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RF_COM_H_53_SUDHA
WHO INFORMATION
SERIES
ON SCHOOL HEALTH
Active Living:
An Essential Element Of A
Health-Promoting School
Unedited Draft, July 1997
For Discussion and Review
at the
Fourth International Conference on Health Promotion,
Jakarta, Indonesia, 21 - 25 July 1997
WHO Global School Health Initiative
FOREWORD
Investments in schools are intended to yield benefits to communities, nations and individuals.
Such benefits include improved social and economic development, increased productivity and
enhanced quality of life. In many parts of the world, such investments are not achieving their full
potential, despite increased enrolments and hard work by committed teachers and administrators.
This document describes how educational investments can be enhanced, by increasing the capacity
of schools to promote health as they do learning.
For better or worse, health influences education. Healthy children leant well. If children are
healthy, they can take full advantage of every opportunity to learn. But, children who cannot attend
school because of poor health or unhealthy conditions cannot seize the opportunities that schools
provide. Similarly, schools cannot achieve their full potential if children who attend school are not
capable of learning well. Poor health and unhealthy conditions jeopardize the value of school
attendance.
This document is part of the technical series on school health promotion prepared for WHO's
Global School Health Initiative. Because Active Living creates personal resources, vigor and health
for students — schools, families and the community also benefit. A health promoting school strives
to offer developmentally appropriate, motivating, sufficiently supervised and safe opportunities for
all students to be active. Through policies and practices that promote physical activity, recreation
and sport, along with complementary actions in support of healthy lifestyles, the health promoting
school fosters social growth and maturation, as well as mental and physical health.
WHO's Global School Health Initiative is a concerted effort by international organizations to
help schools improve the health of students, staff, parents and community members. Education and
health agencies are encouraged to use this document to promote Active Living as part of the Global
School Health Initiative's goal: to help all schools become "health promoting" schools.
Although definitions will vary, depending on need and circumstance, a "health promoting"
school can be characterized as a school constantly strengthening its capacity as a healthy setting
for living, learning and working (see box).
The extent to which each nation's schools become health promoting schools will play a
significant role in determining whether the next generation is educated and healthy. Education and
health support and enhance each other. Neither is possible alone.
Dr Ilona Kickbusch, Director
Division of Health Promotion,
Education and Communication,
WHO
Draft, July 3, 1997
Professor Ilkka Vuori. M.D. Director
The L'KK Institute for Health Promotion Research, Tampere, Finland
Fostering Active Living in Schools:
An Important Element of A Health
Promoting School
1. Introduction
This document is written to help authorities and private citizens to improve
health of children, youth and school personnel by using Health Promotion strategies.
The document is based on the recommendations of the Ottawa Charter for Health
Promotion (1986). It will help individuals and groups apply a renewed approach
to improving peoples’ health. This process creates on-going development that
creates conditions conducive to better health and well-being, as well as to a decrease
in existing health problems.
1.1. Why did WHO prepare this document?
The World Health Organization (WHO) has prepared this document to help
people take control over and to improve their health. It provides information that
will help people strive for and implement measures that will foster conditions for
Active Living and for its adoption in schools.
1.2. Who should read this document?
This document is written to:
a.
b.
c.
d.
Policy- and decision-makers, programme planners and coordinators at local,
district (provincial) and national levels.
Officials and institutions responsible for planning and implementing the
measures described in this document, especially those from the health and
education sectors on all levels.
Programme staff and consultants of international health, education and
development programmes who are interested in promoting health through
schools.
Community leaders, school personnel, health workers, service providers, media
representatives and members of organized groups, e.g. sports and public health
organizations, interested in improving health, education and well-being in the
school and community.
1.3. What is meant by “Active Living”?
Active Living is a way of life in which individuals make useful, pleasurable
and satisfying physical activities an integral pan of their own daily life. Active
living is based on individual preferences and choices but in general active choices
are the preferred choices. In some forms Active Living is accessible and should be
accessible to everyone, everywhere, at all times, and it includes both the actual
doing and the experiences related to it. Active Living has the potential of being
conducive, depending on its content, to physiological, emotional, mental, spiritual,
esthetic, moral, and social benefits of physical activity. In communities Active
Living is an important part of the culture that is reflected in e.g. health and well
being of the people, in the modes and opportunities for physically active recreation
and commuting, in various aspects of the environment, and in the attitudes and
values concerning the above mentioned issues.
1.4. To what extent does Active Living affect education and health?
Active Living is conducive to better health and increased life energy, and
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these give more personal resources for necessary tasks and optional achievements.
The direct effects of activity may not always be great on the individual level and in
short term. However, in groups and populations and in the long run the differences
in activity are likely to make a sizeable difference to the amount and quality of
achievements including those of teachers and students. In addition to the direct
effects of physical activity, it has the potential to influence favorably the social
environment of the school and consequently the spirit and behaviors that are
important for successful work and well-being of both students and teachers. An
active school is a healthier and better performing school and a better place to
work. Adoption of Active Living in schools offers opportunities to improve health
and effectiveness of education of most young people at low costs in most countries
and circumstances.
1.5. Why focus efforts on promoting of Active Living through schools?
There are two main reasons. First, schools themselves benefit from Active
Living because it creates personal resources, health, and vigour for the students
and staff. Secondly, schools make a favorable setting for promotion of Active
Living. A great part, and in most countries the vast majority of every young
generation, attends school. Physical activity in various forms is popular among the
students. Physical activity in schools is managed by responsible teachers, who
know the children and have pedagogic training. These conditions offer more
effective, efficient and equal opportunities than any other setting or time to get
young people interested in Active Living and to give them the necessary skills,
knowledge, experiences, and confidence to practice continuously some physical
activities. The results of the efforts may not be limited to the students and staff.
because there may also be important reflections in the attitudes and practices of,
e. parents and sport clubs. Schools have the potential to extend physical education
g.
given to the children as part of school curriculum to active living practiced by the
children as part of life curriculum. Thus, schools may be the most influential agents
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to work for Active Living especially in societies where their role in creating health
and resources for life is not yet fully recognized.
1-6.
How will this document help people to promote health?
This document provides a framework for the promotion of Active Living
that creates health. It is designed to help people address the broad range of factors
that must be changed to increase physically active life style in and through schools.
The document is based on the best scientific evidence and practical experience of
the promotion of health and physical activity. It will help you and others to:
a.
b.
c.
d.
e.
Create Healthy Public Policy: This document provides information that you
can use to argue for increased local, district and national support for conditions
favoring Active Living in schools and school health efforts. It also provides a
basis for justifying the decisions to increase such support.
Develop Supportive environments: This document describes the environmental
changes that are necessary for Active Living in schools and how those changes
can be made at the lowest possible costs.
Reorient Health Services: This document describes how current health services
can be changed to seize the new opportunities afforded by schools resulting
from the development of more effective school health promotion programs.
Develop Personal Skills: This document identifies the skills that young people
need to adopt and maintain an active way of life. It also identifies skills needed
by others to create conditions conducive to Active Living and health through
the school.
Mobilize Community Action: This document identifies essential actions that
must be taken by the school and community together to make Active Living
possible; identifies ways in which the school can hefp to mobilize the community
to implement such actions and to strengthen school physical education and
health programmes. It also provides arguments and facts that can be
communicated through the mass media to call attention to the necessity to
increase attention to as well as conditions and resources for Active Living in
schools.
2. Convincing others that efforts to foster Active
Living among students and staff will be
beneficial to education as well as health.
This section provides information that you can use to convince others that,
by improving the results of school work as well as health, physical activity and
sports in schools are important to both students and teachers. The arguments
presented in this section can also be used by policy- and decision makers to help
them justify their efforts and decisions to implement measures promoting Active
Living in schools.
2.1.
Positive influence on the school milieu. Physical activity offers possibilities
for open and natural communication and helps to lower the barriers and inequalities
of interaction in the school milieu. Physical activity is one of the best ways to
create contacts between people having different roles and characters. This is
especially true regarding those who are most difficult to get in confidential contact
with. Physical activity can make an important contribution to the school atmosphere
by creating experiences of togetherness, acceptance and success, and by influencing
the self-esteem positively.
2.2.
Essential counterbalance for sitting and mental work. Continuous sitting
and concentration on mental work is contrary to human nature and may lead to
tension, anxiety, restlessness, lack of interest on school work, somatic and nervous
symptoms and consequently to poor performance and eventually to undisciplined
behavior. These risks are greatest among younger children and among those who
have lower than average capacity or interest in school work and achievements.
Active breaks and sufficient amount of adequate physical activity and sports are
natural and necessary antidotes and remedies to these problems. Frequent bursts
of physical activity during the school day can be a good investment in effective
and enjoyable school work.
2.3.
Possibilities to widen and integrate teaching, Physical activity has been and
still is. a natural human function and need in all cultures. Physical activity relates
directly and indirectly to many school subjects and learning tasks, such as biology,
physics, chemistry, zoology, geography, ecology, economics, arts, and naturally,
health education. Features of physical activity can be used to illustrate important
issues in these subjects in an interesting and easily understandable and concrete
way. Vice versa, the deep meaning and real significance of Active Living for health,
functional capacity and well-being can be illustrated in many places of the school
curriculum. Physical activity is concrete action that gives easy and equal
opportunities for interaction between people from different backgrounds. Therefore,
physical activity is well suited to be part of Healthy Schools activities, and it may
be one of the best "icebreaking” activities in the initiation phase.
2.4.
Possibilities to maintain and improve current health and fitness- Many
symptoms such as backache, musculoskeletal and gastrointestinal pains, headache,
feelings of tension, stress, tiredness and fatigue are not uncommon among school
age children. These symptoms are due to various causes, insufficient daily physical
activity being one of them. Obesity among children and adolescents is an increasing,
serious health problem in both developed and developing countries, and part of it
is due to inactivity either in absolute terms or in relation to food intake.
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In pan of the children and youth, physical fitness is likely to be poor as a
direct consequence of insufficient physical activity, but lack of reliable research
data exclude definite conclusions of the status or trend in this regard.
It is obvious that daily physical activities. Active Living, have much to offer:
they decrease the extent and prevalence of the disturbing symptoms of school
children both directly and also indirectly by alleviating psychosomatic ailments
and by decreasing the likelihood of adoption of unhealthy measures and behaviors
producing these ailments.
2.5.
Possibilities to decrease future health risks. Childhood and youth give
possibilities not only to have better current health and well-being but also to lay
the foundations for better health in the future. It is e.g. likely that youth is a unique
time to acquire the strongest possible bones. This may be an advantage in old age
in decreasing the risk of bone fragility (osteoporosis). It is also known that avoidance
of obesity in childhood and youth is important, because once attained, it tends to
continue in adulthood. Increasing evidence indicates that some of the prevalent
diseases such as cardiovascular diseases can begin already in childhood. Many of
the biological characteristics, such as blood pressure and blood lipids that increase
the risk of acquiring these diseases in later life tend to take an unfavorable course
due to inherited susceptibility or unfavorable living habits already in childhood.
The development of important future health risks can thus be counteracted by
healthy living habits, including physical activity in childhood. The schools have a
crucial role in responsibility for helping young people to adopt an active lifestyle
from childhood on and to maintain it uninterruptedly until adulthood and onward!
3. Convincing others that it is important for
schools to foster Active Living
This section provides information that you can use to convince others of the
importance of the promotion of Active Living, especially through schools. It also
contains arguments to help policy and decision-makers justify their decisions to
increase such support.
The following arguments strongly support the importance of the promotion
of Active Living as part of school’s functions and the need for increased investment
in the conditions for Active Living.
3.1. Optimal time. School age is the optimal time of life to adopt Active
Living!
School age is optimal and even unique time to benefit of the effects and
influences of physical activity for biological, mental, moral, ethical, esthetic and
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social growth and maturation. This time is also optimal for learning and adopting
the skills, rules, and norms of exercises and sports as well as for gaining favorable
experiences related to physical activity, all of which are important prerequisites
for the adoption of Active Living as a sustained way of life. The time is optimal
because the growth, adaptation and learning potential of the young people in
response to physical, mental, cognitive, and social stimuli included in. or related
to physical activity are at their peak. Very importantly, the spontaneous interest
and natural enjoyment of a wide variety of physical activities is greatest during the
early school years. The soil is at its best for harvesting the biggest crop!
3.2. Best coverage and most equal opportunities,
No other setting than school offers the opportunity to reach so great a
proportion of every successive age class and to familiarize them with important
aspects of Active Living under qualified guidance. No other setting than school
offers these opportunities on as equal basis. Without physical activity and physical
education offered by schools there would be a risk that part of the children and
adolescents would be highly active in sports clubs, while the rest, those less
interested and less talented as well as those with illnesses or disabilities or without
adequate family support would become physically inactive and possibly remain so
through out their life. When the aim is to influence the current and future health
and well-being of the entire population, schools are in a unique position.
33. Mandate and responsibility, Schools have been given the mandate
and responsibility for enhancing all aspects of development and
maturation of children and youth. This includes teaching the basics
as well as ways and means of Active living to all students.
The responsibility of the schools for fulfilling this task is to offer
developmentally adequate, motivating, sufficiently supervised and safe programs
that allow participation of all students and that enhance biological, moral and
social growth and maturation. Physical activity and sports offer great possibilities
for positive social and moral development but they come true only on the condition
that the activities are practiced in the spirit of high morals. Schools with their
professionally qualified teachers are an ideal setting for using physical activity and
sports to enhance psychosocial and moral development of children and adolescent.
Schools usually have the most resources for adequate physical activity and
physical education, and the schools also have the responsibility for striving for
resources to accomplish this task. Further, each teacher and each school is
accountable for the standard of work. All these conditions make schools superior
to any other setting in providing opportunities for adequate physical activity for
children and youth.
3.4.
Popularity. In all parts of the world physical activity is one of the most
popular school subjects especially among the young children. Thus, physical activity
need not be taught or practiced "up-stream" against the motivation of the students.
On the contrary7, physical activity and sports add to the variety, enjoyment, challenges
and achievements of the school work.
3.5.
Opportunities for collaboration and coordination in communities. Schools
have good opportunities to collaborate with parents, sport and other voluntary
organizations, community officials, health care providers etc. in organizing physical
activity and sports. Schools are also in the best position to coordinate in an effective
and responsible way the gathering and use of the community resources for Active
Living of children and youth. Schools can thus greatly increase the availability and
variety of physical activities while at the same time maintaining their accessibility
and educational qualities on high level.
4. Planning efforts to foster Active Living
Once the importance of Active Living and the feasibility of its promotion
through schools become understood by citizens, school officials and policy- and
decision-makers, the next step is to plan promotion measures. This section describes
important steps that should be considered in the planning process. It includes
conducting a situation analysis, obtaining community commitment and support,
and setting goals and objectives.
4.1. Situation analysis
4.1.1.
Purpose of conducting a situation analysis
Policy- and decision-makers will want a strong basis for their
commitment and support, especially when their policies and decisions
involve the allocation of resources. Accurate and up-to-date data and
information can provide a basis for discussion and justification for
action. Data are also essential for planning measures that foster Active
Living.
The need for adequate situation analysis on national, regional, local
and school levels regarding physical activity is accentuated by several
reasons. There is increasing competition of curriculum time at all school
levels in all countries. It is easy to convince the planners and decision
makers of the importance of academic subjects e.g. supporting
technological and economical competitiveness. The importance of and
continuous need for physical activity is much more difficult to prove.
However, it can be done on the basis of reliable scientific evidence,
and it has to be done in order to win high level political commitment
and support.
It is well accepted that especially the amount of moderate and vigorous
activities as part of daily living has continuously decreased, first in industrialized
but gradually also in non-industrialized countries. It may be claimed that this
decrease in activity is compensated by increased participation in organized sports.
This may be true in a limited part of the youth population in a few countries.
However, for the majority of children and youth physical activity in school is even
more important than previously to fulfil the basic need. This is true especially for
those who are most in need of activity, e.g. the children belonging to underprivileged
and minority groups, or having diseases or disabilities.
4.1.2.
Information needed
It is important to show in what degree, quantitatively and qualitatively,
the present level of physical activity meets the goals and standards set
to adequate activity. Most of the basic data are easy to collect by
questioning the teachers and school administrators.
The information should include the number of hours devoted to and
used regularly for physical activity and sports, description of the content
of these hours (activities and sports practiced, active time during the
lessons, participation rate, criteria for exemption and proportion of
exempted students from active participation, competitiveness etc.) and
of the available resources in the schools and elsewhere in the community
(number and qualifications of the personnel, and information of space,
equipment, dressing rooms, transportation etc.).
It is also, useful to have information on the adequacy of the clothing,
personal equipment and other prerequisites for active and adequate
participation. The attitudes and activities of parents, school health
services, sport and other organizations, municipal authorities etc. as
regards physical activity in schools and in the community are also
important to know. Attitudes, preferences and experiences of children
are important to know, because the content of and experiences brought
by present activities have to correspond sufficiently to the expectations
and needs of the children in order to give them motivation for
continuous activity.
At school level this information can be obtained by direct questioning
from the respective sources. However, in planning programs and
resources at national, regional and even municipal levels, more formal
approaches selected on the basis of expert consultations are advisable
in order to secure feasible programs and effective use of resources.
4.2. Community commitment and support
Realization of physical activity in schools needs community commitment
and consequently support in order to be allocated the necessary time during the
school day and the resources for planning, teaching, sites and other requirements.
The current trends in many industrialized countries show that the time and resources
devoted to school physical education are decreasing indicating lack of commitment.
This seems to be due to increased emphasis on subjects that improve directly the
competitive power of a nation on world market. In many non-industrialized
countries school physical education has not yet gained broad commitment nor
resources for its realization due to many serious and actual problems. Thus, there
is a need to work for more acceptance of the value for individuals and societies of
school physical education in most countries around the world.
Realization of adequate school physical education calls for commitment,
and support of many parties at national, regional and local levels. Commitment of
only one or few parties is usually not sufficient to create substantial change and
consequently support. Partnerships and alliances are needed in order to gain more
awareness, visibility and credibility for school physical education, and to make a
bigger impact on a larger number of people. The potential partners include
representative individuals, groups and organizations from numerous sectors such
as political, public, education, health, business, communication, recreation,
voluntary, service, and even religious sector.
The main goal of the actions of the partners is to work for policies, laws,
and regulations that support creation of social and physical environment conducive
to opportunities for continuing physical activity in schools. One of the most
important functions is advocacy for physical activity by approaching individuals,
groups and populations by way of personal contacts and the media. The success
of this work depends greatly on how well the messages and their presentation are
tailored to meet the interests, priorities, comprehension, and language of the target
audiences. As a consequence, different partners are needed for different tasks in
the advocacy work. The role of parents as the eye witnesses of the value of physical
activity for their children, and of the students themselves as subjects of physical
activity is worth emphasizing.
4.3. Goals and objectives of Active Living in schools
The main goal of school physical activity is to lay the foundations for a
lifelong physical activity by strengthening its most important internal prerequisites,
e. good motivation based on favorable experiences, and sufficient skills and
i.
confidence to practice disciplines that are suitable for continuing practice.
The second goal is to maintain and increase current well-being of the students
by preventing symptoms due to one-sided mental activities and indoor sitting, and
by offering enjoyment, fun and social interaction.
The third goal is to prevent future health risks. This goal can be attained
only by reaching the first one because none of the health-related effects of physical
activity are retained, if it is discontinued.
Several health-related objectives for school physical activity can be set on
the basis of the effects of physical activity. The objectives can be expressed in
somewhat quantitative way if the amount, intensity and type of activity to attain
the effects are known, and if the occurrence of various risk factors or health
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problems related to insufficient physical activity are known. There is paucity of
both sets of data even in countries where they are best known. The optimal amount
and intensity of physical activity needed to confer the health benefits in young
people is not currently known. Furthermore, the prevalence of health risks and
problems vary greatly in different countries, depending not only or mainly on
physical activity but also on. e.g. nutrition and other living habits. Thus, presently
the health-related objectives of school physical activity can be set only broadly
and any quantitative objectives have to be set country by country.
A recent US consensus statement recommends that "all adolescents.... be
physically active daily or nearly every day, as part of play, games, sports, work.
transportation, recreation, physical education or planned exercise, in the context
of family, school, and community activities” and that “adolescents engage in three
or more sessions per week of activities that last 20 minutes or more at a time and
that require moderate to vigorous levels of exertion”.
This recommendation has been developed further, still pointing out the lack
of convincing data, in an international symposium on young people and health
enhancing physical activity: “All young people (all those under the age of 18)
should participate in physical activity of at least moderate intensity for an average
of 1 hour/day. While young people should be active nearly every day, the amount
of physical activity can appropriately vary from day to day in type, setting, intensity,
duration, and amount. As part of the recommended 60 minutes of physical activity,
young people should participate at least twice per week in physical activities that
enhance and maintain strength in the musculature of the trunk and upper arm
girdle. Strength promoting activities that are appropriate for young children include
playground activities that involve climbing, gymnastics, and “exercises”. It is further
recommended that, the activities characterized above be developmentally
appropriate from both physiological and behavioural perspectives.
It is noteworthy that the recommendations cited above include active living
(as contrasted to formal physical education) as an essential and even major part of
the recommended total activity.
5.
Integrating Active Living efforts into various
components of a Health Promoting School
A Health Promoting School can be characterized as a school constantly
strengthening its capacity as a healthy setting for living, learning and working for
the students and the staff. The functional components of health promoting schools
include the creation and implementation of policies and practices supporting health.
cooperation betwe r the schools and the communities, creation of healthy school
environment, inclusion of health education in the curriculum, organization of health
services for the students and staff, involvement of the whole school personnel in
health promoting activities, serving healthy food, and organizing extracurricular
activities that promote physical, mental, and social health and well-being.
The success of the efforts to promote active living in schools depends largely
on how effectively the various functions that have health promoting potential can
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be used to support the adoption and maintenance of physical activity. The following
information describes how efforts promoting active living can be integrated into
relevant health promoting components.
5.1. Supportive school policies and practices
Policies provide formal and informal rules, preferably in written form, that
guide schools in planning, implementation, and evaluation of efforts aimed at
promoting active living. The formulation of policies should incorporate input from
various partners, e.g. school and community administrators, teachers and other
school and community personnel, health care and recreation sectors, public health
professionals, sport and other voluntary and service organizations, parents and
students.
One of the most important policy issues is to require several hours supervised
physical education weekly. That should be instructed by qualified, responsible
teachers in the way that the activity meets the needs and interests of all students oy
taking into account the differences in e.g. gender, developmental and health sta
tus, skills, and motivation.
The exact content of the policies has to be formulated on the basis of the
national and local traditions, needs, and possibilities. It is worth emphasizing that
both in terms of realistic possibilities and the promotion of the development of
independent active lifestyle, only part of the recommended physical activity can
materialize as formal physical education. However, that part should be the
responsibility of teachers who work with the students for longer periods and get
to know them, and who have pedagogic training. It is advantageous to begin
guided physical activity as early as possible, already in kindergarten. This way
children can be socialized into physical activity and sports, and they learn and
internalize the rules and norms. Through physical activity and sports children are
also socialized into some important aspects of life.
Because a major part of the need for physical activity can not be met by
formal physical education, schools should adopt policies and practices that increase
the opportunities for physical activity during the breaks, before and after the school
hours, and in commuting to and from school. Encouraging and creating possibilities
for physical activity during breaks is mainly an internal matter of the schools
depending more on willingness and imagination than on resources. Offering
opportunities for physical activity during out-of-school hours requires collaboration
with school and community administrators and workers, sport clubs and other
voluntary organizations as well as with parents. Vast experience shows, that this
goal is not easily reached. This finding actually demonstrates, that there may be
large amount of incompletely used resources for health promotion due to insufficient
cooperation. The main prerequisite for physically active commuting is the possibility
to use safe walking and bicycle roads from home to school. This may require long
term and intensive lobbying and collaboration with many parties, e.g. community
and traffic planners’, and decision makers in order to persuade them to accept
that the use of human muscle power instead of engine power is profitable for both
the citizens and the nature.
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5.2. Cooperation between schools and the community
Schools and communities have great mutual interests regarding the
administration, effectiveness and resourcing of the schools. This also applies to
physical activity. In many countries the communities are the most important partners
for schools, and the communities should give their full support to schools by
providing funding for qualified instruction and for use and construction of accessible
and safe sites for physical activity. In return these investments yield healthier, fitter
and more energetic citizens.
In order to secure a continuing and open exchange of information between
schools and communities, it is important to establish organs in which school
administrators, teachers, and parents as well as the community planners,
administrators and decision makers are represented.
5.3. A healthy school environment
The physical and social environment of the schools should encourage and
enable the students and the staff to participate in enjoyable and safe physical activities
during, before and after school hours and also during weekends and vacations. In
community planning schools should be a priority location for exercise and sports
facilities. Special care has to be taken to minimize environmental hazards and risks
in the use of these facilities by meeting or exceeding all safety standards regarding
the location, design, installation, equipment, and maintenance of the exercise and
sports facilities. The safety issues related to climatic conditions (heat, cold, air
quality), water, constructed or natural obstacles, lighting, surfaces, and violence
are all the more important, the less adult supervision is provided. Special care has
to be taken to meet the requirements regarding the access to and the use of the
facilities by persons who have disabilities. The best way to handle many
environmental issues related to physical activity is by definite rules, regulations
and laws.
The social environment determined, e.g. by the type, intensity and spirit of
the activities, their guidance and supervision by adults or peers, the selection and
matching of the teams, and compliance with rules and norms has great influence
on the experiences and risks of the practiced activities. Negative experiences due
to any reason have to be especially avoided, because they decrease the motivation
for, and confidence in participation in physical activities. These risks can be
decreased by appropriate instruction, guidance and supervision, by matching
participants in, e.g. team sports according to size and abilities, by modifying rules
to meet the skill level and equipment of the participants, and to eliminate unsafe
practices. The schools have the best possibilities and greatest responsibility to
ensure a positive and safe social environment for physical activity.
5.4. Physical Education, Recreation and Sport
The formal part of the efforts to promote Active Living in schools, physical
education, offers the greatest possibilities to influence in a planned, sequential,
and developmentally appropriate way the major determinants of the adoption and
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maintenance of physical activity, namely motor and behavioral skills, knowledge,
attitudes and self-confidence.
Physical education should be fun and social, it should bring positive
experiences and feelings of mastery, success and self-confidence in order to work
for its primary goal, that of laying the foundations for lifelong physical activity.
Therefore, it is important to teach motor skills that enable the practice of potentially
lifetime activities such as swimming, bicycling, hiking, cross-country skiing, dancing
and some racket games, e.g. badminton.
A great part of the students is most interested in team ball games. These
have to be part of the physical education program, but not at the cost of potential
lifetime activities. The same principle applies to competition. It is a natural and
enjoyable part of sports, but especially an uneven and unsuccessful competition is
likely to decrease seriously the interest of especially the less talented students, and
not only in the respective sports, but also in physical education and activity in
general.
It is also important to teach behavioral skills that help to begin and continue
suitable physical activities. These skills include self-assessment of abilities and
readiness for various physical activities, goal setting, decision making, self
monitoring, and communication related to physical activity. Some of these skills
can be taught and practiced by using fitness testing, and by emphasizing the healthrelated components of fitness (e.g. cardiorespiratory endurance, muscular strength
and endurance, flexibility, and body composition). It should also be stressed that
the test results are to be used for self-assessment and not for comparison with
others or to assign grades.
Physical education classes offer unique possibilities in schools to learn by
active doing. This opportunity is not limited to e.g. learning motor skills, but it can
also be used for learning about the effects and benefits of physical activity for
functional capacity, well-being, and health. Physical education classes also offer
possibilities to learn important social skills, norms and behaviors in realistic
situations but on a manageable scale and with correctable consequences.
Appropriately supervised team sports offer especially good possibilities to leant
social skills, norms, and behaviors.
Physical education only offers the favorable opportunities mentioned above,
but it does not bring positive results automatically. The success of school physical
education depends mainly on the quality of the teachers as educators. Their most
important qualities for the achievement of the primary goals of physical education
are not physical and technical but the pedagogic, psychological and social skills.
Those qualities enable the teachers to understand and handle the students as
individuals with different abilities and motivations. These teachers also see that
there is a whole spectrum of opportunities for effective education hidden in even
simple forms of physical activity. Thus, in order to fully utilize the potential of
physical education as an important part of school curriculum, physical education
should always be taught by appropriately trained teachers, who bear the
responsibility of long-term, comprehensive education of the students.
13
5.5. Health education
Health education aims at stimulating students’ interests in good health by
providing knowledge of the factors that influence health and of the ways and
means in which these factors can be influenced at personal, family, group, and
community level. The reliable information and examples of successes and failures
that are mediated by health education can influence the attitudes, willingness and
abilities of the students and their families, and help them to make health-enhancing
choices in their everyday life.
j
Physical activity is one of the many factors that influence health, and health
education can give a balanced view of its role for individuals and societies in
relation to the other factors. Health education should also bring up the principles
of health promotion, and how they can be used to improve the conditions for
regular physical activity of all citizens.
Health education should have a self-standing status in schools and it should
be taught in a planned and sequential way through the school years. Elements of
health education should be incorporated in many other subjects, too. However,
using only the integrated approach in health education teaching would not give
sufficient visibility and strength for health education, nor the necessary expertise
and responsibility for its teaching.
Health and the personal, societal, and environmental factors that affect it are
heavily influenced by the values, beliefs, attitudes and even myths of individuals
and communities, and these often have deep cultural and religious roots and
economic implications. Ethically sound and effective health education has to take
these issues into account and appreciate them. This is one reason why it is important
to identify groups beyond classroom, that influence the background factors that
are decisive for the results of health education. These groups, especially parents,
should be stimulated to get involved in discussions and debates concerning the
relevant issues in health education.
Health education related to physical activity should stimulate and encourage
students to adopt Active Living as one essential part of their way of life. Health
education should provide knowledge of the biological, mental, and social benefits
of physical activity and of the characteristics of the activities that bring the benefits.
Also the health risks associated with physical activity as well as the ways in which
to prevent them and to give first aid should be covered.
An important part of the curriculum is to help the students use behavioral
skills for the adoption and maintenance of active lifestyle. These skills include self
assessment of activity and fitness level, evaluation of their own readiness and
abilities for certain activities, setting of goals for activity, making decisions regarding
activity, identifying and managing barriers of participation, techniques for self
regulation and reinforcement, and communication and advocacy skills.
It is obvious that health education and physical education have much in
common. Both subjects are commonly taught by the same teachers. This practice
offers many advantages and can be recommended when possible and practical.
<
5.6. Health Services
Health care personnel both in the schools and in the communities at large is
in key position to promote active living in schools. Their role is one of the most
influential ones in advocating the importance of physical activity and physical
education in schools. They are in the position to use their knowledge and expert
authority to influence the knowledge and attitudes of all important parties in the
community and schools, the decision makers, planners, administrators, teachers,
staff, parents and students. Health care personnel has a special role in working for
improved opportunities for physical activity of people who have barriers and
limitations in participation due to disabilities or social or economic reasons. The
credibility and strength of the advice and recommendations of the health personnel
is greatly increased, if they show themselves up as active role models.
Health care personnel also has responsibilities and possibilities in organizing
services which support realization of appropriate physical activities. School or
community health services should periodically assess the physical activity patterns
and the key parameters of health-related fitness of the students. On the basis of
these assessments, the students, teachers and parents can be given advice and
encouragement concerning the participation in physical activities that meet the
needs, possibilities, and individual interests of the young people. A special
responsibility of the health care personnel is to refer to appropriate school or
community services and programs the students, who have chronic diseases and
conditions or risk factors, or physical and cognitive disabilities.
5.7. Health promotion for the school staff
A school health program should not be limited promoting health of the
children enrolled in school, but it should be extended to include the whole staff for
several reasons. The teachers, administrators and supporting staff have to know,
at best based on their own practical experiences, the concepts, principles, strategies
and methods of the implementation of health promotion and its various measures.
Only a very small part of even teachers responsible for health education in schools
have got training in health promotion. The members of the school personnel are
important role models and potential advocators of health promotion in the school,
and also in the community at large. The school staff is doing work that requires
commitment, multiple responsibilities and continuous learning and renewal. The
protection and improvement of their health should also be taken care of.
Physical activity offers several advantages as a health promoting measure
for the school staff. All its effects, biological, mental as well as social, are necessary
for, and welcomed by the staff. The activity itself can be realized in enjoyable,
inexpensive, safe, social, and usually socially acceptable ways. It can often be
incorporated into daily life as utility or recreational, even sporting activities that
bring relaxation and change to the mentally demanding, sedentary work. Personal
experiences of the teachers of physical activity are likely to increase their
understanding of its value and its acceptance as one important subject in the school
curriculum.
15
5.8. Nutrition
Adequate nutrition and physical activity are both cornerstones of good health
and both of them have to be included in comprehensive school health program.
Nutrition and physical activity are also linked together in several ways. The
strongest link is between quantities; if the energy intake from food and the energy
expended in physical activity are not in balance in the course of weeks and months.
there is a change in the amount of stored fat, and consequently in body mass.
Undereating in relation to the amount of physical activity can be found mainly
among competitive, intensively training female athletes who have a clear advantage
of leanness, such as gymnasts, ballet dancers, figure skaters and endurance runners
especially in affluent societies. A much more common problem is, however,
overeating in relation to the amount of physical activity, leading to overweight
and obesity.
The problem of overweight among young peop'e is serious for several
reasons. It causes or aggravates many physical, mental and social health problems,
or is their risk factor. These problems, such as adult onset diabetes, high blood
pressure and degenerative joint diseases, are so common partly because overweight
is so common. The primary cause of overweight is more commonly sedentary
lifestyle, i.e. small amount of physical activity and “normal” or excessive amount
of food, than overeating concomitant with physically active lifestyle. This is true
in both affluent and developing countries.
The trend in many countries shows that overweight among young people is
increasing. Some reasons for this development are the increased size and increased
fat and sugar content of restaurant, especially fast food, meals and decreased
physical activity of daily life. Once overweight has developed in youth, it has a
strong tendency to continue into adulthood.
The negative health consequences of overweight and especially obesity are
likely to be more serious in the sedentary than in the active obese people. Thus,
physically active lifestyle is important both in the prevention of overweight itself
and in decreasing its harmful effects. Schools can and have to play an important
role in obesity prevention by using the possibilities of school nutrition, health
education, and physical activity. If schools succeed in fostering balanced eating
and exercise habits resulting in the maintenance of healthy weight and metabolism
and adequate fitness among the students, the schools make a great service because
those results are likely to influence health deeply and last for a long time.
If healthy weight is maintained in the absence of physical activity, there may
be a risk that the relatively small amount of food does not contain sufficiently
mineral, vitamins, and trace elements. On the other hand, if the amount of physical
activity is large, that risk does not exist due to the greater total amount of food.
Further, the increased metabolism due to physical activity tends to have favorable
effects on some risk factors of cardiovascular diseases, e.g. on blood cholesterol
and triglycerides, already in young people.
16
It is logical to think that healthy eating or healthy activity habits are reflected
m the other living habits, too. This does not occur automatically and no to a larue
extent. However, one healthy living habit gives opportunities to use it as a vehicle
to influence other habits, too. by using the possibilities of school nutrition, health
education, and physical education.
5.9. Extracurricular programs
School physical education can offer only part of the recommended one hour
daily physical activity for children and adolescents. Extracurricular activities, i.e.
those related to schools as outside activities, give great possibilities to complement
the formal physical education and at the same time maintain and increase
cooperation between schools, parents, communities, and voluntary organizations.
Schools and communities can often provide the facilities, and the sport and
other organizations can take care of the supervision and guidance. This cooperation
can also increase in the community the understanding of the value of physical
activity, and its acceptance as an important part of the young people’s life.
Participation of several responsible parties in the organization of the
extracurricular activities can also increase the credibility and visibility of, and
commitment to physical activity in both schools and in the community. The
reflections may be even larger, because organization of activities for young people
is a concrete, motivating task that gives opportunities for many for participation in
joint tasks on an equal basis. This experience may create sense of coherence,
achievement, confidence, and independence especially in small communities, and
encourage the citizens to undertake further tasks as community activities.
Extracurricular physical activities are generally oriented towards sports and
competition. This is natural, because these qualities attract those students, who
are the most motivated for participation. The same applies to the organizers of the
extracurricular activities. In the course of the activities the selection and self
selection of the most talented and best motivated students tends to continue.
The disadvantage of the selection process is that there is not enough facilities,
supervision and other services nor motivation for participation for the less talented
and less competition oriented students, who anyway could be interested of regular
practice of exercise and sports at less or non-competitive level. This risk can be
avoided only by planning and resourcing programs that are targeted for broader
participation.
Physical activity in its various forms has great potential to influence positively
the psychosocial development and behaviors of youth by offering various natural
and socially acceptable outlets for self-expression, emotions and even rebellious
features associated with maturation to personal independence. Therefore it is
important that the schools as well as the communities seek actively individuals and
groups which could benefit of physical activities that meet their needs, abilities,
and interests. These programs should be given high priority among supported
community activities.
17
6. Training teachers and other school personnel
to foster Active Living
Active Living is a way of life, in which individuals choose to make physical
activity a preferred and integral part of daily life. In school physical education is
the main part of Active Living, but there are also other opportunities for activity.
Those opportunities should also be actively created and offered for the students.
Correspondingly, teaching of Active Living is mainly the responsibility of the teacher
who is primarily responsible for teaching physical education, but fostering Active
living is the responsibility of other teachers and staff member as well.
Successful teaching of physical education requires many qualifications. An
ideal solution is to have specially trained physical education teachers responsible
for this subject. In reality this is possible only to a limited degree. Therefore, it is
very desirable that other teachers also get trained in the essential aspects of physical
education and also in health education and health promotion. This applies to a
more limited extent also to other members of the school staff. It also and definitely
applies to those, who organize and supervise the extracurricular physical activities.
Every person who is responsible for fostering Active Living should know
and understand the general value and main benefits of physical activity for physical,
mental and social health and well-being as well as for growth and maturation on
the same domains. They should also know and understand the quantitative and
qualitative requirements that the various activities set on the participants, and ±ey
should be able to assess the matching of the requirements of the activity and the
abilities of the participant. They should know the risks involved in various activities
and conditions and how to avoid them. Especially the teachers should know the
principles, concepts and strategies of health promotion, and the main methods
that can be used in the instruction of physical and health education. The specialized
teachers should get training also in the skills and techniques that can be used in the
advocacy for health and Active Living.
In all education and training of the teachers and other staff members it is
important to emphasize that the adoption and maintenance of Active Living is
based on numerous and continuously repeating personal choices. These are likely
to be made in favor of Active Living, if the active alternatives are considered and
experienced as enjoyable, useful or otherwise satisfying. Thus, it is in very high
degree, especially among the young people, the emotions and feelings that count.
They are based on earlier expectations and experiences. There is no place for
many negative experiences due to any reason, especially among the less talented
and less interested children and adolescents, if Active Living is wanted to be their
preferred choice. These aspects emphasize the desirability of the psychological
and social skills and empathy of the teachers and guardians who are responsible
for teaching and supervising physical education and Active Living for young people.
18
7. Evaluation
Fostering Active Living in schools is a highly accountable task for many
reasons. The expressed goals are high, the expected results are considerable, a
substantial amount of resources is used, and every student goes through the
curriculum only once.
It is important to know, e.g. in what extent the goals are attained how
satisfactory are the results from the school’s, students’, and parents’ point of views,
how sufficient are the resources, and how effectively are they used.
7.1. Evaluation as a planning tool
The results of evaluation can be used to improve various aspects of physical
activity promotion, e.g. policies, facilities, environments, instruction programs,
personnel training, extracurricular activities, health and other services and
integration of physical and health education to other parts of the school curriculum.
The results of objective evaluation are one of the best means to request for additional
support from, e.g. the school or community or improved collaboration with parents
or voluntary organizations. An important aspect of the evaluation is that the purpose
is not to find victims but to obtain reliable information to be used for the continuous
planning - implementation - evaluation - planning cycle.
7.2. Types of evaluation
Efforts to foster Active Living can be evaluated in a number of ways. A
thorough evaluation of both what was done and how it was done, i.e. process
evaluation and what were the results, i.e.' impact evaluation is a task that requires
a substantial amount of resources and mastery of various methods. However, an
evaluation can also be performed in simple ways and with small resources. It is
better, and it is actually essential, that some evaluation rather than none at all is
done on the condition that the obtained, even limited results are peninent and
reliable.
7.3. What to evaluate
It is obvious that the activities of fostering Active Living in schools are
much easier and less costly to evaluate than the various effects of the accomplished
measures. Both types of evaluations are needed, however, in order to maintain
and increase the credibility and acceptance of physical and health education as
well as the promotion of Active Living in schools.
A suitable international division of labor could be that the affluent countries
take the responsibility for developing methods and conducting thorough and large
scale evaluations of both types, and countries wi th limited resources conduct process
evaluations at various levels.
The main aspects to be evaluated are the qualitative and quantitative aspects
of physical education instruction, physical activity programs and facilities. All
evaluations must naturally be made with reference to the set goals and available
19
I
opportunities and resources. The exact content of the evaluation depends on local
circumstances. The facilities are usually the easiest to evaluate. In some countries
models and standards have been developed for evaluation of. e.g. the quantity and
quality of physical education instruction, lesson content, fidelity of curriculum
implementation and opportunities for other physical activities. Also the competence
of the teachers and other professionals in health and physical education, and the
training programs for these people can be evaluated using standardized methods
and criteria. The same applies to the evaluation of students’ attainment of knowledge
and achievement of motor and behavioral skills related to physical activity as well
as to the adoption of healthy behaviors. If the developed methods and accepted
standards can be applied in other national and local circumstances, the evaluations
can be done, at least on a small scale, with even limited resources.
7.4. Reporting progress and achievements
.Any evaluation is useful and complete only when its results are reported and
interpreted to those who need and can use them. The value of the evaluations is
greatly increased if they are reported using repeatedly the same objective criteria
as possible in order to attain continuity and comparability in the interpretation.
The evaluation reports contain interesting and easily understandable material
for many parties in the schools, communities and families. This potential should be
fully used to create discussion, debate, proposals, etc., and in this way to contribute
to the development of, and increased support for physical education, Active Living,
and more broadly for Health Promotion in schools.
20
School Based Health and
'XX Nutrition Programmes:
Findings from a survey of
donor and agency
support
Carmel Dolan
JUNE 1998
Child Development
The Partnership for Child Development (PCD) was established in 1992 to help co-ordinate global efforts to assess the developmental burden of ill health and
poor nutrition at school age. It brings together a consortium of countries, donor organisations and centres of academic excellence to design and test
strategies to improve the health and education of school-age children.
The Partnership has international agency support from UNDP, WHO, UNICEF, The World Bank and British DFID, and is sustained through support from
participating governments, the Rockefeller, Edna McConneD Clark and James S McDonnell Foundations and the Wellcome Trust
The Scientific Coordinating Centre for the Partnership Is based at
The Wellcome Trust Centre for the Epidemiology of Infectious Diseases, University of Oxford,
South Parks Road, Oxford, 0X1 3PS, UK.
Tel: *
44 (0) 1865 271 290
Fax: *44 (0) 1865 281 245
Email: child-development ©zoology.ox.ac.uk
Web: http://www.celd.ox.ac.uk/chlld/
PARTNERSHIP FOR CHILD DEVELOPMENT
Contents
Contents.............................................................................................................................................. 2
List of Abbreviations used in text.................................................................................................... 4
Key Observations............................................................................................................................... 5
Introduction........................................................................................................................................ 6
Section I:
United Nations Organisations, Funds and Agencies.................................................. 7
UNITED NATIONS CHILDREN’S FUND (UNICEF)................................................................ 7
WORLD HEALTH ORGANISATION (WHO)............................................................................. 9
FOOD AND AGRICULTURAL ORGANISATION (FAO)....................................................... 10
WORLD FOOD PROGRAMME (WFP)...................................................................................... 10
UNITED NATIONS EDUCATIONAL, SCIENTIFIC AND CULTURAL ORGANISATION
(UNESCO)...................................................................................................................................... 11
UNITED NATIONS DEVELOPMENT PROGRAMME (UNDP)............................................. 11
UNITED NATIONS POPULATION FUND (UNFPA)...............................................................12
UNITED NATIONS PROGRAMME ON HIV/AIDS (UNAIDS).............................................. 12
INTERNATIONAL ATOMIC ENERGY AGENCY (IAEA)..................................................... 12
Section II: Multilateral Finance Agencies...................................................................................... 13
THE WORLD BANK..................................................................................................................... 13
INTER-AMERICAN DEVELOPMENT BANK (IADB)............................................................. 15
Section III: Bilateral Organisations................................................................................................ 16
CANADIAN INTERNATIONAL DEVELOPMENT AGENCY (CIDA)................................... 16
DANISH INTERNATIONAL DEVELOPMENT ASSISTANCE (DANIDA).......................... 16
DEPARTMENT FOR INTERNATIONAL DEVELOPMENT, U.K. (DFID)............................17
DEUTSCHE GESELLSCHAFT FUR TECHNISCHE ZUSAMMENARBEIT (GTZ).............. 17
NORWEGIAN AGENCY FOR DEVELOPMENT CO-OPERATION (NORAD).................... 18
SWEDISH INTERNATIONAL DEVELOPMENT AGENCY (SIDA)...................................... 18
UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT (USAID)............. 19
Section IV: Non-Governmental Organisations (NGOs), research groups and institutions. ...21
APPROPRIATE HEALTH RESOURCES AND TECHNOLOGIES ACTION GROUP
(AHRTAG)........................................................................................................................................ 21
CARE.................................................................................................................................................21
CATHOLIC FUND FOR OVERSEAS DEVELOPMENT (CAFOD)......................................... 21
CARIBBEAN FOOD & NUTRITION INSTITUTE (CFNI)....................................................... 22
CATHOLIC RELIEF SERVICES (CRS)........................................................................................ 22
CHILD-TO-CHILD (CtC).................................................................................................................23
CHRISTIAN AID (CA)..................................................................................................................... 23
2
PARTNERSHIP FOR CHILD DEVELOPMENT
DANISH BILHARZIASIS LABORATORY (DBL).................................................................... 24
PARTNERSHIP FOR CHILD DEVELOPMENT (PCD)............................................................. 24
PLAN INTERNATIONAL (PLAN).............................................................................................. 24
SAVE THE CHILDREN FEDERATION, USA (SCF USA)....................................................... 25
SAVE THE CHILDREN FUND, UK (SCF, UK)......................................................................... 25
WATER AID................................................................................................................................... 25
WORLD VISION CANADA (WVC)............................................................................................ 26
List of Contacts.................................................................................................................................. 27
3
PARTNERSHIP FOR CHILD DEVELOPMENT
List of Abbreviations used in text
United Nations Organisations, Funds and Agencies
UNICEF - United Nations Children’s Fund
WHO - World Health Organisation
FAO - Food and Agriculture Organisation
WFP - World Food Programme
UNESCO - United Nations Educational, Scientific and Cultural Organisation
UNDP - United Nations Development Programme
UNFPA - United Nations Population Fund
UNAIDS - United Nations Programme on HIV/AIDS
IAEA - International Atomic Energy Agency
Multilateral Finance Agencies
IADB - Inter-American Development Bank
Bilateral Agencies
CID A - Canadian International Development Agency
DANIDA - Danish International Development Assistance
DFID - Department for International Development, UK
GTZ - Deutsche Gesellschaft fur Technische Zusammenarbeit
NORAD - Norwegian Agency for Development Co-operation
SIDA - Swedish International Development Agency
USAID - United States Agency for International Development
Non-governmental organisations (NGOs), research groups and institutions
AHRTAG - Appropriate Health Resources and Technologies Action Group
CARE - Co-operative for Assistance and Relief Everywhere
CAFOD - Catholic Fund for Overseas Development
CFNI - Caribbean Food and Nutrition Institute
CRS - Catholic Relief Services
DBL - Danish Bilharziasis Laboratory
PCD - Partnership for Child Development
PLAN - PLAN International
SCF (USA) - Save the Children, USA
SCF (UK) - Save the Children, UK
WVC - World Vision Canada
4
PARTNERSHIP FOR CHILD DEVELOPMENT
Key Observations
• There is increasing donor interest in the health and nutrition of the school-aged child,
adolescents and youth generally. This is most apparent in the UN system but also in some
of the Bilateral Organisations and increasingly among those NGOs surveyed.
• NGOs in the UK are reporting an increase in requests from governments for support to the
formal and informal education sector and within this the health and nutrition needs of
school-aged children.
• There is a move towards inter-agency school health planning, monitoring and evaluation,
particularly in the UN. This reflects a move by the UN system and bilaterals towards a
sector-wide approach to funding, and away from a project approach. This is also seen as
an essential development among other donors e.g. SCF (US).
• Those donors contacted who stated that they are not supporting school-based health and
nutrition programmes at present, indicated that they are currently considering the issue.
