat ionships thon those who had not. ln the USA, a study of a life-skil·ls-based health educa tion curriculum, Teenage Health Tea ch ing Modu les (THTM) , involving 5000 students, showed a reduction in se lf-reported drug use, alcohol consumpti on and cigarette smoking among students who were educated with the modules. Bath WHO and the World Bank have concluded thot a school health programme which provides safe and law- cast health services and health education is one of the most cast-effective investments thot a nation con make ta improve health. mentation ; increase knowledge about family planning, nutrition and health care; reduce consumption of tobacco, alcohol and other drugs ; and prevent AIDS and sexually-transmitted diseases. Clearly, school health programmes play a major role in addressing these issues, and invest- ments in such programmes are per- haps the "very best of the best". Schools that provide services to reduce certain health problems, par- ticipate in community health projects and encourage people to adopt healthy behaviour clearly benefit large numbers of people. (Box 2) Indeed, schooling alone has been shown to be a powerful way to influ- ence health, worldwide. Its impact is most apparent in the benefits to maternai and child health when girls receive schooling. (Box 3) Young people need to be healthy in order to attend regularly and take full ad van tage of the opportunities provided by schools. School-based efforts that improve health in tum help to improve the leaming poten- tial and school performance of young people. (Box 4) Not ali schools - whether in developing or developed countries- have the resources to support health World Health • 48th Y eor, No. 2, Morch-Aprill995 Condoms con protee! the fa mi/y from AlOS, this drawing won the poster competition run by the Robert Schuman Faundation in Lithuanie on World AlOS Day 1994. The artist is Montas Skrupskelis, aged 16. 2. School health projects benefit the community A very successfu l prog ramme to reduce in testinal worm s was initi ated in the Republic of Korea in the mid- 1960s. The pro- gramme was directed mainly to student groups through schools, was expanded to whole communities, and included moss chemotherapy, health education and environmental sani tation. lt resu lted in: • the prevalence of intestinal worms among schoolchild ren decreasing from over 80% in the 1960s to 0.2% in 1992; • their preva lence in the general popu lation of the country decreasing from 84% in 1971 to 3.8% in 1992. as well as education. The health of students may even be endangered by incidents of violence or by a Jack of sanitation facilities. lndeed, a 1993 study of school sanitation and hygiene in six Latin American countries concluded that facilities en- tailing serious health risks are more common than positive examples of clean school environments. Such 3. Education improves health! • Surveys in 25 deve loping countries show thot, a li else being equa l, 1 to 3 years of schooling among mothers reduced ch ild mortal ity by about 15%, and by much more when mothers had more education. ln Peru for example, seven or more years of schooli ng reduced the mortality ri sks by nearly 7 5%. • Data from 1 3 African countries for 197 5-85 show tho t a 1 0% increase in female li te racy rates was accompanied by a 10% reduction in child mortality. situations obviously must be changed. "Health for Ali" and "Education for Ali" are expressions of the United Nations ' commitment to health and education. Because these goals are inseparably linked, they must be achieved concurrently. This will re- quire strong alliances between health and education agencies , including WHO and UNESCO, national ministries and nongovernmental agencies. Strategies that can assist agencies to work together were discussed at the Third International Conference on Health Promotion held in Sundsvall, Sweden in 1991 . While concerted actions are essential, the impetus for action resides with indi- viduals. Young people, as well as adults, can play a significant role in creating support for school health by raising and acting on such questions as: • Does our school promote health? • Is our school a healthy place to live, work and visit? • Does our school help students, school personnel and families to address their health needs? • What can 1 do both individually and with others to bring about needed change? To tum the world 's schools into "Health-promoting schools", we will need to work together. Indeed, it will 4. Health improves learning potential • Poor die! impairs learning and development. Studies show thot the academie performance and menta l abi li ty of pupi ls with good nutr iti onal sta tus w ere significa ntly higher thon those of pupil s w ith poor nutritional s~ tus , even w hen family income, school quality, teacher abi lity o r menta l ability were laken into account. • Whipworm infestations adverse/y affect school performance. ln jamaica , the removal of w hipworms among school-age child ren led to a significant improvement in short- lerm and long-lerm memo ry. After nine weeks, trea ted children showed no significant difference from uninfested children. • Iron deficiency influences a chi/d's ability to benefit from classroom instruction. Stud ies show th ot when iron-deficient anaem ic children first enrol in schoo l, th ey are at a disadvan tage in terms of their aptitudes. Thi s disadvantage disappears w hen their iron levels become sufficient through supplements to the diet. 11 require the mobilization of people and resources at local, national and intemationallevels to work in a con- certed effort to bring about change. WHO, in collaboration with the US Centers for Disease Control and Prevention and other organizations, is preparing to initiate such an effort. They hope to unite the organizational capacities of agencies at alllevels into a powerful force for health in a global school health initiative. • Mr jack jones is a Health Education Specialist with the Division of Health Promotion and Education (HPE}, Health Education and Health Promotion Unit (HEP}, World Health Organization, 121 1 Geneva 27, Switzerland. Dr Ilona Kickbusch is Oirectar, HPE, and Dr Desmond O'Byrne is Chief, HEP.