•
In the view of donors, the PCD acts as a catalyst to promote donor commitment in the
area of school health, particularly among US based Organisations and agencies. The level
of awareness of school-health issues among UK based NGOs is not as well developed.
•
Strong interest has been expressed in the school health web-site and mail list currently
being developed by PCD with the World Bank. This could provide the necessary vehicle
for greater collaboration among donors/agencies and governments to share school health
related experiences, research, programming etc.
Caveats
•
The inter-sectoral, crosscutting nature of school health and nutrition programmes, along
with the lack of available information at HQ level (many regional offices are autonomous)
combines to make information gathering in this area quite difficult. If a detailed and more
accurate picture of donor support for school health programmes were required, it would
be necessary to make a more detailed regional analysis and to visit the HQ of all the major
donors.
• The results of the telephone survey of donors presented below should be viewed as an
incomplete but reasonable indication of current donor support in this area.
5
PARTNERSHIP FOR CHILD DEVELOPMENT
Introduction
This paper was commissioned by the Scientific Coordinating Centre of the Partnership for Child
Development (PCD), based in the University of Oxford, England. The main objective of this work
was the preparation of a synopsis of donor support for school-based health and nutrition initiatives.
The information was collected over a three week period using telephone, fax, email and the web
site. These media provide a useful introduction to the subject but fall short of providing a
comprehensive overview.
The paper is divided into four sections: Multilateral Organisations, Bilateral Organisations, NGOs
and Academic Institutions. As many Organisations as possible were contacted in the time frame
available and it is likely that some Organisations have been overlooked.
The quality of the information received from the different Organisations is inevitably a function of
the interest of particular individuals and their willingness to give up valuable time to share and
research relevant details. To this effect, thanks should be given to all those who contributed to this
paper.
6
PARTNERSHIP FOR CHILD DEVELOPMENT
Section I: United Nations Organisations, Funds and
Agencies
UNITED NATIONS CHILDREN’S FUND (UNICEF)
UNICEF’s medium-term strategy for 1996-2001 has identified women and young people as two
main priority groups. Their policy is to help meet the basic rights and expand opportunities of
children aged 0 to 18 within the framework of the 1989 UN Convention of the Rights of the Child,
the 1990 World Summit for Children and the 1990 World Conference “Education for AU” (EFA).
In addition, UNICEF’s mandate is to support WHO and UNESCO policies and develop common
strategies that address school health and the joint UN Programme on AIDS, which improves
coverage and quality of school-based life skills/AIDS programmes. They also work within the
Framework for Girls Education (1996) and take guidance from the Notebook on Programming for
Young People’s Health and Development (1997).
UNICEF has been involved with school health programmes for many years and collaborates with a
number of agencies including the World Bank, WHO, UNESCO and UNFPA. Recently UNICEF
has worked in some depth with several countries (Cameroon, Eastern Caribbean, Ghana, Sri Lanka,
Thailand and Zimbabwe) on school health programme policy.
Currently UNICEF supports a range of school health programmes in the following areas:
•
Water, Sanitation and Hygiene programmes for schools in many countries (e.g.
Uganda, Vietnam, and West Africa). These include health education courses in
primary schools that focus on hygiene and the environment, provision of facilities for
safe water, latrines, handwashing and garbage disposal.
•
Life skills/AIDS programmes in schools including curriculum training (e.g.
Zimbabwe, Thailand, Caribbean, Uganda, and Sri Lanka).
•
Child-to-Child and extra-curricular activities for the whole community, with NGOs,
for example: World Scout Federation, Red Cross and Red Cross Crescent Societies.
•
Health and Nutrition services including the provision of micronutrients,
anthelminthics and malaria tablets as part of UNICEF’s overall strategy.
•
Situation Analysis including adolescents’ needs and responses. This was developed
as an inter-agency (UNDP, UNESCO, UNFPA, WHO) activity, with PCD, and has
been evaluated (by WHO) in Ghana, Zimbabwe, Botswana, Uganda and Kenya.
UNICEF is also currently developing ideas for a package of school based interventions that have
the scope for sustainable national adaptation. Currently this package has four components as
follows:
•
School Policies: the focus will be country specific but should include protecting
children against physical/sexual abuse, protecting the rights of pregnant schoolgirls,
protecting the rights of children who are disabled or are living with HIV/AIDS, and
avoiding tobacco and substance abuse.
•
Skills-based health education/Life Skills Training: ensuring school children get the
skills as well as the information they need (for everything from preventing HIV/AIDS
to contributing to civil society), in a way that fosters an interactive relationship
between teachers and school children.
•
Water , Sanitation and Hygiene Promotion: which should be linked to
environmental issues and the hygiene component of health education. Schools could
possibly act as a central point for community managed water programmes.
7
PARTNERSHIP FOR CHILD DEVELOPMENT
•
Specific medical/nutrition interventions: there are a number of interventions that
can be safely and simply implemented by teachers including the regular treatment of
helminth infections, micronutrient supplementation (iron, vitamin A and iodine) and
possibly, in selected areas, malaria treatment and tetracycline for the treatment of
trachoma.
Four programme principles have been identified to support these four interventions:
•
Strengthening partnerships/linkages: between schools and communities/ parents,
between education and the health sector including water and environmental health and
between teachers and health workers.
•
Capacity building: supporting the work teachers are already doing rather than
overwhelming them; this includes the provision of training and the production of
materials.
•
Sustainability: seeking long term programmes, although not necessarily independent
of external support.
•
Children’s participation: programmes which respond to needs recognised by the
beneficiaries, and involving them actively in implementation.
Many UNICEF country programmes are already supporting elements of the package outlined
above. For example in Punjab Province, Pakistan, UNICEF supports the Government Education
Department in an integrated water, sanitation and hygiene education project in primary schools
(IWSHEP). The IWSHEP aims to increase access to water and sanitation facilities (through the
provision of hand pumps and construction of latrines) in primary schools for girls; to promote
hygiene practices and improved health among school-aged children and to strengthen the capacity
of the Education Department by improving in-service teacher training which includes a hygiene
education component. Additional support is targeted at NGO elementary schools to promote
personal hygiene awareness and environmental sanitation among primary school children. School
children and teachers provide an effective channel for education and appropriate training materials
have been developed. About 8000 teachers were trained under the project in 1994.
In Zimbabwe, UNICEF supports a LST/AIDS programme that is now under the Ministry of
Education. In 1992 UNICEF gave US$350,000 for the hire of local staff and programme start-up
after which a fundraising campaign with local donors led to the raising of US$4 million of
supplementary funding for 2 years. The programme supports weekly (compulsory) lessons on life
skills and HIV/AIDS in all schools for children from grade 4 (9-10 years of age). Teacher and
student manuals are provided which are appropriate for the grade level, which address
relationships, growing-up, life skills and health. Self-esteem and assertion are positively
encouraged and concrete ways of responding to negative peer pressure are role-played at school.
Children undertake community-based projects that explore drug use, coping with HIV/AIDS and
responsibilities of husbands and wives.
Whilst many UNICEF country programmes are supporting school health initiatives, these have not
yet been adequately tried and tested in order to be formalised within the organisation. It is
anticipated that a select number of countries will be identified to pilot the package outlined above
and explore the various programming implications before UNICEF formerly adopts the approach
as a broad-based strategy. A body of people with expertise in key areas such as LST, water and
sanitation (including hygiene promotion), helminth infection control, interactive health education
(including HIV/AIDS) along with representatives of donors and key organisations could be
brought together to co-ordinate and catalyse the process.
In addition to school based programmes, UNICEF are also considering the more difficult area of
reaching children in crises, as well as street children and working children, who are often not
attending schools and whose health and nutrition are often most compromised. Work is also
underway to examine options for improving the nutritional status of adolescents.
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PARTNERSHIP FOR CHILD DEVELOPMENT
WORLD HEALTH ORGANISATION (WHO)
In 1996, WHO launched the Global School Health Initiative (GSHI) which aims to increase the
number of schools that can be called “health promoting” schools (HPS). A HPS is defined as a
school that “constantly strengthens its capacity as a healthy setting for living, learning and
working”. Within WHO this initiative is coordinated by a multi-sectoral working group that
incorporates expertise in mental health and LST, health and nutrition, physical environments etc.
Some 22 WHO divisions are relevant to school health strategy, and 8 of these are represented in a
coordinating group. WHO also collaborates with other UN organisations and with the World Bank.
WHO is a cosponsor of PCD.
Four broad strategies have been identified to help schools become health promoting:
•
Building capacity to advocate for improved school health programmes
•
Mobilising resources for developing Health Promoting Schools
•
Strengthening national capacities
•
Research to improve school health programmes
This initiative emphasises the need to harness existing resources that exist at country, community
and school level whilst also assisting governments to advocate for increased funds for HPS. The
focus therefore is on influencing government policy through advocacy and the longer term
sustainability of the initiative.
To date, a broad range of advocacy orientated activities have been implemented under the auspices
of WHO. This includes the development of guidelines and action plans by task force members,
training and workshop based activities and the production of key documents that provide an
important entry point for the development of health promoting schools. Ten documents, earmarked
for production, address important technical issues such as: the reduction of helminth infections: the
prevention of violence: the dangers of tobacco use and the improvement of nutritional status. These
documents are intended for use by governments and those concerned with advocating the
allocation of greater resources for school health.
Although all seven WHO regional offices are actively involved in supporting this initiative, they
are at various stages of development and employ different entry points to HPS depending on the
regional location. The WHO European Region joined forces with the European Commission and
the Council of Europe to create the European Network of HPS in 1992. Starting with four pilot
countries in Central and Eastern Europe they have expanded to cover 37 countries by 1997.
The Western Pacific Region network is also reportedly well developed whilst in South East Asia
the initiative is just starting up. In Africa, the initiative is receiving a great deal of interest. In South
Africa for example, the HPS network is credited with bringing together the ministries of health and
education to plan joint action.
In Fujian, China, for example, WHO have been supporting a project for de-worming since 1996 as
an entry point to the development of HPS. A pilot study was undertaken to demonstrate the
benefits of de-worming and health education.
In addition, the HPS project has become a trigger for activities that improved the physical
environment through mobilising local government and community funds. These improvements
included tree planting, extending the school buildings, increased numbers of toilets and taps for
handwashing and other general environmental improvements.
WHO has also supported research on school based health services through the Task Force for
Healthy School Children, within TDR/WHO. This Task Force, within which PCD was represented,
undertook enabling research on school based health service delivery, and field tested the UNICEFled inter-agency Situation Analysis in Africa.
The Division of Control of Tropical Disease (CTD) has conducted school based deworming
activities in Zanzibar, Seychelles, Oman and Mauritius and has worked with World Bank projects
9
PARTNERSHIP FOR CHILD DEVELOPMENT
in West Africa (Guinea, Mauritania, Mali) to design school based health service delivery of
anthelminthics. The Division is currently establishing a formal collaboration with the World Bank
to support school based deworming projects.
Other sector work on school health is also underway. For example, a general survey of the role of
the school environment on child health has been completed. An interagency evaluation of life skills
training in schools is being planned.
Regional offices are also actively pursuing their own programmes in this area. For example, the
Pan American Health Organisation has a well established network of health promoting schools in
the Americas. Schools are also the basis of health delivery for the ‘PEPIN’ disease control
initiative that is active in Nicaragua, El Salvador, Guatemala and Honduras, and is currently
expanding to 12 other countries. In October 1997, the World Bank and PAHO launched a joint
initiative to promote school health and nutrition programmes in the Americas.
FOOD AND AGRICULTURAL ORGANISATION (FAO)
FAO’s approach towards school aged children’s health is guided by the resolutions agreed at the
International Conference on Nutrition in December 1992 and further reconfirmed at the World
Food Summit in 1996.
FAO’s current focus is on a school nutrition programme that involves the development of nutrition
education materials for children aged between six and fourteen years. The design of these materials
is based upon the findings of a survey of forty countries which revealed a great deal of need and
interest at primary schools for nutrition related materials and for teacher training in the use of these
materials. FAO are collaborating with the Netherlands Nutrition Centre and plan to pilot test the
nutrition education materials in South Africa toward the end of 1998. Following this, they will
adapt materials to country specific situations, and to the level of detail and involvement countries
are ready to absorb. For example, some countries may wish to incorporate nutrition education into
the education curriculum whilst others will want to use the materials in a less structured way.
Whilst FAO and WHO currently have no formal link with respect to HPS, FAO are supportive of
the approach and are developing a dialogue with WHO to avoid duplication and to maximise
resources. They are to a large extent following the principles of the WHO European HPS model in
their current work on nutrition education and anticipate that the programme will run over a period
of five to ten years. The operating budget for this work is approximately US$50,000 for 1998
(excluding the salary of one full time person).
WORLD FOOD PROGRAMME (WFP)
WFP is concerned with two main areas in relation to school health: school feeding programmes
and a micronutrient and health programme.
WFP has a long-standing role in support of School Feeding Programmes (SFP) and supports
around 60 programmes today. SFPs are increasingly targeted at poor countries and poor population
groups within these countries: by the end of 1997 90% of WFP resources are to be directed at lowincome food deficit countries. SFPs are justified on the basis that they contribute to improvements
in school enrolment and attendance rates, improvements in children’s capacity to concentrate and
assimilate information by alleviating short-term hunger and because they reduce the prevalence of
some micronutrient deficiencies through the provision of fortified foods (Vitamin A, iron and
iodine).
Increasingly, school-based de-worming programmes (which follow the WHO technical guidelines)
are being integrated into SFPs. Training of ministerial government staff, teachers and health staff
at the peripheral level enables them to take responsibility for drug distribution.
WFP, in collaboration with WHO, has recently completed the production of a “Health and
Nutrition Manual for School Feeding Programmes” and is in the process of completing a manual
10
PARTNERSHIP FOR CHILD DEVELOPMENT
for the use of school feeding programmes in rehabilitation and recovery. These guidelines are
based on case studies of the health and education sectors in Mozambique and Angola.
WFP is also coordinating the Women’s Health and Nutrition Facility (WHNF), a programme
funded by CIDA. WHNF started in 1996 and is targeted at 15 low-income countries reaching over
900,000 women and 2.2 million children, including the school-aged child. Fortified foods, and
specific micronutrients (depending on country needs) along with de-worming tablets are targeted to
the most vulnerable in the population and at the most vulnerable stages in their life. For example,
vitamin A is targeted at women during pregnancy. The programme, costing Canadian $ 30 million
will be implemented over a 3-4 year period depending on the particular circumstances of the
countries involved. Where possible, WFP aims to integrate the programme into their existing
regular programmes for example Maternal and Child Health (MCH) and SFP and to work closely
with other organisations (e.g. UNICEF) in the target countries.
UNITED NATIONS EDUCATIONAL, SCIENTIFIC AND CULTURAL
ORGANISATION (UNESCO)
UNESCO was one of the first of the UN organisations to undertake sector work on school health
and nutrition. During the late 1980’s UNESCO hosted a series of technical meetings on this topic.
UNESCO has a number of roles in relation to school health. The global Programme of Education
for the Prevention of AIDS has a focus on the integration of HIV/AIDS education into school
curricula. Putting in place large-scale national programmes that draw on the experiences from other
projects and programmes forms the main aim of the programme. Information on activities,
materials and documents already developed by innovative NGO projects are disseminated by
UNESCO’s resource centres. UNESCO also support seminars/training workshops for ministerial
staff and teachers on HIV/AIDS, and is a co-sponsor of UNAIDS.
UNESCO also provides technical support for school health and nutrition programmes. In 1995 a
study of six rural districts in Kenya was done in collaboration with the Kenyan Ministries of
Education and Health, to examine the factors surrounding child health, nutrition and educational
participation. The findings demonstrated high levels of morbidity (malaria, intestinal parasites) and
poor nutritional status (17.8% suffer from severe undemutrition, 34.3% from mild-moderate
growth retardation) among Kenyan school children; as well as delayed school entry and grade
retardation and a poor school environment (e.g. lack of water and sanitation). The findings have
informed UNESCO’s current focus on realistic and feasible actions that can be implemented by the
national, district, school and community levels to improve the health and nutrition of school
children; for example, the involvement of teachers in the collection and use of available
information at the school level. This includes the use of proxy indicators for child health such as
the sanitary facilities, school water supplies and the nutritional status of pupils.
UNESCO provides technical support for WFP School Feeding Programmes. This includes
assistance with the appraisal of new programmes, management reviews, the evaluation of existing
SFPs and the development of manuals in relation to SFPs.
UNITED NATIONS DEVELOPMENT PROGRAMME (UNDP)
The mission of UNDP is to promote sustainable development. UNDP has a history of promotion of
school based health and nutrition approaches. In 1992 it played a leadership role in creating the
Partnership for Child Development to undertake operations research into the role of school health
and nutrition in child development, and remains a cosponsor. UNDP is also a cosponsor of the
Micronutrient Initiative.
UNDP has supported pilot school health and nutrition programmes in Colombia, Ghana, Tanzania,
India, Indonesia and Vietnam, and contributed to programmes in some 14 countries. An innovative
programme to facilitate the creation of local NGOs in school health and nutrition is being piloted in
Africa.
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PARTNERSHIP FOR CHILD DEVELOPMENT
UNDP is currently commissioning sector work on development, including an analysis of the role of
school-based health and nutrition in child development. This work is being undertaken
collaboratively with WHO, and with technical input from PCD.
UNITED NATIONS POPULATION FUND (UNFPA)
UNFPA, along with most of the UN organisations, is increasing the number and scope of health
programmes for youth and adolescents. In recognition of the need to strengthen the impetus and
direction of actions for adolescent health, WHO, UNFPA and UNICEF jointly convened a Study
Group on Programming for Adolescent Health in 1995. This resulted in a number of guidelines for
policy direction at the country, regional and global level.
Currently, UNFPA support adolescent reproductive health programmes (adolescent defined as
persons aged 10-19 years) in approximately 100 countries. These include educational programmes
(In-school education programmes can cover population education, family life education, sexuality
education, "life-planning” and parent education); information and communication programmes (in
school production of Information, Education and Communication - IEC - materials) and health
services programmes.
UNFPA also supports HIV/AIDS prevention activities for youth and adolescents in approximately
95 countries within the global strategy of the Joint United Nations Programme on HIV/AIDS
(UNAIDS) which became operational in 1996. The main focus of UNFPA’s activities is at the
country level where the AIDS prevention activities are integrated into ongoing programmes and
projects in reproductive health. Collaboration with NGOs in undertaking HIV/AIDS prevention
activities is an integral part of most country programmes.
UNITED NATIONS PROGRAMME ON HIV/AIDS (UNAIDS)
This programme was launched in 1996 and seeks to coordinate global - especially UN - strategy on
HIV/AIDS prevention, research and advocacy. Co-sponsors include WHO, UNFPA, UNDP,
UNESCO, UNICEF and the World Bank. There has been a specific focus on school-based
activities, and one of the inter-agency working groups deals only with this topic. The major aim is
to promote life skills and IEC programmes through schools.
UNAIDS also acts as an information resource and can provide access to evaluated materials for use
in schools.
INTERNATIONAL ATOMIC ENERGY AGENCY (IAEA)
The IAEA has a mandate to enlarge the contribution of atomic energy to health (and peace and
prosperity) throughout the world. Specifically, IAEA supports a Human Health Programme, which
includes a nutrition and health-related environmental studies sub-programme. Projects supported
under this sub-programme include “applied human nutrition assessment and research using nuclear
and isotopic techniques” which aims to demonstrate the practical use of nuclear and isotopic
techniques as tools for improving nutrition monitoring and for identifying effective food and
nutrition strategies in developing countries. During 1997, the IAEA supported co-ordinated
research in 33 developing countries and technical co-operation in 9 countries.
In Peru, the IAEA has been working with the Government on a Model Project which provides food
supplements through a daily breakfast to over 500,000 school children over a four year period in
six regions of the country. Nuclear techniques are being used to evaluate the programme impact on
nutritional status of the school children. The IAEA is also considering supporting similar school
based programmes in Latin America and Asia as part of their growing interest in monitoring and
evaluating nutrition programmes.
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PARTNERSHIP FOR CHILD DEVELOPMENT
Section II: Multilateral Finance Agencies
THE WORLD BANK
The World Bank is now giving greater emphasis to social sector approaches which are child
centered, which target poverty and which are responsive to client country needs. School based
health and nutrition programmes contribute to this new approach, and are endorsed in the Health,
Nutrition and Population Sector Strategy and are in the current draft of the Education Sector
Strategy (scheduled for completion in late 1998). Africa Region has a School Health and Nutrition
Affinity Group and an articulated strategy. Latin America and the Caribbean Region also has a
strategy paper, and has launched a joint initiative with the Pan American Health Organisation to
undertake operations and sector work in the Region.
The World Bank is seeking to coordinate information on school health and nutrition approaches
through an International Schoo! Health Initiative based in the Human Development Network. This
seeks to enhance the quality of school health and nutrition programmes by:
•
Providing access to expert advice, particularly in and from client countries.
•
Providing a clearing house for examples of good practice.
•
Developing practical toolkits for implementation, based on actual experience.
•
Making quality information available through the Internet, the World Bank intranet
and the World Bank Advisory Services.
•
Building partnerships with governments and international agencies, institutions and
NGOs.
•
Assisting task teams to prepare school health components for World Bank projects.
The World Bank has established collaborations in order to promote quality technical input into
programme design. The Bank has a formal partnership with PAHO in Latin American Countries
(LAC), and is in dialogue with WHO on technical support for Africa. Within the UN system,
partnerships are being developed with UNICEF, UNAIDS and WFP, amongst others. Partnerships
are also being created with bilaterals. For example, USAID are co-sponsors of the International
School Health Initiative, and DFID, UK, are co-sponsors of sector work on the out of school child.
The Bank is also developing partnerships with NGOs, for example Save the Children Federation,
USA, and is a co-sponsor of the Partnership for Child Development and the Micronutrient
Initiative.
The rationale for World Bank interest in school health and nutrition programmes includes the
following issues:
•
There are more school-age children, and more in school, than ever before.
•
School children are neglected by most health systems.
•
Freedom from disease promotes intellectual as well as physical development.
•
Healthy children get maximum benefit from their only opportunity for education.
•
The benefits are greatest for the most disadvantaged - the girl child, the malnourished
and the poor.
•
The combination of an accessible population and an extensive trained workforce of
teachers keep financial costs to a minimum.
•
Builds on the investment in early child development, and builds the basics for
appropriate social behaviour in adolescence.
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PARTNERSHIP FOR CHILD DEVELOPMENT
Experiences of good practice suggest that, in terms of World Bank Human Development strategy,
school-based health and nutrition programmes should be simple and locally relevant, and should
not overload already overstretched teachers or the curriculum. The following items might usefully
contribute to such programmes:
•
Life Skills Training and IEC - as part of a strategy to promote healthy lifestyles, and
avoid violence, substance abuse, HIV/AIDS and teenage pregnancy.
•
Health Services - as part of the Primary Health Care system, and providing screening
for sight and hearing, simple health interventions (deworming, first aid) and referral.
•
School Snacks - which are fortified with micronutrients and provided early in the
school day.
•
Exemplary School Environment - which supports health education messages about
hygiene and sanitation.
•
Equitable School Health Policies - that ensure the rights of school children.
•
Strategies Beyond the School - that use the school as a community centre to provide
services to out of school children.
A Knowledge Management Site has been established on the intranet to assist World Bank task
teams to prepare school health and nutrition components for client governments. As part of the
International School Health Initiative this site is being transferred to the external internet, where it
will be supported by a mail list for exchange of information amongst co-sponsors and subscribers.
The activities described above are intended to build and promote partnerships with technical
agencies and to ensure the quality of technical advice to client governments. Bank operations in
school health and nutrition involve the inclusion of this component within government projects or
sector-wide approaches supported by Bank credit. Examples of operations include:
•
SHN as part of Education projects that seeks to enhance participation in education.
The overall project will enhance access by traditional means (build schools, train
teachers, provide textbooks) but will also promote participation and learning through
better health and nutrition, not least because EFA aims to reach the poorest children.
Projects of this type (Guinea, Dominican Republic, El Salvador) range from USS 34 to
57 million, of which some 4% to 9% is allocated to school heath and nutrition.
•
SHN as part of Nutrition and Health projects that seeks to improve growth and
nutritional status. The USS 34 million Community Nutrition Project in Madagascar
allocates 17% to school-based snacks, micronutrient supplements and deworming.
•
SHN as an identified use for Community funds. These represent an increasingly
important lending instrument since they place the decision-making within the
community. A central government agency is provided with finance which is released
to local communities on the basis of specific requests made from a menu of options
which typically might include school construction and bore-hole provision, and which
increasingly now include support for school health and nutrition programming. Funds
for SHN have been activated in Panama, the Philippines and Tanzania, but have yet to
be evaluated.
•
SHN as a component of Sector Wide Approaches (SWAP). A SWAP involves a
partnership of donors which works with the government to support activities in an
integrated fashion across a whole sector, rather than as separate projects. This new
approach has obvious benefits but has proved slow to implement. SHN has been
identified in SWAP assistance strategies (for example by Malawi, Ethiopia and
Kenya) and is being developed jointly by USAID and the World Bank as a component
of the Zambia SWAP.
14
PARTNERSHIP FOR CHILD DEVELOPMENT
Experiences of good practice suggest that, in terms of World Bank Human Development strategy,
school-based health and nutrition programmes should be simple and locally relevant, and should
not overload already overstretched teachers or the curriculum. The following items might usefully
contribute to such programmes:
•
Life Skills Training and IEC - as part of a strategy to promote healthy lifestyles, and
avoid violence, substance abuse, HIV/AIDS and teenage pregnancy.
• Health Services - as part of the Primary Health Care system, and providing screening
for sight and hearing, simple health interventions (deworming, first aid) and referral.
•
School Snacks - which are fortified with micronutrients and provided early in the
school day.
•
Exemplary School Environment - which supports health education messages about
hygiene and sanitation.
•
Equitable School Health Policies - that ensure the rights of school children.
•
Strategies Beyond the School - that use the school as a community centre to provide
services to out of school children.
A Knowledge Management Site has been established on the intranet to assist World Bank task
teams to prepare school health and nutrition components for client governments. As part of the
International School Health Initiative this site is being transferred to the external internet, where it
will be supported by a mail list for exchange of information amongst co-sponsors and subscribers.
The activities described above are intended to build and promote partnerships with technical
agencies and to ensure the quality of technical advice to client governments. Bank operations in
school health and nutrition involve the inclusion of this component within government projects or
sector-wide approaches supported by Bank credit. Examples of operations include:
•
SHN as part of Education projects that seeks to enhance participation in education.
The overall project will enhance access by traditional means (build schools, train
teachers, provide textbooks) but will also promote participation and learning through
better health and nutrition, not least because EFA aims to reach the poorest children.
Projects of this type (Guinea, Dominican Republic, El Salvador) range from USS 34 to
57 million, of which some 4% to 9% is allocated to school heath and nutrition.
•
SHN as part of Nutrition and Health projects that seeks to improve growth and
nutritional status. The USS 34 million Community Nutrition Project in Madagascar
allocates 17% to school-based snacks, micronutrient supplements and deworming.
•
SHN as an identified use for Community funds. These represent an increasingly
important lending instrument since they place the decision-making within the
community. A central government agency is provided with finance which is released
to local communities on the basis of specific requests made from a menu of options
which typically might include school construction and bore-hole provision, and which
increasingly now include support for school health and nutrition programming. Funds
for SHN have been activated in Panama, the Philippines and Tanzania, but have yet to
be evaluated.
•
SHN as a component of Sector Wide Approaches (SWAP). A SWAP involves a
partnership of donors which works with the government to support activities in an
integrated fashion across a whole sector, rather than as separate projects. This new
approach has obvious benefits but has proved slow to implement. SHN has been
identified in SWAP assistance strategies (for example by Malawi, Ethiopia and
Kenya) and is being developed jointly by USAID and the World Bank as a component
of the Zambia SWAP.
14
PARTNERSHIP FOR CHILD DEVELOPMENT
•
SHN as a Learning and Innovation Loan (LIL). These new lending instruments are
intended to allow governments to explore new approaches and strategies by providing
modest (<US$ 5 million) support through a fast track system. A LIL is being appraised
with Colombia to support youth development in the community and schools.
Many of these operations are implemented with UN agencies (for example, UNICEF, UNDP,
WFP, WHO) and INGOs (for example, Save the Children, CARE) at the country level. The World
Bank has also supported the development of local inter-sectoral capacity to implement SHN
programmes (for example, in Malawi) by grants from the International Development Fund.
INTER-AMERICAN DEVELOPMENT BANK (IADB)
IADB has an established record in supporting school-based health and nutrition projects.
•
In El Salvador the “Basic Education Modernisation” project aims to promote greater
equity, quality and efficiency in the provision of education services. The components
include activities to develop a school health and nutrition programme targeted to the
El Salvador’s poorest 135 municipalities. The total resources allocated are US $1.5
million.
•
In Dominican Republic the project “Basic Education Improvement Programme, Stage
11” aims to increase the equity, efficiency and sustainability of pre-school and basic
education for Dominican children. An integral part of the project entails the support
provided by the Secretariat of Education, Arts and Culture (SEEBAC) to design
deliver and co-ordinate expanded school nutrition programmes. Resources for this
component are US$3.5 million.
•
In Mexico, the “Integrated Compensatory Education Programme” has a number of
aims which include increasing access to education among poor children, providing
child-rearing education to illiterate/uneducated parents, literacy training for adults and
education in remote areas without schools. Specifically, parents are trained to
recognise the imperative of good nutrition in fostering healthy growth and
development. They are also taught how to improve nutrition and developmental
activities.
•
In Jamaica, the “Primary Education Improvement Programme II” supports research
into the link between cognition and nutrition to enable the Ministry of Education to
plan the timing and distribution of its nutri-bun programme.
15
PARTNERSHIP FOR CHILD DEVELOPMENT
Section III: Bilateral Organisations
CANADIAN INTERNATIONAL DEVELOPMENT AGENCY (CIDA)
CIDA is a lead donor in the area of nutrition programming. Since 1992, CIDA has contributed over
$87 million to nutrition projects of which $78 million have been focused on micronutrients. An
additional $120 million has been contributed to integrated projects which combine nutrition with
health, basic education and income generation activities. CIDA is a founding member of the
Micronutrient Initiative (MI) which has a grant of approximately $53 million and is supported by
IDRC, UNDP, UNICEF, USAID and the World Bank. Examples of CIDA programmes that affect
the school-aged child include:
•
Funding to WFP for school feeding/health programmes and through the Women's
Health Facility (see section on WFP for more details).
•
The MI South Asia Programme which aims to eliminate iodine and vitamin A
deficiency and reduce iron deficiency in women (includes school children) in
Bangladesh, India, Nepal and Pakistan by the year 2000.
•
The Ecuador Iodine Deficiency Disorder (IDD) Programme which has implemented a
school-based IDD monitoring system where school children bring samples of salt to
school to test for iodine in class using low-cost rapid tests.
•
A School Feeding Programme in Haiti implemented by a French-Canadian NGO
costing $1.6 million which started in 1998.
•
CIDA has supported UNICEF in its African Programme for Girl Child Education
which is now in its second phase. This involves HIV/Life skills curriculum
development in Zambia and Zimbabwe and hygiene and bilharzia education through
curriculum development in Egypt.
DANISH INTERNATIONAL DEVELOPMENT ASSISTANCE (DANIDA)
DANIDA do not have a defined strategy for support towards school based health programmes
although they are supporting other agencies through their bilateral programme. For example
funding to UNICEF in Uganda for school based health education activities.
Members of the education and health sector in DANIDA have discussed the need for school-based
health and nutrition programming on a number of occasions but constraints on time and finances
have prevented them from taking this further.
Although DANIDA’s water and sanitation strategy, “Water, Sanitation and Hygiene (WASH)”
does not refer to schoolchildren directly, DANIDA supports the provision of water supplies to
primary schools within their rural water supplies programmes in developing countries. The health
education component of their water strategy, which incorporates messages about hygiene behaviour
and water-related diseases also, targets primary schools.
A typical example of the DANIDA approach is in Burkina Faso where they are working with 110
urban and rural primary schools in the south-east of the country (population covered approximately
400,000) to improve water supplies, construct latrines and provide teaching materials about
hygiene education to the teachers and students. In this programme, each school must have an
active parent-teachers association (PTA) to purchase low-cost hand pumps, open bank accounts for
maintenance costs and for the purchase of ventilated improved pit latrines. The health education
activities involve teacher training in the use of hygiene education materials that are prepared by a
local NGO and includes the use of videos that show local defecation practices as part of the
16
PARTNERSHIP FOR CHILD DEVELOPMENT
training. DANIDA are intending to expand to a new project in the north west of the country to
cover 83 schools over two provinces. They support in similar programmes in Ghana and Benin.
See also “Child to Child” in Kenya.
DEPARTMENT FOR INTERNATIONAL DEVELOPMENT, U.K. (DFID)
DFID do not have a current policy which refers specifically to the school aged child although they
do support a range of projects and programmes which directly benefit this group. Examples of
these are outlined below:
Support to SCF in South America for an H1V/AIDS programme which works with adolescents
within schools and a programme that supports professionals (school teachers, health workers) in
detecting and providing follow-up to individual cases of child abuse.
In Bolivia, a reproductive health project for adolescents which includes curriculum development,
development of teacher training materials and teacher training systems targeted at 13 year olds.
Also in Bolivia, DFID support a project that aims to improve the living conditions of school
children through health education as an integral part of the school curriculum. An example of this
is a project to increase awareness about Chagas disease using health education in schools as well as
radio broadcasts.
In India, DFID have been supporting a large programme in Andhra Pradesh aimed at improving the
health of school children by reorganising and strengthening existing school health services. The
programme, costing more than UKPDS 4 million over a five-year period has recently been
terminated for diverse reasons. Also in India DFID provides funding for the School Health Action
and training Programme (SeHAT) Programme and its expansion into Delhi centre (see Child to
Child and AHRTAG).
In Iraq, the rehabilitation of school facilities, water and sanitation systems and the procurement and
distribution of educational materials in order to prevent the spread of communicable diseases in the
schools.
In Kenya, HIV/AIDS prevention for the 7 - 14 year age group and a project that supports low-cost
rainwater catchment tanks for 800 schools in 8 districts with an estimated coverage of 300,000
children.
In Mozambique, DFID supports SCF to promote the integration of disabled school children into
mainstream school.
In Peru, support is given to the work of the United Nations Drug Control Programme (UNCDP) on
drug abuse prevention through primary education curriculum development and teacher training
DFID also support many countries HIV/AIDS Control Programmes that target school-aged
children.
DEUTSCHE GESELLSCHAFT FUR TECHNISCHE ZUSAMMENARBEIT
(GTZ)
GTZ, through a Multi-Sectoral Planning Group (MPG) have recently developed a Youth in
Development Cooperation concept paper (1997) which outlines their thinking on youth (defined as
12 to 18 years) as a distinct target group for development co-operation. The paper points to the
growing realisation among the donor community that the needs of children and youth have been
inadequately addressed and highlights the potential for increased programming in this area.
GTZ conducted an evaluation of Deutsche Gesellschaft fur Technishe Zusammenarbeit (GTZ TC)
projects in the child and youth sectors which provided important input and ‘lessons learnt’ for the
concept paper. The evaluation revealed that they currently implement youth-specific projects as
well as cross-sectoral approaches which include life-skills-oriented education, youth health and
nutrition, and rural youth in agriculture and community development. A relatively large number of
17
PARTNERSHIP FOR CHILD DEVELOPMENT
projects dealing with youth are in Africa. GTZ projects include various approaches to LST (for
youth in and out of school), health education and HIV/AIDS education.
NORWEGIAN AGENCY FOR DEVELOPMENT CO-OPERATION (NORAD)
NORAD does not have a particular policy focus for school-aged children but does support the
education sector in basic education. NORAD are, however, currently supporting a School Nutrition
Programme (SNP) in Sindh, Pakistan which is implemented with co-operation from the
Government of Sindh and Aga Khan University along with NGOs.
The SNP is a pilot programme that supports school feeding in schools in four rural districts.
Initiated in 1994 the programme reaches around 12,000 beneficiaries and supports the following
objectives:
•
Increase enrolment, retention and regular attendance of children in school
•
Improve the nutritional status of primary school children and their siblings
•
Improve student achievement
•
Increase parental and community awareness of the importance of child nutrition and
education
•
Explore possibilities for community involvement at the school level in improving
education and nutrition
•
Explore the possibilities for implementing SNP through NGOs.
The SNP supports participatory training for PTAs and NGOs to enable them to take increasing
responsibility for the programme and thus ensure its long-term sustainability. PTAs are responsible
for dealing with the funds, food purchasing and in some areas, food preparation. The formation
and commitment of the PTAs is viewed as a particular strength of the programme.
The SNP is being expanded into additional districts and is being considered as an approach for
replication in Nepal.
The impact of the SNP has recently been evaluated (report not yet available) which suggests that
whilst the nutritional status of children has improved along with the school enrolment and retention
rates, there has also been a decline in educational achievement. The latter may be due to the
programme demands on parents and children time.
SWEDISH INTERNATIONAL DEVELOPMENT AGENCY (SIDA)
SIDA has no special policy with respect to the health and nutrition of the school aged child but
supports basic education and education reform.
Within their education reform programme, SIDA supports, and intend to increase their support for,
curriculum development work relating to HIV/AIDS education such as the production of materials,
teacher training and the use of popular theatre media etc to reduce risk behaviour. They consider
school-based programmes to be most effective if integrated with other curriculum content i.e.
health education, social science and biology.
They are working closely with governments as well as international organisations (UNAIDS and
UNICEF) and NGOs. They also support UNESCO’s resource centre for HIV/AIDS education and
UNESCO’s regional training programme for HIV/AIDS education.
SIDA and NORAD are co-funding an African Medical Research Foundation (AMREF) project
“Regional Adolescent Sexual and Reproductive Health (ASHR) Project” with components in
Kenya, Tanzania, Uganda and Ethiopia. The project aims to “achieve an improved and maintained
health status of adolescents in the region through healthy sexual relations and behaviour, reduced
exposure to STD/HIV, unwanted pregnancy and increased access to effective services”. Youth
18
PARTNERSHIP FOR CHILD DEVELOPMENT
both in and out of school are targeted as well as service providers, teachers, parents and community
elders.
UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT (USAID)
USAID’s Africa Bureau (Office of Sustainable Development/Education) has formulated a school
health position paper that emphasises the same program elements and rationale as that of the World
Bank (see page 14). USAID’s position paper particularly emphasises that school health activities
should support education systems reform, and it emphasises community mobilisation for support of
pupil nutrition and community cost-sharing for school-based health interventions. These emphases
aim to maximise community impact of health interventions and education, and program
sustainability. USAID’s Africa Bureau is also a co-sponsor of the International School Health
Initiative based at the World Bank.
USAID support large school-based health programs that deliver health interventions such as
deworming and micronutrient supplementation across Africa. Many of these programs are in
various stages of evaluation. USAID also support smaller school health activities such as latrine
construction, community based nutrition grants, school gardens and borehole drilling within
USAID and UNICEF sponsored programmes in Africa.
Examples of these programmes in Africa include:
•
In Benin, as part of its education reform activities, USAID helped establish a local
NGO to work with parents who were asking for sanitation facilities on school grounds
for their children. Lack of gender-segregated sanitation was cited as a major barrier to
girls attending school. The NGO also delivers health and sanitation education to
schools and communities. The NGO is participating in dialogue with the Ministries of
Health and Education on formulation of a national school health policy, and the NGO
hopes to begin delivery of deworming and micronutrient services in its target schools
within a year or two.
•
In Ethiopia, USAID’s Basic Education System Overhaul program worked with
USAID’s local child survival program to integrate key community health messages
into the new elementary school curriculum. The two USAID programs also have
coordinated their community mobilisation activities so that school and health topics
are integrated at every opportunity.
•
In Uganda, community mobilisation activities of the USAID-sponsored primary
education reform incorporated messages to support student health and nutrition. One
result of community education efforts has been that children in many parts of Uganda
now take food for a mid-day meal to school. Prior to the mobilisation most children in
Uganda did not eat during the school day. This intervention has made a substantial
contribution to the improved quality of children’s classroom experience.
•
In Zambia, the Basic Education Sector Investment Program includes a school health
component. USAID/Zambia will sponsor several aspects of education systems reform
within the sector investment program, including the school health component. The
USAID school health intervention will pilot deworming and micronutrients delivery to
improve student nutrition and reduce iron deficient anaemia. It also intends to
document the benefits for improvement of cognitive capacity and learning outcomes.
•
USAID also sponsors Life Skills Training in several African vocational training
programs, including Zambia and South Africa. These programs emphasise
reproductive health and HIV education.
•
USAID/Africa Bureau also supports The Early Childhood and Readiness for
Schooling Working Group of the Association for the Development of Education in
19
PARTNERSHIP FOR CHILD DEVELOPMENT
Africa (ADEA) (based in Paris). This working group will have a focus on, among
other issues, school health interventions.
The Latin America section of USAID is also developing a policy document that will address
education and health along the lines of the Africa section document. USAID Latin America is also
currently involved in three related areas:
•
The development of a plan of action to be signed by the Ministers of Education from
25 countries to work in health and education. This is seen as significant development
and provides a mandate for a substantial area of involvement for USAID with the
respective countries.
•
In Jamaica, USAID supports a pilot project which aims to provide a holistic approach
to the problems facing around 100 schools which are located in poor areas of the
country. Approximately 15% of the resources for the pilot will be earmarked for
health and nutrition activities such as micronutrient supplementation and de-worming.
In addition, the programme will tackle the specific problems faced by boys in Jamaica
who face disadvantage in educational terms, reflected in very poor results in basic
education compared to girls from the same background and even the same families.
•
USAID support the World Bank and IADB’s education reform in Bolivia through the
provision of food aid for school feeding programmes. The aim is to assist with the
expansion of quality of education and encourage and retain school children at school.
20
PARTNERSHIP FOR CHILD DEVELOPMENT
Section IV: Non-Governmental Organisations (NGOs),
research groups and institutions.
APPROPRIATE HEALTH RESOURCES AND TECHNOLOGIES ACTION
GROUP (AHRTAG)
AHRTAG is supporting the Indian Government to implement one large programme in India that
focuses on primary schools in Delhi and Bombay called the School Health Action and Training
Project (SeHAT). This forms part of a major programme in India the “Education for All by 2000
AD” which aims to tackle low enrolment, retention and achievement levels among school children
and receives funding from UNICEF.
Initially AHRTAG and the School Health Services in Delhi ran a pilot programme in selected lowincome schools for four years, developing methods and materials for incorporating health topics
into the curriculum. These include communicable diseases, sanitation, nutrition and personal
cleanliness as well as other health-related behaviour including tobacco, safety and pollution.
Government policy informs the programme approach: a re-orientation of teaching methodology
away from traditional didactic techniques and towards child-centred, activity based teaching that
fosters informed choice and a teacher-led, curriculum oriented approach to health education in
schools.
Evaluation of the pilot found that there had been a marked increase in awareness of health issues,
up-take of programme issues such as self-care, improvements in oral hygiene and a marked
involvement by teachers and parents in the programme. SeHAT is well monitored and most
recently evaluated in 1997 (report not yet available).
Currently the programme covers 450 primary schools and aims to expand to cover additional 700
schools in the next phase. DFID and UNICEF through Education For All (EFA) have provided
funding. Lottery funding is being applied for to support the next phase.
CARE
CARE supports a range of school health and nutrition projects through its education and health
programmes. Examples of these are provided below:
•
In Thailand, the Children’s Health and Environment magazine Project produces and
distributes a cartoon-format children’s magazine that teaches primary school children
about health and environmental issues. Each edition is distributed to 31,000 schools
countrywide and is read by over 1 million students. The project also provides a
teacher’s guide and seeks to inform and motivate students so that they can positively
influence environmental practices and community health.
•
In Kenya, CARE supports health education in schools using Child to Child approaches
and school based water and sanitation clubs.
•
In Laos, CARE supports a school nutrition project which involves community based
activities for all the primary schools in 22 villages (planting fruit trees and establishing
vegetable gardens, fisheries and poultry farming).
•
In Zambia, they support peri-urban schools for children who are HIV/AIDS orphans.
CATHOLIC FUND FOR OVERSEAS DEVELOPMENT (CAFOD)
CAFOD’s current guidelines are not to support formal education. Recently, however, they are
reconsidering their policy on this as Asian and African governments are increasingly requesting
21
PARTNERSHIP FOR CHILD DEVELOPMENT
assistance in the education sector (including health and nutrition). This has prompted an analysis of
the issues in CAFOD who are currently developing a database of existing education-based
programmes.
CAFOD support a range of small programmes in Africa and Asia (usually through partners) that
affect the school age child but are not school-based. Examples include support for orphans of
AIDS victims through the provision of school fees and education materials; youth programmes
which include health components, for example HIV/AIDS education and life skills training.
CARIBBEAN FOOD & NUTRITION INSTITUTE (CFNI)
CFN1 have supported two studies relating to school aged children: Nutrition Education and the
Consumption of Fruits and Vegetables in School Children and After School Physical Activity
Programme and Academic Performance and Fitness Levels of Jamaican Adolescents.
The purpose of the first study was to determine the effect of a school-based nutrition education
programme designed for the English-speaking Caribbean region, “Project Lifestyle: Eating Right”,
on consumption of fruits and vegetables and nutrition knowledge of secondary school students in
Jamaica. Two 9th grade classes were assigned to the treatment group and two to the control group.
A food frequency questionnaire and a nutrition knowledge test were administered to all students
before and after the intervention. The results indicate that the experimental group significantly
increased their intake of fruits and vegetables and showed a significant increase in nutrition
knowledge compared to the control group.
The purpose of the second study was to determine the effects of an after-school fitness-oriented
exercise programme on the academic performance and fitness level of students in an urban
secondary school. Three 9th grade classes were assigned to the experimental group and three to
the control group. Over a one-year period, students underwent a battery of physical fitness tests and
academic tests before and after the intervention. The results indicate that the experimental group
did not exhibit a significant improvement in either fitness or academic performance. Physical
strength, however, proved to be an important predictor of academic performance in two out of the
three academic tests. Results also indicated that students as a whole spent much of their non-school
time watching television, chatting with friends and other sedentary activities.
CATHOLIC RELIEF SERVICES (CRS)
CRS currently implement or support education activities in ten countries in Africa, Asia, Latin
America and Eastern Europe. The four biggest of these are in Ghana, Burkina Faso, India and
Haiti. These are funded primarily by USAID and incorporate health, hygiene and nutrition (HHN)
school based activities. In Vietnam, CRS also support Child to Child (CtC) school based activities.
CRS collaborate with a number of donors; the World Bank provide Vitamin A and anthelminthics
for Burkina Faso; UNICEF supply Vitamin A in Haiti and the International Red Cross provide first
aid kits and some training in Haiti.
In Haiti, CRS support an expanded school-feeding programme (PROSEF) which is a five-year
programme (1996-2000) which reaches 150,000 children in 450 primary schools and covers the
Southern Peninsula of the country. School canteens provide 1,000 calories per day per child
through the provision of a mid-morning meal. This aims to increase attention span, through the
alleviation of short-term hunger, and to help increase school retention rates. The HHN element of
the programme includes quarterly distribution of vitamin A; a six monthly anthelminthics; and
extra-curricula health education activities. First aid kits are also supplied and teaching staff are
trained in their use. As far as possible the programme works through parent teacher associations.
The programme receives PL40 Title II food aid from USAID and approximately US$50,000 per
annum.
22
PARTNERSHIP FOR CHILD DEVELOPMENT
Other NGOs are implementing school-based programmes using the same model as the CRS
programme through a tripartite agreement with USAID. In effect the programme covers all 2000
primary schools in Haiti. UNICEF is also supporting smaller and more health focussed school
based programmes in Haiti, and WFP are supporting a school feeding programme.
CHILD-TO-CHILD (CTC)
CtC support child centred approaches to health education through the production of materials,
project planning, implementation and evaluation and through information management and
dissemination. More recently, the focus has included work with children in crises (refugees, street
children, the war affected and those in extreme poverty) and improving health promotion in
schools.
The school based approach is undertaken in-line with the WHO Global Initiative and emphasises
what poorer schools can realistically do to improve the health of school children within the
framework of existing resources and without the exploitation of children or the over-burdening of
the teachers.
CtC has run short courses called Planning Health Promotion in Schools and have published a book,
Health Promotion in Our Schools, which is a practical guide for those who wish to develop ‘Health
Action’ schools.
In Pakistan, a five year pilot project entitled Health Action Schools Pilot Project has been initiated
(from April 1997) to develop prototypes for ‘Health Action’ schools and is funded by the Aga
Khan Foundation and SCF UK. The project, which is located in contrasting socio-economic areas
(urban, rural and mixed urban/rural) supports the development of training and support networks for
schools endeavouring to become ‘Health Action’ schools and has an operational research
component to identify changes in health awareness, health behaviour and education performance
among the school children.
In Kenya, a CtC project is currently being implemented through which it is hoped that major policy
changes will occur, especially the inclusion of health education as a separate curriculum subject in
primary education. The programme, based on a three-year plan supports the dissemination of CtC;
training for those working for ‘Health Action’ schools, production of materials, and teacher
training in CtC. Funding is provided by DANIDA.
CHRISTIAN AID (CA)
CA projects fall into three main categories in relation to school-age children and health:
•
Educating children on health issues through the existing school system. An example
of this support is the ‘Molo Songololo’ project in South Africa which works with
school-age children on children’s rights and the promotion of equity among all races
to promote a more equal society. Molo publish a magazine that is read by more than
50,000 children and teachers. Also in South Africa, CA supports the African and
Educational Puppetry Production (AREPP) which focuses on H1V/AIDS awareness,
children’s empowerment which tackles issues around child abuse. These productions
are performed throughout SA in urban and rural schools.
In Jamaica, CA support an AIDS awareness project, which support school-based
workshops and work with youth groups. In Kenya, CA support the Kenya Tourism
Concern project which works in schools to sensitise children on the issues relating to
tourism and child prostitution.
•
Establishing alternative education establishments where health education forms part of
the curriculum. CA works in situations where the school system is inadequate (e.g.
because of political unrest, government cuts etc.) and therefore supports community
efforts to provide education and LST to children who would otherwise not receive any
23
PARTNERSHIP FOR CHILD DEVELOPMENT
education. An example of this is the S-Comer project in Jamaica that involved the
establishment of a college in a very poor area of Kingston experiencing gang violence
and a high dropout rate from schooling. The educational programme includes health
education and LST.
•
Community-based work which addresses both children’s education and health as part
of an overall community development strategy. CA support a range of community
based projects that assist children who are forced to work in the day to obtain night
time schooling (e.g. in India and Tibet) and therefore help them break away from the
destructive poverty cycle which often leads to child-labour.
DANISH BILHARZIASIS LABORATORY (DBL)
DBL is an independent research institution affiliated to the Ministry of Foreign Affairs/ DANIDA,
Denmark, and the University of Copenhagen. The core funding is from DANIDA, but a substantial
part of the research is externally funded. DBL has the double aim of strengthening research
capacity and carrying out applied research, through extensive course activities and collaborative
research projects.
DBL main activities take place in a number of sub-Saharan African countries with the main
emphasis on Uganda, Kenya, Tanzania, Zimbabwe and Ghana. The focus is on control of waterrelated, vector-bome diseases (e.g. malaria, schistosomiasis, filariasis, Guinea worm), but DBL is
also involved in broader, interdisciplinary public health initiatives, comprising studies of
deworming strategies, nutrition, health education, educational psychology and anthropology.
In terms of school health, DBL is deeply involved in school based research projects in Kenya
(Kenya-Danish Health Research Project - KEDAHR) and Tanzania (The Pangani Project). The
various projects are primarily research projects which aim at improving and developing school
health programmes rather than providing services as such. Furthermore, DBL is, or has been,
involved in school health projects in Malawi, Northern Tanzania, Eastern Uganda and the Coastal
Province of Kenya.
PARTNERSHIP FOR CHILD DEVELOPMENT (PCD)
The Partnership for Child Development is an international initiative to improve the health and
education of school-aged children by means of school-based services and research. The
Partnership has programmes and activities in Ghana, Tanzania, Indonesia, Viet Nam, India and
Colombia and contributes to the development of school health programmes in some 14 countries.
Support for the work of the Partnership comes from the United Nations Development Programme,
the Rockefeller Foundation, the Edna McConnell Clark Foundation, the James S. McDonnell
Foundation, the World Bank, UNICEF, the World Health Organisation, the British Department for
International Development and the Wellcome Trust.
PLAN INTERNATIONAL (PLAN)
PLAN has five main inter-related “Domain and Programme Principles”; Growing up Healthy,
Learning, Habitat, Livelihood and Building Relations. Ninety per-cent of PLAN funding is from
individual child sponsorship which supports an annual budget of around US$300 million.
Programmes are being implemented in around forty low income countries.
Within the five principle areas, PLAN supports the following school health programmes:
•
Broad based CtC and Child-to-Adult projects targeted at large numbers of school
children and their teachers.
•
The production of health materials for distribution at schools (for example on the
prevention and treatment of malaria, hygiene behaviour), awareness campaigns for
24
PARTNERSHIP FOR CHILD DEVELOPMENT
teachers, students, health workers and villagers on STD’s and HIV/A1DS
transmission.
•
LST strategies for children in formal and non-formal education.
SAVE THE CHILDREN FEDERATION, USA (SCF USA)
SCF USA has made the policy decision to establish school health and nutrition as a programming
priority. It supports a range of school based health programmes which have in more recent years
incorporated micronutrient supplementation and helminth infection control as well as child-centred
curriculum development.
SCF USA has mobilised private resources to enhance agency capacity and initiate (Malawi) and
plan (Mozambique and Mali) pilot programs to serve as models for school-based health and
nutrition activities which can be shared with other countries, donors and interested parties to learn
from, share ideas etc. They have successfully used this “living university” approach to expand their
nutrition programmes from small pilots to countrywide to-scale programmes. This approach should
provide them with a more systematised and structured programme that should be more open to
evaluation. In addition, at their headquarters, SCF USA have inter-sectoralised school health
allowing health and education staff to collaborate jointly on these programmes, an approach which
needs to be mirrored at county level to maximise available resources. Workshops are planned to
disseminate state-of-the-art thinking and materials and to develop plans for more focused school
health initiatives in other SCF-assisted countries. SCF actively seeks to mobilise additional private
and public sector resources to support this global initiative.
SCF USA has school based health programmes in the following countries: Bangladesh, Bolivia, El
Salvador, Egypt, Ethiopia, Haiti, Malawi, Mali, Nepal, Nicaragua, Philippines, Sudan, Thailand,
Vietnam and West Bank/Gaza.
The programmes cover a wide range of health and education promoting activities for both primary
and secondary school age children including curriculum development in health, hygiene and
nutrition education, de-worming and improvements to water supplies and sanitation and school
lunches and micronutrient supplementation. Not all programmes include all these activities for
example, in Ethiopia the focus is mainly on school rehabilitation and urban school latrines whereas
in Bangladesh and Malawi the programmes are more extensive.
SAVE THE CHILDREN FUND, UK (SCF, UK)
SCF UK’s health sector policy document (draft 7, January 1988), whilst not dealing specifically
with the school-aged child, states that “the health services of most countries have focused on very
young children whilst the health needs, roles and resources of adolescents have not received
adequate attention”.
A recent audit of SCF UK’s health programmes, shows a number of school-age child related
activities. In Nepal, SCF is supporting government schools with health education (using the CtC
approach) and with first aid training for teachers. In India, SCF UK is supporting the provision of
health care for school children <14 years with hearing difficulties. In Latin America (Honduras)
support is given for health education targeting street children and in Peru, health education (inc.
HIV/A1DS) at youth centres. In Jamaica support is provided for health education in a marginalised
youth programme and in Brazil, SCF UK is funding an AIDS awareness pilot group to get
health/AIDS/sex education into school systems.
WATER AID
Water Aid is supporting a joint venture with two small NGOs (SCOPE and CARD) in a School
Health and Hygiene Education Programme. A book of guidelines for health educators has been
produced which focuses on educating school children on a range of key hygiene messages. Water
25
PARTNERSHIP FOR CHILD DEVELOPMENT
Aid programmes in Tanzania, Southern India and Nepal support school based health education
although this is a relatively new area for the organisation. In Uganda, Water Aid is exploring
methods of working with school age children to promote hygiene but in those who do not attend
school.
WORLD VISION CANADA (WVC)
WVC has a Micronutrient and Health (MICAH) Programme currently being implemented in five
African countries: Ethiopia, Ghana, Malawi, Senegal and Tanzania. The budget for this is $25
million for phase 1 (1995-99) which is Canadian International Development Agency (CIDA)
funded. Whilst school-aged children are not the primary target of MICAH, they are targeted
through the programme activities which include health/nutrition education, Vitamin A and iron
supplementation, food based activities such as school gardens and water and sanitation
improvements at the school level.
The MICAH Programme works closely with the Ministry of Health on a national level, UNICEF
and a range of NGO’s particularly in Malawi and Ethiopia with whom programme costs are shared.
Currently no data are available on community or government contributions. In Ethiopia and Ghana
the programme is countrywide, and in the other three countries reaches 200,000 to 500,000 people.
There are plans to extend the MICAH Programme to phase 2 and to expand to Asia.
26
PARTNERSHIP FOR CHILD DEVELOPMENT
List of Contacts
NAME
TEL/EMAIL
CONTACT PERSON
Section I: United Nations Organisations, Funds and Agencies
FAO
Mr. Simmersbach
UNAIDS
Mariella Baldo
(1) 396 5705 3775
(1)212 824 6617
mbaldo@unicef.org
UNDP
Mina Mauerstein Bail
mina.mauerstein-bail@undp.org
UNESCO
Ute Meir
(1) 331 4568 2119
u.meir@unesco.org
UNFPA
Susan van der Vynckt
(1) 331 4568 0842
Mrs Luong
(1) 212 297 5241
(1) 212 297 5233
Delia Barcelona
barcelona@unfpa.org
UNICEF
(1)212 824 6324
Bruce Dick
Bdick@unicef.org
WHO
WFP
Jack Jones
(41)22 791 2582
Ilona Kickbusch
(41)22 791 1211
Rona Birrell-Weissen
(41)22 791 1211
Vivien Razmonson
(43)917 1410
Darleen Bisson
(1)396 6513 2237
Peter Dijkhuizen
IAEA
R.Parr@IAEA.org
R.M. Parr
Section II: Multilateral Finance Agencies
IADB
Gwen O’Donnell
World Bank
Donald Bundy
GWENO@IADB.ORG
dbundy@worldbank.org
Section HI: Bilateral Organisations
CIDA
Barbara Macdonald
(1)819 994 3920
BARB-MACDONALD@acdi-cida.gc.ca
DANIDA
Pia Rockhold
(1)45 3392 0161
Jens Gregerson
(1) 45 3392 0380
Jengre@um.dk
27
PARTNERSHIP FOR CHILD DEVELOPMENT
DFID
David Nabarro
Maison Rahini
Graham Larkbey
(44) 171 917 7000
d-nabarro@dfid.gtnet.gov.uk
(44) 171 917 0139
g-larkbey@dfid.gtnet.gov.uk
GTZ
Mr. Holger
NORAD
Sisil Volan
(1)47 2231 4400
SIDA
Rikard Elfving
(1)46 86985000
(1)49 619 6790
Holger.vagt@gtz.de
Rikard.elfving@sida.se
USAID
Brad Strickland
David Evans
Don Foster-Gross
Penny Nestel
(1) 703 235 4970
(1) 202 712 1328
(1) 202 712 1573
(1) 703 528 7474
Section IV: Non-Governmental Organisations, research groups and institutions
AHRTAG
Kate Harrison
(44) 171 242 0606
CARE
Michelle Kouletio
kouletio@care.org
CAFODUrsula Conlong
Steve King
(44) 171 733 7900
sking@cafod.org.uk
CFNI
Dr. Fitzroy Henry
cfni@uwimona.edu.jm
(1)410 625 2220
CRS
Jennifer Nazaire
Child-to-Child
Christine Scotchmer
Christian Aid
Margaret Brown
DBL
Jens Aagaard-Hansen
(44) 171 612 6648
(44) 171 620 4444
(45) 39 62 61 68
jah@bilharziasis.dk
child.development@ceid.ox.ac.uk
PCD
PCD
PLAN
Dr Gyado
(1)483 755155
SCF USA
David Marsh
(1)203 2214145
SCF UK
Peter Poore
(44) 171 703 5400
Water Aid
Vicky Blagborough
(44) 171 793 4500
WVC
Susan Barber
susan.barber@worldvision.org.uk
dmarsh@savechildren.org
28
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School Health ~ The World Bank in partnership with The Partnership for Child Development
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• School Health & Nutrition: A Situation Analysis - A Participatory Approach to Building
Programmes that Promote Health, Nutrition and Learning in Schools. 1999.
• School Based Health and Nutrition Programmes: Findings from a survey of donor and
agency support. Carmel Dolan, 1998.
• School Feeding Programmes: Improving effectiveness and increasing the benefit to
education. A guide for programme managers. The Partnership for Child Development,
Joy Del Rosso, consultant, 1999.
• WHO information Series on School Health (3 documents currently available)
School Health & Nutrition: A Situation Analysis - A Participatory Approach
to Building Programme F that Promote Health, Nutrition and Learning in
Schools
nliU ill■ 3
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This document has'ueeri developed'by1 fne Partnership for Child Development in collaboration with
other agencies, including UNICEF, The Edna McConnell Clark Foundation, WHO, USAID, PAHO and
The World Bank. It has been field tested in five countries in Africa. The goal of the situation analysis
described in this document is to guide the design and evaluation of school-based health and nutrition
programmes. A situation analysis can be detailed and comprehensive, but the most appropriate initial
approach is usually a low-cost, rapid survey that supplies the preliminary answers necessary for
intelligent efforts to develop or strengthen school nutrition and health programmes. The approach
outlined in this document is not exhaustive; there are likely to be particular sources and types of
information that are relevant to a given country or situation.
A situation analysis following the approach outlined here gathers information sufficient for a report
that:
• Identifies the priority health and nutrition problems of school age children;
• Quantifies school participation (enrolment, absenteeism, repetition, and drop-out rates) and
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identifies the major causes of absence from school;
• Identifies practicable, sustainable interventions that are likely to most improve children's health,
nutrition, school attendance and educational achievement;
• Identifies major gaps in, and problems with, existing school nutrition and health services, and
suggests remedies;
• Informs efforts to monitor and evaluate school nutrition and health services;
• Identifies issues requiring further investigation.
SITUATION ANALYSIS DOCUMENTS TO DOWNLOAD
A Situation Analysis has been translated into 6 languages: English, French, Spanish, Portuguese,
Kiswahili and Hindi. All of these can be opened as Word documents.
To read the Hindi text (in '6 languages' and 'Hindi'), first open Krishna Font
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DOWNLOAD - PDF FORMAT
• A Situation Analysis - 6 languages
• A Situation Analysis - English
• A Situation Analysis - French
• A Situation Analysis - Spanish
• A Situation Analysis - Portuguese
• A Situation Analysis - Kiswahili
• A Situation Analysis - Hindi
• A Situation Analysis - 6 languages
e A Situation Analysis - English
• A Situation Analysis - French
• A Situation Analysis - Spanish
• A Situation Analysis - Portuguese
• A Situation Analysis - Kiswahili
• A Situation Analysis - Hindi
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School Based Health and Nutrition Programmes: Findings from a survey of
donor and agency support. Carmel Dolan, 1998.
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About this document
• There is increasing donor interest in the health and nutrition of the school-aged child,
adolescents and youth generally. This is most apparent in the UN system but also in some of
the Bilateral Organisations and increasingly among those NGOs surveyed.
• NGOs in the UK are reporting an increase in requests from governments for support to the
formal and informal education sector and within this the health and nutrition needs of schoolaged children.
• There is a move towards inter-agency school health planning, monitoring and evaluation,
particularly in the UN. This reflects a move by the UN system and bilaterals towards a sector
wide approach to funding, and away from a project approach. This is also seen as an essential
development among other donors e.g. SCF (US).
• Those donors contacted who stated that they are not supporting school-based health and
nutrition programmes at present, indicated that they are currently considering the issue.
• In the view of donors, the PCD acts as a catalyst to promote donor commitment in the area of
school health, particularly among US based Organisations and agencies. The level of
awareness of school-health issues among UK based NGOs is not as well developed.
• Strong interest has been expressed in the school health web-site and mail list currently being
developed by PCD with the World Bank. This could provide the necessary vehicle for greater
collaboration among donors/agencies and governments to share school health related
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experiences, research, programming etc.
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School Feeding Programmes: Improving effectiveness and increasing the
benefit to education. A guide for programme managers. The Partnership for
Child Development, Joy Del Rosso, consultant, 1999.
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About this document
This guide is designed to assist those engaged in the process of creating new Schoo! Feeding
Programmes (SFPs) or seeking to improve the effectiveness of on-going ones. It is based on a review
of the SFP research and program literature from the last decade. The guidelines include:
• A brief rationale for addressing nutrition and health in schoolchildren. This section
provides the context for this guide by briefly summarizing the role that health and nutrition of
school children can play in learning.
• A summary of the potential benefits of SFPs for education. This section reviews the
research literature that provides evidence that SFPs can improve educational quality and
efficiency. References to the key literature documenting the benefits of SFPs to education are
provided. Annex 1 contains an annotated bibliography of most of the literature related to SFPs
from the last decade.
• Seven recommendations for building effective SFPs as an integral part of a package of
nutrition and health interventions for school-age children. This section is the core of the
guide, discussing the steps to take to implement the seven recommendations, which aim to
enhance the impact of SFPs on education. Program examples, both successes and failures,
are presented to assist the reader in understanding the potential advantages and caveats in
implementation. Specific data are provided on the costs and rations of actual programs to
provide a point of reference for other programs.
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WHO Information Series on School Health
Preventing HIV/AIDS/STDs and Related Discrimination: An Important Responsibility of healthPromotinq Schools
This document exhibits that HIV prevention programmes are effective in reducing the risk of HIV
infection among young people. It explains why schools must accept the responsibility to educate their
community members and work with them to determine the most appropriate and effective ways to
prevent HIV infection among young people.
Tobacco Use Prevention: An Important Entry point for the Development of a Health-Promoting
School
This paper demonstrates that tobacco use prevention programmes have a positive impact on the
health of children and adolescents and that comprehensive tobacco use prevention programmes in
schools work and effectively reduce tobacco consumption.
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Violence Prevention: An Important Element of a health-promoting School
This document explains how violence affects the well being and learning potential of millions of
children around the world. It provides interventions that can reduce violence through schools.
If you have any problems opening these documents, please contact: celia.maier(a)ceid.ox,ac.uk
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http://www.ceid.ox.ac.uk/schoolhealth/download%20documents.htm
11-May-2000
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The New Challenge
We expect schools to be places of learning. We expect invest
benefits to individuals, communities, and nations. Schootslt
to socud and economic development, increased proadc
if '.f?lifefor all. In many parts of the world, same schools are\n
even more could be achieved if all schools could promote the
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. .- people as acdvely as they promote learning.
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For healthpromotion to be treated as an equal
resource. If we nurture their development, their
priority, policymakers, community leaders,
potential to create a better world is great.
teachers, parents, and students will need to be
When the world focused on child survival, we
all learned how to help children survive beyontf
tributes to the overall goals and purposes of the
school. They heed information about how health
promotion through schools can increase the
return on investments in education. To learn
effectively, and benefit from the investments in
education, children must be healthy, able to con
centrate, and attend school regularly. People in
countries around the world also need to know
whalt steps they can take to create health pro-
moting schools.
birth.Now it is time to focus on developing
children’s and adolescents’ minds and bodies.
Today, we know that promoting health through
schools is one of the most efficient arid effective
ways to improve our children’s lives. We, as edu
cators, parents, policymakers, and concerned
community members, know that by creating
“health promoting schools,” we can advance both
education and health. It is the next step toward
making our dream a reality. This document
More’children thanever are attending school.
describes why this step is practical, why we
In the developing world, more than 70% of chil
should take it, and how we can do it together.
dren complete at least four years of school. There
are now one billion young people between the
ages of 10 and 19. The vast majority, 84%, live in
developing countries. In only six years, there will
be 2 billion teenagers on the planet—more than
there have ever been in history. They will live
mostly in Africa, Asia, and Latin America, but
they will be every country’s most precious
This document provides a summary of that
information. It includes recommendations to
help individuals at all levels foster the develop
ment of health promoting schools. The recom
mendations are based on the findings of the
WHO Expert Committee on Comprehensive
School Health Promotion and Education, which
met in Geneva, Switzerland, in September 1995.
Every school can promote health and contribute to a strong and sustainable future for its
community and its nation. Working together, as individual parents, teachers, comrnunity
leaders, government officials, and representatives of international agencies, we can increase
the number of health promoting schools in every country. As tve succeed, everyone benefits.
WHO Global School Health Initiative
What Is Education?
What Is Health?
People sometimes think of education as the
accumulation of facts and basic skills. They
sometimes think of health as the opposite of
illness. But education and health are broader,
richer concepts—and they are inseparably linked.
Education is about learning. It is about the abil
ity. to combine knowledge, attitudes, and skills
and use that strength to shape one’s life and con
tribute to the lives of others. Throughout the
world, a higher level of education often allows
people to have better jobs, lead healthier lives,
and contribute to family and community well
being. Indeed, as noted in WHO’s Constitution
and restated in the Ottawa Charter on Health
Promotion (1986), education is a prerequisite
for health.
As defined by WHO and accepted broadly
throughout the world, health is a state of complete physical, mental, and social
well-being. The Ottawa Charter (1986) recognizes that, “Health is created and
lived by people within the settings of their everyday life; where they learn,
work, play and love. Health is created by caring for oneself and others, by being
able to make decisions and have control over one’s life circumstances, and by
ensuring that the society one lives in creates conditions that allow the attain
ment of health by all its members.”
In almost every community, the school is a setting in which many people live,
learn, and work. It is a place where students and staff spend a great portion of their
time. It is a place where education and health programmes can have their greatest
impact because they can reach students at influential
stages in their lives—childhood and adolescence.
Thus, schools are not merely one of the institutions and
settings in which health can be created, but are among
the most important. Because we know much about the
relationship between education and health, we can use
that knowledge to help create health promoting schools,
tvhich improve education and learning potential as they
improve health. Here is why.
WHO
Good Health Supports Successful Learning
We know that healthy children learn well. If young people are healthy, they can
take full advantage of every opportunity to learn.
We also know a child’s ability to attend school is affected by health. Health and
health-related conditions—such as illness among children and their families, the
lack of hygienic and sanitary conditions in the school, and fear of violence or
abuse en route to school or at school—all of these factors can prevent children
from being enrolled in school or reduce their attendance, thus reducing the value
of investments in education.
Successful Learning Supports Health
We know that simply by attending school, children’s health is improved.
Mothers with even one year of schooling tend to take better care of their babies.
They are more likely to seek medical care for their children and to have their
children immttnized.
We know that investments in education yield benefits by improving maternal
and child health. In developing countries, as the literacy rate improves, fertility
rates tend to decline. Literate women tend to marry later and are more likely to
use family planning methods to space their children, protecting their own health
and that of their babies.
Schools can make it possible for children and adolescents to gain the knowledge,
attitudes, values, skills, and services they need to be healthy and to avoid important
health problems. The promotion of healthy lifestyles can contribute to children’s
and adolescents' health now and in their lives as adults, enabling them to con
tribute to their communities and nations now and in the future.
2 WHO Global School Health Initiative
Important public health problems common to all countries, such as HIV/AIDS:
injuries caused by violence; and the effects of using tobacco, alcohol, and other
drugs, are preventable through education and other school-based interventions.
Important health problems of developing countries, such as schistosomiasis, other
helminth infections, nutritional deficiencies, and vaccine-preventable diseases can
be prevented, reduced, or controlled through efficient and cost-effective school
based treatments and education. Schools can also contribute to improved health
among children and staff by referring them to services at local health institutions.
Thus, through prevention, treatment, and referral, schools influence many of the
health problems that affect learning as well as health.
Even how a school is organised—its policies, physical and social environment,
curricula, teaching and learning styles, examinations, and the ways in which
students are engaged in their own education—can promote or discourage health.
Thus, investments in both education and health are compromised unless a school
is a healthy place in which to live, learn, and work.
Finally, we know that there are too few safe places for children today. Many chil
dren live and suffer through physical, social, or cultural conditions that jeopardize
their physical safety, emotional health, or security. For much of the day, a school
can provide safety and security, if it is a healthy place, as well as a place of learning.
Education and Health
Are inseparable
If we nurture the health, hopes, and skills of children
and teenagers, their potential to improve the ivorld is
unbounded. Ij they are healthy, they can take the best
advantage of every opportunity to learn. If children are
educated, they can live fulfilled lives and contribute to
building a future for everyone.
The extent to which each nation's schools become
health promoting schools will play a significant role in
determining whether the next generation is educated and
healthy. Education and health support and enhance each
other. Neither is possible alone. Together, they serve as the
foundation for a better world.
Health Promoting Schools:
Foundation for a Better World
Every school is different. From country to country, and even within different
regions and communities of one country, each school has its own strengths. But by
building on those strengths and harnessing the imaginations of students, parents,
teachers, and administrators, every school can become a health promoting school.
And every health promoting school can respond to the challenge to improve and
support the education and health of students and the health of staff. By fostering
health and learning with all of the measures at its disposal, every health promoting
school is a building block in the foundation for a better world.
To do so, a health promoting school must be more than a collection of
different programmes and services. It must be an organism, a living thing ,<
in which all of the parts work together.
How Does a Health Promoting School
Accomplish Its Goals?
A "health promoting" school:
Fosters health and learning with all the measures at its disposal.
Engages health and education officials, teachers, students, parents, and
community leaders in efforts to promote health.
Strives to provide a healthy environment, school health education,
and school health services along with school/community projects and
outreach, health promotion programmes for staff, nutrition and food safety .
programmes, opportunities for physical education and recreation, and
programmes for counseling, social support, and mental health promotion.
Implements policies, practices, and other measures that respect an
individual's self-esteem, provide multiple opportunities for success, and
acknowledge good efforts and intentions as well as personal achievements.
Strives to improve the health of school personnel, families, and community
members as well as students, and works with community leaders to help
them understand how the community contributes to health and education.
For all schools to become health promoting schools, a variety of supportive actions
are required by organizations at various levels. No organisation or sector can meet
these requirements alone. We must take these steps together.
In September 1995, WHO convened an Expert Committee Meeting on
Comprehensive School Health Education and Promotion to encourage education and
health institutions and other agencies and individuals to support health promotion
through schools. WHO charged the Committee to make recommendations on policy
and action steps that should be taken at the local, national, and international levels
to help schools become health promoting schools.
The Committee reviewed research from both developing and developed countries
and noted that, without question, promoting health through schools “could simulta
neously reduce common health problems; increase the efficiency of the education system;
and thus advance public health, education, social and economic development'1 in all
nations. The committee agreed that a rich base of knowledge exists on which to
act now.
The Committee's recommendations are made with the recognition that:
an investment in education is an investment in health
the health of children significantly affects their ability to Jearn
schools can be health promoting environments only if they are healthy organizations
On the following pages, the full text of each of the WHO Expert Committee’s
recommendations is presented in red. Each recommendation is accompanied by
information that individuals and organizations can use in advocating for school
health programmes.
WHO Global School Health Initiative
5
Investment inlschooling must be
Ln 1
improved and expanded.
Education is a fundamental
human right. Therefore, every
Member State must provide edu
cation in schools that meets the
full range of children’s learning
and developmental needs, and
should extend education to chil
dren ivho are not receiving
schooling, including those ivho
have physical or mental impair
ments.
Article 26 of the Universal
Declaration of Human Rights
(1948) specifies that, “Everyone
has the right to education.
Education shall be free, at least
in the elementary and funda
mental stages.”
Although much work remains
to be done, the nations of the
world have made great strides
in increasing the number of
children who attend at least the
lower grades of school.
According to UNESCO’s World
Education Report 1995, over a
billion young people are
involved in formal education
(in all grades) today. But nearly
145 million 6- to 11-year-old
children remain out of school.
6 WHO Global School Health Ini11a
Many obstacles prevent
children from attending school:
poverty, lack of transportation,
or parental attitudes. Perhaps
among the most tragic cases are
those children whose physical or
mental disabilities currently pre
vent them from attending or
benefiting from schppl. With the
success of child survival pro
grammes, many children who
might have died from polio and
other diseases are living,
although still suffering from phys
ical disabilities. With the increas
ing success of the WHO Global
Immunization Programme, polio
may well be eradicated in the
next century. But other problems
persist:
• In 1990, iodine deficiency
killed 60,000 infants; the
120,000 children who
survived are afflicted with
cretinism. Progress is being
made, but the problem
persists.
• In 1990, 250,000 children
died within their first year as
a result of Vitamin A defi
ciency; many of the 250,000
who survived will never see
again. Progress is being made,
but the problem persists.
• The vast fields of buried
landmines in every region of
the world are daily creating a
new generation of disabled
children. Little progress has
been made either to remove
existing landmines or pre
vent their further use. (The
U.S. Department of State
has conservatively estimated
that there are at least 85-90
million unexploded land
mines distributed across
more than 60 countries.)
Each of the disabilities resulting
from these problems greatly
reduces the likelihood that a
child will be sent to school. But
Article 23 of the Convention on
the Rights of the Child (1989) is
very clear:
[A] mentally or physically dis
abled child should enjoy a full
and decent life, in conditions
which ensure dignity, promote
self-reliance and facilitate the
child’s active participation in
the community.
The full educational participation
of girls must be expanded.
Full participation and a dignified,
decent life require education. To
provide that education, schools
must be accessible to, and appropri
ate for, children with disabilities.
Educational programmes should
take into account both the specific
developmental needs of disabled
students and the common develop
mental needs of all students.
Even when children are able
to attend school, the investment
made to enroll them will be wasted
unless schools have the basic
resources to provide a safe environ
ment and a developmentally
appropriate and intellectually
challenging education. Making it
possible for all children to attend
school is critical, but not sufficient
for investments in education to
yield the greatest possible benefits.
Once the children arrive, they
must be met by teachers who are
well-trained, healthy, and sup
ported in their professional tasks.
Throughout the world, many
schools aspire to meet these
needs, but many need help to
do so.
The enrollment and retention
of girls in school lag signifi
cantly behind those of boys.
Improving and expanding edu
cational opportunities for girls
is one of the best health and
social investments a country
can make. Every Member
State and community must
strive to break down the social,
cultural, and economic barriers
to the education of girls.
Improving the health and
education of girls is a special
challenge. Even as the total
number of children in school
continues to grow, the education
of girls lags behind that of boys.
The imbalance between boys
and girls attending school is
dramatic. While one-sixth of 6- to
11-year-old boys is not in school,
one quarter of 6- to 11 -year-old
girls is being denied an education
and the benefits it confers.
A basic human right is at stake.
As numerous international dec
larations and conventions affirm,
girls and boys have equal rights
to health and education.
Girls benefit from education
just as boys do—their health
and ability to learn improves.
But everyone else benefits as
well when girls are educated.
Educated girls choose to bear
children later, seek prenatal
care earlier, and give birth to
healthier babies.
A child’s chance to be healthy
improves if both parents, but
especially the mother, are
educated. The research is
unequivocal: the single most
important factor in determining
a child's health is its mother’s
level of education. For example:
• Many national reports state
that the more years of edu
cation a female receives, the
more likely it is that her
children will survive the first
five years of life.
• Data from I 3 African coun
tries between 1975—85 show
that a 10 percent increase
in female literacy rates was
accompanied by a 10 percent
reduction in child deaths.
• In Peru, seven or more years
of schooling lor girls reduced
children's mortality risks by
75 percent.
Education also increases access
to better jobs for women, just as
it does for men. As countries
seek to achieve sustainable
development, they can ill-afford
to waste any of their precious
resources. We must be deter
mined, in the words of the
Beijing Declaration (1995), to:
Promote people-centered sus
tainable development, including
sustained economic growth,
through the provision of basic
education, life-long education,
literacy and training, and pri
mary health care for girls
and women.
WHO Global School Health Initiative
7
Every school must provide a safe
Every school mtis&enable children
learning environment for students
and adolescentSMpW'le\-els to learn
and a safe workplace for staff.
critical health and life skills.
Too often the school environ
ment itself can threaten physical
and emotional health.
The school environment must:
>- provide safe water and
sanitary facilities;
>- protect from infectious
diseases;
>- protect from discrimination,
harassment, abuse, and
violence;
>- reject the use of tobacco,
alcohol, and illicit drags.
Students and staff cannot prac
tice healthy behaviours and pro
tect themselves from disease if a
school does not provide clean
water and functioning latrines.
The absence of such essentials
can even further reduce the par
ticipation of girls during the days
of the month when they are
menstruating because they can
not wash or care for themselves
in privacy.
Injuries are a major cause of
death and harm to children and
adolescents. Studies in Europe,
North America, and other
regions indicate that schools are
an important place in which
those injuries occur. Falls, sports
injuries, and injuries related to
fighting are common.
• In the United States, 22 mil
lion children are injured
each year; 10% to 25% of
the injuries occur in or
around schools.
• In the United Kingdom,
one child in 50 is treated
8
for a school-based injury
each year.
• In Tasmania, Australia, onethird of childhood injuries
occurred in school.
Discrimination, harassment,
and physical or sexual abuse
affect access to schookand the
quality of children’s health and
education. One reason often
given by parents for refusing to
send their daughters to school
at all is either their knowledge
(or fear) that they could be
physically or sexually abused by
staff or male students.
Finally, schools have the
power not only to teach healthy
behaviours but to support or
undermine them. A school that
teaches tobacco use prevention
must also prohibit smoking by
staff in or near the school
grounds. A school that teaches
about good nutrition should also
provide nutritious food.
WHO Global School Health Initiative
Such education includes:
>- focused, developmentally
app ro p riate, skills - b as e d
health education in topics
such as infectious diseases,
nutrition, preventive health
care, and reproductive
health;
comprehensive, integrated,
life skills education that can
enable children to make
healthy choices and adopt
healthy behaviour through
out their lives;
>- health education that
enables young people to
protect the xcell-being of
the families for which they
ivill eventually become
responsible and the commu
nities in which they reside.
Research about the healthy
development of children and
adolescents and the health
risks they face has identified
the keys to making successful
and efficient school health
programmes possible. Students
who are at risk of engaging in
one unhealthy behaviour (such
as smoking tobacco, early sexual
behaviour, or violence) are often
at high risk of engaging in others
as well. Similarly, the positive
actions that can protect them
from harm (such as the ability- to
communicate with parents, to
assess risks realistically, and to
resist peer pressure) apply not
just to one risk, but to many.
This fact makes it possible for
health programmes to address
underlying life skills that can
determine risk or protection.
Life skills education focuses on
the combination of psychological
and social factors that contribute
to healthy behaviour. These
are the skills—communication,
decision-making, conflict
resolution, critical thinking—
that permit children to avoid
unhealthy behaviours in the
present and maintain healthful
ones as they grow into adulthood.
Life skills education has been
implemented in many schools
with positive results both for the
health and educational achieve
ment of students. For example,
the effect of such education on
reducing tobacco and other drug
use, on decreasing fighting
among adolescents, and on
improving students’ self-esteem
and overall mental health status
have all been documented.
Every school must more effectively serve
as an entry point fohhealth promotion
and a location for health intervention.
Schools should prevent when
possible, treat when effective,
and refer tvhen necessary the
common health problems of
children and staff.
They should:
>- provide safe and nutritious
food and micronutrients to
combat hunger, prevent dis
ease, and foster growth and
development;
establish prevention pro
grammes to reduce the use
of tobacco, alcohol, and
illicit drugs, and behaviour
that promotes the spread of
HIV infection;
>* treat when possible
helminth, malarial, skin
and respiratory infections,
as ivell as other infectious
diseases;
>- identify
*
and treat when pos
sible oral health, vision, and
hearing problems;
>- identify psychological prob
lems and refer those affected
for appropriate treatment.
The World Declaration on
Education for All (1990) notes,
“Learning does not take place
in isolation. Societies must
ensure that all learners receive
the nutrition, health care, and
general physical and emotional
support they need in order to
participate actively in and bene
fit from their education.” Thus,
a school that provides a safe
environment for learning, that
gives its students the opportunity'
to leam and practice life skills
that will enable them to make
healthy decisions, must also
serve as a location (or referral
point) for prevention and inter
vention services if it is to be a
health promoting school in the
fullest sense.
In fact, it is precisely because
schools are so well-positioned to
carry out this third role that they
can provide such an efficient and
cost-effective component of a
community’s healthcare system.
Researchers from the World
Bank, the Partnership for Child
Development, WHO, UNICEF,
and other agencies have con
cluded that delivering health and
nutrition interventions in schools
(to provide supplementary food
and specific nutrients such as
iodine or vitamin A; to give
drugs to prevent or treat infec
tions; or to screen for hearing,
vision, dental, psychological, and
other problems) can prove to be
a very high-yield investment.
Researchers at UNESCO, the
UN Development Programme,
and other agencies have
documented the positive effects
that addressing such problems
can have on children’s ability
to leam.
The prevention role of the
health promoting school is par
ticularly important in building
a sustainable future for our
teenagers. For example:
• Nearly one quarter of people
with AIDS are in their 20s.
Many became infected in
their teenage years. In combi
nation with other prevention
programmes, the health
promoting school can help to
change the future. Otherwise,
by the year 2000, 26 million
people will have AIDS or be
HIV positive. Two million of
them will die each year.
• Injuries are one of the major
causes of death and disability
among the young in countries
at all stages of development.
Through the efforts of health
promoting schools we can
reverse the rate of injury,
which now continues to grow.
• In many countries adolescents
are the fastest growing group
of new smokers. Unless we
strengthen our efforts for
prevention, and help those
teenagers who already smoke
to quit, in 30 years more
deaths in the developing world
will be caused by tobacco
than by AIDS, tuberculosis,
and the complications of
childbirth combined.
WHO Global School Health Initiative
9
Policies, legislatignrtind guidelines
Teachers and school staff must be
must be de\’el<|p^d':tb.ensiire the iden
tification, allocation, mobilization, and
properly valued and provided with the
/
necessary support to enable them to
coordination of resources at the local,
promote health.
national, and international levels to
This support includes:
- c/
support school health.
This support includes:
>- helping decisionmakers and
the public to understand
that schools could provide the
most cost-effective means to
improve the health of children
and thus to advance social
and economic development;
>" fostering active collaboration
between the health and
education ministries;
>- developing school health
committees and networks
that include representatives
of government agencies
(such as transport, planning.
agriculture, and physical
exercise and sport) and non
governmental organizations
who can contribute expertise
and resources necessary to
improve comprehensive
school health, programmes;
just three of rhe major risks and
determined chat:
• Money spent on preventing
the use of tobacco was worth
19 times as much as money
spent treating the conse
quences of that behaviour.
• Money spent on preventing
alcohol and drug abuse was
worth 6 rimes as much as
money spent on creating the
consequences cjf chat behaviour.
• Money spent on education to
prevent early and unprotected
sex was worth 5 times as much
as money spent on the conse
quences of that behaviour.
>■ identifying, training, and
developing qualified staff
at the national and local
levels;
’>■ establishing clear lines of
responsibility and account
ability for comprehensive
school health programmes.
Well-organized and coordinated
school health programmes, deliv
ered through health promoting
schools, can be among the most
efficient and cost-effective ways
to improve both education and
health. For example, one recent
study looked at the relative value
of such school-based health
promotion activities in preventing
10 WHO Global School Health Initiative
providing the resources to
train and enable existing
teachers, school staff, and
school administrators to
address the health and edu
cational needs of students;
>- involving universities,
teacher-training colleges, and
relevant nongovernmental
organizations in preparing
new teachers, school staff,
and school administrators
to promote the health of
children and adolescents;
>- providing opportunities
and facilities for teachers,
school staff, and school
administrators to improve
their own health.
For example, the Teacher
Empowerment Project in India
brings educators together for
seminars in which they share
their experiences, leam skills,
and create new learning materials
and strategies. Beginning in 23
of Madhya Pradesh stare’s school
districts, die project now includes
the state’s 45 districts and 77.CCO
schools. As a result, teachers report
feeling greater empowerment,
participation, and satisfaction.
And there have been dramatic
improvements in student atten
dance and learning achievement.
In other studies, health
promotion programmes for school
staff have decreased teacher
absenteeism as well as that of
students. And one programme for
school staff in the United States
demonstrated reductions in such
important indicators of good
health as weight, heart rate, blood
pressure, and cholesterol level.
The community apTthe school must work
together to support health and education.
Families, conununity members,
health service agencies, and
other institutions have an
important role to play in
improving the health of young
people. At the same time, the
school can play an important
role in improving the health of
the community as a ivhole.
Such roles include:
>■ advocacy and support by the
community for the develop
ment of the school as a
healthy organization;
active consultation and col
laboration among families,
the comnumity, and the
school to improve the health
of children and adolescents
who attend school, as well
as those tvho do not;
>■ active participation by the
school and its students in
programmes to improve the
health and development of
the entire community.
The Ottawa Charter recognizes
that, “Health promotion works
through concrete and effective
community action in setting
priorities, making decisions,
planning strategies and imple
menting them to achieve better
health. ...This requires full
and continuous access to infor
mation, learning opportunities
for health, as well as funding
support.” The health promoting
school must be a participant in
this process and can be one of its
beneficiaries as well.
Students and staff benefit when
the community makes the cre
ation and support of health pro
moting schools one of its prior
ity strategies for achieving better
health. Health promoting
schools participate when they
make their resources available to
the community as a whole. For
example, in many communities,
schools have organized health
fairs. Parents, students, teachers,
and other community members
come together to spend an
enjoyable afternoon learning
about health and about the
availability of preventive ser
vices. Often such fairs are used
by community health educators
and health care providers to
screen for important and treat
able health conditions, such as
high blood pressure or the need
for glasses.
WHO’s Adolescent Health
Programme has developed a
number of strategies to build
community participation and
support:
The Grid Approach—a oneweek workshop that enables
participants to use a grid to iden
tify health problems, examine
existing responses, and identify
actions to reduce the gaps
between the two.
The Gatekeeper Method—
a process used to solicit the
opinions, support, and recom
mendations of “gatekeepers.”
These practitioners working in
the field can be asked about
problems, how to handle them,
how they react to suggested
plans or reforms, and who else
should be interviewed.
Drama as a Research Tool—
a method to engage students
and key adults in the community
in discussion and decision
making after seeing a student
performance on a key topic.
By providing a shared experience
to stimulate audience reaction,
dialogue is stimulated.
The Narrative Research
Method—a tool employed for
studying behaviour patterns of
young people, by young people,
through the development and
testing in the community of
prototypical stories.
WHO Global School Health Initi.
School health programmes must
International support must be further
be well-designed, monitored, and
’■Hi the ability
developed to enhance'
evaluated to ensure their successful
of Member States, local communities,
implementation and outcomes.
and schools to promote health
These actions include:
5* developing or adopting in
each Member State the
most appropriate and afford
able methods to collect data
about children’s health,
education, and living condi
tions, by age-group and sex;
>• emphasizing, whenever
possible, research that
draws on the knowledge
and skills of local educators,
students, families, and
community members;
If we carefully document what
school health programmes do
and evaluate their achievements,
we will leam which approaches
work best and under what
circumstances. As we come to
know more about such "promis
ing practices,” we c?n turn our
attention to how they can be
adapted best for a broad range of
communities and cultures.
>- developing methods for
the rapid analysis, dissemi
nation, and utilization of
data at the local level,
where they can have the
greatest impact.
We now know a great deal
about the health and education
needs of school-age children.
We have learned much, too,
about how to meet those needs
through health promoting
schools. There are still important
research questions to be
answered (e.g., what are the pre
cise relationships among specific
nutritional deficiencies and spe
cific learning problems; what is
the lowest, most cost-effective
dose of anti-helminthic drugs
that will prevent infections;
what is the extent to which
schools promote health; what
is the extent to which students
and others receive health pro
motion information through
schools), but we are well-poised
to implement and evaluate
programmes now'.
12 WHO Global School Health Initiative
and education.
Such support includes:
>• developing a global school
health initiative, with con
certed action by organiza
tions such as WHO,
UNESCO, UNICEF,
UNFPA, the World Bank,
the World Food Programme,
Education International,
the International Union for
Health Promotion and
Education, and others;
coordinating among international organizations and
Member States to share
efforts, reduce fragmentation
and duplication of effort, and
establish a broad vision of
comprehensive and integrated
school health programmes.
A wise and experienced gov
ernment leader once said that,
“All politics is local." Similarly,
investments in school health
programmes will only be fully
realized if they make it possible
for educators, parents, students,
and members of their communi
ties to create local health
promoting schools. But, in order
for this to happen, the develop
ment of health promoting
schools must be supported at
every level: local; district, state,
or provincial; national; regional;
and international.
There is a need for partnerships
at every level and among levels.
There is a need for communica
tions systems that will encourage
dissemination of the best knowl- (
edge and experience within and
across levels. But these systems can
only succeed when individuals
within them have:
• A passion to promote health
through schools.
• Authority and responsibility
to develop plans and imple
ment activities.
• Sufficient time and other
resources to make their goals
and objectives practical.
• A commitment to work in
partnership with others to
improve education and health.
Finally, these individuals must
be charged with working
together to develop efficient anc|
flexible mechanisms for planning
and implementing programmes.
When they do so, when they
carefully document their
achievements and evaluate the
results, we will travel far along
the road to success.
The time has never been better,
nor the need more important.
Developing a Global School Health Initiative
A Call to Action
The WHO Expert Committee on Comprehensive School Health Education and
Promotion urges all people to imagine:
A future in which schools in every nation have the healthy development of
'
all c hildren as an essential part of their core mission.
A world where schools take on this challenge and implement new and
exciting ways to coordinate the educational process, the environmental conditions
within and outside the school, and the range of available health services to enhance
the educational achievement and health of young people.
I
Indeed, the recommendations of the WHO Expert
Committee, if implemented, could attain that vision and
could make a significant contribution towards achieving
the major goals established by the Health for All by the
Year 2000 and Education for All movements, as well as The
Children’s Summit, New York, 1990; The Social Summit,
Copenhagen, 1995; and The Fourth World Conference on
Women, Beijing, 1995.
Therefore, the Expert Committee calls on all Member
States, relevant international organisations, relevant
nongovernmental organizations, and schools around the world
to develop and implement plans for achieving these recommen
dations, in order to develop more fully the potential of
successive generations.
• .
A Strong Foundation on Which to Build
Promoting the health of children through schools has been an
important goal of WHO, UNESCO, UNICEF, and other inter
national agencies since the 1950s. Since the 1980s, WHO’s work
in school health has steadily increased. In May 1994, WHO’s
commitment and support for school health was further enhanced when the
Director-General of WHO created the Division of Health Promotion, Education
and Communication (HPR).
The new Division was charged with strengthening WHO’s capacities to promote
health through schools. Many divisions within WHO, including its regional
offices, provide technical support for a wide range of school-based health promo
tion. health education, and disease and injury prevention efforts.
WHO Global School Health Initiative
13
The support of many WHO programmes is needed to foster the development of
integrated and comprehensive approaches to school health. Thus, the Division
established a School Health Team as part of its Health Education and Health
Promotion Unit, to serve as the secretariat for an inter-divisional Working
Group on School Health. Through the team, the working group, and its regional
offices, WHO is committing its full organizational capacity toward the develop
ment of a Global School Health Initiative.
The WHO Global School Health Initiative is designed to improve the health of
students, school personnel, families, and other members of the community
through schools. Its objective is to increase the number of schools that are health
promoting schools. It is built on a strong foundation of past actions:
■
1985
The WHO/UNICEF International Consultation on Health Education for
School-age Children
. ■ .
1987
Publication of The Comprehensive School Health Programme. Exploring an
Expanded Concept (The Journal of School Health, USA)
1988
WHO Regional Office for the Eastern Mediterranean (WHO/EMRO) develops
Action-Oriented School Health Curriculum
•’
1989-95
The US Centers for Disease Control and Prevention supports the
Comprehensive School Health Education Network, which trains 350,000
teachers across the country
1990
WHO establishes a Collaborating Center of Health Promotion and Education
for School-age Children at the Division of Adolescent and School Health, US
Centers for Disease Control and Prevention
1991
Joint WHO/UNESCO/UNICEF meeting on Comprehensive School Health
Education (and the publication of Guidelines for Action)
1991
WHO Regional Office for Europe (WHO/EURO) pilots Health Promoting
Schools projects in Hungary, Czech Republic, Slovak Republic, and Poland
1992
The European Network of Health Promoting Schools (ENHPS) is founded
by WHO/EURO, the Council of Europe, and the Commission of the
European Communities
1992
WHO Regional Office for Southeast Asia (WHO/SEARO) develops Guidelines for
Implementing and Strengthening Comprehensive School Health Education
1993
The World Bank's World Development Report. Investing in Health confirms
the value of school health programmes
1994-95
WHO Regional Office for the Western Pacific (WHO/WPRO) holds school health
promotion workshops in Australia, Singapore, Fiji (with more planned for
1996), and establishes two Regional Networks of Health Promoting Schools
1995
WHO Expert Committee on Comprehensive School Health Education
and Promotion
1995
WHO/UNESCO/Education International Global Conference on School Health
and HIV Prevention in Harare, Zimbabwe
1996
WHO Regional Office for the Americas (WHO/AMRO), WHO/HQ, Bolivia, Costa
Rica, and Education Development Center, Inc. develop and pilot a Rapid
Assessment and Action Planning Tool for countries to examine their ability to
promote health through schools
1996
WHO Regional Office for the Americas (WHO/AMRO) and the WHO Regional
Office for Africa (WHO/AFRO) begin development of regional plans for health
promoting schools
14 WHO Global School Health Initiative
This is but the beginning. As the Global School Health Initiative advances,
WHO will continue to work in partnership with other organizations,
governments, and individuals to: .
• Revitalize and enhance worldwide support for promoting health
through schools.
• Build on research and experience worldwide, and particularly on
international, national, and local efforts to help schools become
health promoting schools.
• Provide an impetus for mobilizing and strengthening school health.
Enable organizations to maximize the use of their resources.
• Unite the diverse school health initiatives of the United Nations family.
Provide full partnership to all organizations involved.
WHO Global Si i':• »i Health Initiative
15
The WHO Expert Committee on Comprehensive School Health
Education and Promotion:
Ms. I. Capoor, Director, Centre for Health Education Training and Nutrition
Awareness, Ahmedabad, India
Dr. D. Hopkins, Institute of Education, University of Cambridge, Cambridge, England
Dr. L. J. Kolbe, Director, Division of Adolescent and School Health, National Center
for Chronic Disease Prevention and Health Promotion, Centers for Disease Control
and Prevention, Atlanta, GA, USA (Chairperson)
Dr. D. O. Nyamwaya, Director, Health Behaviour and Education Department, African
Medical and Research Foundation, Nairobi, Kenya
Mrs. K. Sanguor, National Coordinator for School Health and Environment
Education, Ministry of Education, Manama, Bahrain
Dr. Ye Guang-Jun, Director, Institute of Child and Adolescent Health, Beijing
Medical University, Beijing, China
The following Expert Committee documents are available from WHO (HPR/HEP).
Promoting Health Through Schools. Report of the WHO Expert Committee on Comprehensive School Health Education and Promotion,
Geneva, 18-22 September 1995.
The Status of School Health (WHO/HPR/HEP/96.1)
Improving School Health Programmes. Barriers and Strategies (WHO/HPR/HEP/96.2)
Research to Improve the Implementation and Effectiveness of School Health Programmes (WHO/HPR/HEP/96.3)
This document was prepared by Stu Cohen, Deputy Director, Health and Human Development Programs (HHDP) at Education Development
Center, Inc. (EDC) and Cheryl Vince-Whitman, Senior Vice-President (EDC) and Director (HHDP), working In collaboration with
WHO/HPR/HEP staff: Dr. Ilona Kickbusch, Director, Division of Health Promotion, Education, and Communication (HPR);
Dr. Desmond O'Byrne, Chief, Health Promotion and Health Education Unit (HPR/HEP); Mr. Jack T. Jones, School Health Team Leader (HPR/HEP);
and Dr. Yu Sen-Hai, Health Education Specialist (HPR/HEP).
Design by Cambridge Graphics, Cambridge, Massachusetts, USA
Photographs from the WHO Archives and by Harry Anenden and Gillian Cohen
I
he Global School Health Initiative is founded on partnerships
both within and outside WHO, and fosters new partnerships among
organizations with capacities, constituencies,- and experience that can
the world’s schools become institutions, for health
education
WHO gratefully acknowledges the generous financial contributions to support the publication
of this document from the following organizations:
• Division of Adolescent and School Health
National Center for Chronic Disease Prevention and Health Promotion
Centers for Disease Control and Prevention
Atlanta, Georgia, USA
• Johann Jacobs Foundation
Zurich, Switzerland
• Johnson and Johnson European Philanthropy Committee
Kent, United Kingdom
, '•
Organizations wishing to contribute to the work of WHO by supporting the Global School
Health Initiative and anyone desiring further information about the Initiative or the WHO
Expert Committee on Comprehensive School Health Education and Promotion should contact
Dr. Desmond O'Byrne, Chief, Health Education and Health Promotion Unit (HEP),
Division of Health Promotion, Education and Communication (HPR), WHO, Geneva,
Telephone. (41 22) 791 25 78; FAX. (41 22) 791 07 46.
©World Health Organization 1996
y
This document is not issued to the general public, and all rights are reserved by the World Health Organization (WHO). The document may not be reviewed,
abstracted, quoted, reproduced, or translated, in any part or In whole, without the prior written permission of WHO. No part of this document may be
stored in a retrieval system or transmitted in any form or by any means—electronic, mechanical, or other—without the prior written permission of WHO. The
views expressed In documents by named authors are solely the responsibility of those authors.
's>:
V:
Recommendations of
T
J
.c
The WHO Expert Committee oii Comprehensive -.T
School Health Education and Promotion
St
Investment in schooling must be improved and expanded.
The full educational participation of girls must be expanded.
3
Every school must provide a safe learning environment for
students and a safe workplace for staff.; ; i
■
Every school must enable children and adolescents at all levels
to learn critical health and life skills.
£ 5
Everyschool must more effectively serve as an entry point
for health promotion and a location for health intervention.
-
.
Policies, legislation, and guidelines must be developedto ensure
the identification, allocation, mobilization, and coordination of resources
at the local, national, and international levels to support school health.
Teachers and school staff must be properly valued and
provided with the necessary support to enable them to promote health.
I
:
«
The community and the school must work together
to support health and education.
9 .
-
? ■' School health programmes must be well-designed, monitored,
and evaluated to ensure their successful implementation and outcomes.
10
i
I
International support must be further developed to enhance the ability
of Member States, local communities, and schools
to promote health and education.
Geneva, Switzerland, 18-22 September 1995
Health Promotion Modules - 9th Std.
9th STANDARD
ACTIVITY MATERIALS
Health Promotion Modules - 9th Sid.
Increasing Motivation to Study - Snakes and Ladders
ACTIVITY MAT1RIAI.-2.1
Health Promotion Modules - 9th Std.
Increasing Motivation to Study - Snakes and Ladders
ACTIVITY MATERIAL - 2.1a
FACTORS, WHICH AFFECT STUDENTS’ PERFORMANCE AT SCHOOL (HAND OUT):
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
1 8.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
Parents sending you to school
Parents wanting you to learn
Parents believing that you can learn
Teachers believing that you can learn
Natural intelligence
Student friendly school
Regular study habits
Hard work by you
Teacher who teaches well
Friends who help you learn
Marks oriented school
Friends not interested in learning
Poor memory
Past failure
Poor interest in studies
Excessive interest in hobbies
Poor health
School with poor student-teacher ratio
Poorly motivated teacher
Parents not keen on studies
You believe you are stupid
Having to work due to poverty
Distance from school
Being a girl
Books not bought by parents
Teachers partial to first rankers
Friends forcing you to cut class
Subjects not interesting
Dreams of finishing school
Anger when marks are less
Studying with friends
Learning only by getting byheart
Discontinuing school after failure
Parents helping you in studies
Parents checking on your difficulties at school
Parents attending Parent Teachers Meeting on a regular basis
Having a specific ability based on interest - ‘becoming a lawyer’ or ‘becoming a teacher’
Giving up trying if marks are less
Believing that education is not at all important to be successful in life
Becoming very anxious when there is an examination
LSE-NIMHANS/2002
Health Promotion Modules - 9th Std.
Study Habits - Work While You Work; Play While You Play.
ACTIVITY MATERIAL - 2.2
Situation - 1:
BRILLIANT BOY WHO FAILED IN EXAMS
Krishna is a very bright and intelligent boy. He has always scored high marks in all the exams he
has appeared so for in the school. Topping has been a habit for Krishna till about three months
ago. He has fared very badly in his first term exams. Krishna has recently taken up pop music as a
hobby. His parents presented him a Walkman and all the latest pop music cassettes of his choice
because he was doing very well in studies. Over the previous three months, his parents return
home late because of their work commitments and not provide enough supervision. Taking
advantage of this, Krishna would read as he listened to music. He was mote keen on knowing all
the songs by heart and hummed along with the singer as he read. He thought he understood all
that he read and was confident that he would stand first in the class. Unfortunately, Krishna failed
very badly and indeed scored very poor marks in two subjects. His parents were shocked to see his
marks card and wondered what went wrong with their son from whom they had high expectations.
Krishna has no problem in reading or writing and his communication is excellent. This made
parents curious to know the reasons for his failure.
Situation -2:
I
FORGET EVERYTHING
Raji is a 14 year old adolescent studying in VIII standard. Raji, is not very much interested in
studies. Her parents are educated and working. Education is their first choice for all their children.
Till the VII standard, Raji’s mother would sit with Raji two days before the exams and help her to
learn the portions in simple ways and write the exams. With this help, Raji was able to pass the
exams with 55% in VII standard. Raji’s mother insists that she studies every day. Raji also spends
time with books every day; but most of the time is spent in copying notes. She tries to study just
before the monthly tests. When she goes to the class, the question papers especially Maths and
Science, look ver}' complicated. Raji usually comes back home crying and complaining of having
forgotten whatever she has read. Parents feel that Raji works hard but has poor memory.
Discussion Questions for the Groups :
1.
Are the problems of Krishna and Raji common among young persons today?
2.
Why did Krishna fail in his class test?
3.
What do you think about Krishna’s reading habits?
4.
What should Krishna do to overcome his difficulties?
5.
What is the role of his parents in helping him overcome the problems?
6.
Do you think Raji has poor memory?
7.
What is wrong with her study habits?
8.
What should she do to improve her memory - especially for Mathematics and Science?
9.
What skills are needed by a student to understand his or her study habits?
10.
What skills are needed by a student to improve study habits?
LSENIMHANS/2002
Health Promotion Modules - 9th Std.
Boy Girl Relationship - Romance with Ravi-ILove Ravi VerrrrrryMuch!!!
ACTIVITY MATERIAL - 2.5
Situation :
Rupa is a 14-year-old girl studying in VIII standard. She has two younger brothers and one elder
sister. Her parents are poor, but are very proud of their family. Father runs a small petty shop and
mother helps the father in running the shop.
Rupa is an intelligent girl. Recently Rupa was taken by the school authorities to a music competition
where she had the opportunity to meet students - boys and girls from other schools. She made a
number of friends there. One of them is Ravi, who is studying in X standard in another school 5
kms. away from her school. Ravi helped Rupa in getting drinking water and also shares and eat
with her. They have started meeting after school hours. They talk about their friends, TV. programs
etc. They tease each other a lot. Rupa has not spoken about Ravi to her parents or sister. She
received a small card from Ravi on her birthday saying that he likes her very' very much. Rupa was
happy to see such a card from Ravi. Whenever she sits to study, her thoughts drift to Ravi.
Discussion Questions for the Groups :
1.
How can we describe the relationship between Rupa and Ravi?
2.
Why is romance more common among teenagers and young people?
3.
How can we recognize love, romance, infatuation, desire, lust, and sexual feelings in us
towards somebody else?
4.
How can we recognize friendship, love, romance, and lust towards us by somebody?
5.
Can a girl and a boy be friends - when would somebody else think that they are lovers but
not friends?
6.
What skills does a girl or a boy need to understand the type of relationship he/she has with
another person of opposite sex?
7.
What do you think of young people dying and committing suicide for the sake of romance/love?
LSE-NIMHANS/2002
Health Promotion Modules - 9th Std.
Sleep Hygiene - Goodnight! Sweet Dreams !!
ACTIVITY MATERIAL - 2.4
SLEEP HYGIENE - TIPS
Some Do’s Before Sleep:
0
Establishing a regular time to go to bed and to get up in the morning and following it even
on weekends and during vacation/holidays. The brain is trained by this to slow down activities
and help the person to go to sleep during a specific period - Sleep Routine.
0
Wearing loose and light clothing while going to bed..
0
Choosing a place, which is airy, dark and less noisy.
0
Sleeping in the same place.
0
Practicing relaxation for half an hour before bedtime is useful.
0
Reading something light, meditating and walking leisurely for a short time are all appropriate activities.
0
Exercising before dinner. A low point in energy occurs a few hours after exercise; one sleeps
more easily at that time. Exercising closer to bedtime, however, may increase alertness.
0
Having a cup of warm milk is also helpful.
0
Taking a hot water bath 1-2 hours before bedtime is good. This alters the body’s core
temperature rhythm and helps people to fall asleep more easily and more continuously
(Taking a bath shortly before bed increases alertness).
Some Don’ts Before Sleep:
0
Avoiding beverages with caffeine, such as coffee, soda after 4 PM.
0
Avoid smoking before sleep or when one does not get sleep.
0
Avoiding large meals before sleep time.
0
Avoiding interesting reading or computer games before going to bed.
0
Avoiding violent or scary television shows or movies or reading mystery and horror books
that might disturb sleep.
0
Avoiding fluids just before bedtime so that sleep is not disturbed by the need to urinate.
0
Avoiding sleeping in a noisy place; in an uncomfortable place/posture.
0
Avoiding thinking about problems/stress while trying to sleep.
0
Avoiding taking sleeping tablets without doctor’s advice.
0
Not forcing oneself to sleep. Getting out of bed and doing something non-stimulating until
one feels sleepy is more helpful.
LSE-NIMHANS/2002
Health Promotion Modules - 9th Std.
Anemia - “I am Tired”
ACTIVITY MATERIAL - 2.3
Situation :
‘I AM TIRED’
Rekha, Anita and Jayalaxmi are classmates and good friends studying in standard IX of a village
high school.
Rekha
: Jayalaxmi! Come, let us practice throw ball. The sports competition is about to
start and the sports day is two weeks away
Jayalaxmi :
Rekha
:
No Rekha, I cant play. Please don’t force me.
Why, Jayalaxmi what happened?
Jayalaxmi :
I don’t know Rekha; now a days I become very tired and breathless while doing
simple work. I told my mother. She says it is just weakness and that it will become
OK within some time. She is giving extra milk for that. But I still feel very weak and tired.
Rekha
:
OK Jayalaxmi take rest. I will check with Anita and play with her.
Rekha
:
Anita come let us play throw ball.
Anita
:
Rekha where is our friend Jayalaxmi?
Rekha
: Jayalaxmi is not well. I am worried about her.
Anita
:
What happened to her? I find her to be very dull and not interested in any activities
in the class or school. She was never like this before.
Rekha
:
Do you know Anita; yesterday our Miss scolded her for sleeping in the classroom
and for not doing homework assignment. Her mother had come to school and
complained to Miss that she does not eat properly and that she gets irritable with
everyone in her home for simple reasons. I feel very sad about her. She was not like
this before
Poor girl. She has another problem also. She has been
bleeding heavily since she started her periods last year. Now she is not well with
this problem of tiredness. I don’t know what is going on with her.
Discussion Questions for the Groups :
1.
What are Jayalaxmi’s problems?
2.
What are the causes for lack of interest, increased sleep, decreased appetite, tiredness, lack
of energy and appearing dull and irritable behavior?
3.
Do you think Jayalaxmi has anemia?
4.
What should Jayalaxmi do to solve her problems?
5.
Do you think Jayalaxmi requires a doctor’s help?
6.
Who usually suffers from anemia?
7.
What should a student do to avoid anemia?
8.
What skills are needed by a student to prevent anemia?
9.
Can poor children prevent anemia in themselves?
10.
How can they do that?
LSE-NIMHANS/2002
Health Promotion Modules - 9th Std.
Study Habits - Work While You Work; Play While You Play.
ACTIVITY MATERIAL - 2.2a
STUDY HABITS QUESTIONNAIRE
Read the following statements and mark at the end of each statement whether it is True (*^)
False (x).
or
Part - A
I finish my work before I go to play.
I spend a definite time every week in revising each subject.
I recall the important points after I read a lesson.
I spend most of my time on difficult subjects and less time on the easy ones.
I take class notes.
I am careful to learn the important words used in each subject.
I have a regular time and place for studying.
I know how to underline and take notes when I study.
I relate material learnt in one subject with those learnt in others.
I use free time in the school for studying.
My spelling ability is good.
I feel satisfied if I read my lessons.
I look for main ideas while reading a lesson and associate the details with them.
I pronounce the words as I read.
I study with others rather than by myself.
I make use of computer, Internet etc for enriching my understanding about a subject.
I regularly solve old examination papers.
I take mock examinations periodically.
My health is good. I need not worry about it while studying.
I plan out the answer to a question in my mind before I write it in the examination.
I read up the lesson before I go to the class and review what is done in the classroom soon after
I get back home.
LSE-NIMHANS/2002
Health Promotion Modules - 9th Std.
Part - B
I don’t feel like studying at all.
I am a slow reader and therefore, I have difficulty in finishing the assignment in time.
I understand a lesson while reading it but I have trouble remembering what I have read.
I find it hard to concentrate on what I am studying.
If I read faster, I could study more efficiently.
I find it difficult to decide key points that are important in a lesson.
I don’t study' until evening.
I take longer time to get started with the task of studying.
I daydream instead of studying .
I postpone studying my lessons.
I feel so tired that I cannot study efficiently.
I cannot make out much of what I read.
Many activities like working on a job, household work, play and other such activities interfere
with my studying.
I worry a lot about my studies.
I miss important points in the lecture while taking down the notes.
My dislike towards my subject and teachers interferes with my success.
I study the subject that I enjoy regularly and put off studying those which I don’t like till the last
minute.
I study in the midst of distractions, like radio, TV, people talking, children playing etc.
I become nervous at the time of examination and I cannot answer as well as I should.
I spend too much of my time in reading fiction, going to movies etc which decreases my efficiency
in studies.
I have to be in a good mood before starting my studies.
LSE-NIMHANS/2002
Health Promotion Modules - 9th Std.
Peer Pressure - Let Us Enjoy
ACTIVITY MATERIAL - 2.6
Situation :
“I AM SORRY, I DID NOT KNOW”
Hemantha is the son of a politician. He is the only son of his parents. He is used to wearing
expensive clothes to college, spending a lot of money on his friends. He has his own car and
smokes the best cigarettes. Friends always like to go out with him as they get the best of everything.
Last year Hemantha and his friends decided to celebrate New Year at Goa.
Hemantha and his friends Jayanth, Roshan, and Raju went to Goa and stayed in a hotel. Hemantha
had brought alcohol and other injectable drugs to have ‘fun’ on New Year’s Eve. He offered drugs
to Roshan, Raju and Jayanth. Jayanth and Raju refused to take drugs and firmly said no to his
offer. Hemanth was very upset with them and picked up a big quarrel with them. Both of them
were willing to leave the hotel and Goa but refused to have drugs. Roshan initially refused but
later agreed to join Hemantha as he promised him a job in Hemanth’s father’s business. Both used
one syringe to inject the drug over the next two days. They also visited a set-up where commercial
sex workers were available. Both had a good time and felt it was the most memorable day in their
Eves. Roshan felt very happy and felt that the others were fools to have refused such an offer.
After returning home, few months later Roshan started to fall sick repeatedly. His parents took him
to the family doctor. They got to know after investigations that Roshan had developed HIV infection.
While talking, Roshan found out that the probable time he could have picked up the infection was
with the commercial sex worker or from Hemanth with whom he shared the needle. Roshan was
unable to bear the shame and also a future with AIDS, jumped to death from his fifth floor flat.
Discussion Questions for the Groups :
1.
Is the story of Hemantha and Roshan common?
2.
What skills did Hemantha need to convince Roshan to take drugs and indulge in sex?
3.
What skills did Roshan lack?
4.
What skills did Raju and Jayanth have to say ‘NO’ to Hemantha?
5.
What skills did Roshan need to face the stress of having HIV infection?
6.
What are the common activities for which students have pressure to follow others or friends?
7.
What techniques/skills does an average student need to avoid such pressures from friends?
LSE-NIMHANS/2002
Health Promotion Modules - 9th Std.
Appearance - Pimples -Mera Kubsuratbi Ka Rastha - Gori Plus Goro Plus!!!!
ACTIVITY MATERIAL - 2.7
TEENAGE COLUMN IN A FASHION MAGAZINE
Letters to the Magazine Doctor from Teenagers
1. Letter from Niveditha
Dear Doctor, let me introduce myself to you. I am Niveditha, 14 years old studying in VI standard.
I am worried about my face. From the past 1 year small pimples have started appearing on my
face. My friends told me that I eat more oily foods because of which I have pimples on my face. I
have stopped eating oily food items but still have pimples. I also see ads on the TV. which say
eating potato chips can cause pimples. Doctor, tell me what should I do. I also want to make my
skin fairer. What should I do for this?
2. Letter from Tara
Dear Doctor, please help me. I have too many pimples on my face. My friends laugh at me saying
that I think more about sex because of which I have pimples on my face. I do not think of boys.
How is it that I have so many pimples? They are also painful at times.
I feel ver}' shy to go to school. I want to know what causes pimples and how to get rid of this problem.
3. Letter from .Alice
Doctor, I have small pimples on my face, neck, shoulders, upper back and chest. I wash my face
4 to 5 times with soap. I have severe itching and feel like scratching my face often. I have applied
various creams like Far and Lonely, Goro Plus, Samami Ayurvedic Cream etc. and my friends told
me to take internal medicines (Ayurvedic ones) to purify my blood. I tried all these but there is no
improvement. In spite of using Never Marks cream the pimples leave black spots on my face and
forehead. My mother told me to stop applying anything to my face. She told me to not to prick or
squeeze the pimples as it leaves a scar mark on my face and it increases pimples on my face. She
also tells me that a fat girl like me will always have acne. Doctor, please suggest what I should do
to decrease weight and get rid of the pimple marks? Should I consult a Doctor? What kind of a
Doctor should I consult?
4. Letter from Aaron
Dear Doctor, I am a 15 years old student in IX Standard. I want to become a model in future. The
only block to this are the pimples on my face. My friends make fun of me saying that pimples are
more common among girls and I am girlish - so I get more pimples. I read in a magazine recently that
some very' expensive treatment electro-curetting can be used to get rid of the pimples. Can you
advise me whom to consult for this treatment? Am I getting more pimples because I have more
female hormones? Can I use male hormones to decrease the pimples and also to develop muscles?
Discussion Questions for the Groups :
1.
2.
3.
4.
5.
6.
7.
8.
Is acne a common problem among the teenagers like Niveditha, Tara, Alice and Aaron?
According to you, why do adolescents get acne or pimples?
How to take care of acne? Are there any ‘Do’s and Don’ts?’
How effective are the creams, soaps and surgery in curing or preventing acne?
Are adolescents with no pimples and looking beautiful or handsome more confident than
those with pimples?
What can a teenager do if he/she is very self - conscious about his/her pimples?
What are the other aspects of appearance which we teenagers are especially worried about ?
Other than appearance what qualities can improve our Self - esteem?
LSE-NIMHANS/2002
Health Promotion Modules - 9th Std.
High Risk and. Adventure - Living Life King Size
ACTIVITY MATERIAL - 2.8
Situation - 1:
Ashoka is a X standard student who hails from a very conservative family. He is a good student
and known to be friendly. Ashoka loves cricket and has joined a group of older students to practice
cricket during the vacation. These older boys are in the habit of having ‘fun’ on Saturday evenings
by going to one of the boy’s hostel terrace and drinking alcohol till late at night. Ashoka also goes
with them on these occasions. On the first two occasions Ashoka resists the pressure to drink.
He is teased by his friends as a ‘goody, goody boy’ and ‘girl’. Later, he starts drinking alcohol with
these boys as he has seen that nothing wrong has happened to these boys and they seem to be
having a lot of ‘fun’ by drinking. They are bolder, comment at girls, sing and dance.
One Saturday night Ashoka was returning home on his bicycle after ‘drinking’. He felt he was
totally under control. He suddenly saw a lorry coming in the opposite direction. Ashoka thought
he was slowing down correctly; but he was not. Hence he fell down with the cycle into the pit by
the side of the road and broke his leg. The lorry owner did not have to pay any compensation to
Ashoka’s parents as he was smelling of alcohol. That blame was on Ashoka.
Discussion Questions for the Groups :
What do you think of this situation?
Why do students drink?
If drinking is “bad’ why does the government permit sale of drinks?
What are the other drugs apart from alcohol, which are used by students of your age?
How do students start these habits?
What skills does a student need to say ‘NO’ to drinks?
Situation - 2:
Surabi is a X Standard girl. She is very fun loving and is always ready for any activity which is
playful and enjoyable. She is always the first in the class to play pranks on other girls and boys.
two of her friends in the class planned to run away from home for 3 days to have fun. They
planned to go to Bangalore - the city that they have never seen, stay in a lodge have fun, see
movies, if possible meet their favorite movie star. After 3 days they would come back and tell the
parents that they were kidnapped and managed to get away. They expected Surabi to join them
willingly. But Surabi refused to join them saying that their plan was ‘very risky’.
Discussion Questions for the Groups :
What do you think of Surabi’s decision?
Is there anything wrong in taking ‘risks’ - small ones like Surabi’s friends did?
Life should be lived King Size - It will be boring if young people do not do adventurous and risky
things - what is your opinion?
What sorts of risks are all right?
What skills does a student need to decide whether an activity is ‘adventurous’ or ‘high risk’.
LSE-NIMHANS/2002
Health Promotion Modules - 9th Std.
High Risk and Adventure - Living Life King Size
ACTIVITY MATERIAL - 2.8a
ADVENTURE QUESTIONNAIRE
‘Adventure’ or ‘Calculated Risk’ is when a person does something very different from the routine,
but has thought through the whole novel (new) activity and has a clear idea of what he/she would
do in case of difficulties and setbacks. Here the goal is to achieve something and feel the high by
achievement through the novel method. One’s thoughts, feelings and preparation goes into this.
For example, a trained cyclist deciding to cycle backwards between two cities for 100 kms.
He prepares himself by planning and training to cycle backwards. The cyclist understands the
novelty and difficulty of the task but prepares carefully for that.
‘Risk Taking Behavior’ is when a person does something quickly and impulsively for the momentary
high without thinking about the consequences of the act. ‘Let me handle it when it happens’ is the
attitude of the person. There is no thought or preparation. Only feelings of wanting a quick high
for self or pleasing somebody else is predominant. For e.g., jumping from a high building to attract
the attention of the crowd, driving on the wrong side of the road for long distances and observing
the anxiety' of the other drivers.
Decide which of the activities are Adventurous (A) and are of High Risk (R)
Driving a bike at high speed in a crowded street without a helmet.
Joining a group to climb the top of Ramnagaram Rock through a new route.
Drinking and driving with friends.
Joining friends and going for horse racing to gamble.
Having sex with a neighbor during vacation as she says it is fun.
Driving a van at high speed without lights along a busy street.
Playing Lottery’ with pocket money.
Breaking a coconut with bare hands in a karate class after training.
Smoking ganja with friends at the beach during holidays.
Jumping from the first floor of a building.
Taking part in a car race.
Demonstrating that you can cook for 100 people within 60 minutes without anyone’s help.
Developing a new method of writing (not Kannada or English).
Playing ‘KHO KHO’ with everybody’s eyes blindfolded.
Breaking into a shop along with your friends.
Running away from home and calling parents to say that you have been kidnapped to make them
pay a ransom.
LSE-NIMHANS/2002
Health Promotion Modules - 9th Sid.
Sexually Transmitted Diseases - Save Yourself
ACTIVITY MATF.RI Al -2.9
Sexually Transmitted Diseases
Discussion Questions for the Groups :
Set 1:
1.
What disease do these pictures illustrate ?
2.
What is the full expansion for the words - HIV, AIDS? What is die difference between the two?
3.
What are the other diseases, which can be transmitted by hating sex with an infected person (STDs)?
4.
What are the activities that can spread STDs among men and women?
5.
What are the activities, which do not spread STDs, but are still usually feared?
6.
What should an infected person do?
7.
What are the usual fears about AIDS/HIV, Syphilis and Hepatitis B among students?
Set 2 :
1.
What can a student do to avoid these diseases?
2.
What are the abilities a student needs to prevent STDs?
3.
Is it possible to suggest some activities, which can increase and decrease our sexual urges?
4.
Which sets of questions (Set 1 or 2) were difficult to discuss and answer? Why?
LSE-NIMHANS/2002
Health Promotion Modules - 9th Std.
HIV/AIDS - Health is in Your Hands!!!!!
ACTIVITY MATERIAL - 2.10
Read the following statements and mark at the end of each statement whether it is True (/) or
False (x).
Modes of Transmission of HIV/AIDS :
1.
You can become infected with HIV by sleeping with others.
2.
You can become infected with HIV from sharing toothbrush.
3.
People get HIV/AIDS by sexual intercourse with an infected person.
4.
A person can get HIV/AIDS using unsterilized needles or syringes used by infected person.
5.
A person can get HIV by hugging an HIV infected person.
6.
A person can get HIV by shaking hands of infected person.
7.
A person can get HIV by kissing, hugging, playing, swimming with infected person.
8.
A person can get HIV/AIDS by eating food prepared by infected person.
9.
A person can get HIV/AIDS by indulging in sex with a commercial sex worker.
10.
A person can get HIV by indulging in sex with multiple partners.
11.
An unborn child can develop AIDS if the mother is infected.
12.
A person can get infected by sharing toilets with an HIV/AIDS infected person.
13.
A person can become infected with HIV if he or she has anal sex with an HIV infected person.
14.
A baby can get AIDS by breast-feeding from an HIV infected mother.
15.
A person gets HIV by having unprotected sex with multiple partners.
16.
Bed bugs, mosquitoes can spread HIV/AIDS.
17.
A person can get HIV through blood transfusion from an HIV infected person.
1 8.
Having vaginal sex with an HIV infected person transmits HIV infection.
LSE-NIMHANS/2002
Health Promotion Modules - 9th Std.
HIV/AIDS - Health is in Your Hands!!!!!
FOMENTS FOR Tatq
ACTIVITY MATERIAL - 2.10b
LSE-NIMHANS/2002
Health Promotion Modules - 9th Std.
HIV/AIDS - Health is in Your Hands!!!!!
ACTIVITY MATER1 AL - 2.10c
LSE-NIMHANS/2OO2
Health Promotion Modules - 9th Std.
HIV/AIDS - Health is in Your Hands!!!!!
by IN F E C T E D
ACTIVITY MATERIAL - 2.10c
LSE-NIMHANS/2002
Health Promotion Modules - 9th Std.
Sexual Harassment - Road Side Romeos and Bus Teasers
ACTIVITY MATERIAL - 2.11
Situation - 1:
A group of school girls are traveling in crowded bus to school. While traveling a man who is
standing next to one of the girls Vani, intentionally leans against her, touching/brushing her
shoulder and bottom. Whenever the driver applies the breaks he falls against her. Vani.
Situation - 2:
Raghav, is a 15 year old boy. Past 1 month, he is receiving ‘calls’ in which the person does not
speak, but keeps making noises - as if kissing. If somebody else receives the call, the caller
disconnects the call. Raghav, initially felt very good about such calls; now he has become tired
of them and hates these calls. He.
Situation - 3:
Rachitha, has to pass a small shop on her way to school. A group of boys stand there and pass
comments - describing her physical features and comparing to that of a movie star. One boy
makes the comments and the others roar in laughter. Rachitha.
Discussion Questions for the Groups :
1.
Are the above types of sexual harassment common?
2.
What are the other types of sexual harassment you are aware of?
3.
How do girls/boys respond to such harassment?
4.
What do you think are the correct ways of responding - reporting to teachers, police, calling
Makkala Sahayavani, etc?
5.
How much is the harassed girl/boy responsible for the harassment?
6.
What skills are needed for a girl/boy to face such harassment?
7.
Why do some people involve in such harassing acts?
LSE-NIMHANS/2002
Health Promotion Modules - 9th Sid.
Sexual Harassment - Road Side Romeos and Bus Teasers
ACTIVITY MATERIAL - 2.1 la
Some Useful Methods to Handle Sexual Harassment:
>
‘Ignoring’ if the incident is by a total stranger in a strange place and the chances of repetition
is very low (noticing some one exhibiting genitals in a bus). Here the ignoring must be total
- expressing ‘shock’ or ‘surprise’ encourages the person.
>
‘Not responding’ is also effective in some other incidents - anonymous obscene calls.
>
Indicating that one is aware of harassment and not appreciative of it. For example, if a man
harasses a girl in a moving bus by brushing against her repeatedly, she could handle it initially
by moving away from him; later firmly telling him to stand properly without abusing him. If
abuser continues to harass, complaining to others or conductor is desirable.
>
Predicting and avoiding a harasser - e.g., if a male teacher often touches a girl student whenever
she is alone, the girl could foresee this and always take a friend along while meeting the teacher.
>
Taking support and being in company are effective for a variety of harassment - for being
bullied, ragged, leered, teased or followed by a male or group of boys.
>
Informing to a supportive sibling, friend, parent or teacher, if the harassment is repetitive.
>
Lodging complaint with the police after discussing with the parents if the harassment continues.
>
Screaming for help, taking instruments for confidence (a stick, knife or chilli powder) can
be helpful for girls to face harassment.
>
Adolescents especially boys to be taught that sexual harassment does not indicate superiority
but rather inadequacy.
z*
Have ‘Sexual Harassment Awareness Week’ and discussing the above issues in the school.
LSE-NIMHANS/2002
Health Promotion Modules - 8th Sid.
8th STANDARD
ACTIVITY MATERIALS
LSE-NIMHANS/2002
Health Promotion Modules - 8th Std.
Continuing School - Stepping Stone to Success!!!!!
ACTIVITY MATERIAL - 1.1
Situation - 1:
Ramappa is a 20 years old youth who works as a helper in a scooter garage. Ramappa used to be
an average student in 7th standard about 7 years ago when his earning brother died in an accident.
He decided on his own to give up studies and join his brother’s work as a garage helper. His
parents were against his decision. But Ramappa was very happy with the fact that he was able
to earn Rs. 50 per dav and help his parents. He was proud that he was only 13 years but earned
like a man. He felt that God would bless him as he helped his parents live a better life. He now
earns about Rs. 75 per day and is hardly able to meet the basic needs of his life. His family
consists of an old, sick mother and two sisters. The sisters have also discontinued studies and
work as labourers in a garment factory. They earn Rs.75 each per day, but spend about a third
of their income everyday traveling up and down to their places of work and eating lunch.
Ramappa meets some of his old school friends and learns that they are continuing their education
in commerce, engineering, medicine, arts and so on. He deeply repents his decision of
discontinuing school and often spends sleepless nights. He now understands that the present
job fetches him money, but it is hardly enough to meet the demands of his family. He has not
learnt any specialized skills, which would help him to earn much more. This makes him worry a
lot resulting in decreased efficiency at work. Ramappa feels totally lost in his life; neither can
he restart schooling to acquire higher skills nor can he do something different to earn more
monev to meet the demands of his family. Lately, his worries make him resort to using alcohol
which is further worsening his financial situation. Ramappa did not give a thought to the
consequences that would follow when he decided to stop school. He feels sorry about his
situation and wonders why he did not listen to his parents.
Discussion Questions for the Groups :
1.
Why did Ramappa discontinue studies?
2.
What should he have done when he thought of giving up studies?
3.
Did Ramappa prepare himself mentally to face the consequences of discontinuation of
education and problems that were likely to come up in future?
4.
What should Ramappa do to handle his unhappiness and worry now?
5.
What are the other reasons why a student stops attending school without completing X or
XII standard?
6.
What should any one of you do if similar situations arise in your lives?
7.
Is it necessary to study even in the face of difficulties?
8.
Why should one continue studies, when completing X or XII standard does not guarantee
anyone a very good job nor can the youth then go back to manual or unskilled work?
9.
What are the skills/abilities needed and steps to be taken by a student to continue studies
even in the face of difficulties?
10.
How can others like teachers or parents or friends help in such a situation?
LSE-NIMHANS/2002
zooc/siwiiifw-usi
Understanding Motivation - We can Still Do It
ACTIVI’I’Y MATERIAL- 1.2
Health Promotion Modules
■
8th Sid.
Health Promotion Modules - 8th Std.
Eating Habits - The Key to My Health
ACTIVITY MATERIAL -1.4
Situation -1:
Rani is studying in VIII standard. She comes from a very poor family. She frequently develops
ulcers at the angles of the mouth and complains of burning tongue. These problems occur frequently
following bouts of fever. As she is often sick her mother gives her thin rice kanji. Rarely does she
sit and eat the simple meal of ragi ball and saru with greens with her two sisters. Rani is short
statured compared to her classmates and sisters. Her hair is brown and she looks pale and fairer
than her sisters. Rani’s mother likes her more than the other children, as she is always sick, and
also fairer than the other daughters. She says - she is really a Phirangi Rani - (foreign queen).
Mother feels sorry that she is not able to give Rani milk and chicken soup, which can be easily
digested and better for her health. Rani always feels weak, unable to play and concentrate on her
studies. Rani’s mother thinks that she should be given only simple kanji as she is often sick and it
is difficult for her to digest ragi mudde and saru. Rani’s class teacher says that Rani falls sick
because she is not eating normal food and has no resistance in her body.
Discussion Questions for the Groups :
1.
Do you agree with Rani’s mother?
2.
Why does Rani fall sick so often?
3.
Do you think her light colored hair and pale skin are signs of beauty?
4.
How can Rani’s mother improve her health without spending much money?
Stituation-2:
Varun is an intelligent 14-year-old boy in IX standard. He is the only son of his parents. He is very
choosy about his food. He is very fond of meat and chicken. He does not like to eat any vegetables.
He eats rice and thill saru every day. However, he eats rice with meat or chicken curry whenever
it is prepared. Parents are not worried as he eats meat and chicken, which are healthier than
vegetables. Mother tries very hard to make egg curry at least two to three times a week for Varun’s
sake. Varun also buys snacks (cotton candy, potato chips) from the shop and eats them twice a day.
Discussion Questions for the Groups :
1.
What do you think of Varun’s eating habits?
2.
He seems to be healthy - is there a necessity' to eat vegetables at all?
3.
How can Varun’s parents encourage him to eat vegetables?
Stituation-3:
Ayesha is a X standard girl who is worried about her final board exams. Often she has no time in
the mornings to have breakfast as she is attending tuitions from 6 a.m. So she leaves home after
having a cup of tea. Her mothers packs bread and jam almost every day for lunch as she leaves
very early. Ayesha comes home at 6.00 p.m. after school. She is very hungry and eats a large meal
at that time. This makes her tired and sleepy. She has difficulty in concentrating on studies after
the meal. This makes her unhappy and irritable. She has a lot of tea to keep her awake.
Discussion Questions for the Groups :
1.
Is this common among students of your age?
2.
Is it healthy? If not why?
3.
Why is Ayesha tired and sleepy after the meal?
4.
What advice can we give to improve Ayesha’s food habits to suit her routine?
LSE-NiMHANS/2002
Health Promotion Modules - 8th Std.
Healthy and Unhealthy Food -1 Do not wantlddli again for Breakfast
ACTIVITY MATERIAL -1.5
LSE-NIMHANS/2002
Health Promotion Modules - 8th Sid.
MOTIVATION-HOWTO IMPROVEMEMOR Y
ACTIVITY MATERIAL-1.3
Memory Tips:
>
>
>
>
>
>
y
>
>
>
>
Repeating the learnt material again and again. This is unfortunately possible only for short pieces
of information. Children learn mainly by this method because what they learn is simple.
Very large amount of information cannot be repeated easily many times. Other methods are :
Repeating the concepts has the same effect and this can be achieved in multiple ways.
Totally understanding what is read - as it is connected to earlier known information.
Summarizing.
Explaining in one’s own words.
Discussing with friends.
Focused group study i.e. a group of students discuss a particular topic.
Explaining to a friend who has not read the lesson.
Having a question answer session on it among friends.
Having mock exams with model questions.
Reading the same topic/ information in different ways and by different authors - Bible information by
various authors - Luke, Mathew. Different sources give you the same information with
different views, which helps the student to understand and repeat thoroughly in his/her mind.
Connecting it to earlier known information - Student remembers that India got independence in
1947. Gandhi died soon after that. So the year of death of Gandhi should be after 1947 probably 1948.
Connecting it to mental images i.e. pictures or numbers - Remembering that Yellow River flows in
China - imagining yellow race men and women with small eyes taking bath in a river in
which yellow color lemons are flowing.
Making connections between multiple new information by an unique technique to whichyou are used to e.g., the first letters of the color of the rainbow are grouped as VIBGYOR for the order.
This is called MNEMONICS.
Using methods where the initial registration is good - by reading in a quiet place with no distractions
and focused attention.
Training the brain to register, review and recall any information by making reading and
writing a regular habit and not only before exams. This reading can be books, other than
subject books, in which one is interested.
Training the brain to be prepared to register whenever you sit for studying
- sit in the same place, specific time and after a small ritual of decreasing
noise, distracting things and a prayer of self suggestion.
Reading the information with interest - positive framework and keen interest
make any type of learning easier as the connections are made better
and faster. Example, the cricket scores and match dates are remembered better by a student
who is a cricket fan, than the geography of South America.
Avoiding aspects, which can interfere with registration and recall for e.g., mental
tension. It is a common experience that we sometimes forget names, addresses and telephone
numbers very familiar to us in situations when we are anxious. Emotional state significandy
impedes recall and one will presume that his or her memory is poor. This leads to lack of
self-confidence and poor self-esteem, which further increases the tension and decreases
registration and recall.
READ, RE IdE IE and RECALL are the three important steps.
LSE-NIMHANS/2002
Health Promotion Modules - 8th Sid.
Myths and Facts about Food - Porlicks Jyada Shakthi Detha Hai
ACTIVITY MATERIAL- 1.6
Situation - 1:
Ramu is a 14-year-old boy living in a dry and hot place near Bellary. He is a poor boy whose father
is dead and mother is a labourer. Ramu has two other younger brothers. During the summer, Ramu
and Ills brothers ate a lot of mangoes while playing in garden. All three of them developed many
boils, which were painful.
Their mother and grandmother explained that the boils were due to ‘heat’, got by eating too many
mangoes and prevented the brothers from eating anymore, although they liked them a lot. They
were forced to apply castor oil everyday to their scalp to cool their bodies.
Since the boils did not heal, their mother took them to the doctor. He gave all the three brothers
injections and advised the mother to clean the boils by washing with soap and water regularly and
to apply some medicinal powder.
The boils healed in four days. Ramu who was studying in class IX, wanted to know why the
method of cooling of body with castor-oil on the head did not help the boils heal. He also wanted
to know whether the injection given was to cool the body. He asked the doctor his doubts.
Discussion Questions for the Groups :
1.
2.
What do you think was the answer of the doctor?
Are these ‘cold/heat’ food items?
Situation - 2:
Ragini is a 12-year-old girl who lives in Tiptur. Recendy she attained puberty and since then she
has heavy bleeding every' month. Ragini feels very weak and tired. Father and mother took her to
a doctor who advised healthy food and iron tablets. Her father bought a bottle of a popular health
drink and biscuits for her and felt that these would help her.
Discussion Questions for the Groups :
1.
2.
Do you think that the health drink and biscuits would have helped Ragini to get adequate
nutrition?
What should she do to take care of problems such as weakness and tiredness?
Situation - 3:
Krithika is a 14-year-old girl in IX standard. She is the only daughter of her parents. She is very
choosy about her food. She does not like vegetables and fruits. Bananas (yelaki bale) is the only
fruit she likes. Her mother does not allow her to eat yelaki bale as she gets cold and running nose
whenever she eats it, since childhood. She eats rice and rasam every day. She enjoys meat
preparations, as well. Krithika is often constipated and feels very uncomfortable in her stomach
due to this. There is a lot of tension in the house in the morning if Krithika does not have a good
bowel movement. Krithika’s uncle who is a nurse visited her during holidays. He clearly' told her
and her parents that the constipation was due to improper food habits and she needs to eat all
vegetables and fruits including bananas - yelaki bale.
Discussion Questions for the Groups :
1.
2.
Do y'ou think Krithika has good food habits?
Is her uncle correct?
LSE-NIMHANS/2002
Health Promotion Modules - 8th Std.
Being Clean - Do not Hold Your Nose!!!!!!!
ACTIVITY MATERIAL -1.7
Cleanliness Statements:
The sheet has various activities which we do everyday/week/year. Discuss among your group
members and mark by die side of each statement whether it C or S or F.
b.
c.
Activities one does to keep himselfI herself clean/healthy in a day/every two days/ each week /
each month/each year (H)
Activities one does for social reasons - to be presentable or cultural (S)
Activities one does for improving one’s appearance or for being fashionable (F)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
Brushing teeth in the morning
Brushing teeth in the night
Batiiing in the morning
Bathing in the night
Cleaning the ears and nose
Scrubbing the tongue
Gargling after eating food
Brushing the teeth after eating food
Removing footwear before entering the house
Washing the feet before entering the house
Wearing footwear while going out
Wearing footwear while going out to pass motion in the fields
Washing hands with soap before food
Washing hands with soap after eating
Shaving and trimming the beard and moustache
Cutting hair
Removing lice from hair - by medicine
Washing private parts after passing urine
Washing the bottom after passing motion
Washing hands with shikakai/soap after passing motion
Using a silk handkerchief
Using a small cloth as a hanky to cover your mouth while coughing
Wearing a tie
Wearing shoes
Wearing chappals
Washing undergarments every day
Washing clothes when they look dirty
Wearing socks
Washing socks when it is dirty
Washing handkerchief and towel everyday
a.
LSE-NIMHANS/2002
...
Health Promotion Modules - 8th Std.
31.
Drying undergarments and towels in the sun
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
51.
52.
53.
54.
55.
56.
57.
58.
59.
60.
61.
62.
63.
64.
65.
66.
Drying clothes in the shade
Drying clothes in the sun
Wearing cotton salwar kameez
Wearing nylon salwar kameez
Wearing cotton pant/shirt
Wearing terry cot pant and shirt
Shaving underarms
Shaping eyebrows
Washing underarms
Wearing a wristwatch
Wearing bangles and chains
Applying powder to the armpits
Applying powder to the face
Cutting nails every week
Washing hair with shampoo/soap everyday, once a week or twice a week
Wearing bindi
Washing hair with shikakai
Applying oil to the hair
Applying'nail polish
Applying mehendi to the hair
Wearing washed clothes every day
Changing bra/bartian, underwear every day
Applying cream to the face
Wearing ironed clothes
Wearing kajal
Wearing flowers on the hair
Eating with a spoon
Applying oil to the hair
Combing the hair
Applying lipstick
Spraying scent on the body
Wearing undergarments
Wearing chandan or vibhuthi on the forehead
Plaiting or tying the hair
Wearing a hat or holding an umbrella or a wearing a cloth around your head while going out
in the sun
Washing bed sheets and pillow covers every week
Wearing cooling glasses while going out in the sun
Wearing well fitting clothes
Wearing nylon bra/banian and underwear
67.
68.
69.
70.
LSE-NIMHANS/2002
Health Promotion Modules - 8th Std.
Prevention ofInfectious Diseases - Wash, Wash, Wash!!!!!!
ACTIVITY MATERIAL-1.8
Green Card
Yellow Card
Red Card
Prevention Card
Signs and Symptoms
Infectious Diseases
Diarrhoea
Avoid eating contaminated food
Watery stools with blood
Fever, rashes on trunk which later spread to Isolate infected person
Chicken pox
Take vaccine
face and limbs
Swelling of eye lids/discharge from eyes and/ Do not share personal care items that come in
Conjunctivitis
contact with the eyes such as face cloths, towels,
redeyes
pillowcases, makeup or eye drops. Wash eyes
regularly. Wash hands frequently and keep away
from eyes
Develop habit of covering mouth while
Influenza
Cough, running nose and fever
sneezing and coughing. Don’t share
handkerchiefs, towels of infected person
Typhoid
Fever, body aches and pain, low pulse rate, Develop the habit of washing hands with soap
after passing stool. Take vaccine during an
vomiting, diarrhea and abdominal pain
endemic breakout and avoid contaminated food.
Measles
Fever, pink colour rashes and Itching
Cholera
Hepatitis - A
Isolate infected person
Immunization
Passing stools which is white in colour Drink boiled water
frequently (rice water stools) and vomiting Always cover the food and other eatables.
Do not eat articles/ food exposed to [lies.
Wash hands after passing motions
Yellow urine, yellow eyes, fever, lack of Wash hands after going to the toilet and
immediately prior to handling food
appetite
Tuberculosis
Cough, sputum with blood, fever, loss of Consult doctor immediately
Isolate the patient
weight and appetite
Give BCG to children for immunity
Malaria
Fever with chills, body aches and pain
Lice Crabs
Severe itching in pubic area, seen moving on Regular bath with soap and water - keeping the
the body or pubic area
pubic area clean
LSE-N1MHANS/2002
Prevent mosquito bites
Prevent mosquito from breeding
Sleep under mosquito net
Health Promotion Modules ■ 8th Sid.
Peer Pressure - Friend or Foe?
ACTIVITY MATERIAL-1.9
Situation - 1:
Pramod is a very shy but a bright student. He is hard working, obedient and religious. He has very
few friends and most often he is the subject of jokes in his class as he is considered a ‘goody
goody boy’. He is teased and ragged all the time, which makes him feel isolated and rejected.
Pramod spoke about this with his parents and they told him that he should be brave and courageous
but did not tell him what he should do about it.The feeling of isolation at school bothers Pramod
a lot. He tries a lot to be friendly with his classmates. No matter how hard he tries he is pushed
aside and teased. One day when he approaches his classmates they challenge him to prove his
becoming a ‘Man’ by giving a love letter to one of his class girls. They promise to make him a part
of their group if he does so. Pramod initially refuses. The boys repeatedly challenge and lure him.
After days of bargaining, Pramod takes a decision to do what the boys have instructed. He writes
a love letter to one of the class girls, shows it to the classmates, and in their presence walks up to
the girl and gives it to her.
The girl is shocked at Pramod’s behavior and brings it to the notice of her parents and the Principal.
Principal takes a decision to suspend Pramod for 10 days after a preliminary enquiry, for bad
behavior, Pramod asks the classmates’ help to talk with the Principal and prevent suspension.
But the classmates refuse to help him. Pramod realizes that despite their promise to become his
friends, they are not extending a helping hand though he gave into their pressure. He regrets that
he had not thought through the whole act well, but focused only on becoming a part of the gang.
Situation - 2:
Sarayu is a very bold and intelligent girl of 16 years in X standard. She comes from a poor family.
Her parents work as manual labourers and send the children to school. Sarayu is aware of the
difficult}' of the family and behaves in a responsible way. She is in the Class Squad - two and very
popular among the squad members. One day four girls who are best friends of Sarayu plan to cut
class and go to a movie and later to a hotel to celebrate before leaving school. Sarayu expresses
inability to participate due to lack of money. The girls plead with her repeatedly to somehow join
them as this would be their last outing together in school Life. Sarayu knows the poverty at home
but is lured by the argument of the friends. The friends do not have money to spare. So Sarayu
steals money from the God’s Hundi, which she plans to put back, whenever she gets money. She
is also convinced that nobody will nonce the loss of money from the Hundi because no one
checks it. She goes to the movie and later to the hotel. When she comes out of the hotel, she sees
her father unloading rice bags from a lorry for the hotel. Her father also sees her coming out of the
hotel with her friends. When father demands an explanation for Sarayu’s behavior she argues and
shouts at him that she has a ‘right to have good time like other girls’. Also adds that there is
nothing wrong with her behavior of using the money from the Hundi which was anyhow not
being used by anyone.
Discussion Questions for the Groups :
1. Are the situations of Pramod and Sarayu common among adolescents?
2. How do they handle such situations?
3. What skills are needed by an adolescent to handle such situations?
4. What was Pramod’s difficulty in saying ‘NO’?
5. What was Sarayu’s difficulty in saying ‘NO?’
6. Sarayu’s arguments with her parents - Is it Assertion? Discuss.
7. What are instances where assertive skills are needed a lot - with whom?
8. With whom is it difficult to be assertive - parents or friends?
LSE-NIMHANS/2002
Health Promotion Modules - 8th Std.
Bullying - The Esteemed Chair
ACTIVITY MATERIAL-1.10
BULLYING “HANDLING TECHNIQUES”:
>
When being bullied do not show that you are afraid, upset or angry - this needs anticipation
and practice by the child/adolescent who is bullied. Bullies usually do not like to trouble
others who are not troubled by it.
>
Do not fight with the bullies, as they are usually big and well built.
>
It is not worth hiding your possessions or money if a bully is looking for it. Preventing
physical injury is more important than losing your possessions.
>
Making a funny comment or joke when one encounters the bully is very helpful.
Such behavior puts bullies off.
>
Be in the company of your friends so that you get support even if bullied.
>
Disclose bullying to a close friend, a sensitive teacher, parent or other significant
adults. It is not telling tales about others.
>
If you feel very upset by the bullying write a diary of your feelings. This may
help you to handle it without much fear and anger.
LSE-NIMHANS/2002
Health Promotion Modules - 8th Std.
Dealing with Anger -1 Feel like HITTING Him, Idiot!!!!!!!!
ACTIVITY MATERIAL -1.11
DO’S AND DON’Ts OF HANDLING ANGER :
Do’s :
0
Say Stop. Close your eyes count 1 to 10 forward and backward.
0
Take deep breath and tell yourself ‘Relax’, ‘Calm Down’.
0
Walk away from the person or issue which is making you angry until you calm down.
0
Talk to yourself: Say what is wrong. Use your words to say what you do not like rather than
what you think the other person is doing to make you angry. Example, say “I do not like
being charged excess meter without valid reason” rather than, saying for e.g. “This
auto driver is cheating me by charging excess”.
0
When you are angry with a person, give a clear indication that you are upset and you do not
want to deal with the issue as you are angry - indicate a specific time later when you would
be more under control - for e.g., “I do not like the fact that you told about me to
Suresh. I would want to talk with you about it tomorrow evening”.
0
While discussing about the issue of anger avoid using words like “never or always” and use
the “I” word in distress mode. Instead of saying, “You hurt me” say, “I feel so hurt”. This is
one way of taking responsibilities for one’s own emotions (here anger) and allowing space
for dialogue and possible ways of solving problem or situation that is causing anger.
0
Write down your feelings when you are angry with others. Read and reread it till you are
able to think about the problem in a calmer manner.
0
Express anger more assertively than aggressively (assertion has been dealt with in the earlier
two classes). That means know your rights and also respect others’ rights.
0
Practice of relaxation also helps in controlling anger.
Don’ts:
0
Do not conclude that “getting angry” is wrong.
0
Don’t suppress anger or pretend it is not there.
0
Don’t smash things, punch walls, beat, scream etc.
0
Don’t drink alcohol to “wash away” problems.
0
Do not blame yourself and injure self.
LSE-NIMHANS/2002
Z()OZ/SNVIIIVIN-:IS'I
Understanding Body and Mind -lam a Growing Boy/I am a Growing Girl!!
ACTIVITY MAT1-.RI AL -1.12
Health Promotion Modules - 8th Std.
|
Understanding Body and Mind -1 am a Growing Boy/I am a Growing Girl!!
S
ACTIVITY MATERIAL-1.12a
Health Promotion Modules
PSYCHOSOCIAL DEVELOPM ENT -
Health Promotion Modules - 8th Std.
Understanding Body andMind -1 am a Growing Boy/I am a Growing Girl!!
ACTIVITY M \TI.RI \l. 1.12.1
PSYCHOSOCIAL DEVELOPMENT - 3
PSYCHOSOCIAL DEVELOPMENT - 3a
LSE-NIMHANS/2002
E-NIM H ANS/2002
Understanding Body and Mind -1 am a Growing Boy/I am a Growing Girl!!
ACTIVITY MATERIAL- 1.12a
Health Promotion Modules - 8th Std.
INTELLECTUAL DEVELOPMENT - 4
LSE-NIMHANS/2002
Understanding Body and Mind - Body Mapping
ACTIVITY MATERIAL -1.13
SECONDARY SEXUAL CHARACTERISTICS IN BOY/GIRL
Health Promotion Modules - 8th Std.
Menstruation -1 Wonder Why ??!!!!!!!
ACTIVITY MATERIAL -1.14
AIDS FOR MENSTRUAL HYGIENE
LSE-NIMHANS/2002
W et Dreams & M asturbation - 1 W onder
Health Promotion Modules - 8th Sid.
LSE-NIMHANS/2002
Health Promotion Modules - 8th Std.
Wet Dreams & Masturbation -1 Wonder Why??????
ACTIVITY MATERIAL - 1.15a
Some Myths about Wet Dreams and Masturbation:
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MYTH: Loss of semen during wet dreams leads to weakness of body.
FACT: Wet dreams/masturbation is normal among adolescent boys. It does not make
one tired.
MYTH: Wet dreams are more among the boys who are over-sexed and always pre-occupied
with sexual fantasies.
FACT: Wet dreams are common soon after puberty in a boy - this is normal. Sexual urges
and fantasies are common in all healthy boys. Many learn to channelize and divert
their attention to other pleasurable activities like games, studies and hobbies.
MYTH: Masturbation is mote among young boys than married people.
FACT: Masturbation is common among the young, married and even elderly people.
Acting on sexual urges is less among the married and elderly due to other stress
and hormonal changes.
MYTH: Only the young, unmarried and the immature individuals practice masturbation.
FACT: Even married people can practice masturbation. There is no research evidence to
show that only immature people practice masturbation.
MYTH: Practicing masturbation is a sin.
FACT:
Masturbation is an outcome of a physiological need. The guilt feelings associated
with such an act and the attitudes of the society make the person to drink that it is a sin.
MYTH: Only boys practice masturbation. Girls do not practice masturbation.
FACT: Masturbation is practiced by both sexes. It is more common among the men.
Women are taught culturally to suppress sexual needs. This does not mean they
have no sexual needs. A woman masturbates by stimulating the clitoris.
MYTH: Masturbation leads to weakness, impotency and insanity.
FACT: There is no connection between masturbation and weakness, impotency and
insanity. It does not lead to insanity.
MYTH: Masturbation leads to homosexuality among boys in later years.
FACT: Masturbation does not lead to homosexuality among adolescents in later years.
There is no research evidence to show that practicing masturbation causes
homosexuality in later years.
MYTH: Masturbation causes dark circle around the eyes.
FACT: Masturbation is normal among adolescent boys and girls. It does not cause dark
circles around the eyes.
MYTH: People who masturbate are not sexually normal.
FACT: They are normal as it is a physiological need in every adult.
MYTH: Frequent masturbation leads to shrinkage of penis.
FACT: No, Masturbation does not lead to shrinkage of penis. After ejaculation the penis
normally shrinks to its usual size.
MYTH: Masturbation causes mental illness.
FACT: Mental illness is not caused by masturbation. But misconceptions about
masturbation can result in anxiety and memory problems due to impaired attention
and concentration.
LSE-N1MHAHS/2002
Health Promotion Modules - 8th Std.
Wet Dreams & Masturbation -1 Wonder Why??????
ACTIVITY MATERIAL -1.15b
Genital Hygiene in Boys:
>
Washing genitals daily with warm water.
>
Gently removing foreskin back and washing the tip of the penis. Secretions
accumulate under the foreskin and could cause infection if not cleaned regularly.
>
Changing underwear regularly.
>
Using cotton undergarments only - synthetic undergarments do not absorb moisture and
also increase the temperature.
Washing undergarments everyday and drying them in sun.
LSE-NIMHANS/2002
Health Promotion Modules - 10th Sid.
10th STANDARD
ACTIVITY MATERIALS
Health Promotion Modules - 10th Std.
Making Life Choice - When I Grow Up I want to become A BIG
ACTIVITY MATERIAL - 3.1
The Life Choice Career Sheet:
Today you are a student. According to you, what job, will you be in, 10 years from now?
1.
Does it need further studies?
2.
Does it need training?
3.
According to you how many years of further studies does it need?
4.
According to you how many years of training does it need?
5.
Is it a skilled job or unskilled job?
6.
Would you like a salaried job?
7.
Would you like a self - employed job?
8.
Would like a private firm job?
9.
Would you prefer a government job?
10.
In what way are you preparing yourself for this job?
11.
Is the job - decision, made by you or by your parents?
12.
Will your parents support your decision?
13.
How much guidance do you expect from parents for this decision? - full/ little/ a lot
14.
How much guidance do you expect from your teachers for this decision? - full/ Litde/a lot
15.
How much finance do you need to get this dream of yours realized?
16.
Do you think about your job/career?
17.
Have you discussed this with your friends?
18.
Have you discussed this with your parents?
You have decided on this career because
1.
You always wanted it - Yes/No
2.
You think you have the abilities required for this job - Yes/No
3.
Your parents decided this for you - Yes/No
4.
Many of your friends choose it - Yes/No
LSE-N1MHANS/2002
Health Promotion Modules - 10th Std.
5.
This job is the most popular today - Yes/No
6.
Pays most money - Yes/No
7.
Gives stability and security - Yes/No
8.
Good dowry market - Yes/No
9.
Quick money - Yes/No
10.
Gives employment to others - Yes/No
11.
Socially meaningful - Yes/No
12.
Allows you as a woman to be married, have children & work - Yes/No
13.
Easy to get - Yes/No
14.
Extra income possible - Yes/No
Is there a possibility that you will be unemployed ten years from now? Why?
Family:
1.
Do you expect to get married?
2.
When do you think you will get married - number of years from now?
3.
Will be it an ‘arranged marriage’ or ‘love marriage’?
4.
If arranged will you say ‘no’ if you do not like the person?
5.
Do you think your parents will listen to your opinion?
6.
Most important quality your life partner should have?
7.
Truly speaking will you give/take dowry?
8.
Would you like to work after marriage/would you like your wife to work?
9.
Have you discussed about marriage with friends?
10.
Have you discussed about marriage with siblings - brothers, sisters?
11.
Do you love somebody now?
12.
Do you plan to marry him/her?
13.
Do you plan to have children?
LSE-NIMHANS/2002
Health Promotion Modules - 10th Sid.
Preparing for Examination -I will do my BEST!!!!!!!!!!!!!
ACTIVITY MATERIAL - 3.2
HOW TO PREPARE FOR EXAMINATION: Guidelines
Preparation throughout the Year
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Adequate and early preparation is very important to reduce examination tension.
Preparation starts from the day the student enters the class for that year.
Attending classes regularly and listening with interest.
Taking down proper notes in the class.
Reading textbooks and comparing it to the class - notes, to a get clear picture and
understanding of the lesson covered by the teacher.
Any reading is to be understood by its concept than just memorizing it.
Writing and summarizing by the student in a way, which is easy for him/her to remember
what is read (using mnemonics as an aid to cover all points).
Discussing the lesson with friends out of the class.
Clarifying doubts with teachers or other classmates.
Getting the help of teachers, parents or a tutor if the student has difficulty in understanding
certain topics or chapters.
Finding a method to connect it to other known information.
Reviewing notes regularly.
Giving more time and importance to subjects found difficult by the student - e.g.
Mathematics, English.
Avoiding choosing portions in each subject and reading only that based on earlier question papers.
One Month Before the Exams
Preparing a study plan.
Combining favorite and not so favorite subjects in the study plan of a day.
aTrying and completing two Model Question Exams (each subject) in this time.
>
Having fixed time of sleep and relaxation (including TV. time).
>
Meditating and doing autosuggestion every day - to be calm in the examination situation.
>
Discussing with one’s parent or sibling or friend regarding progress in the exam preparation
from time to time.
Some DON’Ts Few Days Before the Exams
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0
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Collecting new notes and materials from friends and reading them till the last minute without
time for revision.
Trying to learn new things on one’s own at the last moment.
Sitting for long hours continuously to read. Not taking breaks for bath, food, relaxation and
sleep. It makes one feel more tired, reduces concentration and makes studying boring and
anxiety producing.
Keeping awake whole night and reading for few days before the exams.
Excessive use of Coffee or Tea or Cigarettes to keep awake the whole night.
Giving up studying totally as the student feels that his/her mind is ‘BLANK’ and seems to
have forgotten everything that was read; hence giving up.
LSE-NIMHANS/2002
Health Promotion Modules - 10th Sid.
S
S
Spending time to trace the ‘question papers’ or teachers who are probably involved in paper correction.
Copying large amount of materials on bits of paper thinking that it might help during exams.
Some Do’s on the Day of the Examination
Having a good night’s sleep the previous night.
Having a light but adequate breakfast.
Leaving for the examination hall well in advance.
Checking whether one has taken all the necessary things - pens, pencils, geometry box,
hall-ticket - a checklist of all items is essential.
0
Going to the toilet before entering the examination hall.
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Taking deep breaths, making suggestion or a prayer to do well.
Steps to be Followed when the Student Gets the Question Paper in Hand
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Reading the instructions carefully. If there are any doubts clarify with the instructor, teacher
or invigilator.
Budgeting the time and planning the answers. Allocating time for each question. Many
times students write one answer for too long a time and ends up with too little time for the
other questions.
Choosing the best known questions if choices are available.
If not sure of an answer, not spending long time thinking and recalling answers. Going to
the next known question. Handling the less known questions towards the end.
Writing legibly - if a mistake is made do not overwrite but cross it out.
Highlighting important points - underline, write in capital etc.
Answering to the point and not writing unnecessary information to make the answer appear long.
Giving equal importance to things like formulas (maths, science), drawing figures (science),
marking on the map (geography), graphs (maths and physics).
Trying to finish ten minutes earlier. This helps the student to go through the paper and
correct mistakes/underline important points etc.
Most of the students have a habit of discussing answers with friends after the examination.
This makes the student anxious and worried. The anxiety may interfere with the reading for
the next examination. Once an exam is over it is better to concentrate on the next one.
Review and discussion could be done after the last examination.
How to Handle the Anxiety:
The Guidelines
►
►
►
►
►
►
Following “How to Prepare for Exams” suggestions during preparation before
and on the da}' of exams.
Following some specific relaxation techniques many times a day - meditation,
breathing exercises, prayers and autosuggestion. This method must be comfortable and
useful to the student. So it is necessary that the student starts using it, months before the
exams and see whether it is effective for him/her.
Solving old examination papers within specified time - 3 hours, i.e. doing mock exams on one’s own.
Recognizing whether one is mildly anxious or highly anxious that interferes with concentration
and learning. If one is highly anxious, sharing it with someone whom the student trusts in
and taking help is desirable.
Avoiding negative thoughts, for example ‘I have not prepared well’, ‘I may fail in this
exams’ or ‘I have not covered all the portions’.
Practice group relaxation exercises in the school for 10 minutes everyday at least 3 months before exams.
LSE-NIMHANS/2002
Health Promotion Modules - 10th Std.
Coping with Stress and Suicidal Behavior - Flying the Kite ofHope
ACTIVITY MATERIAL - 3.3
DIRECTOIN : You have to connect all the nine dots by four lines without Lifting the pen/
pencil from the paper or retracing a line already drawn.
PROBLEM:
LSE-NIMHANS/2002
Health Promotion Modules - 10th Std.
Coping with Stress and Suicidal Behavior - Flying the Kite ofHope
ACTIVITY MATERIAL - 3.3a
Situation - 1:
Krupakar and Vasumathi are good friends studying in X class. They spend time together reading,
talking, exchanging class notes etc. They never consider themselves to be ‘lovers’. One of Krupakar
friends’ who is jealous of Vasumathi’s friendship with Krupakar, writes on the school walls and black
boards that they are ‘lovers’. Both of them feel very upset and ashamed by this. Vasumathi goes home
during the class and without telling her mother anything hangs herself with her dupatta in her room.
Knowing about her suicide, Krupakar drinks Tik-20 the next day but is saved by his brother.
Situation - 2:
Shareen is the only daughter of her parents. Her parents constantly fight with each other on
money matters and father’s drinking. Shareen often threatens to run away from house if they
continue fighting. Her parents never take her threats seriously. One day Shareen jumps out of her
flat from the second floor when parents are fighting and hitting each other.
Discussion Questions for the Groups :
1.
Are the problems of Vasumathi, Krupakar and Shareen common among adolescents?
2.
In the face of failure; Romeo and Juliet committed suicide. What do you think about it?
3.
What are the common methods usually used by adolescents like them to solve any problems today?
4.
Is there an effective way of solving even the most difficult of problems in our lives ?
5.
Is ‘suicide’ ‘an option’ at any time for any ‘problem’?
6.
Solving any problem is not easy. How do you go about solving it?
LSE-N1MHANS/2002
Health Promotion Modules - 10th Std.
Sexual Intercourse - What is this Sex Stuff??????!!!!!
ACTIVITY MATERIAL - 3.4
Situation - 1:
Geetha is a 15 years old adolescent student in X class. She feels very nice whenever she sees a
romantic song on the T.V. Recently she has started tuitions in her house for mathematics with her
cousin Sudhir - a college boy. Geetha does not object, whenever Sudhir touches her while giving
notebooks or pencils. He has started brushing against her while teaching her. Geetha feels very
light and nice - she knows that Sudhir also likes these small touches. One day when they are alone
Sudhir boldly hugs and kisses Geetha and suggests ‘sex’ indirectly by pressing his body against
hers tightly.
Situation - 2:
Swapna is a 19 years old girl who is married 2 months back to Roy, who is 28 years old. Swapna
has had a strict upbringing where topics like ‘love’; ‘sex’ ‘childbirth’ were never discussed. Swapna
is very afraid to be alone with her husband Roy, as he always tries to touch and talk of having sex
with her. Swapna feels uncomfortable and tries to avoid being alone with him.
Discussion Questions for the Groups :
1.
What are the abilities a boy like Sudhir or girls like Geetha/Swapna need in order to understand
their sexual feelings?
2.
What skill does an adolescent boy (like Sudhir) or girl like Geetha or Swapna need in order
to decide about when to have sex?
3.
What do you understand about sex/sexual act?
4.
What is the opinion of your group after discussion about sex?
5.
How or from whom do we get information on sex?
6.
Do men and women have similar or different sexual needs - why?
7e
How is sex seen differently in our country when compared to Western countries?
8.
Why is there a Marriage Law in most of the countries which says that marriage is permitted
only after the age of 18 years? How does it influence sexual behavior in adolescents?
9.
What are common doubts/anxieties regarding sex at your age?
LSE-NIMHANS/2002
Health Promotion Modules - 10th Std.
Contraception -1 have the CHOICE!!!!!!
ACT! VITY MATERIAL - 3.5
FEMALE D/,
LSE-NIMHANS/2002
Health Promotion Modules - 10th Std.
Myths and Misconceptions - Pretty and Handsome
ACTIVITY MATERIAL - 3.6
STATEMENTS:
PINK CARDS (Myths) AND GREEN CARDS (Facts)
>
>
>
>
MYTH :
Frequent masturbation leads to impotency.
FACT
Masturbation does not lead to impotency especially in boys. Young people who
indulge in that excessively lose interest in other important activities Like studies
and games. Hence, it is advisable for boys to keep it under control. Anything,
even eating in excess is not advisable.
MYTH :
Frequent masturbation diminishes size of penis.
FACT
No, Masturbation does not lead to shrinkage of penis or breasts. After ejaculation
the penis normally shrinks to its usual size.
>
:
MYTH :
Women do not have sexual urges.
FACT
Women also have sexual urges. Culturally, women have been told that it is wrong
to show their sexual desire. Hiding sexual desire is connected to being ‘chaste’
and also ‘good’. These are attitudes. Proper expression of sexual desires by a
woman with a stable partner like spouse is satisfying to both.
:
MYTH :
FACT
>
:
:
If you are god-fearing you should not have thoughts of sex or sexual urges.
Somebody can be god-fearing and yet be sexually active. Proper expressions of
sexual desire - within a marriage, with a single partner, with love and trust both
by men and women are necessary and healthy.
MYTH :
Touching private parts, kissing, holding, hugging lead to pregnancy.
FACT
Pregnancy is a result of sexual intercourse between a man and a woman. Touching
private parts, kissing, holding, hugging do not lead to conception.
:
MYTH :
A well-built person is sexually stronger.
FACT
Physical strength in a person with good health is not connected to sexual power.
If somebody is generally unhealthy and weak, then he/she can be sexually
weak due to fatigue.
:
MYTH :
FACT
:
LSE-NIMHANS/2002
One should not have sexual intercourse during menstruation.
One can have sex during menstruation. If both partners are willing and
comfortable they can have sex during menses. Infection of genitals if not clean,
is a possibility.
Health Promotion Modules - 10tb Sid.
(•
>
>
>
>
>
>
MYTH :
Taking contraceptive pills causes breast cancer among women.
FACT
:
Research does not totally confirm that taking contraceptive pills causes cancer.
One needs to keep in touch with the doctor.
MYTH :
Loops like Copper - T for women leads to pain in the abdomen and causes
severe bleeding. It interferes with sexual act.
FACT
If a correct size loop is introduced the discomfort and bleeding stops after a few
days. It does not interfere with sexual intercourse.
MYTH :
Loop inserted improperly may enter the chest/abdomen and cause death.
FACT
The copper - T (IUD) stays in the womb until a doctor, or nurse removes it. It
never enters the chest or stomach and cause death. If it gets dislodged, it usually
comes out through the vagina.
>
>
>
:
MYTH :
Sterilization in men and women is irreversible.
FACT
Sterilization is reversible to a certain extent in both men and women. A minor
surgery can be done for re-canalization. The couple can have a child after the
re-canalization. Success rate is higher for men than women. It can fail in men also.
:
MYTH :
After sterilization men become impotent and lose interest in sex.
FACT
Man cannot become impotent after sterilization. What is cut is only the vas
deferens (tubes which carry spermatic fluid). Sexual act is controlled by desire,
attitudes and male hormones.
:
MYTH :
FACT
>
:
:
Women should not lift heavy objects at all after sterilization.
Women can carry out day-to-day activities after a routine sterilization. (Avoiding
heavy manual labor for 6 weeks is sufficient). They do not require any additional
rest, periodic checkup or scanning.
MYTH :
Use of condoms decreases sexual satisfaction in men.
FACT
Condoms do not decrease sexual satisfaction.
:
MYTH :
One person can have sex with multiple partners, but should wash genitals
immediately after having sex to prevent STDs, HIV/AIDS.
FACT
Washing genitals immediately after sex does not prevent HIV/AIDS or STDs.
:
MYTH :
AIDS is common only among poor people.
FACT
HIV/AIDS affect all class of people (rich, poor and middle class people).
:
MYTH :
Washing genital with soap immediately after sexual intercourse prevents pregnancy.
FACT
Washing genitals after sex does not prevent pregnancy.
:
1SE-NIMHANS/2002
Health Promotion Modules - 10th Std.
Myths, and Misconceptions - Pretty and Handsome
ACTIVITY MATERIAL - 3.6
STATEMENTS:
PINK CARDS (Myths) AND GREEN CARDS (Facts)
>
MYTH :
Women with smaller breasts are not sexually attractive.
FACT
Size of breasts alone does not decide the sexual attractiveness of a girl.
:
MYTH :
Application of cream, exercise, consuming pills and injections help in breast
enlargement or development.
FACT
There is no medicine, cream or injections of hormones that enlarge or develop
the breast. Advertisements shown on the T.V., newspaper, and magazines about
how to increase breast size misguide people. Size of breasts can be changed
only by surgery - expensive and has its own risks.
:
MYTH :
Bra is worn by women to look sexier and attract men.
FACT
Breast is a very soft gland or organ. Bra is used to support the breasts and
avoid/prevent sagging.
:
MYTH :
Wearing a tight bra causes breast cancer.
FACT
One should wear a bra, which is neither too tight nor too loose. Wearing a tight
bra does not cause breast cancer.
:
MYTH :
Girls who have a ‘sexy figure’ with big breasts are sexually more active.
FACT
Shape of a girl has nothing to do with her being sexually active. It is to do with
:
her urges controlled by hormones and culture too decides the attitude.
>
>
MYTH :
Big breasts produce more milk than smaller breasts.
FACT
The breasts are made up of the fatty tissue, which determines the size of the
breast. Milk glands, which secret the milk after delivery are not influenced by
the amount of fat or size of breasts, but by hormones. So size is not related to
secretion of milk.
:
MYTH :
Breast-feeding a baby makes women less attractive and older.
FACT
Breast-feeding a newborn baby does not make the breast sag. It helps in developing
bonding with the baby and the uterus to get back, to its original size. Pregnancy
increases the size of die uterus.
:
LSE-NIMHANS/2002
Health Promotion Modules - idth Std.
>
MYTH :
Menstruation is nothing but bad blood going out of the body.
FACT
Menstrual blood is not impure - it is like saliva or tears. Body does not remove
:
any toxins through menstrual blood. It is a misconception to say it is impure scientifically not correct.
>
MYTH :
A girl is impure during menstruation.
FACT
Girls are not dirty during periods. She can have a good bath and be as clean as
:
other persons.
>
>
>
MYTH :
Women have more than 2 or 3 menses in a month.
FACT
Women usually have period or menses only once in a month.
:
MYTH :
A man with a larger penis is sexually stronger than a man with a smaller penis.
FACT
The size of penis and sexual ability in a man are unrelated.
:
MYTH :
Night emission makes a boy tired, weak and lose Ills memory. He should consume
more food.
FACT
:
There is no connection between wet dreams and sexual impotency nor memory.
One can consume normal food and doesn’t require any extra nourishment. The
inadequacy if present may be due to guilt about such act. Memory' problems are
related to anxiety about semen loss.
>
MYTH :
Loss of semen during masturbation or wet dreams leads to dark circles around
the eyes of a boy.
FACT
:
Wet dream or night emission is normal among adolescent boys. It does not
make one tired, weak or cause dark circle around the eyes.
>
>
MYTH :
Masturbation is a sin.
FACT
Masturbation is physiological. It is more in men than women.
:
MYTH :
Only men (not women) practice masturbation. It is more common among
young than married people.
FACT
:
Masturbation is practiced by both sexes. It is more common among men. Women
are taught culturally to suppress sexual needs. This does not mean they have no
sexual needs. A woman masturbates by stimulating the clitoris. It is common
among young, married and even elderly. It is not a sin as it is physiological.
LSE-NIMHANS/2002
Health Promotion Modules - 10th Sid.
Empathy - HIV/AIDS - Please Help Us
ACTIVITY MATERIAL - 3.7
Situation :
“PLEASE HELP US”
Rashmi
:
You know yesterday in village meeting people suggested that Zaved’s father should
leave the village along with his family members.
Shabana
:
Why? Did Javed’s father commit any sinful act?
Rashmi
:
No! Javed father has AIDS and it seems his little brother and mother are also
infected. People in the village are scared to speak with them.
Shabana
:
Oh really? That means his father had sex with lots of women.
Rashmi
:
Look Shabana, Javed is coming towards us along with his little brother Haniff.
Shabana
:
Rashmi I don’t want to stand here and speak with them. I am going. Are you coming
with me?
Rashmi
:
Don’t be stupid. HIV/AIDS does not spread through talking, touching, playing
with them. I think you should talk with his brother and treat him as a friend rather
than running away Like this.
Shabana
:
I can’t do this. My parents have told me not speak or play with HIV infected
person. They always say that HIV infected people should be kept separately. One
woman from the neighboring village was asked to leave the place because she had
AIDS. She was not allowed to speak with anybody or visit the temple or public
places. She was kept away from every activity in the village. I read about the same
type of incident happening in several places in the newspapers. I feel Javed and
Haniff should not be allowed to attend school. “ I AM SCARED OF AIDS”.
I don’t want to speak with them. I am going................. Bye!
Discussion Questions for the Groups :
1.
How do you feel after listening to Javed’s family condition?
2.
Is our attitude same for illness like fever, cancer, tuberculosis, leprosy, etc?
3.
Have come across or read similar situations like Javed’s family? How did you feel about it?
4.
Will you make an attempt to change Shabana’s attitude? How?
5.
Which are the illnesses which are looked down upon (stigma)?
LSE-N1MHANS/2002
Health Promotion Modules - 10th Sid.
Homosexuality - Is he OK???????
ACTIVITY MATERIAL - 3.8
PICTURE 1
PICTURE 2
LSE-NIM1IANS/2002
WHQ/llPfVHfPAJ8.4
Disir.: General
Original; English
WHO’s Global School Health Initiative
A healthy setting for living, learning and working
World Health Organization
Division of Health Promotion,
Education and Communication
Health Education and Health Promotion Unit
Geneva, Switzerland
1948
1998
'.'"‘■'■'AI.'MtOHMarrflsM.l r-i iamht“
WHO’s Global
School Health
Initiative
This document has been prepared by Mr Jack T. Jones, School Health
Team Leader, in cooperation with Mr Matthew Turner, Technical
Officer, Health Education and Health Promotion Unit, Division of
Health Promotion, Education and Communication, WHO.
WHO gratefully acknowledges the generous financial contributions to
support the publication of this document from the following
organizations:
Division of Adolescent and School Health, National Center for Chronic
Disease Prevention and Health Promotion, Centers for Disease Control
and Prevention, Atlanta, Georgia, USA; UNAIDS; and the Johann
Jacobs Foundation, Zurich, Switzerland.
© World Health Organization, 1998
This document is not a formal publication of the World Health Organization (WHO), and all rights are reserved by the
Organization. The document may, however, be freely reviewed, abstracted, reproduced and translated, in part or in
whole, but not for sale or for use in conjunction with commercial purposes.
The views expressed in documents by named authors are solely the responsibility of those authors.
Organizations wishing to contribute to the work of WHO by supporting the
WHO Global School Health Initiative and anyone desiring further information
about the Initiative should contact Dr Desmond O'Byrne, Chief Health
Education and Health Promotion Unit (HEP), Division ofHealth Promotion,
Education and Communication (HPR), WHO, 1211 Geneva, Switzerland 27,
Telephone: (+41 22) 791 25 78: Eax: (+41 22) 791 07 46.
circumstances and create conditions that are
conducive to health.
WHO’s Global School
Health Initiative
Jakarta Declaration for
Promoting Health
BACKGROUND
The
Jakarta
Declaration
focuses WHO’s Initiative on
creating sustainable health
promotion
programmes.
Thus, the WHO Initiative
calls
for
international,
national, district and local
actions to promote social
responsibility,
increase
investments in schooling, consolidate and
expand
partnerships,
build
community
capacity, empower individuals and secure an
infrastructure for health promotion through
schools.
Such actions help to unlock the
potential for health promotion that is inherent
in all schools.
The Division of Health Promotion, Education
and
Communication
is
charged
with
strengthening the World Health Organization’s
capacities to promote health through schools. It
has a clear and comprehensive vision and a
strategic plan to do so. The Division’s Health
Education and Health Promotion Unit maintains
a school health team that serves as a secretariat
to an intradivisional WHO Working Group on
School Health.
The school health team,
Working Group and WHO Regional Offices
work together, and with other relevant
organizations, in creating WHO’s Global School
Health Initiative.
The general direction of WHO’s Initiative is
guided by the Ottawa Charter for Health
Promotion (1986) and the Declaration of the
Fourth International Conference on Health
Promotion held in Jakarta (1997). It is also
guided by the recommendations of WHO’s
Expert Committee on Comprehensive School
Health Education and Promotion (1995).
WHO Expert Committee
WHO’s Expert Committee on Comprehensive
School Health Education and Promotion
reviewed barriers to the development of school
health programmes as identified by national,
district and local education and health workers.
Five broad barriers commonly identified at
each organizational level are:
Ottawa Charter for Health Promotion
1.
2.
The Ottawa Charter focuses
HEALTH
WHO’s
Initiative
on
PROMOTION
SANTE
creating: 1) healthy public
policy;
2)
supportive
environments; 3) community
action; 4) personal skills; and
5) a reorientation of health
services. It also focuses the
Initiative on creating health
as well as preventing health
problems by calling for actions that enable
individuals to: care for themselves and others,
make decisions and have control over their life
3.
4.
5.
Inadequate vision and strategic planning.
Inadequate understanding and acceptance
of programmes.
Lack of responsibility and accountability.
Inadequate collaboration and coordination
among persons addressing health in
schools.
Lack of programme infrastructure,
including financial, human and material
resources
as
well
as
organizing
mechanisms.
Despite
the
barriers,
WHO’s
Expert
Committee found major reasons why school
health
programmes
should
be
further
1
WHO/HPR/HEP/98.4
WHO'S GLOBAL SCHOOL HEALTH IN1T1A TIVE
school health programmes must be well
designed, monitored and evaluated to ensure
their successful implementation and their
intended outcomes
international support must be further
developed to enhance the ability of countries,
local communities and schools to promote
health and education.
►
developed. The Committee concluded that there
is a rich base of knowledge on which to act to
develop and improve school health programmes.
Furthermore, it concluded that research in both
►
developing
and
developed
countries
demonstrates that school health programmes
can simultaneously reduce common health
problems, increase the efficiency of the
education system and advance public health,
education and social and economic development
in each nation.
Together, the Ottawa Charter, the Jakarta
Declaration and the recommendations of
WHO’s Expert Committee on Comprehensive
School Health Education and Promotion
provide the foundation for WHO’s Global
School Health Initiative.
Expert Committee Recommendations
To strengthen each nation’s capacity to improve
health as well as education, the WHO Expert
Committee recommended two broad actions that
must be supported at the local, national and
international levels. They are:
►
►
WHO’S GLOBAL SCHOOL
HEALTH INITIATIVE
WHO's Global School Health Initiative,
launched in 1995, seeks to mobilize and
strengthen health promotion and education
activities at the local, national, regional and
global levels. The Initiative is designed to
improve the health of students, school
personnel, families and other members of the
community through schools.
expanding investments in schooling
expanding the educational participation of girls.
To promote health through schools, the WHO
Expert Committee made three recommendations
about what schools must do:
►
►
►
provide a safe learning and working
environment for students and staff
serve as an entry point for health promotion and
a location for health intervention
enable children and adolescents to learn critical
health and life skills.
~V-
The Goal
The goal of WHO’s Global School Health
Initiative is to increase the number of schools
that can truly be called “Health-Promoting
Schools”.
Although definitions will vary,
depending on need and circumstance, a HealthPromoting School can be characterized as a
The WHO Expert Committee also recognized
that schools clearly need support to enable them
to promote health; thus, they made the
following five recommendations:
►
►
►
school constantly strengthening its capacity
as a healthy setting for living, learning and
working.
policies, legislation and guidelines must be
developed to ensure the identification,
mobilization and coordination of resources at
the local, national and international levels
teachers and school staff must be valued and
provided with the necessary support to enable
them to promote health
communities and schools must work together to
support health and education
WHO/HPR/HEP/98.4
A Health-Promoting School:
►
2
strives to improve the health of school
personnel, families and community members
as well as students
WHO'S GLOBAL SCHOOL HEALTH INITIA LIVE
►
►
►
►
implementation strategies and components of
comprehensive school health programmes.
fosters health and learning with all the measures
at its disposal
engages health and education officials, teachers
and their representative organizations, students,
parents and community leaders in efforts to
make the school a healthy place
strives to provide a healthy environment, school
health education and school health services
along with school/community projects and
outreach, health promotion programmes for
staff, nutrition and food safety programmes,
opportunities for physical education and
recreation and programmes for counselling,
social support and mental health promotion
implements policies and practices that respect
an individual’s self-esteem, provide multiple
opportunities for success and acknowledge good
efforts and intentions as well as personal
achievements.
Improving
School
Health Programmes:
Barriers
and
Strategies,
WHO/HPR/HEP/96.2.
This
manuscript
addresses barriers that
impede local, national
and
international
efforts to improve
school
health
programmes.
It
provides successful examples of specific local,
national and international strategies, as well as
six general strategies, that can be implemented
to improve school health programmes.
Research to Improve Implementation and
Effectiveness of School Health Programmes,
WHO/HPR/HEP/96.3. This text provides
information regarding the kinds of research
that can guide practice on school health
environments, health education and health
services. It discusses other research-relevant
information such as indicators that can be used
in planning, implementing and monitoring
school health programmes, what is known
about the cost-effectiveness of school health
programmes and specific health-problem
interventions that can be delivered through
schools.
Four Strategies for Action
WHO’s Global School Health Initiative consists
of four broad strategies:
Building capacity to advocate for improved
school health programmes
WHO generates technical documents that
consolidate research and expert opinion about
the nature, scope and effectiveness of school
health programmes. The materials are designed
to help individuals in international, national and
local organizations argue effectively for
increased support of efforts to promote health
through schools. They are also designed to help
policy- and decision-makers justify decisions to
increase support for such efforts.
Basic
documents include:
►
Promoting
Health
Through
Schools:
A
Summary
and
Recommendations
of
WHO’s Expert Committee
on Comprehensive School
Health Education and
Promotion,
WHO/HPR/HEP/96.4.
This document defines
health education in the context of a HealthPromoting School and provides a rationale for
each of the ten recommendations of the WHO
Expert Committee. The full report of the
WHO Expert Committee is available in the
WHO Technical Report Series, #870.
The
Status
of
School
Health,
WHO/HPR/HEP/96.1. The Status of School
Health discusses the role of schools in
promoting health and rationales for investing in
a comprehensive approach to school health. It
discusses major health problems that can be
reduced through school health programmes,
3
WHO/HPR/HEP/98.4
WHO'S GLOBAL SCHOOL HEALTH INIT!A TIVE
world. It describes how schools can begin to
address violence through schools.
To help individuals and groups advocate for the
development of Health-Promoting Schools,
WHO produces an “Information Series on
School Health”. Each document in the Series
provides strong arguments for addressing one or
more important health issues through schools,
describes the concept and qualities of a HealthPromoting School and delineates multiple ways
in which the health issue(s) is addressed in a
Health-Promoting
School.
While
each
document in the Series addresses a priority
health issue, it also focuses on the positive
affects that will be accrued by the education
sector if the issue is effectively addressed.
Documents in this Series include:
►
►
►
►
Local Action: Creating Health-Promoting
Schools, WHO/HPR/HEP/98. Local Action
assists school and community leaders in efforts
that improve the health and education of young
people. It provides practical guidance, tools and
“tips” from Health-Promoting Schools around
the world.
Strengthening Interventions to Reduce Helminth
Infections: An Entry Point for the Development
of
Health-Promoting
Schools,
WHO/HPR/HEP/96. Research and case studies
have proven that schools are a remarkably
efficient means to prevent and reduce helminth
(worm) infections. This document describes
how helminth reduction interventions can have
a positive impact on children’s health, learning
potential and school attendance.
Primary School Physical Environment and
Health, WHO/School/97.2, WHO/EOS/97.15.
This document identifies key elements for
achieving a healthier school environment. It
focuses on adequate services, particularly water
and sanitation; operation and maintenance; and
local motivation and ownership, with an
emphasis on the physical environment of the
school.
Violence Prevention: An Important Element of
a
Health-Promoting
School,
WHO/HPR/HEP/98.2. This document explains
how violence affects the well-being and learning
potential of millions of children around the
WHO/HPR/HEP/98.4
4
►
Healthy Nutrition: An Essential Element of a
Health- Promoting
School,
WHO/HPR/HEP/98.3.
Healthy Nutrition
describes how nutrition interventions in
schools benefit the entire community, and how
healthy eating contributes to health and well
being while also decreasing important health
risks.
►
Food, Environment and Health: A guide for
primary school teachers, ISBN 92 4 1 54400 7.
This book discusses how teachers can teach
their students practical aspects of storing and
handling food safely, making water fit to drink,
disposing of wastes and maintaining healthy
school and home environments.
►
Preventing HIV/AIDS/STDs and Related
Discrimination: An Important Responsibility of
Health-Promoting
Schools,
WHO/HPR/HEP/98. This document includes
descriptions of HIV-prevention programmes
that are effective in reducing the risk of HIV
infection among young people. It explains
why schools must accept the responsibility to
educate their community members and work
with them to determine the most appropriate
and effective ways to prevent HIV infection
among young people.
►
Active Living: An Essential Element of a
Health-PromotingSchool,WHO/HPRIHEP/9S.
This document shows how school age is the
optimal time of life for individuals to adopt
useful, pleasurable and satisfying physical
activities as an integral part of their own daily
life.
►
Tobacco Use Prevention: An Important Entry
Point for the Development of a HealthPromoting
School,
WHO/HPR/HEP/98.
Tobacco Use Prevention demonstrates that
comprehensive tobacco use prevention
programmes in schools can effectively reduce
tobacco consumption.
WHO’S GLOBAL SCHOOL HEALTH INITIATIVE
Life Skills Education: An Essential Element of a
Health-Promoting School, WHO/MNH/98. This
document focuses on obtaining maximum
results of life skills education by integrating it
into the various activities and goals of a HealthPromoting School.
organizations throughout the world to use their
unique capacities and experience to improve
health through schools. Special emphasis has
been placed in strengthening policies, curricula
and training programmes that can help prevent
HIV infection and related discrimination. In
1997, teachers’ representative organizations in
Asia and Central Europe were assisted by the
WHO-EI-UNAIDS-UNESCO alliance.
Creating Networks and Alliances for the
development of Health-Promoting Schools
WHO’s Regional Networks
for the Development of
Health-Promoting
Schools
may be the world’s most
comprehensive and successful
international effort to mobilize
support for school health
promotion. The first Network
was initiated by the European
Regional Office of WHO, the Council of Europe
and
the Commission of the European
Strengthening national capacities
As part of the development
of WHO’s Mega-Countries
Health Promotion Network,
WHO and the Centers for
Disease
Control
and
Prevention
(USA)
periodically brings together
persons responsible for
health promotion and school
health from countries with
the
world’s
largest
populations. Participants exchange strategies
and experience and work together to improve
health promotion and school health programmes
on a large scale.
Communities in 1991. This Network has grown
in six years to include 34 countries, 500 core
schools and 1 600 affiliated schools, reaching
about 400 000 students.
In conjunction with the
Global
School
Health
Initiative, Regional Networks
for the Development of
Health-Promoting
Schools
were started in the Western
Pacific (1995), Latin America
(1996) and Southern Africa
(1996) through joint efforts
by WHO/HQ and the respective WHO Regional
Offices. In 1997, meetings were held to develop
Networks in South East Asia and the northern
countries of the Western Pacific. Each Network
will be composed of public and private
organizations interested in planning and working
together toward the goal of helping schools
become Health-Promoting Schools.
In July 1997, meeting at the Fourth International
Conference on Health Promotion in Jakarta,
Indonesia, school health officials from the
Mega-Countries agreed to jointly publish a
manuscript describing national strategies for the
support of school health promotion in their
countries. They called upon WHO to help
generate increased commitment for school
health promotion by requesting that the
Ministers of Education and Health each
designate a policy-maker to work together in
coordinating the resources of the two ministries
in support of school health promotion. They
also called upon WHO to convene a meeting of
the
ministers,
their
designees
and
representatives of UN agencies and other
relevant international organizations to plan
concerted actions that will build national
capacities for school health promotion in the
Additionally, WHO works in alliance with
Education International (El), UNAIDS and
UNESCO to enable teachers’ representative
5
WHO/HPR/HEP/98.4
WHO'S GLOBAL SCHOOL HEALTH INITIATIVE
world’s largest countries. WHO agreed to seek
support for such an effort.
and trends among school-age children and
adolescents.
In 1997, WHO also provided technical support
for country-level actions to create HealthPromoting Schools. WHO worked with China
and South Africa to use priority health issues as
entry points for the development of HealthPromoting Schools. WHO worked with China to
strengthen national and local capacities for
helminth control and prevention and to
strengthen HIV/STD prevention efforts in
schools. WHO worked with South Africa to use
helminth control and prevention and violence
prevention as entry points. Experiences gained in
these efforts are diffused through the Regional
Networks of Health-Promoting Schools.
Research
to
programmes
improve
school
Partnerships and Support
WHO recognizes that the success of the Global
School Health Initiative rests on the extent to
which partnerships can be formed at local,
national and international levels. This will
require organizations interested in promoting
health through schools to identify individuals
with responsibility, time and authority to work
in partnerships with others. It will also require
them to jointly develop mechanisms that enable
their organizations to plan and work together,
document their achievements and improve their
programmes.
health
The extent to which each nation’s schools
become “Health-Promoting Schools” will play
a significant role in determining whether the
next generation is educated and healthy.
Education and health support and enhance each
other. Neither is possible alone. Together, they
serve as the foundation for a better world.
WHO
consolidates
existing
research to
strengthen knowledge about interventions that
can improve health through schools. It also
fosters the development of ways to: 1) assess
national capacity for school health promotion; 2)
evaluate the extent to which schools become
Health-Promoting Schools; and 3) monitor the
health status of children and teachers.
WHO is taking an active lead to ensure that the
health promotion principles of the Ottawa
Charter and the health promotion guidelines of
the Jakarta Declaration are diffused worldwide
and applied in the development of HealthPromoting Schools. The concept of HealthPromoting Schools is a sound vision for a better
world. WHO’s Global School Health Initiative
invites all governmental and nongovernmental
organizations,
development
banks,
organizations of the United Nations system,
interregional bodies, bilateral agencies, the
labour movement and cooperatives, as well as
the private sector to help advance health
promotion actions as called for in the Jakarta
Declaration by helping all schools become
WHO’s Rapid Assessment and Action Planning
Process is being developed by the WHO
Collaborating Centre to Promote Health Through
Schools
and
Communities,
Education
Development
Center,
Inc.,
Newton,
Massachusetts.
The Process helps countries
assess national capacity for school health
promotion. WHO works with partner agencies
to develop methods for evaluating the extent to
which schools become Health-Promoting Schools
and the extent to which students are practising
healthy lifestyles. An evaluation of the extent to
which helminth interventions could be used to
create Health-Promoting Schools in China was
completed in 1997. In the World Health Report
Health-Promoting Schools.
***
of 1998, WHO will report on the health status
WHO/HPR/HEP/98.4
6
Recommendations of the WHO Expert Committee on
Comprehensive School Health Education and Promotion
1
Investment in schooling must be improved and expanded.
2
The full educational participation of girls must be expanded.
3
Every school must provide a safe learning environment for students and a safe
workplace for staff.
4
Every school must enable children and adolescents at all levels to learn critical
health and life skills.
5
Eveiy school must more effectively serve as an entry point for health promotion
and a location for health intervention.
6
Policies, legislation and guidelines must be developed to ensure the
identification, allocation, mobilization and coordination of resources at the local,
national and international levels to support school health.
7
Teachers and school staff must be properly valued and provided with the
necessary support to enable them to promote health.
8
The community and the school must work together to support health
and education.
9
School health programmes must be well-designed, monitored and evaluated to
ensure their successful implementation and outcomes.
10
International support must be further developed to enhance the ability of Member
States, local communities and schools to promote health and education.
Geneva, Switzerland, 18-22 September 1995
Expand Investment in Schooling
Health-Promoting Schools focus on:
v' Caring for oneself and others
Making healthy decisionsand taking
control over life’s circumstances
Creating conditions thatare
conducive to health
- Policies
• S^fvices
- Phys icai/socia 1 cond■tinns
S tJuilding cupac
es for:
~ Shelter
- Peace
- Education
- Food
‘ A stable eco-system
- Income
- Equity
- Social justice
- Sustainable d h'eiopment
A Preventing leading causes of death,
disease and disability:
- Violence
- Nutrition
- Injuries
- Helminths
- Tobacco use
- HIV/AlDS/STDs
- Sedentary lifestyle
- Drugs and alcohol
Influencing health-related
behaviours
- Knowledge
- Beliefs
-Skills
- Attitudes
- Values
- Support
c
Round Table Discussion
GOVERNMENTS
M
AND
M
NGOS
M
Partnerships in
Health Promotion
Record of a meeting held during the
52nd World Health Assembly
Geneva, J 9 May 1999
WHO/NMH/HPS/OO.2
Distribution: Limited
English only
World Health
Organization
WHO/NMH/HPS/OO.2
English only
Distribution: Limited
© World Health Organization 2000
This document is not a formal publication of the World Health Organization (WHO), and all rights are reserved by
the Organization. The document may not be reviewed, abstracted, quoted, reproduced or translated in part or in
whole, without prior written permisson of WHO. No pan of this document may be stored in a retrieval system or
transmitted in any form or by any means - electronic, mechanical or other - without prior written permission of
WHO. The views expressed in documents by named authors are solely the responsibility of those authors.
1
Partnerships in Health Promotion
Round Table Discussion
GOVERNMENTS AND NGOS
Partnerships in Health Promotion
This is a record of a Lunchtime meeting held during the 52nd World Health Assembly, in
Geneva, on May 19, 1999.
The meeting was organised and chaired by the NGO Ad Hoc Advisory Group on Health
Promotion. The objective was to give some Governments the opportunity to show how they
are working with NGOs in health promotion and in the follow up to the Jakarta Declaration
and thereby encourage others to do the same
Table of Contents
Chair
Mats Ahnlund, NGO Ad Hoc Advisory Group on Health Promotion................... 3
Intervention
Dr. Pamela Hartigan, Director Department of Health Promotion, WHO.............. 5
Intervention
Professor Javier Urbina Soria, Government of Mexico............................................. 7
Intervention
Dr. B. Bamouni, Government of Burkino Faso.......................................................... 9
Intervention
Dr. Bosse Pettersson, Government of Sweden....................................................... 10
Intervention
Mohammed Aktar, Government of United States of America..............................12
Intervention
Dr. Elaine Stowers, Government of Samoa.............................................................1 1
Intervention
Delegate of the Government of Benin.................................................................... 14
Intervention
Dr. S. Shangula, Government of Namibia............................................................... 15
Intervention
Dr. Thomas Bongo, Government of Congo...........................................................17
Intervention
Delegate of the Government of Mali....................................................................... 18
Intervention
Dr. Gillian Durham, Government of New Zealand................................................ 19
Intervention
Dr. E. Samba, Regional Director AFRO.................................................................... 20
Intervention
Dr.Desmond O'Byrne, Department of Health Promotion, WHO........................ 22
NGO Ad Hoc Advisory Group on Health Promotion............................................................................23
Round Table Discussion
GOVERNMENTS AND NGOS
3
Partnerships in Health Promotion
Chairman Mats Ahnlund
International Health Cooperatives Organisation / ICA
We wish you all a very warm welcome at today's Round Table Discussion. I am here representing
one of the organisers of this meeting, the International Health Cooperatives Organisation, where
I am Secretary General.
An NGO briefing like this during the World Health Assembly is becoming a little bit of a tradition.
Last year we held a similar discussion, and the title was the NGO Response to the Jakarta
Declaration.
As most of you know, there was a "Call to Action" from the Jakarta Conference and one of the
proposals in this document was to create a Global Health Promotion Alliance, inviting different
actors in the health sector to be part of this alliance. The NGOs and among them cooperatives.
were mentioned as partners. With this as a background, we in the Ad Hoc Group of NGOs
represented here today are collaborating with WHO in this health promotion work. The result of
last years NGO meeting, which took place in the room next door, oneyearago, was a publication,
the NGO Response to the Jakarta Declaration. In that the NGOs said yes to this Global Health
Promotion Alliance, planned to be founded at the next Global Conference on Health Promotion
in Mexico.
Pamela Hartigan who is the Director of the Department of Health Promotion in WHO opens
today's discussions.
4
Round Table Discussion
GOVERNMENTS AND NGOS
Dr. Pamela Hartigan
Director Department of Health Promotion, WHO
Thank you for coming to this meeting I look forward to learning from all of you of the work you
are doing in health and development. The work that NGOs carry out at the local, national and
global levels is very familiar to me because I. too. come from the NGO world. For the better part
of fifteen years, I worked within organizations of the Latino community in Washington, D.C. that
were formed by many newly arrived immigrants from Central America who sought to flee the
conflict that characterised these nations in the 1980s. Coming to the U.S. in search for better
opportunities, they found that they needed their own organizations to represent their legal
needs, to respond more appropriately to their health concerns and to ensure the preservation of
their cultural heritage in an alien land
I Joined the Pan American Health Organization, or PAHO. the regional office of WHO in the
Americas in 1990, precisely with the purpose of facilitating greater linkages between NGOs that
worked in health and development in Latin America, and the Ministries of Health. Initially, this
was no easy task. Up until very recently, NGOs and governments were hostile to one another
The history of Latin America has been marked by authoritarian rule, and NGOs have been
overtly anti-governmental. On the other hand, governments were threatened by NGOs which
were growing in number throughout the region. Yet as democracy swept the region, it became
increasingly evident that the time had come to build bridges between the two so as to promote
health improvements, particularly among the poor. So PAHO set out to bring governments and
NGOs closer together.
The work that is carried out by many NGOs is largely promotional in character They work to
build local capacity, empower communities to fully engage in shaping their own future So
whether NGOs call what they do "health promotion" or something else, the work that they
carry out on a day by day basis is at the very heart of what promoting health is all about.
Chairman;
Thank you very much Pamela.
It is very much thanks to the Department of Health Promotion that we sit here today. They let us
in. As you know, WHO is an organisation of governments and a guerilla force like the NGOs
doesn't have automatic access We have to do very special things to get inside the walls here,
but it is thanks to Pamela's department that we have succeeded. And it also thanks to them that
we have this good collaboration with WHO.
We are now moving on, but before we start to get news from governments we will have a small
presentation about the Mexico Conference and what is going to happen there. We have the
Director General of Health Promotion from the Government of Mexico, Prof. Javier Urbina Soria
and he will talk about the preparations for the 5th Global Conference on Health Promotion to
be held in June next year.
5
Partnerships in Health Promotion
Prof. Javier Urbina Soria
Director General of Health Promotion, Government of Mexico
Thank you for giving me this opportunity to share with you some of the ideas we are planning
for the forthcoming conference in Mexico which is being shared with the Government of Mexico.
WHO Headquarters, Geneva and PAHO, Washington. They are like three parts of one single
whole that together seeks new associates and new partners.
The conference in Mexico City follows the others that have taken place in Jakarta, Sundsvall,
Adelaide and Ottowa. Our principal objective is to find new partners for health promotion. One
of the basic objectives at Mexico City is that we want to have an open commitment to involve
national governments The conference will have a technical component as in the previous
conferences and there will also be a powerful political component. We have invited Ministers of
Health to attend and it is our great hope that a maximum number will be able to come to
Mexico. Over the last few months we have prepared a draft Ministerial Declaration in the hope
that those Ministers of Health who will be present in Mexico City can sign it This will serve as the
prime thrust for the worldwide alliance.
On the technical side there are going to be one or two innovative ideas, which I hope will be
very productive WHO has asked for technical reports to be prepared by specialists. These will
cover the health promotion priorities that we defined in Jakarta, and each one of those priorities
will be the subject of a report. And then to bring things into the day to day life within our
communities there will be presentations of some experiences in community work, such as case
studies which show good health promotion practices and successful experiences in this particular
field.
So to summarise, I think we can say that the Mexico City Conference will be very enriching from
the technical standpoint, as well as serving as a powerful political thrust for health promotion.
One of the main participant groups is of course the NGOs. And it is our strong hope that the
majority of those here will be with us in Mexico next year. Let me simply say I look forward to
seeing you in Mexico City next year. We have a publicity leaflet on the Conference which was
handed out to the ministers in the Assembly, and is being distributed now. We will be sending it
out to all the organisations and countries throughout the world that are going to be involved.
Mexico and its Government is very committed to this conference We know it is going to be
successful and I hope you will be part of that success. Thank you very much.
6
Round Table Discussion
GOVERNMENTS AND NGOS
Chairman:
Thank you very much Prof. Soria. Let's hope that we all will meet there next June.
We are now moving into the main topic of the day and that is how governments look upon
NGOs as partners in health work.
At our Round Table last year it was the NGOs that had some ideas on how they could contribute
to this partnership work in Health Promotion. This year we have asked some governments to
give their views on the usefulness of NGOs in health care work Of course it would be good if it
could be widened in the way Pamela Hartigan mentioned to include also NGOs outside the
traditional heath sector that work with empowerment and enabling people as preventive action
I was asked by one or two of the speakers what they should say or what they should stress and
I said the best thing would be of course to say that the NGOs are great partners and we would
like them to be included as a complement in their own work, but we will see if they elaborate a
bit more on that. We have asked Burkino Faso to start and after that it will be Sweden, and the
United States and then we have some others on the list
Partnerships in Health Promotion
Dr. B. Bamouni
Government of Burkino Faso
NGO work is part of the overall activities of Burkino Faso There is a big health problem in our
country We have development priorities. We suffer from resource shortages, financial and human,
which means that the NGOs have become a vital partner in the overall development process.
Health promotion is one sphere in which the NGOs have a very considerable role to play.
National NGO's work is recognised by the government. The international ones have signed a
collaboration agreement with the Ministry of Health and this is the legal framework within which
they work.
NGOs have a follow up office which is responsible for managing the work of the NGOs in the
country from the diplomatic, administrative and legislative aspects. We also have a permanent
NGO secretariat which is responsible for the coordination side, and for providing guidance for
the geographic distribution of activities throughout the country The coordination office brings
together the various NGO representatives. They meet regularly and discuss their experiences
and exchange views on the way the work is organised.
The Ministry organises an annual conference of partners to take stock of the situation for all
partners including NGOs The NGO objectives are defined by the Ministry of Health and they
work to achieve the objectives of the Ministry. Their work focuses on participation in decentralised
planning. There is direct community action involving full participation by the communities.
Coordination work is also conducted among the NGOs. As to follow up and evaluation, we
have health indicators which arejointly defined with the Ministry of Health and these are mutually
discussed as well as the use of funds that are allocated to NGOs.
Technical support is provided at the regional and central levels and field activities are funded.
Very often therefore the health administration is improved by the assistance given by and to the
NGOs. The government provides a certain amount of financial contribution for this work. There
is support at the central and district levels and some NGOs are responsible solely for the execution
of activities in the field. There is a central office that is responsible for purely vertical management
The principal areas of work are preventative care, combating HIV/AIDS. maternal and child
health care, programmes for the elderly and re-education and rehabilitation programmes. The
results in the community are measured in terms of availability of care and coverage.
What difficulties do we encounter?
Often there are two organizations working in the same field. Some NGOs tend to focus on
specific regions. Then there is irregularity in the provision of funds which sometimes makes planning
rather difficult at the operational level. Some NGOs set their own requirements for their work
and do not really wish to discuss priority setting at the central levels. Sometimes it is hard to
capitalise on what has been achieved because there is no adequate follow up. NGOs sometimes
come and work and then disappear without a trace. However we are developing contracts in
our country so that it will be possible for NGOs to sign a contract with the government for
8
Round Table Discussion
GOVERNMENTS AND NGOS
implementation of programmes. This should result in improved integration of health activities
particularly at the community level.
And then there is the United Nations Initiative for Africa, where NGOs can work in a more closely
organised way and that I think will certainly improve things in the future. Thank you very much
Chairman:
Thank you Dr. Bamouni from the Government of Burkmo Faso.
I think in one of your statements you made a good point, namely to choose your NGOs carefully
so they don't disappear after a little while. I think if we look at this group of NGOs that has invited
you here today, we have together some thousands of years of experience. So we promise not to
disappear if you start to work also with us!
We have Dr. Bosse Pettersson who is working for a Swedish authority and is representing the
Swedish Government here today. For some of you he may be familiar as he was the Secretary
General of the Third Global Health Promotion Conference in Sundsvall in 1991
9
Partnerships in Health Promotion
Dr. Bosse Pettersson
Government of Sweden
Thank you. Let me start by saying that the potential of the partnership between governmental
organisations and NGOs has very much to offer especially in a field like health promotion
since it is so inter and multisectorial A brief history of Sweden tells us that it was NGOs that took
the initiative of creating a modern welfare society and social accountability. However, their aim
was to transfer those responsibilities to public structures and that meant that they also withdrew
some of their own possibilities for being more active players in the present times. The role of
NGOs has thus become more of an advocate than an active player and participatory provider
for its members. So I would say that we would need much more, and better, partnerships with
NGOs in Sweden To encourage you, I would like to give three very brief examples of successes
in which we have been collaborating with them.
We have been working together with the Swedish Cancer Foundation, a Non Smoking
Organisation, and Physicians and Nurses Against Tobacco, and have succeeded in passing
legislation through parliament for an age limit for purchasing tobacco and for further advertising
restrictions.
Secondly, the Swedish Heart and Lung Foundation together with leading cardiologists has chosen
physical activity as its priority in an EU funded project to combat coronary heart disease. And it
goes hand in hand with a recent national public health priority for getting Sweden on the move.
In the middle of the 1970s breastfeeding was declining in Sweden. That negative was turned
into a positive one and now we have much better figures and this is very much due to an NGO
working in the breastfeeding field.
To sum up with some principles for partnership, I would like to mention an overall principle that
partnership must be built on trust, shared goals and visions and also a reasonable division of
roles between NGOs and governmental organisations. Public health and public good must
be the core. As an example, NGOs must want to be more disease orientated advocates for
patients' groups and define their position in relation to health promotion and disease prevention.
Normative function is mainly the role of the governmental organisations. NGOs are in the unique
position to be able to empower people and communities for health development and they
can often have a comparative advantage in taking initiatives for policy development in health.
speaking as a third voice outside formal political and administrative structures.
Chairman:
Thank you, the representative of the Swedish government.
10
I Round Table Discussion
GOVERNMENTS AND NGOS
Mohammed Aktar
Executive Director of the American Public Health Association, USA
Thank you Mr. Chairman for inviting me to come here and share some of our experiences from
the United States. I bring greetings from the USA to you and best wishes as you plan for the
conference in Mexico. We are very interested in health promotion and disease prevention as this
is the future of public health. This is the vaccine for the next century and that is why we have put
so much emphasis on this particular area.
NGOs in the USA work very closely with the government and that is one of the reasons that
as the head of an NGO I am part of the US delegation to the World Health Assembly. With
me is Beverly Malone, President of the American Nurses Association, another NGO and she is
also part of the US delegation. We work very much together in consultation on various issues
relating to public health. We put publications together with the government and share information
with the people at large. We play a key role in three areas.
** Education of the health professionals themselves. We have 55 thousand members in the US
And we provide health education and health promotion information to our members so that
they can in turn be educated enough to provide to the public at large. And that is a very important
responsibility which we can do and which the government cannot do by itself We start each
year in April by celebrating a public health week. In that week we pick an important theme and
we start with the Secretary of the Health and Human Services who is our Minister of Health. We
celebrate throughout that week and throughout the country that particular theme that we
want the public to become aware of and be knowledgeable about. And then we end that week
again, with the Secretary or the Surgeon General in Washington. In that way we provide
information to the public about the important issues that we want them to focus on during that
year.
** Our second area of expertise is in terms of getting assignments from the government for
preparing the material ourselves and distributing it to the public. For example, we have the
assignment from the government on HIV/AIDS treatment. What are the best treatments? How
to make sure the patient will comply with the treatment? Our membership gets together and
we prepare the material on behalf of the government and then share it with the public at large
to educate them on HIV/AIDS, prevention and treatment. And even more importantly, on
maintenance of that treatment because it is very important that when somebody starts to take
the medication, they must stay on it to really benefit and not create drug resistant HIV/AIDS.
Those are the kinds of things where we take the lead with the government. We do the same
thing as what my colleague here from Sweden said in that we are able to bring in all parties with
different view points. We offer the table around which people can sit down to discuss and
come to consensus where government is unable to do Sometimes it takes too long for the
government and we can do it very fast.
11
Partnerships in Health Promotion
** Our last contribution to collaboration is also very important. We go to our Congress and to
our President and ask for more money to be put into health education and health prevention
programmes. We go and advocate a lobby for the budgets for our health programmes and that
collaboration is absolutely essential, particularly in a democracy because somebody needs to pull
from within and someone needs to push from outside and by working together, governments
and the NGOs, we can serve our people better. Mr Chairman that concludes my statement.
thank you for this opportunity
Chairman:
Thank you Mr Aktar I think the ultimate proof that you are serious about NGOs as a partner
you have shown by including them in your delegation to the WHA. And I think that could
be a good model for all of us.
12
Round Table Discussion
GOVERNMENTS AND NGOS
Dr. Elaine Stowers
Director of Nursing, Department of Health, Government of Samoa
Thank you Mr. Chairman. I feel rather privileged to be here, speaking with all these big countries,
like the United States. Sweden and so on. I should like to talk of some Samoan experiences in
terms of working with NGOs in the health field. This goes way beyond or further back than
Jakarta, or even the Alma Ata. We have always worked with communities that are not government
paid or funded. These are traditional communities in our villages and we have worked with
them in areas like maternal and child health for a long time.
When the NGOs came to our country as an established mechanism from the west, there
was some conflict. This was a concept which was introduced as an organised entity into our
country which already had its own traditional ways and cultures, and it clashed with governments
and established departments
99% of all the health work, especially health promotion out in the rural areas.was done by
nurses It was fully managed by nurses and it was the nurses who always worked with women's
groups out in the community. Then came the new word NGO and the women's groups wanted
to be grouped into corporations This was an indication that our women wanted to have their
potential needs recognised. I am a woman and also a member of the Nurses Association so
there I see there is a need for this. We had to take into account the cultural and traditional
structures so that they can work together.
One traditional example of work was in the area of immunisation - EPI The way we used to
work, is that the women in the village identified the contact points themselves. They had done
that for a very long time. We could not enter a village without the women's permission When
the NGOs came in the women were divided under different umbrellas and we found there
were conflicting agendas. For a long time NGOs and Government departments wasted a lot of
time working out who was following whose agenda instead of pursuing one agenda in health
We found that too much time was spent on trying to analyse what was available and how
structures work. Now I think we have matured. About three years ago a central body was set up
which now coordinates all the NGOs, men and women, irrespective of gender
From the health sector point of view for the last three years we have involved the NGOs especially
the women's groups working in the villages, around the table in developing our strategic health
sector plans at the beginning of every year. This was absent in the past. The Department of
Health prepared the programmes and then delegated them, but now the women or the NGOs
are involved at the planning table. And since last year foreign donors are now allowing NGOs
to go in direct. It is only recently that we have managed to work out our differences.
Partnerships in Health Promotion .
Chairman:
Thank you. You have pointed out a very important thing, that when we talk about Non
Governmental activities it is not only about organisations with rules and statutes registered with
the county council or the national government, there are also other more informal non
governmental structures that are working since a long time. So thank you very much.
14
Round Table Discussion
GOVERNMENTS AND NGOS
Delegate of the Government of Benin
Thank you very much. When you listen to the various experiences encountered in different
countries, it seems to me that much of what I would say simply echoes what my friend from
Burkino Faso was talking about. Therefore I would like tojust refer to a specific experience that
we had with cooperatives which we undertook at the beginning of the 1980s.
There was an economic crisis and less and less public funds were available. The government was
no longer systematically recruiting graduates from school, in particular administrative schools
and the health sector. The Ministry realised it was simply not possible to entrust health tasks to
service providers and we were therefore obliged to try and organise doctors, nurses, midwives,
laboratory seivices and so forth into health cooperatives. The dual purpose was to improve
health coverage throughout the country and to cut unemployment among young graduates in
the health sector We were very lucky because we were given technical support from WHO,
and UNDP provided us with funds. We were able to organise about 100 young people into
cooperatives throughout the country, particularly in rural areas and in destitute semi urban
areas. That went back some ten years or so and whilst they encountered some difficulties they
nevertheless gained experience of taking stock of their activities, and drawing a kind of balance
of the various difficulties There were basically four difficulties:
* The first was that they had thrown themselves into an experience that they were not prepared
for. The provision of health care is very different from managerial tasks and the level of funding
they had to work with was not high enough.
* Second, they did not have any kind of formal post graduate training programme. They had not
taken any special courses and that in turn led to other problems.
* Third, they were badly equipped. It became increasingly harder to provide for seivices More
and more human beings were available but the resources were not there for them to be properly
equipped and fitted out
* Fourth, there was a competitive environment As a result, some of the clinics developed the
same type of activities as they were involved in, to have the right set up in the same areas Over
the last seven or eight years solutions have been found for this but there are nevertheless other
problems that definitely persist. Thank you very much.
Chairman:
Of course I am very pleased to hear this, working with co-operatives myself. The IHCO newsletter
on the table has a description of this specific case on the back page. Its called "possible model for
Africa - cooperatives of health professionals in Benin". Thank you very much. We now move in to
Namibia.
15
Partnerships in Health Promotion
Dr. S. Shangula
Government of Namibia
Thank you Mr Chairman for giving me the chance to present our situation.
Namibia has adopted the concept of a primary health care approach that has put us in a position
where we cannot exclude the NGOs if we are strictly following this concept as it is. Right from
the beginning, since we got our independence eightyears ago, the Government has committed
itself to improving primary health care and we have worked very closely with the NGOs also in
other sectors. A specific area I would like to highlight is child health and development The policy
developed for that specific area has been developed with the involvement of NGOs. The donors
supporting the government are also supporting the NGOs and the NGOs that are
implementing that aspect in that area, register with the government or the local government.
Once they register they are entitled to get what funding is coming through the government in
support of NGO activities. That is one area The government or local government is also giving
support in terms of training members from the non governmental organisations in that area
Secondly regarding women's health and adolescent health. The Ministry of Health in particular
has assisted in establishing the regional Planned Parenthood Association in the country which
relieves the Ministry of a lot of work in terms of advocating for the womens' health and reproductive
health as well as adolescent health They are currently setting up centers throughout the rural
areas to try to help adolescent health and get health services accessible in terms of information
and health education
Thirdly, regarding the control of communicable diseases, particularly HIV and TB control. There
are organisations working in that area and recently our own President launched the Mid Term
Plan to control HIV. I think that the epidemic in our country has brought us to work closer with
NGOs and with the other sectors, the public sectors, the private sectors. The process we have
followed by coming up with that Mid Term Plan has involved everybody throughout It took us
almost one and a half years, and every sector was involved in the development of that plan. We
have now set up structures for coordinating the activities of controlling HIV throughout the
country. NGOs at the regional level work through their regional committees, chaired by the
government At the national level we have set up the national coordinating committee in which
all the sectors are represented. We hope by working together we will be able to control this
epidemic in our country.
The other area I want to emphasise is the care of the aged. NGOs in my country are fully
responsible for taking care of the aged. However, the Government has subsidised these NGOs.
They register with the Ministry of Health and they get a small amount of money to be able to
carry out their activities As the government will not be able to take care of everybody due to
financial constraints so we entrust the NGOs with a lot of work which the health sector cannot
do by itself.
’6
MH Round Table Discussion
GOVERNMENTS AND NGOS
Finally Mr. Chairman, the key areas we are actually involved in as the Government is to provide
technical support to NGOs to develop their policies together with the NGOs chat are working in
our country, and for the Government to provide to some extent the financing of some activities.
We are active in producing HIV information, education materials and communication and the
Government is expected to coordinate this. However, for the distribution of this information and
the education of the public, we expect the NGOs to become very involved in this area. One
example is the distribution of condoms to prevent HIV. We also expect them to provide the care
of those who are infected and affected. So we are expecting that to happen. We also provide
training in whatever technical area the NGOs wish to be supported in. We look forward to
strengthening our collaboration with NGOs in my country. Thank you.
■■■■■■■■■ 17
Partnerships in Health Promotion
........
Dr. Thomas Bongo
Director of Health, Government of Congo
My friends from Benin and Burkino Faso have said much of what needs to be said about NGOs
in our country. NGOs are a necessary partner for the Government of Congo. Today's government
is faced with many difficulties. We are going through a severe economic crisis. We have a group
of NGOs working in health They are grouped together under a coordination bureau and that
bureau works directly with the Health Ministry Cooperation Department. So that shows how
significant we see them as being partners. We have a budget heading within the Health
Ministry that is entitled Support to NGOs. The NGOs come to us and ask us for funds and the
Government provides a budget heading precisely for that purpose. This is very important.
The Ministry of Health works with NGOs in areas of immunisation. For example we had to
relaunch a campaign last year and as part of information, education and communication, NGOs
provided about one and a half thousand people throughout the country for this particular
campaign In the fight against HIV/AIDS we have relied on NGOs to a very great extent. Five
NGOs are working in that particular field very closely with the Ministry of Health An interesting
point as well is that we have an Association of Unemployed Graduates called AMISAB and
the Ministry entrusts them with epidemiological survey work on the basis of pre established
protocols and this I think demonstrates just how important all this work is That is for national
NGOs.
There are international NGOs that come into the CONGO as well, but it is quite rare for an NGO
to come on their own initiative. Very often they come to our country because they are chosen
by donor partners to execute particular programmes. In that particular area the government
sometimes experiences difficulties. We have an American NGO in our country that is rehabilitating
and reconstructing a hospital. You may recall there was a war in Brazzaville and a good many
things need to be rebuilt But what is difficult for us is to know precisely what budget has been
allocated to those operations because sometimes the management of them is fairly impenetrable
It is difficult for me when I have to make a report on health expenditure to the Ministry, if I don't
know what the NGOs have spent on health In these cases, I cannot give a precise figure to my
government and this presents some problems. So to respond to your concern I would definitely
say that in the CONGO the NGOs are very important partners We would like to work even
more closely together to try and ensure that the population's health is helped as much as possible.
is
■■ Round Table Discussion
GOVERNMENTS AND NGOS
Delegate of the Government of Mali
Burkino Faso and Benin have described very well the importance of NGOs in our various policies.
There are more than a 1000 NGOs working in my country and to try and regulate the situation
a framework agreement was prepared and has to be signed by every national or international
NGO. The contents are precisely the same. Its a kind of NGO visa to work in Mali. So you have to
sign that document if you wish to work in Mali.
If an NGO wishes to work in health education or agriculture then another agreement has to be
signed with the department concerned On the subject of health the specific agreement refers
to the work to be done in the field. You define what your wishes are and of course this has to
have its place in the Five Year Plan, and your activity has to find a place in that Five Year Plan.
Once that is done you can sign at the community or regional level. The structure has been put
in place to avoid subsequent problems of disagreement on the operational side in the field. But
clearly, if you agree with those you are working with in the field the entire operation can be
success.
In health itself we have about 200 NGOs working on the subject of collaboration and partnership.
The Ministry developed these partnerships through the Dakar Forum which we attended along
with many other NGOs. In 1994 we set up the framework for cooperation involving annual
meetings with NGOs. We called these "NGO Partnership meetings" and they served to define
problems in the field and to seek solutions These are usually in the form of recommendations
addressed to NGOs or to the Ministry.
This year we organised a National Partnership Workshop which discussed a number of
problems such as the difficulties that NGOs encounter or when importing tax free equipment.
Under the agreement they are meant to be able to do that but there are difficulties and we have
signed an agreement with the Ministry of Finance requiring them to find a solution to that
importation problem. We do have a good many difficulties, but we have made a great deal of
progress. Often in our country young unemployed people get togetherand set up an NGO but
unfortunately they don't have the required level of ability and competence in the health field.
This is a problem as the work cannot be done without the proper expertise and skills. Thank you
very much.
Partnerships in Health Promotion
■
Dr. Gillian Durham
Government of New Zealand
I would like to give a brief perspective as a policy adviser in a very decentralised health sector. We
have a large indigenous population - 14% of our population is Maori and about 6% are from the
Pacific islands The basis of our relationship with NGOs is that we have common goals but
different roles The roles of our NGOs are for advocacy service provision and in some instances
research, whereas the government role is around policy advisory regulation and funding. Our
partnership arrangements are both formal and informal. The most important formal relationship
is the Treaty of Waitangi between the Maoris and the Crown which embraces the principles of
partnership, protection and participation. And then we have arrangements whereby NGOs are
part of formal advisory groups in the Policy Development process or through consultation. In the
reciprocal arrangement government officials are invited to be observers on some NGO groups.
So for instance we have agencies for nutrition action and we are observers on that group. We
have contractual relationships and in some instances undertake joint research. And we have a
number of informal relationships particularly with the smoke free coalition, a coalition of over 20
NGOs and by and large we share the work.
In respect of our experiences of the partnership relationship, from our perspective it rises and falls
on mutual understanding. From our perspective - the understanding of NGO's objectives, their
funding base and also their decision making processes and time frames. From the NGOs
perspective - understanding the machinery of government and the budget cycle. I think the
most important thing in a developed country is to get control of the budget
Where things can improve is in the area of mutual respect and trust and an acceptance of the
different environments in which we operate. We like to operate in an environment of no
surprises, sharing the information, and what we believe is critical to the whole thing, is
having personal relationships between particular government officials who know what is
happening and also the key people in NGOs.
Chairman:
This ended this part of the programme and it was the most important part, the views among
governmentsand NGOs And if this represents an average of views of governments, it would be
of course fantastic, but we also understand that those governments who have a positive approach
towards NGOs are those governments who are here today.
We now give the floor to the WHO Regional Director for Africa, Dr. Samba, who by reputation,
(I never met him before, but I heard about it) is a man very open to collaboration with NGOs.
20
Round Table Discussion
GOVERNMENTS AND NGOS
Dr. E. Samba
WHO Regional Director for Africa
Thank you very much Mr. Chairman. I didn't know about this meeting. I was going to another
meeting because we have an epidemic of meetings at this time, and then I saw some of my
NGO colleagues and I said what's all this about. An NGO meeting? So I decided to come here
today.
I have an officer in AFRO exclusively for NGO collaboration. But why did I come here? At the
WHA in 1997 there was a similar meeting. And I heard NGOs complaining that WHO doesn't
treat them as equal partners and that they wait until everybody has spoken. I said I am going to
correct this. Because before joining WHO I was Director of Medical services in my country and
afterjoining WHO and knowing all African countries I have found out that NGOs are extremely
useful. There are maverick NGOs You know them all. My estimate is very conservative, there are
over 30,000 NGOs in Africa, in Angola, Ethiopia, and over 1,500 in South Africa. Therefore we
need to work together in better harmony and organisation.
Following that meeting in May 1997 I decided I was going to call up a meeting in Dakar in
October 1997. We wrote to the NGOs and were overwhelmed with the responses. So we
decided that instead of 1997 we would have it in February 1998. and we did. And some of you
here were present. There were 19 governments, 300 NGOs, WHO Africa and Headquarters,
and after 3 days we all agreed it was really a good meeting. And it was. But I emphasised to all
that its not just enough to meet and say what a wonderful thing and slap each other on the
back, there has to be a follow up and we agreed to a protocol and to an agreement It was not
what they complained of in 1997. And we agreed that the NGOs were not going to regard
WHO as Father Christmas.
Another thing, we agreed there would be a secretariat in AFRO and somebody to deal exclusively
with NGOs We sent a copy of the protocol to all rhe NGOs, Africans and non Africans. What
was the result? I have to say that the African NGOs did very well. They responded and there
were far more than we expected. But the international NGOs response was extremely poor. I
think only two or three out of 153 respondents. So why did I stop and come to this meeting
instead of the other one?. I am convinced that we need each other. Governments cannot do
it alone . WHO cannot do it alone. Nor can the NGOs do it alone. Together we can do
much better than what we are doing at this moment.
It is not easy bringing NGOs together. It means surrendering certain facilities and taking on more
and so I am appealing now to the international NGOs, please respond to the protocol that we
agreed on because as you all know most of us attend meetings and then after the meeting we
all say what a wonderful meeting that was, and after that we continue as before. So I do hope
that we will follow up because you are doing a good job. This is no flattery. If I didn't think so I
wouldn't say so. You are doing a very good job but we need more and better organisation.
Thank you so much.
2
Partnerships in Health Promotion
Chairman:
Thank you Dr. Samba.
So this positive approach from a Regional Director was a good final speech before the very last
one and we shouldn't regard as you say, WHO as a Father Christmas. With the new Director
General we should in that case anyway talk about Mother Christmas now
The very last word is from Desmond O'Byrne, who is our liaison and he is also working and in
charge of health promotion at WHO.
22
Round Table Discussion
GOVERNMENTS AND NGOS
Dr. Desmond O'Byrne
Department of Health Promotion, WHO
It really is very encouraging to see such a full attendance at this, the second meeting to be
organised during the World Health Assembly by the NGO Ad Hoc Advisory Group on Health
Promotion. This NGO Group, as many of you may know, was formed in response to the Jakarta
Conference and Declaration. The importance given to the role of NGOs in WHO is underlined
by the presence and presentation of Dr. Samba, the Regional Director of WHO in the African
Region.
I fully support the previous speakers who stressed that partnerships between Governments,
IGOs and NGOs, must be built on mutual respect
The Jakarta Declaration called for the development of a global alliance in health promotion. This
Ad Hoc NGO Group took up the challenge and has been actively promoting collaboration
between its many members It has acted as a catalyst among NGOs in promoting partnership
and collaboration.
Dr. Mahler, in speaking to this meeting at the WHA last year, stated that NGOs provide the
political dynamite to mobilise action for health This meeting it is hoped will help to contribute
to that motivation.
Dr. Brundtland, Director General of WHO, in her forward to the World Health Report, referred
to the importance of NGOs and of the need to reorganise to form more strategic alliances. I am
sure we all agree with that. We need to strengthen and build partnerships between NGOs
themselves, but also between Governments, NGOs and the private sector. If progress towards
health for all is to continue then all sections of society will need to contribute in partnership and
mutual respect. NGOs have, and are setting a good example of such partnership. We look
forward to this ongoing strengthening of collaboration with Governments and all sectors of
society. This meeting is another positive step in the direction.
Partnerships in Health Promotion
A Partnership of Committed INGOs
We are an informal group of international NGOs which attended the WHO 4tr International
Conference on Health Promotion in Jakarta, in July 1997. We saw the need to implement the
Jakarta Declaration, and to work in partnership towards the next Global Conference on Health
Promotion in Mexico City. June 5-9 2000
We come from widely different areas of activity Education
Health co-operatives,
Traditional health practices
Nursing,
Rural women.
Social welfare.
Women's health.
Our wide diversity of interests, international structures and grass root involvement gives the
NGO Ad Hoc Advisory Group on Health Promotion its richness of approach, experience and
expertise.
Together we represent many millions of members around the world
Working together and individually, and m close liaison with the Health Promotion Unit at the
WHO headquarters, we have endeavoured to keep the Jakarta and Mexico agendas in the
forefront of the NGO community As a Group we held two successful lunchtime Briefings at the
1998 and 1999 World Health Assemblies, on NGO and Government partnerships in the follow
up to Jakarta. As an individual NGO this would not have been possible
We hope that this example of partnership will encourage others to become involved in health
promotion, and that it will seive as an example for NGO Groups in other areas and disciplines.
The Members of the Group
Associated Country Women of the World (ACWW)
Global Alliance of Womens Health (GAWH)
Inter African Committee (IAC)
International Baccalaureate Organisation (IBO)
International Council of Nurses, (ICN)
International Council of Social Welfare (ICSW)
International Health Cooperatives Organisation (IHCO)
International Union of Health Education and Promotion (IUHPE)
Contact Address:
Joanna Koch, Fax: 0041 17 15 4137, Email: joannakoch@gmx.net
World Health Organization
20 Avenue Appia, 1211 Geneva 27, Switzerland
Tel: +41 22 791 211 1, Fax: +41 22 791 4178
www.who.int
j E OCUSING
R ESOURCES
&
ON .
E FFECTIVE
f § CHOOL
(Health
hsB
a FRESH Start to Improving the Quality
and Equity of Education.
FOCUSING RESOURCES ON EFFECTIVE SCHOOL HEALTH
WHO, UNESCO, UNICEF, the World Bank
and Education International:
Partners in taking a FRESH Start to school health
For health to be put high on the agenda of education reform, and given the priority attention
it deserves, policymakers, community leaders, teachers, parents and students will need to be
convinced that health contributes to the overall goals and purposes of the education sector,
schools in particular.
In April, 2000, Education International, WHO, UNESCO, UNICEF, and the World Bank
jointly organized as strategy session at the World Education Forum in Dakar, Senegal. The
strategy session was aimed at raising the education sector’s awareness of the value of
implementing an effective school health, hygiene and nutrition programme as one of its
major strategies to achieve Education for All.
Attached you will find information that is the foundation and reasoning behind our
willingness to join in partnership to Focus Resources on Effective School Health (FRESH).
This information is concisely written and contains the kind of arguments you may need to
call attention to the value of effective school health programmes to the education sector, and
to justify calls for increased resources to implement and improve them.
Information in this document will help you to make a strong case that an effective school
health programme:
•
•
•
•
•
Responds to a new need
Increases the efficacy of other investments in child development
Ensures better educational outcomes
Achieves greater social equity
Is a highly cost effective strategy.
It also provides information that you can use to clearly argue why the following basic
components of a school health programme, should be made available together, in all schools:
•
•
•
•
Health related school policies
Provision of safe water and sanitation - the essential first steps towards a
healthy physical, learning environment
Skills based health education
School based health and nutrition services.
Lastly, it provides concise and sound reasons that you can use to foster effective partnerships
between:
•
•
•
•
Education and health sectors
Teachers and health workers
Schools and community groups
Pupils and persons responsible for school health programmes.
FOCUSING RESOURCES ON EFFECTIVE SCHOOL HEALTH
Improving the health and learning of school children through school-based health and
nutrition programmes is not a new concept. Many countries have school health programmes,
and many agencies have decades of experience. These common experiences suggest an
opportunity for concerted action by a partnership of agencies to broaden the scope of school
health programmes and make them more effective. Effective school health programmes will
contribute to the development of child-friendly schools and thus to the promotion of
education for all.
This interagency initiative has identified a core group of activities, each already
recommended by the participating agencies, that captures the best practices from programme
experiences. Focusing initially on these activities will allow concerted action by the
participating agencies, and will ensure consistent advice to country programmes and
projects. Because of the focused and collaborative nature of this approach, it will increase
the number of countries able to implement school health components of child-friendly school
reforms, and help ensure that these programmes go to scale. The focused actions are seen
as a starting point to which other interventions may be added, as appropriate.
The actions also contribute to existing agency initiatives. They are an essential component
of the “health promoting schools” initiative of WHO and of global efforts by UNICEF,
UNESCO and the World Bank to make schools effective as well as healthy, hygienic and
safe. Overall, the inter-agency action is perceived as Focusing Resources on Effective
School Health, and giving a FRESH Start to improving the quality and equity of education.
Focusing Resources on the School-Age Child
A child’s ability to attain her or his full potential is directly related to the synergistic effect
of good health, good nutrition and appropriate education. Good health and good education
are not only ends in themselves, but also means which provide individuals with the chance
to lead productive and satisfying lives. School health is an investment in a country’s future
and in the capacity of its people to thrive economically and as a society.
An effective school health, hygiene and nutrition programme offers many benefits:
O Responds to a new need
The success of child survival programmes and the greater efforts by many
governments and communities to expand basic education coverage have resulted
both in a greater number of school-age children and in a greater proportion of these
children attending school. In many countries, targeted education programmes have
ensured that many of these new entrants are girls for whom good health is especially
important. Thus, the school is now a key setting where the health and education
sectors can jointly take action to improve and sustain the health, nutrition and
education of children previously beyond reach.
FOCUSING RESOURCES ON EFFECTIVE SCHOOL HEALTH
O Increases the efficacy ofother investments in child development
School health programmes are the essential sequel and complement to early child
care and development programmes. Increasing numbers of countries have
programmes that ensure that a child enters a school fit, well and ready to learn. But
the school age child continues to be at risk of ill health throughout the years of
schooling. Continuing good health at school age is essential if children are to sustain
the advantages of a healthy early childhood and take full advantage of what may be
their only opportunity for formal learning. Furthermore, school health programmes
can help ensure that children who enter school without benefit of early development
programmes, receive the attention they may need to take full advantage of their
educational opportunity.
O Ensures better educational outcomes
Although schoolchildren have a lower mortality rate than infants, they do suffer from
highly prevalent conditions that can adversely affect their development.
Micronutrient deficiencies, common parasitic infections, poor vision and hearing,
and disability can have a detrimental effect on school enrolment and attendance, and
on cognition and educational achievement. In older children, avoidance of risky
behaviours can reduce dropping out due, for example, to early pregnancy. Ensuring
good health at school-age can boost school enrolment and attendance, reduce the
need for repetition and increase educational attainment, while good health practices
can promote reproductive health and help avoid HIV/AIDS.
O Achieves greater social equity
As a result of universal basic education strategies, some of the most disadvantaged
children - the girls, the rural poor, children with disabilities - are for the first time
having access to school. But their ability to attend school and to learn whilst there
is compromised by poor health. These are the children who will benefit most from
health interventions, since they are likely to show the greatest improvements in
attendance and learning achievement. School health programmes can thus help
modify the effects of socioeconomic and gender-related inequities.
O Isa highly cost effective strategy
School health programmes help link the resources of the health, education, nutrition,
and sanitation sectors in an infrastructure - the school — that is already in place, is
pervasive and is sustained. While the school system is rarely universal, coverage is
often superior to health systems and has an extensive skilled workforce that already
works closely with the community. The accessibility of school health programmes
to a large proportion of each nation’s population, including staff as well as students,
FOCUSING RESOURCES ON EFFECTIVE SCHOOL HEALTH
contributes to the low cost of programmes. The high effectiveness of these
programmes is a consequence of the synergy between the health benefit and the
educational benefit. The effectiveness is measurable in terms not only of improved
health and nutrition, but also of improved educational outcomes, reduced wastage,
less repetition and generally enhanced returns on educational investments.
The Basic Framework for an Effective School Health and Nutrition
Programme
The framework described here is the starting point for developing an effective school health
component in broader efforts to achieve more child-friendly schools. Much more could be
done, but if all schools implement these four interventions then there would be a significant
immediate benefit, and a basis for future expansion. In particular, the aim is to focus on
interventions that are feasible to implement even in the most resource poor schools, and in
hard-to-reach rural areas as well accessible urban areas, that promote learning through
improved health and nutrition. These are actions known to be effective, and actively
endorsed by all the supporting agencies: this is a framework from which individual countries
will develop their own strategy to match local needs.
Core framework for action: Four components that should be made
available together, in all schools.
(i)
Health-related schoolpolicies
Health policies in schools, including skills-based health education and the provision
of some health services, can help promote the overall health, hygiene and nutrition
of children. But good health policies should go beyond this to ensure a safe and
secure physical environment and A positive psycho-social environment, and should
address issues such as abuse of students, sexual harassment, school violence, and
bullying. By guaranteeing the further education of pregnant schoolgirls and young
mothers, school health policies will help promote inclusion and equity in the school
environment. Policies that help to prevent and reduce harassment by other students
and even by teachers, also help to fight against reasons that girls withdraw or are
withdrawn from schools. Policies regarding the health-related practices of teachers
and students can reinforce health education: teachers can act as positive role models
for their students, for example, by not smoking in school. The process of developing
and agreeing upon policies draws attention to these issues. The policies are best
developed by involving many levels, including the national level, and teachers,
children, and parents at the school level.
FOCUSING RESOURCES ON EFFECTIVE SCHOOL HEALTH
(ii)
Provision ofsafe water and sanitation - the essential first steps towards
a healthyphysical, learning environment.
The school environment may damage the health and nutritional status of
schoolchildren, particularly if it increases their exposure to hazards such as infectious
disease carried by the water supply. Hygiene education is meaningless without clean
water and adequate sanitation facilities. It is a realistic goal in most countries to
ensure that all schools have access to clean water and sanitation. By providing these
facilities, schools can reinforce the health and hygiene messages, and act as an
example to both students and the wider community. This in turn can lead to a
demand for similar facilities from the community. Sound construction policies will
help ensure that facilities address issues such as gender access and privacy. Separate
facilities for girls, particularly adolescent girls, are an important contributing factor
to reducing dropout at menses and even before. Sound maintenance policies will
help ensure the continuing safe use of these facilities.
(Hi) Skills based health education
This approach to health, hygiene and nutrition education focuses upon the
development of knowledge, attitudes, values, and life skills needed to make and act
on the most appropriate and positive health-related decisions. Health in this context
extends beyond physical health to include psycho-social and environmental health
issues. Changes in social and behavioural factors have given greater prominence to
such health- related issues as HIV/AIDS, early pregnancy, injuries, violence and
tobacco and substance use. Unhealthy social and behavioural factors not only
influence lifestyles, health and nutrition, but also hinder education opportunities for
a growing number of school-age children and adolescents. The development of
attitudes related to gender equity and respect between girls and boys, and the
development of specific skills, such as dealing with peer pressure, are central to
effective skills based health education and positive psycho-social environments.
When individuals have such skills they are more likely to adopt and sustain a healthy
lifestyle during schooling and for the rest of their lives.
(iv) School based health and nutrition services
Schools can effectively deliver some health and nutritional services provided that the
services are simple, safe and familiar, and address problems that are prevalent and
recognized as important within the community. If these criteria are met then the
community sees the teacher and school more positively, and teachers perceive
themselves as playing important roles. For example, micronutrient deficiencies and
worm infections may be effectively dealt with by infrequent (six-monthly or annual)
oral treatment; changing the timing of meals, or providing a snack to address short
term hunger during school - an important constraint on learning - can contribute to
school performance; and providing spectacles will allow some children to fully
participate in class for the first time.
FOCUSING RESOURCES ON EFFECTIVE SCHOOL HEALTH
Supporting Activities
These activities provide the context in which the interventions can be implemented.
(i)
Effective partnerships between teachers and health workers and between the
education and health sectors
The success of school health programmes demands an effective partnership between
Ministries of Education and Health, and between teachers and health workers. The
health sector retains the responsibility for the health of children, but the education
sector is responsible for implementing, and often funding, the school based
programmes. These sectors need to identify responsibilities and present a coordinated
action to improve health and learning outcomes from children.
(ii)
Effective communitypartnerships
Promoting a positive interaction between the school and the community is
fundamental to the success and sustainability of any school improvement process.
Community partnerships engender a sense of collaboration, commitment and
communal ownership. Such partnerships also build public awareness and strengthen
demand. Within the school health component of such improvement processes,
parental support and cooperation allows education about health to be shared and
reinforced at home. The involvement of the broader community (the private sector,
community organizations and women’s groups) can enhance and reinforce school
health promotion and resources. These partnerships, which should work together to
make schools more child-friendly, can jointly identify health issues that need to be
addressed through the school and then help design and manage activities to address
such issues.
(Hi)
Pupil awareness andparticipation
Children must be important participants in all aspects of school health programmes,
and not simply the beneficiaries. Children who participate in: health policy
development and implementation; efforts to create a safer and more sanitary
environment; health promotion aimed at their parents, other children, and community
members; and school health services, learn about health by doing. This is an
effective way to help young people acquire the knowledge, attitudes, values and
skills needed to adopt healthy lifestyles and to support health and Education for All.
FOCUSING RESOURCES ON EFFECTIVE SCHOOL HEALTH
SUPPORTIVE
ENVIRONMENTS
FOR
HEALTH
SUNDSVALL
Statement
This Statement on supportive environments for
Health was adopted on 15 June 1991 in
Sundsvall, Sweden, by participants at the
Third International Conference on
Health Promotion
*
9-15 June 1991, Sundsvall, Sweden
♦Co-sponsored by the United Nations Environment Programme, the Nordic Council of Ministers, and the
World Health Organization.
SUPPORTIVE ENVIRONMENTS FOR HEALTH
SUPPORTIVE ENVIRONMENTS FOR HEALTH
SUNDSVALL Statement
The Third International Conference on Health Promotion: Supportive Environments for Health - the
Sundsvall Conference - fits into a sequence of events which began with the commitment of WHO to the goals
of Health For All (1977). This was followed by the UN1CEF/WHO International Conference on Primary
Health Care, in Alma-Ata (1978), and the First International Conference on Health Promotion in
Industrialized Countries (Ottawa 1986). Subsequent meetings on Healthy Public Policy, (Adelaide 1988)
and a Call for Action: Health Promotion in Developing countries, (Geneva 1989) have further clarified the
relevance and meaning of health promotion. In parallel with these developments in the health arena, public
concern over threats to the global environment has grown dramatically. This was clearly expressed by the
World Commission on Environment and Development in its report Our Common Future, which provided a
new understanding of the imperative of sustainable development.
The third International Conference on Health Promotion: Supportive Environments for Health - the first
global conference on health promotion, with participants from 81 countries - calls upon people in all parts of the
world to actively engage in making environments more supportive to health. Examining today's health and
environmental issues together, the Conference pointed out that millions of people are living in extreme poverty
and deprivation in an increasingly degraded environment that threatens their health, making the goal of Health
For All by the Year 2000 extremely hard to achieve. The way forward lies in making the environment - the
physical environment, the social and economic environment, and the political environment - supportive to
health rather than damaging to it.
The Sundsvall Conference identified many examples and approaches for creating supportive environments
that can be used by policy-makers, decision-makers and community activists in the health and environment
sectors. The Conference recognized that everyone has a role in creating supportive environments for health.
A CALL FOR ACTION
This call for action is directed towards policy-makers and decision-makers in all relevant sectors and at all
levels. Advocates and activists for health, environment and social justice are urged to form a broad alliance
towards the common goal of Health for All. We Conference participants have pledged to take this message
back to our communities, countries and governments to initiate action. We also call upon the organizations of
the United Nations system to strengthen their cooperation and to challenge each other to be truly committed to
sustainable development and equity.
A supportive environment is of paramount importance for health. The two are interdependent and
inseparable. We urge that the achievement of both be made central objectives in the setting of priorities for
development, and be given precedence in resolving competing interests in the everyday management of
government policies.
Inequities are reflected in a widening gap in health both within our nations and between rich and poor
countries. This is unacceptable. Action to achieve social justice in health is urgently needed. Millions of
people are living in extreme poverty and deprivation in an increasingly degraded environment in both urban and
rural areas. An unforeseen and alarming number of people suffer from the tragic consequences for health and
well-being of armed conflicts. Rapid population growth is a major threat to sustainable development. People
must survive without clean water, adequate food, shelter or sanitation.
Poverty frustrates people's ambitions and their dreams of building a better future, while limited access to
political structures undermines the basis for self-determination. For many, education is unavailable or
insufficient, or, in its present forms, fails to enable and empower. Millions of children lack access to basic
education and have little hope for a better future. Women, the majority of the world's population, are still
oppressed. They are sexually exploited and suffer from discrimination in the labour market and many other
areas, preventing them from playing a full role in creating supportive environments.
More than a billion people worldwide have inadequate access to essential health care. Health care systems
undoubtedly need to be strengthened. The solution to these massive problems lies in social action for health
and the resources and creativity of individuals and their communities. Releasing this potential requires a
fundamental change in the way we view our health and our environment, and a clear, strong political
commitment to sustainable health and environmental policies. The solutions lie beyond the traditional health
system.
SUNDSVALL Statement
SUPPORTIVE ENVIRONMENTS FOR HEALTH
Initiatives have to come from all sectors that can contribute to the creation of supportive environments for
health, and must be acted upon by people in local communities, nationally by government and
nongovernmental organizations, and globally through international organizations. Action will predominantly
involve such sectors as education, transport, housing and urban development, industrial production and
agriculture.
DIMENSIONS OF ACTION ON
SUPPORTIVE ENVIRONMENTS FOR HEALTH
In a health context the term supportive environments refers to both the physical and the social aspects of
our surroundings. It encompasses where people live, their local community, their home, where they work and
play. It also embraces the framework which determines access to resources for living, and opportunities for
empowerment. Thus action to create supportive environments has many dimensions: physical, social, spiritual,
economic and political. Each of these dimensions is inextricably linked to the others in a dynamic interaction.
Action must be coordinated at local, regional, national and global levels to achieve solutions that are truly
sustainable.
The Conference highlighted four aspects of supportive environments:
1.
The social dimension, which includes the ways in which norms, customs and social processes affect
health. In many societies traditional social relationships are changing in ways that threaten health,
for example, by increasing social isolation, by depriving life of a meaningful coherence and
purpose, or by challenging traditional values and cultural heritage.
2.
The political dimension, which requires governments to guarantee democratic participation in
decision-making and the decentralization of responsibilities and resources. It also requires a
commitment to human rights, peace, and a shifting of resources from the arms race.
3.
The economic dimension, which requires a re-channelling of resources for the achievement of
Health for All and sustainable development, including the transfer of safe and reliable technology.
4.
The need to recognize and use women’s skills and knowledge in all sectors including policymaking, and the economy in order to develop a more positive infrastructure for supportive
environments. The burden of the workload of women should be recognized and shared between
men and women. Women's community-based organizations must have a stronger voice in the
development of health promotion policies and structures.
PROPOSALS FOR ACTION
The Sundsvall Conference believes that proposals to implement the Health for All strategies must reflect
two basic principles:
1.
Equity must be a basic priority in creating supportive environments for health, releasing energy and
creative power by including all human beings in this unique endeavour. All policies that aim at
sustainable development must be subjected to new types of accountability procedures in order to
achieve an equitable distribution of responsibilities and resources. All action and resource allocation
must be based on a clear priority and commitment to the very poorest, alleviating the extra hardship
borne by the marginalized, minority groups, and people with disabilities. The industrialized world
needs to pay the environmental and human debt that has accumulated through exploitation of the
developing world.
2.
Public action for supportive environments for health must recognize the interdependence of all
living beings, and must manage all natural resources, taking into account the needs of future
generations. Indigenous peoples have a unique spiritual and cultural relationship with the physical
environment that can provide valuable lessons for the rest of the world. It is essential, therefore,
that indigenous peoples be involved in sustainable development activities, and negotiations be
conducted about their rights to land and cultural heritage.
SUNDSVALL Statement
SUPPORTIVE ENVIRONMENTS FOR HEALTH
IT CAN BE DONE:
STRENGTHENING SOCIAL ACTION
A call for the creation of supportive environments is a practical proposal for public health action at the
local level, with a focus on settings for health that allow for broad community involvement and control.
Examples from all parts of the world were presented at the Conference in relation to education, food, housing,
social support and care, work and transport. They clearly showed that supportive environments enable people
to expand their capabilities and develop self-reliance. Further details of these practical proposals are available
in the Conference report and handbook.
Using the examples presented, the Conference identified four key public health action strategies to promote
the creation of supportive environments at community level.
1.
Strengthening advocacy through community action, particularly through groups organized by
women.
2.
Enabling communities and individuals to take control over their health and environment through
education and empowerment.
3.
Building alliances for health and supportive environments in order to strengthen the cooperation
between health and environmental campaigns and strategies.
4.
Mediating between conflicting interests in society in order to ensure equitable access to supportive
environments for health.
In summary, empowerment of people and community participation were seen as essential factors in a
democratic health promotion approach and the driving force for self-reliance and development.
Participants in the Conference recognized, in particular, that education is a basic human right and a key
element in bringing about the political, economic and social changes needed to make health a possibility for all.
Education should be accessible throughout life and be built on the principle of equity, particularly with respect
to culture, social class and gender.
THE GLOBAL PERSPECTIVE
People form an integral part of the earth's ecosystem. Their health is fundamentally interlinked with the
total environment. All available information indicates that it will not be possible to sustain the quality of life,
for human beings and all living species, without drastic changes in attitudes and behaviour at all levels with
regard to the management and preservation of the environment.
Concerted action to achieve a sustainable, supportive environment for health is the challenge of our times.
At the international level, large differences in per capita income lead to inequalities not only in access to
health but also in the capacity of societies to improve their situation and sustain a decent quality of life for
future generations. Migration from rural to urban areas drastically increases the number of people living in
slums, with accompanying problems - including lack of clean water and sanitation.
Political decision-making and industrial development are too often based on short-term planning and
economic gains which do not take into account the true costs to people's health and the environment.
International debt is seriously draining the scarce resources of the poor countries. Military expenditure is
increasing, and war, in addition to causing deaths and disability, is now introducing new forms of ecological
vandalism.
Exploitation of the labour force, the exportation and dumping of hazardous substances, particularly in the
weaker and poorer nations, and the wasteful consumption of world resources all demonstrate that the present
approach to development is in crisis. There is an urgent need to advance towards new ethics and global
agreement based on peaceful coexistence to allow for a more equitable distribution and utilization of the earth's
limited resources.
SUNDSVALL Statement
SUPPORTIVE ENVIRONMENTS FOR HEALTH
ACHIEVING GLOBAL ACCOUNTABILITY
The Sundsvall Conference calls upon the international community to establish new mechanisms of health
and ecological accountability that build upon the principles of sustainable health development. In practice this
requires health and environmental impact statements for major policy and programme initiatives. WHO and
UNEP are urged to strengthen their efforts to develop codes of conduct on the trade and marketing of
substances and products harmful to health and the environment.
WHO and UNEP are urged to develop guidelines based on the principle of sustainable development for use
by Member States. All multilateral and bilateral donor and funding agencies such as the World Bank and
International Monetary Fund are urged to use such guidelines in planning, implementing and assessing
development projects. Urgent action needs to be taken to support developing countries in identifying and
applying their own solutions. Close collaboration with nongovernmental organizations should be ensured
throughout the process.
The Sundsvall Conference has again demonstrated that the issues of health, environment and human
development cannot be separated. Development must imply improvement in the quality of life and health while
preserving the sustainability of the environment.
The Conference participants therefore urge the United Nations Conference on Environment and
Development (UNCED), to be held in Rio de Janeiro in 1992, to take the Sundsvall Statement into account in its
deliberations on the Earth Charter and Agenda 21, which is to be an action plan leading into the 21st century.
Health goals must figure prominently in both. Only worldwide action based on global partnership will ensure the
future of our planet.
SUNDSVALL Statement
LES MILIEUX
FAVORABLES
SANTE
Declaration de
SUNDSVALL
La presente declaration sur les milieux
ffavorables d la sante a ete adoptee le 15 juin
1991 d Sundsvall, Suede, par les participants d la
Troisieme Conference internationale pour la
promotion de la sante
*
9-15 Juin 1991, Sundsvall, Suede.
* Co-parrainee par le Programme des Nations Unies pour 1'Environnement, le Conseil des Ministres
des pays nordiques et 1'Organisation mondiale de la Sante.
LES MILIEUX FAVORABLES A LA SANTE
LES MILIEUX FAVORABLES A LA SANTE
Declaration de SUNDSVALL
La Troisieme Conference internationale sur la promotion de la sante, on Conference de Sundsvall,
convoquee sur le theme "des milieux favorables a la sante", s'inscrit dans une suite d'evenements qui a debate
avec I'engagement pris par I'OMS, en 1977, d'instaurer la sante pour tous. Cette decision a ete suivie par la
Conference internationale de I'UNICEF et de I'OMS sur les soins de sante primaires tenue a Alma-Ata, en
1978, et la premiere Conference Internationale pour la Promotion de la Sante dans les pays industrialises,
reunie a Ottawa en 1986. Les reunions organisees ensuite a Adelaide en 1988 sur une politique publique pour
la sante, et a Geneve en 1989 sur la promotion de la sante dans les pays en developpement, ont permis de
preciser ['importance et le sens de la promotion de la sante. Parallelement a cette evolution dans le domaine
de la sante, les preoccupations suscitees par les menaces qui pesent sur notre environnement n'ont cesse de
grandir. C'est ce qu'a clairement exprime la Commission mondiale sur I'environnement et le developpement
dont le rapport decrit sous un jour nouveau les conditions necessaires a un developpement durable.
La Troisibme Conference Internationale pour la promotion de la sanfe, convoquee sur le theme "des
milieux favorables & la sanfe", a 6fe la premiere conference mondiale dans ce domaine avec des participants
venus de 81 pays. Ceux-ci ont demands & tous les peuples du monde de prendre des mesures energiques pour
rendre les milieux plus favorables h la sanfe. Evoquant ensemble les questions de sanfe et d'environnement de
notre temps, ils ont nofe que des millions d'individus vivent dans la pauvrefe et le ddnuement le plus extreme,
dans un environnement de plus en plus degrade qui menace leur sanfe, faisant de 1’instauration de la sanfe pour
tous d'ici fan 2000 un objectif tfes difficile H atteindre. Pour progresses il faut veiller & ce que I'environnement
- physique, social, dconomique et politique -favorise la sanfe, au lieu de lui nuire.
La Conference de Sundsvall a illustfe par de nombreux exemples les moyens que pourraient mettre en
oeuvre les responsables politiques, les ddcideurs et les agents communautaires de la sanfe et de I'environnement
pour cfeer des milieux favorables. Elie a reconnu que chacun avait un role 11 jouer dans cette entreprise.
APPEL A L’ACTION
Cet appel s'adresse aux responsables politiques et aux decideurs dans tous les domaines concemes et a
tous les niveaux. Tous ceux qui s'emploient 11 promouvoir la sanfe, I'environnement et la justice sociale sont
instamment pries de former une alliance pour atteindre 1'objectif commun de la sanfe pour tous. Nous autres,
participants a cette Conference, nous sommes engages a transmettre ce message a nos communautes, H nos pays
et 11 nos gouvemements pour que soient prises les mesures qui s’imposent. Nous demandons aussi aux
organisations du sysfeme des Nations Unies de renforcer leur cooperation et de s'encourager mutuellement H
oeuvrer en faveur d'un developpement durable et de requite.
L'existence d'un milieu favorable est d’une importance capitale pour la sanfe.
Les deux sont
interdependants et indissociables. Nous demandons instamment que les conditions necessaires aux deux soient
considefees comme des objectifs essentiels lors de 1’eiaboration des priorites pour le developpement, et
occupent la premiere place dans la solution des conflits d'inferet qui peuvent surgir dans la gestion au jour le
jour des politiques des pouvoirs publics.
Le fosse qui se creuse, aussi bien 11 1'inferieur des pays qu'entre pays riches et pays pauvres, traduit les
inegalifes qui existent dans le domaine de la sanfe, et cela est inacceptable. Des mesures s’imposent d'urgence
pour instaurer la justice sociale dans le domaine de la sanfe. Dans les villes comme dans les campagnes, des
millions d’individus vivent dans la pauvrefe et dans un denuement extreme dans un milieu qui se degrade de
plus en plus. Un nombre impfevu et alarmant de personnes subissent les consequences tragiques des conflits
amfes pour la sanfe et le bien-etre. La croissance ddmographique rapide compromet serieusement les chances
d'un developpement durable. Nombreux sont ceux qui sont obliges de survivre sans eau propre, sans
alimentation correcte, sans abri et sans assainissement.
La pauvrefe frustre les gens de leurs ambitions et de leurs aspirations h un avenir meilleur, tandis que les
limites de I’accds aux structures politiques nuisent a 1'autodetermination. Pour beaucoup, 1'instruction est
inexistante ou insuffisante ou, sous ses formes ac'tuelles, incapable de donner les moyens d'agir. Des millions
Declaration de SUNDSVALL
5
LES MILIEUX FAVORABLES A LA SANTE
d'enfants n'ont pas acc&s H un enseignement de base et ne peuvent guere esp<Srer en un avenir meilleur. Les
femmes, qui repfesentent la majority de la population mondiale, sont encore opprimees. Elies sont
sexuellement exploitdes et les discriminations dont elles sont victimes sur le marc he du travail et dans bien
d'autres domaines les empechent de jouer pleinement leur role dans la mise en place d'environnements plus
favorables.
Dans le monde, plus de un milliard de personnes n'ont pas d'acc&s ad^quat a des soins de sanfe essentiels.
Les sysfemes de sanfe doivent ^vidcmment etre renforces. La solution & ces problemes considerables reside
dans des mesures d'action sociale en faveur de la sant6 et dans les ressources et les capacites d'innovation des
individus et des communaufes. Pour tirer parti de toutes ces possibility, il faudrait que nous modifiions
radicalement notre fa^on de concevoir la sanfe et 1'environnement et que se degage un engagement politique
clair et dnergique en faveur de politiques de sanfe et d'environnement durables. Les solutions doivent etre
cherchdes au-deD des limites du secteur traditionnel de la sanfe.
Des initiatives doivent etre prises dans tous les secteurs qui peuvent contribuer & la creation de milieux
favorables il la sanfe et soutenues au niveau local par les membres de la communaut^, au niveau national par les
pouvoirs publics et les organisations non gouvemementales et au niveau mondial par les organisations
intemationales. Les secteurs concemSs seront essentiellement ceux de I'Sducation, des transports, du logement
et du d^veloppement urbain, de la production industrielle et de 1'agriculture.
COMMENT CREER DES MILIEUX
FAVORABLES A LA SANTE
Du point de vue de la sanfe, 1’expression milieux favorables designe les aspects physiques et sociaux de
notre environnement, c'est h dire le cadre de vie de 1’individu, sa communaute, son foyer, son milieu de travail
et ses lieux de detente, mais aussi les structures qui determinent J'acc&s aux ressources vitales et les possibilites
d’obtenir les moyens d'agir. Ainsi, les dimensions de toute action visant H cfeer un milieu favorable sont
multiples: physiques, sociales, spirituelles, 6conomiques et politiques. Tous ces aspects sont titroitement
associ^s les uns aux autres en une interaction dynamique. Les mesures prises doivent etre coordonnees aux
Echelons local, regional, national et mondial afin que soient mises au point des solutions reellement durables.
La Conference a 6voqu6, en particulier, les quatre aspects suivants d'un environnement favorable :
1.
La dimension sociale, c'est-il-dire les famous dont les normes, les coutumes et les schemas sociaux
influencent la sanfe. Dans de nombreuses socfefes, Involution des relations sociales traditionnelles
repfesente une menace pour la sanfe, par exemple en renfonjant la solitude, en privant la vie de sens
et de coherence et en attaquant les valeurs et ftferitage culture! traditionnels.
2.
La dimension politique, qui oblige les gouvemements il garantir une participation d^mocratique it la
prise des decisions et H la decentralisation des responsabilifes et des ressources. Elie suppose aussi
un engagement en faveur des droits de 1’homme, de la paix, et 1'abandon de la course aux
armements.
3.
La dimension dconomique, qui suppose une redistribution des ressources en faveur de la sanfe pour
tous et d'un d6veloppement durable, et notamment le transfert d'une technologic sure et fiable.
4.
La n^cessife enfin de reconnattre et d'utiliser les competences et les connaissances des femmes dans
tous les domaines, y compris ceux de la politique et de Ifeconomie, pour mettre en place des
infrastructures plus propices il des environnements favorables il la sanfe. Il faudrait reconnaitre que
les femmes ont de lourdes taches et veiller & ce que les hommes assument leur part de ce fardeau. II
faudrait que les associations feminines communautaires aient les moyens d’intervenir plus
6nergiquement dans Ifelaboration de politiques et de structures propres & promouvoir la sanfe.
Declaration de SUNDSVALL
LES MILIEUX FAVORABLES A LA SANTE
ACTIONS PROPOSEES
Pour la Conference de Sundsvall, les actions envisages afin de mettre en oeuvre les strategies de la sante
pour tous doivent reposer sur deux grands principes fondamentaux :
1.
L'£quite doit etre un objectif prioritaire fondamental de toute mesure prise pour creer des milieux
favorables it la sante et mobiliser les energies et les imaginations en associant 1'humanite toute
entire & cette entreprise unique. Toutes les politiques visant h un developpement durable seront
soumises it de nouvelles regies d'approbation en vue d’une distribution equitable des responsabilites
et des ressources. Toute action et toute allocation de ressources sera guidde par le souci, clairement
exprime, de venir en aide aux plus pauvres, d'alldger le fardeau des marginalises, des groupes
minoritaires et des handicap's. II faut que le monde industrialist s’acquitte de la dette accumulee,
sur les plans ecologique et humain, h la suite de 1'exploitation du monde en developpement.
2.
Toute action publique en faveur de milieux propices h la sant6 doit tenir compte de
1'interdtpendance de tous les etres vivants, et bien gerer les ressources naturelies en se preoccupant
des besoins des generations futures. Les peuples autochtones entretiennent avec leur environnement
physique une relation spirituelle et culturelle unique qui peut etre riche d'enseignements pour le
reste du monde. II est done essentiel de les associer aux strategies de developpement et de prevoir
des negociations pour preserver leurs droits a leurs terres et a leur heritage culture!.
UN OBJECTIF REALISTE:
RENFORCER L’ACTION SOCIALE
Cet appel pour la mise en place de milieux favorables a la sante peut etre un objectif realiste de faction de
sante publique au niveau local, avec pour cible privil<5giee les contextes propices a une large degr6 de
participation et de controle de la part de la communautd. Des exemples du monde entier ont dte presentes a la
Conference dans les domaines de 1’education, de falimentation, de fhabitat, de la protection sociale, du travail et
des transports. Ces illustrations ont trfcs bien montrd qu'un milieu favorable permettait aux gens de developper
leur capacitds et leur autoresponsabilite. Le rapport et le guide de la Conference contiennent des
renseignements detail 16s sur ces projets concrets.
A 1'aide des exemples ainsi pr6sent6s, les participants a la Conference ont defini comme suit les quatre
strategies cl6s de sante publique susceptibles de promouvoir la creation de milieux favorables au niveau de la
communautd.
1.
Renforcer faction de plaidoyer au niveau de la communaute, notamment par le biais de groupes
organises par des femmes.
2.
Donner aux communautds et aux individus les moyens de g6rer leur propre sante et leur
environnement par 1'education et differentes mesures d'habilitation.
3.
Constituer des alliances en faveur de la sante et de milieux favorables afin de renforcer la
cooperation entre les campagnes et les strategies de sante et d'environnement.
4.
Concilier les int6rets conflictuels de la soci6t6 pour garantir un accfes equitable & des milieux
favorables it la sante.
En bref, I'habilitation des individus et la participation des communautes ont 6t6 definies comme les facteurs
cl6s d'une action d£mocratique de promotion de la sante et comme fdlement moteur permettant d'atteindre
fautoresponsabilite et d'assurer le developpement.
Les participants a la Conference ont reconnu, en particulier, que 1'education est un droit fondamental de
fhomme et la cie des changements politiques, dconomiques et sociaux qui s'imposent pour que tous puissent
prdtendre a la sante. Chacun devrait avoir acc6s, tout au long de sa vie, a une education con^ue sur des
principes d'equite, eu 6gard notamment h ia culture, h la classe sociale et au sexe.
Declaration de SUNDSVALL
LES MILIEUX FAVORABLES A LA SANTE
UNE PERSPECTIVE MONDIALE
L'humanite fait partie intdgrante de I'dcosyst&me de la terre. La sante des hommes est etroitement associee
h 1'environnement. Toutes les donndes disponibles montrent qu'il sera impossible de preserver la qualite de la
vie des individus et de toutes les espiJces vivantes sans modifier partout radicalement les attitudes et les
comportements face h la gestion et & la protection de 1'environnement.
Le grand dessein de notre dpoque doit etre une action concertfe visant h creer un environnement durable,
favorable it la sante.
Au niveau international, les Snormes disparities du revenu par habitant conduisent a des in^galitds du point
de vue non seulement de I'acc&s aux prestations de sante, mais aussi des moyens dont disposent les societes
pour amSliorer leur situation et garantir aux generations futures une certaine qualite de vie. Le depeuplement
des campagnes au profit des villes entraine la proliferation des bidonvilles et des problemes qui leur sont lies,
notamment le manque d'eau propre et d'installations d'assainissement.
Les decisions politiques et le developpement industriel reposent trop souvent sur des plans et sur une
volonte de profit h court terrne sans qu'il soit tenu compte de leur cout reel pour la sante et 1'environnement. La
dette mondiale appauvrit serieusement les maigres ressources des pays pauvres. Les depenses militaires
augmentent et, outre les tribut qu’ils preifevent en morts et en blesses, les conflits armes representent maintenant
de nouvelles formes de vandalisme ecologique.
Sexploitation de la main-d'oeuvre, 1'exportation et 1'evacuation de dechets et de produits dangereux, en
particulier dans les nations les plus faibles et les plus pauvres, et le gaspillage des ressources mondiales
temoignent d'une crise de I'approche actuelle du developpement. Il est urgent de se doter d'une ethique nouvelle
et de parvenir & un accord mondial base sur la coexistence pacifique pour permettre une distribution et une
utilisation plus equitables des ressources limitees de la planete.
POUR UNE RESPONSABILISATION MONDIALE
La Conference de Sundsvall invite la communaute Internationale a elaborer de nouveaux mecanismes de
responsabilisation sanitaire et ecologique reposant sur les principes d'un developpement sanitaire durable. Dans
la pratique, cela suppose que les grandes initiatives politiques et programmatiques soient assorties d'etudes de
leur impact sur la sante et 1’environnement. L'OMS et le PNUE sont invites a redoubler d'efforts pour elaborer
des codes de conduite regissant la commercialisation et I'echange des substances et des produits nocifs pour la
sante et 1'environnement.
L’OMS et le PNUE sont instamment pries d'eiaborer, 5 1’intention de leurs Etats Membres, des principes
directeurs reposant sur 1'idee d'un developpement durable. Tous les organismes d'aide multilaterale et bilaterale
et toutes les institutions de financement, comme la Banque mondiale et le Fonds monetaire international, sont
invites h utiliser ces principes directeurs lors de la planification, de I’eiaboration et de revaluation des projets de
developpement. Des mesures doivent etre prises d'urgence pour aider les pays en developpement a trouver des
solutions A leurs problemes. Une collaboration etroite sera maintenue avec les organisations non
gouvemementales tout au long de ce processus.
La Conference de Sundsvall a montre, une fois de plus, que les questions de sante, d'environnement et de
developpement humain sont indissociables. Le developpement doit permettre I’ameiioration de la qualite de la
vie et de la sante tout en preservant 1'environnement.
En consequence, les participants H la Conference prient instamment la Conference des Nations Unies sur
1’Environnement et le Developpement qui aura lieu tl Rio de Janeiro en 1992 de tenir compte de la Declaration de
Sundsvall lorsqu'elle etudiera la Charte sur la terre et le Programme 21 destine il preparer I'avenement du 21 erne
siecle. Ces deux documents devront faire h la sante la place importante qui lui revient. Seule une action mondiale
basee sur un partenariat international preservera 1'avenir de notre planete.
8
Declaration de SUNDSVALL
WHO♦OMS
Division of Health Promotion, Education and Communication
.
Division de la Promotion de la Sante, de 1‘Education et de la Communication pour la San e
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HEP
Health Education and Health Promotion Unit
Unite de 1'Education sanitaire et de la Promotion de la Sante
CH - 1211 Gendve 27, Suisse
Telegr.:UNISANTE-GENEVE Telex: 415416
Tel: (022) 791 21 11 - Fax/Teliicopie: (022) 791 07 46
WH0/HPR/HEP/95.2
World Health Organization
Organisation mondiale de la Sante
HEALTHY
PUBLIC
POLICY
ADELAIDE
Recommendations
....
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...I-..:.-.7
CONFERENCE STATEMENT OF THE
2ND INTERNATIONAL CONFERENCE ON
HEALTH PROMOTION
*
THE ADELAIDE RECOMMENDATIONS
HEALTHY PUBLIC POLICY
April 5-9, 1988 Adelaide South Australia
♦Co-sponsored by the Australian Federal Department of Community Services and Health, Canberra,
Australia, and the World Health Organization.
HEALTHY PUBLIC POLICY
_______ HEALTHY PUBLIC POLICY_______
Conference Statement, the Adelaide Recommendations
The adoption of the Declaration ofAlma-Ata a decade ago was a major milestone in the Health for All
movement which the World Health Assembly launched in 1977. Building on the recognition of health as a
fundamental social goal, the Declaration set a new direction for health policy by emphasizing people's
involvement, cooperation between sectors ofsociety, and primary health care as its foundation.
THE SPIRIT OF ALMA-ATA
The spirit of Alma-Ata was carried forward in the Charter for Health Promotion which was adopted in
Ottawa in 1986. The Charter set the challenge for a move towards the new public health by reaffirming social
justice and equity as prerequisites for health, and advocacy and mediation as the processes for their
achievement.
o
o
»
o
•
o
The Charter identified five health promotion action areas:
build Healthy Public Policy,
create supportive environments,
develop personal skills,
strengthen community action, and
reorient health services.
These actions are interdependent, but healthy public policy establishes the environment that makes the
other four possible.
The Adelaide Conference on Healthy Public Policy continued in the direction set at Alma-Ata and Ottawa,
and built on their momentum. Two hundred and twenty participants from forty-two countries shared
experiences in formulating and implementing healthy public policy. The following recommended strategies for
healthy public policy action reflect the consensus achieved at the Conference.
HEALTHY PUBLIC POLICY
Healthy public policy is characterized by an explicit concern for health and equity in all areas of policy
and by an accountability for health impact. The main aim of health public policy is to create a supportive
environment to enable people to lead healthy lives. Such a policy makes health choices possible or easier for
citizens. It makes social and physical environments health-enhancing. In the pursuit of healthy public policy,
government sectors concerned with agriculture, trade, education, industry, and communications need to take
into account health as an essential factor when formulating policy. These sectors should be accountable for the
health consequences of their policy decisions. They should pay as much attention to health as to economic
considerations.
THE VALUE OF HEALTH
Health is both a fundamental human right and a sound social investment. Governments need to invest
resources in healthy public policy and health promotion in order to raise the health status of all their citizens. A
basic principle of social justice is to ensure that people have access to the essentials for a healthy and satisfying
life. At the same time, this raises overall societal productivity in both social and economic terms. Healthy
public policy in the short term will lead to long-term economic benefits as shown by the case studies presented
at this Conference. New efforts must be made to link economic, social, and health policies into integrated
action.
ADELAIDE Recommendations
5
HEALTHY PUBLIC POLICY
EQUITY, ACCESS AND DEVELOPMENT
Inequalities in health are rooted in inequities in society. Closing the health gap between socially and
educationally disadvantaged people and more advantaged people requires a policy that will improve access to
health-enhancing goods and services, and create supportive environments. Such a policy would assign high
priority to underprivileged and vulnerable groups. Furthermore, a healthy public policy recognizes the unique
culture of indigenous peoples, ethnic minorities, and immigrants. Equal access to health services, particularly
community health care, is a vital aspect of equity in health.
New inequalities in health may follow rapid structural change caused by emerging technologies. The first
target of the European Region of the World Health Organization, in moving towards Health for All is that:
by the year 2000 the actual differences in health status between countries and between groups within
countries should be reduced by at least 25% by improving the level of health of disadvantaged nations
and groups.
In view of the large health gaps between countries, which this Conference has examined, the developed
countries have an obligation to ensure that their own policies have a positive health impact on developing
nations. The Conference recommends that all countries develop healthy public policies that explicitly address
this issue.
ACCOUNTABILITY FOR HEALTH
The recommendations of this Conference will be realized only if governments at national, regional and
local levels take action. The development of healthy public policy is as important at the local levels of
government as it is nationally. Governments should set explicit health goals that emphasize health promotion.
Public accountability for health is an essential nutrient for the growth of healthy public policy.
Governments and all other controllers of resources are ultimately accountable to their people for the health
consequences of their policies, or lack of policies. A commitment to healthy public policy means that
governments must measure and report the health impact of their policies in language that all groups in society
readily understand. Community action is central to the fostering of healthy public policy. Taking education
and literacy into account, special efforts must be made to communicate with those groups most affected by the
policy concerned.
The Conference emphasizes the need to evaluate the impact of policy. Health information systems that
support this process need to be developed. This will encourage informed decision-making over the future
allocation of resources for the implementation of healthy public policy.
MOVING BEYOND HEALTH CARE
Healthy public policy responds to the challenges in health set by an increasingly dynamic and
technologically changing world, with is complex ecological interactions and growing international
interdependencies. Many of the health consequences of these challenges cannot be remedied by present and
foreseeable health care. Health promotion efforts are essential, and these require an integrated approach to
social and economic development which will re-establish the links between health and social reform, which the
World Health Organization policies of the past decade have addressed as a basic principle.
PARTNERS IN THE POLICY PROCESS
Government plays an important role in health, but health is also influenced greatly by corporate and
business interests, nongovernmental bodies and community organizations. Their potential for preserving and
promoting people's health should be encouraged. Trade unions, commerce and industry, academic associations
and religious leaders have many opportunities to act in the health interests of the whole community. New
alliances must be forged to provide the impetus for health action.
ADELAIDE Recommendations
HEALTHY PUBLIC POLICY
ACTION AREAS
The Conference identified four key areas as priorities for healthy public policy for immediate action:
SUPPORTING THE HEALTH OF WOMEN
Women are the primary health promoters all over the world, and most of their work is performed without
pay or for a minimal wage. Women's networks and organizations are models for the process of health
promotion organization, planning and implementation. Women's networks should receive more recognition
and support from policy-makers and established institutions. Otherwise, this investment of women's labour
increases inequity. For their effective participation in health promotion women require access to information,
networks and funds. All women, especially those from ethnic, indigenous, and minority groups, have the right
to self-determination of their health, and should be full partners in the formulation of healthy public policy to
ensure its cultural relevance.
This Conference proposes that countries start developing a national women's healthy public policy in
which women's own health agendas are central and which includes proposals for:
o equal sharing of caring work performed in society;
• birthing practices based on women's preferences and needs;
o supportive mechanisms for caring work, such as support for mothers with children, parental leave, and
dependent health-care leave.
FOOD AND NUTRITION
The elimination of hunger and malnutrition is a fundamental objective of healthy public policy. Such
policy should guarantee universal access to adequate amounts of healthy food in culturally acceptable ways.
Food and nutrition policies need to integrate methods of food production and distribution, both private and
public, to achieve equitable prices.
A food and nutrition policy that integrates agricultural, economic, and environmental factors to ensure a
positive national and international health impact should be a priority for all governments. The first stage of
such a policy would be the establishment of goals for nutrition and diet. Taxation and subsidies should
discriminate in favour of easy access for all to healthy food and an improved diet.
The Conference recommends that governments take immediate and direct action at all levels to use their
purchasing power in the food market to ensure that the food-supply under their specific control (such as
catering in hospitals, schools, day-care centres, welfare services and workplaces) gives consumers ready access
to nutritious food.
TOBACCO AND ALCOHOL
The use of tobacco and the abuse of alcohol are two major health hazards that deserve immediate action
through the development of healthy public policies. Not only is tobacco directly injurious to the health of the
smoker but the health consequences of passive smoking, especially to infants, are now more clearly recognized
than in the past. Alcohol contributes to social discord, and physical and mental trauma. Additionally, the
serious ecological consequences of the use of tobacco as a cash crop in impoverished economies have
contributed to the current world crises in food production and distribution.
The production and marketing of tobacco and alcohol are highly profitable activities - especially to
governments through taxation. Governments often consider that the economic consequences of reducing the
production and consumption of tobacco and alcohol by altering policy would be too heavy a price to pay for the
health gains involved.
This Conference calls on all governments to consider the price they are paying in lost human potential by
abetting the loss of life and illness that tobacco smoking and alcohol abuse cause. Governments should commit
ithemselves to the development of healthy public policy by setting nationally-determined targets to reduce
ttobacco growing and alcohol production, marketing and consumption significantly by the year 2000.
2*FIAIDF Recommendations
HEALTHY PUBLIC POLICY
CREATING SUPPORTIVE ENVIRONMENTS
Many people live and work in conditions that are hazardous to their health and are exposed to potentially
hazardous products. Such problems often transcend national frontiers. Environmental management must
protect human health from the direct and indirect adverse effects of biological, chemical, and physical factors,
and should recognize that women and men are part of a complex ecosystem. The extremely diverse but limited
natural resources that enrich life are essential to the human race. Policies promoting health can be achieved
only in an environment that conserves resources through global, regional, and local ecological strategies.
A commitment by all levels of government is required. Coordinated intersectoral efforts are needed to
ensure that health considerations are regarded as integral prerequisites for industrial and agricultural
development. At an international level, the World Health Organization should play a major role in achieving
acceptance of such principles and should support the concept of sustainable development.
This Conference advocates that, as a priority, the public health and ecological movements join together to
develop strategies in pursuit of socioeconomic development and the conservation of our planet's limited
resources.
DEVELOPING NEW HEALTH ALLIANCES
The commitment to healthy public policy demands an approach that emphasizes consultation and
negotiation. Healthy public policy requires strong advocates who put health high on the agenda of policy
makers. This means fostering the work of advocacy groups and helping the media to interpret complex policy
issues.
Educational institutions must respond to the emerging needs of the new public health by reorienting
existing curricula to include enabling, mediating, and advocating skills. There must be a power shift from
control to technical support in policy development. In addition, forums for the exchange of experiences at
local, national and international levels are needed.
The Conference recommends that local, national and international bodies:
• establish clearing-houses to promote good practice in developing healthy public policy;
• develop networks of research workers, training personnel, and programme managers to help analyse
and implement healthy public policy.
COMMITMENT TO GLOBAL PUBLIC HEALTH
Prerequisites for health and social development are peace and social justice; nutritious food and clean
water; education and decent housing; a useful role in society and an adequate income; conservation of resources
and the protection of the ecosystem. The vision of healthy public policy is the achievement of these
fundamental conditions for healthy living. The achievement of global health rests on recognizing and accepting
interdependence both within and between countries. Commitment to global public health will depend on
finding strong means of international cooperation to act on the issues that cross national boundaries.
FUTURE CHALLENGES
8
1.
Ensuring an equitable distribution of resources even in adverse economic circumstances is a challenge
for all nations.
2.
Health for All will be achieved only if the creation and preservation of healthy living and working
conditions become a central concern in all public policy decisions. Work in all its dimensions - caring
work, opportunities for employment, quality of working life -dramatically affects people's health and
happiness. The impact of work on health and equity needs to be explored.
3.
The most fundamental challenge for individual nations and international agencies in achieving healthy
public policy is to encourage collaboration (or developing partnerships) in peace, human rights and
social justice, ecology, and sustainable development around the globe.
ADELAIDE Recommendations
HEALTHY PUBLIC POLICY
4.
In most countries, health is the responsibility of bodies at different political levels. In the pursuit of
better health it is desirable to find new ways for collaboration within and between these levels.
5.
Healthy public policy must ensure that advances in health-care technology help, rather than hinder, the
process of achieving improvements in equity.
The Conference strongly recommends that the World Health Organization continue the dynamic
development of health promotion through the five strategies described in the Ottawa Charter. It urges the
World Health Organization to expand this initiative throughout all its regions as an integrated part of its work.
Support for developing countries is at the heart of this process.
RENEWAL OF COMMITMENT
In the interests of global health, the participants at the Adelaide Conference urge all concerned to reaffirm
the commitment to a strong public health alliance that the Ottawa Charter called for.
ADELAIDE Recommendations
POLITIQUES
POUR LA
SANTE
Les recommandations d'
ADELAIDE
DECLARATION FINALE DE LA
2EME (CONFERENCE INTERNATIONALE SUR LA
PROMOTION DE LA SANTE
*
RECOMMANDATIONS D'ADELAIDE
POLITIQUES POUR LA SANTE
5-9 Avril 1988, Adelaide, Australie du Sud
* Co-parrainee par le Departement des Services Communautaires et de Sant£, Canberra, Australie et
rOrganisation mondiale de la Sant£.
POLITIQUES POUR LA SANTE
POLITIQUES POUR LA SANTE
LES RECOMMANDATIONS D’ADELAIDE
L'adoption de la Declaration d'Alma-Ata. en 1978, a marque une etape decisive dans le mouvement en
faveur de la Sante pour tons auparavant lance par I'Assemblee mondiale de la Sante. S'appuyant sur le
constat que la sante est un objectif social fondamental, la Declaration a donne aux politiques de sante une
nouvelle orientation en privilegiant la participation de la population, la cooperation entre les divers secteurs
de la societe et les soins de sante primaires.
L’ESPRIT D’ALMA-ATA
L'esprit d'Alma-Ata a trouve un echo dans la Charte pour la promotion de la sante adoptee a Ottawa en
1986. Cette Charte mettait le monde au defi de mener une nouvelle action de sant6 publique en reaffirmant
que la justice sociale et requite constituaient les pr&tlables de la sante et qu'une action de plaidoyer et de
mediation etait le moyen d'y parvenir.
La Charte degageait cinq domaines d'action pour la promotion de la sante :
o
o
o
o
o
forger des politiques pour la sante,
crder des environnements favorables,
developper les aptitudes personnelles,
renforcer faction communautaire, et
r^orienter les services de sante.
Ces domaines d'action sont bien sur interdependants, mais l'adoption de politiques pour la sante cree
I’environnement qui rend possibles les quatre autres types d'action.
La Conference d'Adelaide sur la politique publique pour la sante a poursuivi dans la direction esquiss6e
a Alma-Ata et a Ottawa en s'appuyant sur la dynamique alors enclenchee. Deux cent vingt participants venus
de quarante-deux pays ont fait part de leur experience dans felaboration et la mise en oeuvre de ce type de
politique. Les strategies ci-apr&s, preconisees en vue de idtablissement de politiques pour la sante, sont
I'aboutissement du consensus qui s'est instaure A la Conference.
LES POLITIQUES POUR LA SANTE
Les politiques pour la sante se caracterisent par le souci explicite de garantir la sante et Idquite dans
tous les domaines politiques et par fobligation de rendre compte des retombees, sur le plan de la sante, des
decisions prises dans les divers secteurs. Leur but principal est d'instaurer un environnement propice qui
permette h chacun de mener une vie saine. Ces politiques rendent possibles, voire facilitent, les choix des
citoyens en faveur de la sante. Elies font en sorte que I’environnement social et physique renforce la sante.
Dans cette optique, les secteurs publics responsables de fagriculture, du commerce, de Idducation, de
findustrie et des communications doivent tenir compte du role essentiel de la sante lorsqu'ils formulent leurs
grandes orientations. Ils doivent aussi etre tenus pour responsables des consequences de leurs decisions
politiques sur la sante et accorder la meme attention a la sante qu'aux probiemes economiques.
LA VALEUR DE LA SANTE
La sante est A la fois un droit fondamental de fhomme et un excellent investissement social. Les
gouvemements doivent investir dans les politiques pour la sante et dans la promotion de la sante afin
d'ameiiorer 1'etat de sante de tous les citoyens. Un principe fondamental de la justice sociale veut que chacun
ait accfes H tout ce qui est indispensable pour mener une vie saine et satisfaisante. Cela souieve aussitot la
question de la productivite de la societe, en termes aussi bien sociaux qu'economiques. Les politiques pour la
sante ne tarderont pas A avoir des retombees economiques h long terme, comme 1'ont montre les etudes de
cas presentees A la Conference. II faut redoubler d’efforts pour lier les politiques economiques, sociales et de
sante dans une action integree.
Les recommendations d'ADELAIDE
5
POLITIQUES POUR LA SANTE
EQUITE, ACCES ET DEVELOPPEMENT
Les inEgalitEs face h la santE sont enracinEes dans les inEgalitEs au sein de la sociEtE. Combler 1’ecart de
santE entre les personnes dEsavantagEes du point de vue social et Educatif et les autres exige une politique qui
amEliore 1'acc^s aux biens et aux services favorables a la santE et cree des environnements d'appui. Cette
politique doit donner la priorite aux groupes dEfavorisEs et vulnerables. D’autre part, elle doit reconnaitre le
caractEre spEcifique de la culture des peuples indigenes, des minorites ethniques et des immigrants. L'egalite
d'accEs aux services de santE, notamment aux soins de sante communautaires, est un aspect decisif de 1'equite
en matiEre de santE.
Les Evolutions structurelles rapides nEes des nouvelles technologies peuvent engendrer de nouvelles
inEgalitEs face it la santE. Le tout premier but fixe par la REgion europEenne de 1'Organisation mondiale de la
SantE en vue de la santE pour tous est explicite h cet Egard :
D'ici I'an 2000, les ecarts reels d'etat de sante entre pays et entre groupes a I'interieur du meme pays
devraient avoir ete reduits d'au moins 25 %, grace a une elevation du niveau de sante dans les pays et
les groupes defavorises.
Etant donnE 1'importance des Ecarts de santE entre les pays, phEnomene sur lequel s'est penchEe la
ConfErence, les pays dEveloppEs ont pour devoir de veiller a ce que leurs politiques aient des effets positifs
sur la santE des nations en dEveloppement. Les participants a la ConfErence ont recommandE que tous les
pays Elaborent des politiques publique pour la santE qui s'attaquent expressEment a ce probleme.
RESPONSABILITE ET SANTE
Les recommandations de la ConfErence ne se concrEtiseront que si les autoritEs nationales, rEgionales et
locales agissent, L'Elaboration des politiques pour la santE est aussi importante au niveau local qu'au niveau
national. En matiEre de santE, les gouvemements doivent fixer explicitement des buts qui mettent en valeur
la promotion de la santE.
La responsabilitE des pouvoirs publics E 1'Egard de la santE est un facteur indispensable au
dEveloppement des politiques pour la santE. Les gouvemements et tous ceux qui maitrisent les ressources
sont, en fin de compte, responsables devant le peuple des consEquences de leur politique ou de leur absence
de politique en matiEre de santE. En s'engageant a adopter les politiques pour la santE, les gouvemements
doivent mesurer les rEpercussions que ces politiques auront sur la santE et les faire connaitre dans un langage
comprehensible par tous. L'action communautaire est vitale pour encourager la politique en faveur de la
santE. Des efforts spEciaux, s'appuyant sur ('Education et I'alphabEtisation, doivent etre faits pour
communiquer avec les groupes spEcialement visEs par ces politiques.
Les participants h la ConfErence soulignent la nEcessitE d'Evaluer I'impact des grandes orientations. II
faut pour cela mettre sur pied des systEmes d’information, ce qui permettra de prendre des dEcisions en toute
connaissance de cause concemant 1'affectation ultErieure des ressources pour la mise en oeuvre des
politiques.
PAR LES SOINS DE SANTE
Les politiques pour la santE se proposent de relever les dEfis que pose, pour la santE, un monde de plus
en plus dynamique et en pleine mutation technologique, avec ses interactions Ecologiques complexes et ses
interdEpendances intemationales croissantes. Ces dEfis ont des consEquences que les systEmes de soins de
santE, tels qu'ils sont aujourd'hui et tels qu'ils seront pour la plupart encore demain, ne peuvent assumer. Des
efforts de promotion de la santE s'imposent et cela implique une approche intEgrEe a 1'Egard du
dEveloppement Economique et social, rEtablissant les liens entre rEforme sanitaire et rEforme sociale principe
fondamental vers lequel tendent les politiques de 1'Organisation mondiale de la SantE depuis dix ans.
PARTENAIRES DANS L'ACTION POLITIQUE
Les gouvemements jouent un role important dans le domaine de la santE, mais celui-ci est aussi
fortement influencE par des intErets commerciaux et industriels, des organismes non gouvemementaux et des
organisations communautaires, dont il faut dEvelopper le potentiel de protection et de promotion de la santE
de la population. Syndicats, milieux commerciaux et industriels, associations universitaires et dirigeants
religieux ont bien des occasions d'agir dans I'intEret de la santE de toute la communautE. De nouvelles
alliances sont, par consEquent, nEcessaires pour imprimer I’Elan voulu a faction de santE.
Les recommandations d'ADELAIDE
POLITIQUES POUR LA SANTE
DOMAINES D'ACTION
La Conference a degage quatre domaines prioritaires qui appellent une action immediate et qui fondent
les politiques pour la sante.
PROMOTION DE LA SANTE DES FEMMES
Les femmes sont en premiere ligne pour promouvoir la sante dans le monde et elles travaillent, la
plupart du temps, sans remuneration ou pour un salaire minimal. Les reseaux et organisations de femmes
sont des modeles pour ['organisation, la planification et la mise en oeuvre des actions de promotion de la
sante. Les decideurs et les institutions officielles devraient apprecier it ieur juste valeur les reseaux de
femmes et leur fournir un appui, faute de quoi cet investissement dans le travail des femmes accentuera les
in6galit6s. Pour pouvoir participer vraiment a la promotion de la sante, les femmes doivent avoir acces h
1'information, aux reseaux de communication et a I'argent. Toutes les femmes, notamment dans les groupes
ethniques, indigenes et minoritaires, ont droit ii i'autoddtermination en sante et doivent etre des partenaires a
part entire dans la formulation des politiques pour la sante : e'est ce qui en garantira la pertinence
culturelle.
La Conference propose que les pays commencent par elaborer, au niveau national, une politique pour la
sante des femmes, donnant une place centrale it leurs preoccupations en ia matiere et comportant notamment
des propositions dans les domaines suivants :
o
partage, sur une base d'egalit6, du travail de soins assure dans la societd;
o
pratiques en matiere d’accouchement fonddes sur les preferences et les besoins des femmes;
•
mdcanismes appuyant le travail de soins, par exemple aide aux meres, conge parental et conge pour
soins aux personnes dependantes.
ALIMENTATION ET NUTRITION
Eliminer la faim et la malnutrition est un objectif fondamental des politiques, lesquelles doivent garantir
1'accds de tous h des quantitds suffisantes d'aliments sains selon des modalitds culturellement acceptables.
Les politiques en matiere d'alimentation et de nutrition doivent intdgrer des methodes, tant privdes que
publiques, de production et de distribution alimentaires h des prix abordables.
Les politiques d'alimentation et de nutrition, qui integrant les facteurs agricoles, economiques et
environnementaux et qui ont un impact positif sur la sante, aux plans national et international, doivent etre
prioritaires pour tous les gouvemements. La premiere etape consiste ii fixer des buts concemant la nutrition
et le regime alimentaire. Taxes et subventions doivent favoriser I'acces it des aliments sains pour tous et
I'amdlioration du regime alimentaire.
La Conference recommande que les gouvemements agissent, des h present et directement, il tous les
niveaux de leur pouvoir d’achat sur le marche de 1'alimentation pour veiller tl ce que la clientele des services
qu'ils controlent (services de restauration des hopitaux, des ecoles, des creches, des services sociaux et des
entreprises, par exemple) puisse accdder aisement a des aliments nutritifs.
TABAC ET ALCOOL
Le tabagisme et 1'abus d'alcool sont deux grands probldmes de sante face auxquels il faut agir sans plus
tarder en elaborant des politiques pour la sante. Non seulement le tabac est directement prSjudiciable ii la
sante du fumeur, mais on connait mieux desormais les consequences du tabagisme passif, particulierement
pour les nourrissons. L'alcool contribue aux dissensions sociales, de meme qu'aux traumatismes physiques et
psychologiques. De plus, les graves consequences ecologiques de la culture du tabac comme culture de
rapport dans des pays economiquement affaiblis ont contribue & la crise mondiale actuelle de la production et
de ia distribution alimentaires.
La production et la commercialisation du tabac et de l'alcool sont des activites productrices de revenus
importants, notamment pour les gouvemements par le biais des taxes. Ceux-ci considerent souvent que les
consequences economiques d'une reduction de la production et de la consommation de tabac et d alcool par
un changement de politiques seraient d'un prix trop lourd it payer par rapport aux benefices engranges sur le
plan de la sante.
recominandations d'ADELAIDE
7
POLITIQUES POUR LA SANTE
La Conference lance un appel h tons les gouvemements pour qu'ils songeni au prix paye en potentiel
humain perdu en cautionnant les pertes en vies humaines et les degradations de 1'etat de same attribuables au
tabagisme et h 1'abus d’alcool. Ils devraient s'engager a d6velopper des politiques favorables a la same en
fixant, au niveau national, des cibles en vue de rdduire sensiblement la culture du tabac et la production
d'alcool, ainsi que la commercialisation et de la consommation de ces substances d'ici 1’an 2000.
MISE EN PLACE D'ENVIRONNEMENTS FAVORABLES
Bien des gens vivent et travaillent dans des conditions pnSjudiciables h leur sante et sont exposes & des
produits dangereux. Or, ces problemes debordent souvent les frontieres nationales. La gestion de
1'environnement doit permettre de proteger la same des hommes des effets deleteres, directs ou indirects, des
facteurs biologiques, chimiques et physiques et prendre en compte le fait que I’etre humain fait partie d’un
ecosysteme complexe. Les ressources naturelies extremement diverses mais limitees qui sont source de
croissance sont essentielles H la survie, a la sante el au bien-etre de I'humanite. Seul un environnemcnt
favorable it la conservation des ressources, grace a des strategies ecologiques mondiales, regionales et
locales, permettra d'appliquer des politiques pour la same.
L'engagement des pouvoirs publics a tous les niveaux est une necessite. Des efforts intersectoriels
coordonn^s s'imposent pour que la sante soit consid^ree comme un prealable essentiel au developpement
industriel et agricole. Au niveau international, 1'Organisation mondiale de la Same doit jouer un role de
premier plan pour faire accepter ces principes et appuyer 1’idee d'un developpement durable.
La Conference demande, it titre prioritaire, que les mouvements en faveur de la same publique et de
recologie s'associent pour mettre au point des strategies de developpement socio-£conomique et de
conservation des ressources limit6es dont dispose la planete.
NOUVELLES ALLIANCES POUR LA SANTE
L'engagement en faveur de politiques favorables tl la same exige une approche qui privilegie la
consultation et la negociation.
Ces politiques ont besoin de defenseurs energiques capables d'inscrire ]a sante au premier plan des
preoccupations des ddcideurs. Cela signifie qu'il faut encourager faction des groupes de persuasion et aider
les madias h interpreter des questions politiques complexes.
Les etablissements d'enseignement doivent repondre aux besoins de la nouvelle action de sante en
reorientant les programmes d’etude pour y inscrire 1'acquisition de moyens d'action, ainsi que 1'acquisition de
competences en matiere de mediation et de persuasion. II doit y avoir transfer! de pouvoirs, passant du
controle it I'appui technique, dans feiaboration des politiques. De plus, il faut des instances ou puissent etre
echangees les donnees d'experience aux niveaux local, national et international.
La Conference recommande que les organismes locaux, nationaux et intemationaux prennent les
mesures suivantes :
•
creation de centres d'echange pour promouvoir les bonnes pratiques en matiere d'eiaboration de
politiques pour la sante;
•
mise en place de reseaux de chercheurs, de formateurs et de gestionnaires de programmes pour
aider & analyser et mettre en oeuvre ces politiques.
ENGAGEMENT A L'EGARD DE LA SANTE
DANS LE MONDE
Il existe plusieurs prealables indispensables it la sante et au developpement social : la paix et la justice
sociale, une alimentation nutritive et une eau propre, feducation et un logement decent, un role utile dans la
societe et un revenu suffisant, la conservation des ressources et la protection de 1'ecosysteme. La vision
qu'incament les politiques est la concretisation de ces aspirations fondamentales il une vie saine. Instaurer la
sante partout dans le monde suppose que Ton reconnaisse et que 1'on accepte 1'interdependance it I'intdrieur
des pays et entre les pays. Pour s'engager it regard de la sante dans le monde, il faudra trouver des moyens
efficaces de cooperation intemationale permettant d'agir face a des problfemes qui ignorent les frontieres.
8
Les recommandations d'ADELAIDE
POLITIQUES POUR LA SANTE
DEFIS POUR L'AVENIR
1.
La repartition equitable des ressources meme dans des situations dconomiques defavorables pose
tin defi a toutes les nations.
2.
La sante pour tous ne deviendra fealife que si I'instauration et la preservation de conditions de vie
et de travail favorables it la sante deviennent une preoccupation centrale de tous les hommes
politiques. Le travail sous tous ses aspects - travail de soins, possibility d'emploi, quality de la
vie professionnelle - a d'immenses repercussions sur la sanfe et le bien-etre des individus. Il faut
done etudier 1’impact du travail sur la sante et l'6quit6.
3.
Encourager la collaboration (ou forger des partenariats) pour la paix, les droits de 1'homme et la
justice sociale, Ideologic et un developpement durable dans le monde est le defi le plus essentiel
que doivent relever les nations et les institutions internationales dans des politiques favorables a
la sanfe.
4.
Dans presque tous les pays, les responsabilifes en matiere de sante incombent a des organismes
situes a des niveaux politiques differents. Dans I'interet de 1'amelioration de la sanfe, il est
souhaitable de trouver de nouvelles modalites de collaboration il chaque niveau et entre ces
niveaux.
5.
Les politiques pour la sante doivent veiller a ce que les progres de la technologic medico-sanitaire
soient un moteur et non pas un frein au progres qui doit conduire a 1'equife.
La Conference recommande vivement que 1’Organisation mondiale de la Sante poursuive, avec
dynamisme, faction de promotion de la sante fondee sur les cinq strategies enoncees dans la Charte
d'Ottawa. Elie invite instamment 1'Organisation mondiale de la Sante a developper cette initiative dans toutes
ses regions, comme faisant partie integrante de son activite. L'appui aux pays en developpement est au coeur
de ce processus.
REAFFIRMATION DE L’ENGAGEMENT
Dans finferet de la sanfe mondiale, les participants a la Conference d'Adelaide invitent instamment
toutes les parties concentres H feaffirmer leur determination de forger la solide alliance de sante publique,
voulue par la Charte d'Ottawa.
Ees recommandations d'ADELAlDE
9
WHO♦OMS
Division of Health Promotion, Education and Communication
Division de la Promotion de la Sante, de 1'Education et de la Communication pour la Sante
Health Education and Health Promotion Unit
Unite de 1'Education sanitaire et de la Promotion de la Sante
CH -1211 Geneve 27, Suisse
T616gr.:UNISANTE-GENEVE Telex: 415416
T61.: (022) 791 21 11 - FaxjTel&opie: (022) 791 07 46
<Tjte
(feobat Conference
on J-Ceaftfi (Promotion
7-11 August 2005
'UnitedNations Conference Centre
‘Bangkok, 7fiai(and
QENEICN INTONATION ~ '~
CONTENTS
PAGE
GENERAL INFORMATION
3
CONFERENCE AGENDA
FIELD TRIPS PROGRAM
5
LOCATION OF UNCC
6
MAP OF UNCC (GROUND FLOOR)
7
MAP OF UNCC (FIRST FLOOR)
8
MAP OF UNCC (SECOND FLOOR)
9
IMPORTANT TELEPHONE NUMBERS
10
UNCC TELEPHONE NUMBERS
11
Program on 7 August 2005
- Conference Registration is opened from
09.00 - 17.00 hrs. at Ground Floor
- The Opening Ceremony of the Conference is held
a^CAP Hall at 17.00 hrs.
- The Opening Ceremony of the Exhibition is held at
the first floor at 17.45 hrs.
- “Sawasdee Night Reception" hosted by the Ministry
of Public Health, Thailand at Royal Thai Navy
Convention Hall during 18.30 - 20.30 hrs.
o Shuttle buses depart from UNCC at 18.00 hrs.
and back from Royal Thai Navy Convention
Hall at 20.30 hrs.
o Delegates should inform Hotel to arrange the
hotel shuttle bus.
Field Trip Program on 10 August 2005
- The booking counter is opened on 7 - 8 August
2005 from 9.00-17.00 hrs.
- Coaches depart from UNCC at 13.00 hrs.
- Delegates should inform Hotel to arrange the hotel
shuttle bus.
Pr^prm on 11 August 2005
- Bangkok Charter
- Closing Ceremony at ESCAP Hall
Free of charge buffet lunch will be provided from
8-11 August 2005 at Dining Room, First Floor and
Reception Area.
Q
EIELE) WPS
COWFE<KENCE AQENDJl
The 6th Global Conference on Health Promotion
“Policy and Partnership for Action : Addressing
the Determinants of Health”
Sunday, 7 August 2005
^0)
09.00 - 17.00 hrs. Registration at UNCC
17.00 - 18.00 hrs. Opening Session at UNCC
18.30 - 20.30 hrs. “Sawasdee Night Reception" at
Royal Thai Navy Convention Hall
by Ministry of Public Health
(MOPH),Thailand
Monday, 8 August 2005
08.30 - 18.30 hrs. Plenary Sessions & Discussions
18 30 - 20.00 hrs. WHO Reception
Tuesday, 9 August 2005
08.30 - 20.00 hrs. Plenary Sessions & Discussions
There are 13 routes of the field trips. Delegates
are invited to register on 7 - 8 August 2005 from
09.00 -17.00 hrs. at Ground Floor, UNCC.
Limited numbers are reserved on the first come
fin^^erved basis. For more information, please
cc®tt Field Trips Counter, Ground Floor.
Route # 1 Health Promoting School
Route # 2 Healthy Community
Route # 3 Healthy Market Place
Route # 4 Healthy Day Care Centre
(for pre-school children)
Route # 5 Thai Traditional Medicine and Health
Care
Route # 6 Health Promotion / Treatment /
Rehabilitation of Narcotic Addicts
Route # 7 Health Promoting Hospital
Wednesday, 10 August 2005 (Thai Day)
08.30 - 12.00 hrs. Keynote & Technical Sessions
12.00- 13.00 hrs. Lunch
13.00 - 17.30 hrs. Field Trip Program
Thursday, 11 August 2005
08.30 - 12.30 hrs. Feed Back
Bangkok Charter Plenary
11.00 - 12.30 hrs. Welcome to 7th Global
Conference on Health Promotion
14.00 - 14.30 hrs. Bangkok Charter
Route # 8 Health Care for AIDS patients
Route # 9 Mental Health Promotion in Community
R<^fc #10 Healthy Municipality
Route # 11 Healthy Hospital / Healthy Community
Route
Health Promoting School / Day Care
Center
11
Route #;<J Civil Network and Health Promotion
'3
■' COCAriO^OT UNCC
MWPOF UWCC
Ground Floor
Phraya
Naknon Sawan RD.
Ground Floor
1.
Reception Hall
2.
Registration Counter and Information Centre
3.
UN Stamps and Souvenir Counter
Public Foyer
s
5.
Press Centre
6.
Press Briefing Room
7.
Post Office
8.
First-aid room
MA<P OF V1NCC
C
First Floor
Second Floor
First Floor
1.
Conference Room 3
2.
Conference Room 4
3.
Dining Room
1. ESCAP HALL
4.
Meeting Room A
2. Conference Room 1
5.
Meeting Room B
3. Conference Room 2
6.
Meeting Room C
4. Executive Office Suite (EOS)
7.
Meeting Room D
8.
Meeting Room E
9.
Meeting Room F
10.
Meeting Room G
11.
Meeting Room H
12. Exhibition Area
Second Floor
Chairperson Office Suite (COS)
6. Exhibition Area
IMPCERXflWT TEE'E'PE/'O'jEE NVtM<B‘E<ltf
Official Hotel :
WCC ttLfflWO'M NUMBERS
Telephone Number: 0 2288 1174, 0 2288 1140-1
Telephone Number. 0 2288 1140 Ext: 2403
1. Prince Palace Hotel
0 2628 1111
2. Royal Princess Hotel
0 2281 3088
Re^^-ation Counter
1282,1298,2111
3. Trang Hotel Bangkok
0 2282 2141
First Aid
2282
Post office
1256,1260
4. Thai Hotel
0 2282 2833
Press Centre
2424, 2425, 2429
5. Viengtai Hotel
0 2280 5434
ESCAP Hall
2394
6. Grand China Princess
0 2224 9977
Executive Office Suite (EOS)
2397
7. Siam City Hotel
0 2247 0123
Conference Room 1
2411
8. Bangkok Palace Hotel
0 2253 0510
Conference Room 2
2357
Conference Room 3
2336
Conference Room 4
2339
Meeting Room A
2320
Meeting Room B
2321
Meeting Room C
2322
Telephone Extensions:
Chairperson Office Suite (COS) 2417
Emergency Call
191
Tourist police
1155
Immigration Division
0 2287 3101
Hospital
BTS Sky Train
|Q
0 2632 0550 Q)
0 2617 7300,
0 2617 7340
Room D
2323
Meeting Room E
2324
Meeting Room F
2325
Meeting Room G
2326
Meeting Room H
1141
Dining Room
2210, 2090
WHO/HED/92,1
Dlsfr.: General
. Alien ,
pour a sante
publique
SUNDSVALL STATEMENT
ON SUPPORTIVE
ENVIRONMENTS FOR HEALTH
9-15 JUNE 1991, SUNDSVALL, SWEDEN
EbVWONMEM PPOCPAMME
DECLARATION DE SUNDSVALL
SUR LES MILIEUX
RABLES A LA SANTE
9-15 JOIN 1991.. SUNDSVALL, SUEDE
NO0t»- COUNCtt Of MiNlOTlS
iX?l’AYSi'rorijx:.'vt$
”TV
I
SUNDSVALL STATEMENT ON SUPPORTIVE
ENVIRONMENTS FOR HEALTH
The Third International Conference on Health Promotion: Supportive Environments
for Health - the Sundsvall Conference - fits into a sequence of events which began with the
commitment of WHO to the goals of Health For All (1977). This was followed by the
UNICEF/WHO International Conference on Primary Health Care, in Alma-Ata (1978), and
the First International Conference on Health Promotion in Industrialized Countries, in Ottawa
(1986). Subsequent meetings on Healthy Public Policy, in Adelaide (1988) and a Call for
Action: Health Promotion in Developing Countries, in Geneva (1989) have further clarified
the relevance and meaning of health promotion. In parallel with these developments in the
health arena, public concern over threats to the global environment has grown dramatically.
This was clearly expressed by the World Commission on Environment and Development in
its report
which provided a new understanding of the imperative of
sustainable development.
Our Common Future,
The Third International Conference on Health Promotion: Supportive Environments
for Health - the first global conference on health promotion, with participants from 81
countries - calls upon people in all parts of the world to engage actively in making
environments more supportive to health. Examining today s health and environmental issues
together, the Conference pointed out that millions of people are living in extreme poverty and
deprivation in an increasingly degraded environment that threatens their health, making the
goal of Health For All by the Year 2000 extremely hard to achieve. The way forward lies
in making the environment - the physical environment, the social and economic environment,
and the political environment - supportive to health rather than damaging to it.
The Sundsvall Conference identified many examples and approaches for creating
a to thnt mn hp used bv nolicy-makers, decision-makers and community
supportive environments that can be useu oy
oirorvnni> has
activists in the health and environment sectors. The Conference recognized that everyone has
a role in creating supportive environments for health.
A CALL FOR ACTION
This call for action is directed towards policy-makers and decision-makers in all
relevant sectors and at all levels. Advocates and activists for health, environment and social
justice are urged to form a broad alliance towards the common goal of Health For All. We
Conference participants have pledged to take this message back to our communities, countries
and governments to initiate action. We also call upon the organizations of the United Nations
system to strengthen their cooperation and to challenge each other to be truly committed to
sustainable development and equity.
A supportive environment is of paramount importance for health. The two are
interdependent and inseparable. We urge that the achievement of both be made central
objectives in the setting of priorities for development, and be given precedence in resolving
competing interests in the everyday management of government policies.
Inequities are reflected in a widening gap in health both within our nations and
between rich and poor countries. This is unacceptable. Action to achieve social justice in
health is urgently needed. Millions of people are living in extreme poverty and deprivation
in an increasingly degraded environment in both urban and rural areas. An unforeseen and
alarming number of people suffer from the tragic consequences of armed conflicts for health
and welfare. Rapid population growth is a major threat to sustainable development. People
must survive without clean water or adequate food, shelter and sanitation.
Poverty frustrates people’s ambitions and their dreams of building a better future,
while limited access to political structures undermines the basis for self-determination. For
many, education is unavailable or insufficient, or, in its present forms, fails to enable and
empower. Millions of children lack access to basic education and have little hope of a better
future. Women, the majority of the world’s population, are still oppressed. They are sexually
exploited and suffer from discrimination in the labour market and many other areas which
prevents them from playing a full role in creating supportive environments.
More than a billion people worldwide have inadequate access to essential health care.
Health care systems undoubtedly need to be strengthened. The solution to these massive
problems lies in social action for health and the resources and creativity of individuals and
their communities. Releasing this potential requires a fundamental change in the way we
view our health and our environment and a clear, strong political commitment to sustainable
health and environmental policies. The solutions lie beyond the traditional health system.
Initiatives have to come from all sectors that can contribute to the creation of
supportive environments for health, and must be acted on by people in local communities,
nationally by government and nongovernmental organizations, and globally through
international organizations. Action will involve predominantly such sectors as education,
transport, housing and urban development, industrial production and agriculture.
2
DIMENSIONS OF ACTION ON SUPPORTIVE ENVIRONMENTS FOR
HEALTH
In a health context the term supportive environments refers to both the physical and
the social aspects of our surroundings. It encompasses where people live, their local
community, their home, where they work and play. It also embraces the framework which
determines access to resources for living, and opportunities for empowerment. Thus action
to create supportive environments has many dimensions: physical, social, spiritual, economic
and political. Each of these dimensions is inextricably linked to the others in a dynamic
interaction. Action must be coordinated at local, regional, national and global levels to
achieve solutions that are truly sustainable.
The conference highlighted four aspects of supportive environments:
1.
The social dimension, which includes the ways in which norms, customs and social
processes affect health. In many societies traditional social relationships are changing
in ways that threaten health, for example, by increasing social isolation, by depriving
life of a meaningful coherence and purpose, or by challenging traditional values and
cultural heritage.
2.
The political dimension, which requires governments to guarantee democratic
participation in decision-making and the decentralization of responsibilities and
resources. It also requires a commitment to human rights, peace, and a shifting of
resources from the arms race.
3.
The economic dimension, which requires a re-channelling of resources for the
achievement of Health For All and sustainable development, including the transfer of
safe and reliable technology.
4.
The need to recognize and use women’s skills and knowledge in all sectors,
including policy-making, and the economy, in order to develop a more positive
infrastructure for supportive environments. The burden of the workload of women
should be recognized and shared between men and women. Women’s community
based organizations must have a stronger voice in the development of health
promotion policies and structures.
PROPOSALS FOR ACTION
The Sundsvall Conference believes that proposals to implement the Health For All
strategies must reflect two basic principles:
1.
Equity must be a basic priority in creating supportive environments for health,
releasing energy and creative power by including all human beings in this unique
endeavour. All policies that aim at sustainable development must be subjected to new
types of accountability procedures in order to achieve an equitable distribution of
3
responsibilities and resources. All action and resource allocation must be based on a
clear priority and commitment to the very poorest, alleviating the extra hardship borne
by the marginalized, minority groups, and people with disabilities. The industrialized
world needs to pay the environmental and human debt that has accumulated through
exploitation of the developing world.
2.
Public
action
for
supportive
environments
for
health
must
recognize
the
interdependence of all living beings, and must manage all natural resources taking
into account the needs of coming generations. Indigenous peoples have a unique
spiritual and cultural relationship with the physical environment that can provide
valuable lessons for the rest of the world. It is essential therefore that indigenous
peoples be involved in sustainable development activities and negotiations be
conducted about their rights to land and cultural heritage.
IT CAN BE DONE: STRENGTHENING SOCIAL ACTION
A call for the creation of supportive environments is a practical proposal for public
health action at the local level, with a focus on settings for health that allow for broad
community involvement and control. Examples from all parts of the world were presented
at the Conference in relation to education, food, housing, social support and care, work and
transport. They clearly showed that supportive environments enable people to expand their
capabilities and develop self-reliance. Further details of these practical proposals are available
in the Conference report and handbook.
Using the examples presented, the Conference identified four key public health action
strategies to promote the creation of supportive environments at community level.
1.
Strengthening advocacy through community action, particularly through groups
organized by women.
2.
Enabling communities and individuals to take control over their health and
environment through education and empowerment.
3.
Building alliances for health and supportive environments in order to strengthen the
cooperation between health and environmental campaigns and strategies.
4.
Mediating between conflicting interests in society in order to ensure equitable access
to supportive environments for health.
In summary, empowerment of people and community participation were seen as
essential factors in a democratic health promotion approach and the driving force for selfreliance and development.
Participants in the Conference recognized in particular that education is a basic human
right and a key element to bring about the political, economic and social changes needed to
make health a possibility for all. Education should be accessible throughout life and be built
on the principle of equity, particularly with respect to culture, social class and gender.
4
THE GLOBAL PERSPECTIVE
Humankind forms an integral part of the earth’s ecosystem. People’s health is
fundamentally interlinked with the total environment. All available information indicates that
it will not be possible to sustain the quality of life, for human beings and all living species,
without drastic changes in attitudes and behaviour at all levels with regard to the management
and preservation of the environment.
Concerted action to achieve a sustainable, supportive environment for health is the
challenge of our times.
At the international level, large differences in per capita income lead to inequalities
not only in access to health but also in the capacity of societies to improve their situation and
sustain a decent quality of life for future generations. Migration from rural to urban areas
drastically increases the number of people living in slums, with accompanying problems
including a lack of clean water and sanitation.
Political decision-making and industrial development are too often based on short-term
planning and economic gains, which do not take into account the true costs to our health and
the environment. International debt is seriously draining the scarce resources of the poor
countries. Military expenditure is increasing, and war, in addition to causing deaths and
disability, is now introducing new forms of ecological vandalism.
Exploitation of the labour force, the exportation and dumping of hazardous waste and
substances, particularly in the weaker and poorer nations, and the wasteful consumption of
world resources all demonstrate that the present approach to development is in crisis. There
is an urgent need to advance towards new ethics and global agreement based on peaceful
coexistence to allow for a more equitable distribution and utilization of the earth’s limited
resources.
ACHIEVING GLOBAL ACCOUNTABILITY
The Sundsvall Conference calls upon the international community to establish new
mechanisms of health and ecological accountability that build on the principles of sustainable
health development. In practice this requires health and environmental impact statements for
major policy and programme initiatives. WHO and UNEP are urged to strengthen their
efforts to develop codes of conduct on the trade and marketing of substances and products
harmful to health and the environment.
WHO and UNEP are urged to develop guidelines based on the principle of sustainable
development for use by Member States. All multilateral and bilateral donor and funding
agencies such as the World Bank and International Monetary Fund are urged to use such
guidelines in planning, developing and assessing development projects. Urgent action needs
to be taken to support developing countries in developing their own solutions. Close
collaboration with nongovernmental organizations should be ensured throughout the process.
5
The Sundsvall Conference has again demonstrated that the issues of health,
environment and human development cannot be separated.
Development must imply
improvement in the quality of life and health while preserving the sustainability of the
environment.
The Conference participants therefore urge the United Nations Conference on
Environment and Development (UNCED), to be held in Rio Janeiro in 1992, to take the
Sundsvall Statement into account in its deliberations on the Earth Charter and
Agenda 21, which is to be an action plan leading into the 21st century. Health goals must
figure prominently in both. Only worldwide action based on global partnership will ensure
the future of our planet.
This Statement is the first of three outcomes from the Sundsvall Conference. The Conference
report and handbook will expand the principles of the Statement in the form of practical
guidelines for action for the future at all levels. Together, the three documents provide a
coherent way forward.
6
LA DECLARATION DE SUNDSVALL:
DES MILIEUX FAVORABLES A LA SANTE
La Troisieme Conference internationale sur la promotion de la sante, ou Conference
de Sundsvall, convoquee sur le theme "des milieux favorables a la sante", s’inscrit dans une
suite d’evenements qui a debute avec I’engagement pris par I'OMS, en 1977, d’instaurer la
sante pour tous. Cette decision a ete suivie par la Conference Internationale de
I'UNICEF/OMS sur les soins de sante primaires tenue a Alma-Ata en 1978 et la premiere
Conference Internationale pour la Promotion de la Sante dans les Pays industrialises, reunie
a Ottawa en 1986. Les reunions organisees ensuite a Adelaide (1988) sur des politiques
publiques saines, et a Geneve (1989) sur la promotion de la sante dans les pays en
developpement ont permis de preciser I’importance et le sens de la promotion de la sante.
Parallelement a cette evolution dans le domaine de la sante, les preoccupations suscitees par
les menaces qui pesent sur notre environnement n’ont cesse de grandir. C’est ce qu’a
clairement exprime la Commission mondiale sur I’environnement et le developpement dont
le rapport decrit sous un jour nouveau les conditions necessaires a un developpement
durable.
La Troisfeme Conference Internationale pour la promotion de la sanfe, convoqude sur
le theme "des milieux favorables i la sanfe", a 6t6 la premiere conference mondiale dans ce
domaine avec des participants venus de 81 pays. Ceux-ci ont demandd it tous les peuples du
monde de prendre des mesures dnergiques pour rendre les milieux plus favorables & la sanfe.
Evoquant ensemble les questions de sanfe et d’environnement de notre temps, ils ont nofe que
des millions d’individus vivent dans la pauvrefe et le ddnuement le plus extreme dans un
environnement de plus en plus ddgradd qui menace leur sanfe, faisant de 1’instauration de la
sanfe pour tous d’ici 1’an 2000 un objectif trds difficile & atteindre. Pour progresser, il faut
veiller & ce que 1’environnement - physique, social, dconomique et politique - favorise la
sanfe au lieu de lui nuire.
La Conference de Sundsvall a illustrd par de nombreux exemples les moyens que
pourraient mettre en oeuvre les responsables politiques, les ddcideurs et les agents
communautaires de la sanfe et de 1’environnement pour cfeer des milieux favorables. Elie a
reconnu que chacun a un role & jouer dans cette entreprise.
7
UN APPEL A L’ACTION
Cet appel s’adresse aux responsables politiques et aux ddcideurs dans tous les
domaines concents et ii tous les niveaux. Tous ceux qui s’emploient U promouvoir la santd,
1’environnement et la justice sociale sont instamment prids de former une alliance pour
atteindre 1’objectif commun de la sante pour tous. Nous autres, participants & cette
Conference, nous sommes engages & transmettre ce message & nos communautds, pays et
gouvemements pour que soient prises les mesures qui s’imposenL Nous demandons aussi aux
organisations du systeme des Nations Unies de renforcer leur cooperation et de s’encourager
mutuellement & oeuvrer en faveur d’un developpement durable et de requite.
Un milieu favorable revet une importance capitate pour la sante. Les deux sont
interdependants el indissociables. Nous demandons instamment que les conditions necessaires
aux deux soient considdrdes comme des objectifs essentiels lors de 1’eiaboration des priorites
pour le developpement, et occupent la premiere place dans la solution des conflits d’intdret
qui peuvent surgir de la gestion au jour le jour des politiques des pouvoirs publics.
Le fosse qui se creuse, aussi bien e 1’interieur des pays qu’entre pays riches et pays
pauvres, traduit les indgalitds dans le domaine de la sante, et cela est inacceptable. Des
mesures s’imposent d’urgence pour instaurer la justice sociale dans le domaine de la sante.
Dans les villes comme dans les campagnes, des millions d’individus vivent dans la pauvrete
et le denuement extreme dans un milieu qui se degrade de plus en plus. Un nombre imprdvu
et alarmant de personnes subissent les consequences tragiques, pour la sante et le bien-etre,
de conflits armds. La croissance ddmographique rapide compromet serieusement les chances
d’un developpement durable. Nombreux sont ceux qui sont obliges de survivre sans eau
propre, sans alimentation correcte, sans abri et sans assainissement.
La pauvrete frustre les gens de leurs ambitions et de leurs aspirations H un avenir
meilleur, tandis que les limites de 1’accds aux structures politiques nuisent A
1’autodetermination. Pour beaucoup, 1’instruction est inexistante ou insuffisante ou, sous ses
formes actuelles, incapable de donner les moyens d’agir. Des millions d’enfants n’ont pas
accds & un enseignement de base et ne peuvent gudre espdrer en un avenir meilleur. Les
femmes, qui representent la majorite de la population mondiale, sont encore opprimdes. Elies
sont sexuellement exploitdes et les discriminations dont elles sont victimes sur le marchd du
travail et dans bien d’autres domaines les empechent de jouer pleinement leur role dans la
mise en place d’environnements plus favorables.
Dans le monde, plus d’un milliard de personnes n’ont pas d’accds addquat d des soins
de santd essentiels. Les systdmes de sante doivent dvidemment etre renforcds. La solution d
ces probtemes considerables rdside dans des mesures d’action sociale en faveur de la santd
et dans les ressources et les capacitds d’innovation des individus et des communautds. Pour
tirer parti de toutes ces possibilites, il faudrait que nous modifiions radicalement notre fa?on
de concevoir la santd et 1’environnement et que se ddgage un engagement politique clair et
dnergique en faveur de politiques de sante et d’environnement durables. Les solutions doivent
etre cherchdes au-dete des limites du secteur traditionnel de la santd.
8
Il faut que des initiatives soient prises dans tons les secteurs qui peuvent contribuer
A la crdation de milieux favorables A la santd et soutenues au niveau local par les membres
de la communautd, au niveau national par les pouvoirs publics et les organisations non
gouvernementales, et au niveau mondial par les organisations internationales. Les secteurs
concernds seront essentiellement ceux de 1’dducation, des transports, du logement et du
ddveloppement urbain, de la production industrielle et de 1’agriculture.
DIMENSIONS DE L’ACTION TENDANT A CREER DES MILIEUX
FAVORABLES A LA SANTE
Du point de vue de la santd, 1’expression milieux favorables ddsigne les aspects
physiques et sociaux de notre environnement, c’est A dire le cadre de vie de 1’individu, sa
communautd, son foyer, son milieu de travail et ses lieux de ddtente mais aussi les structures
qui ddterminent 1’accds aux ressources vitales et les possibilitds d’obtenir les moyens d’agir.
Ainsi, les dimensions de toute action visant A crder un milieu favorable sont multiples :
physiques, sociales, spirituelles, dconomiques et politiques. Tous ces aspects sont dtroitement
associds les uns aux autres en une interaction dynamique. Les mesures prises doivent etre
coordonndes aux dchelons local, rdgional, national et mondial afin que soient mises au point
des solutions rdellement durables.
La Confdrence a dvoqud en particulier les quatre aspects suivants d’un environnement
favorable :
1.
La dimension sociale, c’est-A-dire les faqons dont les normes, les coutumes et les
schdmas sociaux influencent la santd. Dans de nombreuses socidtds, 1’dvolution des
relations sociales traditionnelles reprdsente une menace pour la santd, par exemple en
renforcant la solitude, en privant la vie de sens et de cohdrence et en attaquant les
valeurs et 1’hdritage culturel traditionnels.
2.
La dimension politique, qui oblige les gouvemements & garantir une participation
ddmocratique A la prise des ddcisions et A la ddcentralisation des responsabilitds et des
ressources. Elie suppose aussi un engagement en faveur des droits de 1’homme, de la
paix, et 1’abandon de la course aux armements.
3.
La dimension economique, qui suppose une redistribution des ressources en faveur
de la santd pour tous et d’un ddveloppement durable, et notamment le transfert d’une
technologic sure et liable.
4.
La ndcessitd enfin de reconnaitre et d’utiliser les competences et les connaissances
des femmes dans tous les domaines, y compris ceux de la politique et de 1’dconomie,
pour mettre en place des infrastructures plus propices & des environnements favorables
A la santd. n faudrait reconnaitre que les femmes ont de lourdes taches et veiller A ce
que les hommes assument leur part de ce fardeau. Il faudrait que les associations
fdminines communautaires aient les moyens d’intervenir plus dnergiquement dans
1’dlaboration de politiques et de structures propres A promouvoir la santd.
9
ACTIONS PROPOSEES
Pour la Conference de Sundsvall, les actions envisages pour mettre en oeuvre les
strategies de la sante pour tous doivent reposer sur deux grands principes fondamentaux :
1.
L’equite doit etre un objectif prioritaire fondamental de toute mesure prise pour creer
des milieux favorables H la sante et mobiliser les energies et les imaginations en
associant I’humanite toute entiere H cette entreprise unique. Toutes les politiques visant
A un developpement durable seront soumises A de nouvelles regies d’approbation en
vue d’une distribution equitable des responsabilites et des ressources. Toute action et
toute allocation de ressources sera guidee par le souci clairement exprime de venir en
aide aux plus pauvres, d’alldger le fardeau des marginalises, des groupes minoritaires
et des handicapes. n faut que le monde industrialise s’acquitte de la dette accumulde,
sur les plans dcologique et humain, it la suite de 1’exploitation du monde en
developpement.
2.
Toute action publique en faveur de milieux propices H la sante doit tenir compte de
1’interdependance de tous les etres vivants, et bien gdrer les ressources naturelies en
tenant compte des besoins des generations futures. Les peuples autochtones
entretiennent avec leur environnement physique une relation spirituelle et culturelle
unique qui peut etre riche d’enseignements pour le reste du monde. Il est done
essentiel de les associer aux strategies de developpement et de prdvoir des
negociations pour preserver leurs droits & leurs terres et & leur heritage culture!.
UN OBJECTIF REALISTE : RENFORCER L’ACTION SOCIALE
Cet appel pour la mise en place de milieux favorables it la sante peut etre un objectif
realiste de I’action de sante publique au niveau local, avec pour cible priviiegiee les contextes
propices & une participation et H un contrble importants de la communaute. Des exemples du
monde entier ont 6t6 prdsentes & la Conference dans les domaines de 1’education, de
1’alimentation, de 1’habitat, de la protection sociale, du travail et des transports. Ces
illustrations ont trds bien montre qu’un milieu favorable permet aux gens de ddvelopper leurs
capacitds et leur autoresponsabilite. Le rapport et le guide de la Conference contiennent des
renseignements ddtailies sur ces projets concrets.
A 1’aide des exemples ainsi presenlds, les participants i la Conference ont ddfini
comme suit les quatre strategies clefs de sante publique susceptibles de promouvoir la creation
de milieux favorables au niveau de la communaute.
1.
Renforcer I’action de plaidoyer au niveau de la communaute, notamment par le biais
de groupes organises par des femmes.
2.
Donner aux communautes et aux individus les moyens de gerer leur propre sante
et leur environnement par reducation et differentes mesures d’habilitation.
3.
Constituer des alliances en faveur de la sante et de milieux favorables afin de
renforcer la cooperation entre les campagnes et strategies de sante et d’environnement
10
4.
Concilier les intdrets conflictuels de la socidtd pour garantir un accds dquitable A des
milieux favorables A la santd.
En bref, 1’habilitation des individus et la participation des communautds ont dtd
ddfinies comme des facteurs clefs d’une action ddmocratique de promotion de la santd et
comme 1’dldment moteur permettant d’atteindre 1’autoresponsabilitd et d’assurer le
ddveloppement.
Les participants A la Confdrence ont reconnu en particulier que 1’dducation est un droit
fondamental de l’homme et la cld des changements politiques, dconomiques et sociaux qui
s’imposent pour que tous puissent prdtendre A la santd. Chacun devrait avoir accds tout au
long de sa vie A une dducation congue sur des principes d’dquitd, eu dgard notamment A la
culture, A la classe sociale et au sexe.
UNE PERSPECTIVE MONDIALE
L’humanitd fait partie intdgrante de 1’dcosystdme de la terre. La santd des hommes est
dtroitemcnt associde A 1’environnement. Toutes les donndes disponibles montrent qu’il sera
impossible de prdserver la qualitd de la vie des individus et de toutes les espdces vivantes
sans modifier partout radicalement les attitudes et les comportements face A la gestion et A
la protection de 1’environnement.
Le grand dessein de notre dpoque doit etre une action concertde visant A crder un
environnement durable, favorable A la santd.
Au niveau international, les dnormes disparitds du revenu par habitant conduisent A des
indgalitds, du point de vue non seulement de 1’accds aux prestations de santd, mais aussi des
moyens dont disposent les socidtds pour amdliorer leur situation et garantir aux gdndrations
futures une certaine qualitd de vie. Le ddpeuplement des campagnes au profit des villes
entraine la prolifdration des bidonvilles et des probldmes qui leur sent lids, notamment le
manque d’eau propre et d’installations d’assainissement.
Les ddcisions politiques et le ddveloppement industriel reposent trop souvent sur des
plans et la volontd de profit A court terme sans qu’il soit tenu compte de leur cout rdel pour
la santd et 1’environnement. La dette mondiale appauvrit sdrieusement les maigres ressources
des pays pauvres. Les ddpenses militaires augmentent et, outre les morts et les blessds, les
conflits armds reprdsentent maintenant de nouvelles formes de vandalisme dcologique.
L’exploitation de la main-d’oeuvre, 1’exportation et 1’dvacuation de ddchets et de
produits dangereux, en particulier dans les nations les plus faibles et les plus pauvres, et le
gaspillage des ressources mondiales tdmoignent d’une crise de 1’approche actuelle du
ddveloppement. Il est urgent de se doter d’une dthique nouvelle et de parvenir A un accord
mondial basd sur la coexistence pacifique pour permettre une distribution et une utilisation
plus dquitables des ressources limitdes de la plandte.
11
POUR UNE RESPONSABILISATION MONDIALE
La Conference de Sundsvall invite la Communaufe Internationale & ^laborer de
nouveaux nfecanismes de responsabilisation sanitaire et ecologique reposant sur les principes
d’un developpement sanitaire durable. Dans la pratique, cela suppose que les grandes
initiatives politiques et programmatiques soient assorties dfetudes de leur impact sur la sanfe
et 1’environnement. L’OMS et le PNUE sont invifes A redoubler d’efforts pour ^laborer des
codes de conduite fegissant la commercialisation et Ifechange des substances et des produits
nocifs pour la sanfe et I’environnement.
L’OMS et le PNUE sont instamment prfes dfelaborer, A 1’intention de leurs Etats
Membres, des principes directeurs reposant sur l’id£e d’un developpement durable. Tous les
organismes d’aide multilaferale et bilaferale et institutions de Gnancement comme la Banque
mondiale et le Fonds monetaire international sont invifes A utiliser ces principes directeurs lors
de la planification, de Elaboration et de revaluation des projets de developpement. Des
mesures doivent etre prises d’urgence pour aider les pays en developpement A trouver des
solutions A leurs probfemes. Une collaboration etroite sera maintenue avec les organisations
non gouvemementales tout au long de ce processus.
La Conference de Sundsvall a montfe une fois de plus que les questions de sanfe,
d’environnement et de developpement sont indissociables. Le developpement doit permettre
1’amelioration de la qualife de la vie et de la sanfe tout en pfeservant I’environnement.
En consequence, les participants A la Conference prient instamment la Conference des
Nations Unies sur 1’Environnement et le Developpement qui aura lieu A Rio de Janeiro en
1992 de tenir compte de la Declaration de Sundsvall lorsqu’elle etudiera la Charte sur la terre
et le Programme 21 destine A preparer 1’avAnement du 21e sfecle. Ces deux documents devront
faire A la sanfe la place importante qui lui revient. Seule une action mondiale basee sur un
partenariat international pfeservera 1’avenir de notre planAte.
Cette Declaration est le premier des trois documents issus de la Conference de
Sundsvall. Le rapport et le guide qui seront etablis developperont les grandes idees exposees
dans la Declaration sous la forme de principes directeurs pour des actions concretes A tous
les niveaux. Ces trois documents representent ensemble un moyen coherent d’aller de 1’avant.
12
This Statement was adopted on 15 June 1991 in Sundsvall, Sweden, by participants
at the Third International Conference on Health Promotion: Supportive Environments for
Health, the first global conference on the interdependence between health and environment
in its physical, cultural, economic and political dimensions.
The Conference was attended by 318 participants from 81 countries. They represented
a wide range of sectors, disciplines, agencies and organizations.
The Conference was able to achieve an equitable gender balance. It was the first of
these conferences on health promotion in which haJf of the participants came from developing
countries.
At the Conference more than 700 references on supportive environments were
submitted and 200 case histories presented.
The full outcome from the Conference will be presented in a report and a handbook
demonstrating different ways of creating supportive environments.
The Sundsvall Conference was held from 9 to 15 June 1991 and jointly organized by
the World Health Organization and the Nordic Countries in association with the United
Nations Environment Programme.
*
*
*
La presente Declaration a ete adoptee le 15 juin 1991 a Sundsvall,
Suede, par les participants a la Troisieme Conference intemationale sur la promotion de la
sante. Axee sur la creation d'environnements favorables a la sante, cette premiere Conference
mondiale a traite de I’interdependance de la sante et de I’environnement, dans ses aspects
physiques, culturels, economiques et politiques.
La Conference a reuni 318 participants venus de 81 pays. Ils representaient
un tres large eventail de secteurs, de disciplines, d’institutions et d'organisations.
La Conference a ete caracterisee par un juste equilibre et a ete la
premiere de ces, conferences sur la promotion de la sante dont les participants venaient pour
moitie de pays en developpement.
Au totql, plus de 700 references sur les environnements favorables ont
ete soumises et 200 etudes de cas ont ete presentees.
Les travaux de la Conference seront consignes dans un rapport et un guide illustrant
differents moyens de creer des milieux favorables.
Reunie du 9 au 15 juin 1991, la Conference de Sundsvall etait organisee
conjointement par ['Organisation mondiale de la Sante et les Pays nordiques en association
avec le Programme des Nations Unies pour I’Environnement.
The Sundsvall Conference on supportive environments for health fits into a sequence of events which began with the
commitment of the WHO to the goals of Health For All (1977); it was followed by the Declaration ofAlma-Ata on
Primary Health Care (1978): and An International Conference on Health Promotion, in Ottawa (1986). Subsequent
conferences on Healthy Public Policy, in Adelaide (1988), and A Callfor Action: Health Promotion in Developing
Countries, in Geneva (1989) have further developed the relevance and meaning of health promotion. In parallel
with these developments in the health arena, there has been growth in public concern over the threats to the global
environment. This was clearly expressed by the World Commission on Environment and Development in its report
Our Common Future which developed a new understanding of the imperative of sustainable development.
La Conference de Sundsvall sur des milieuxfavorables a la same s'inscrit dans une suite d'evinements qui a debut#
avec /'engagement pris par TOMS d'instaurer la sante pour tons (1977): cette decision a ete suivie par la
Declaration d'Alma Ata sur les soins de sante primaires (1978) et une conference internationale pour la promotion
de la sante, reunie a Ottawa en 1986. Les reunions organisees ensuite a Adelaide (1988) sur des politiques
publiques saines. et a Geneve (1989) sur la promotion de la sante dans les pays en developpement ont permis de
clarifier I'importance et le sens de la promotion de la sante. Parallelernent a cette evolution dans le domaine de la
sante. les preoccupations suscitees par les menaces qui pesent sur notre environnement n'ont cess# de grandir.
C'est ce qu'a clairement exprim# la Commission mondiale sur I'environnement et le d#veloppement dont le rapport
d#crit sous tin jour nouveau les conditions n#c#ssaires a tin d#veloppement durable. .
The national Swedish organizers were
Les organisateurs suedois etaient les solvents
■S3. Socialstyrelsen
/L&fA Karoilnska
/ Institute
*
■jg Landstinset
SB Vasternorrland
I® Sundsvalls kommun
|O;
CONTENT
1
- School Health Programme Budget
2
- Donations to School Health Programme
3
- Donations to School Health Programme
4-5 - School Health Programme Endowment Fund
6
- School For Special Education Endowment Fund
7
- School Health Programme Building Fund
8
- Seva Ashram School Building Fund
& High School Building Fund
9
- Contribution to Deena Seva Sangha
& Contribution to children
10-11-Sponsors for children St.Andals Girls Home
12-13-A Summary of Sub-Totals and Grand Total
22^2B§_12_2§lLIA_SEVA_S^Gm_THROUGH_MARIA_ 1GJ,ZILI2LI
SEVA_ASHRAM_z_5TH_MAINi_SRIRAMPURAMA_BANGALgRE_~_560001
E50M_1988_z_JUNE_1993
SCHOOL HEALTH PROGRAMME BUDGET
Date
8/88
1/89
Currency
Name
Trust for Human and Community
Development/Mysore/India
25,000
- do -
25,000
Total
Date
11/89
Rupees
50,000
Name
Currency
Rupees
Aid Organisation
•Help to Help Yourself’
5/90
Liechtenstein/Europe
- do -
S.Fr. 5,000
52,313
8,000
97,645
2,42,634
4/92
- do - do -
14,000
16,000
5/93
- do -
16,000
3,32,000
Total
59,000
10,28,368
Hanni Bubendorfer1s Fund
Liechtenstein/ Europe
S.Fr. 3,000
62,342
9/91
5/93
S.Fr. 62,000
Rs.
50,000
3,03,776
DONGRS_TC_DEENA_SEVA_SANGHA_THRCLGH_MARIA iG_.ZILigLI
SEVA_ASHRAM_=_5TH_MAINI_£._SRIRAMPURAMi_BANGALORE_r_560021
FR0M_W88_=_JUNE_1_993
DONATIONS TO SCHOOL HEALTH PROGRAMME
Rupees
Date
Name
6/88
Doselli/ Italy
750
7/88
7/88
Doselli/Italy
Bertuletti/Italy
300
500
9/88
8/89
Mignani/Italy
Friends of India
7/90
7/90
Currency
500
12,833
U.S.S
780
Consonni/Italy
Van Putten/Belgium
$
100
1 ,715
14,186
7/90
3/91
Lugli/Italy
Cavalli/ Italy
$
200
3,430
44/91
5/91
Spelgatti/Italy
Dr.Sarala/USA
5/91
8/91
Bare hiesi/Italy
11/91
11/91
2/92
10,000
S
S.Fr.
Moro/Italy
Barchiesi/Italy
100
4,000
2,000
400
5,000
6,435
2,000
7,650
H&P Bubendorfer/Liechtenstein
Maria.G.Zilioli/Italy
400
Maria.G.Zilioli/Italy
Friends of India/ltaly
5,000
$
887
24,672
8/92
10/92
Friends of India/ltaly
$
576
Dr.Velo/ltaly
S
100
15,928
2,765
10/92
Liverani/ Italy
$
100
2,765
10/92
Kaufmann/Liechtenstein
3/93
4/93
Kars tin/Germany
3/92
8/92
5,000
Ferrari/Italy
D.M.
70
S
200
1 ,440
5,863
1,35,132
U.S.$' 3043
D.M.
70
S.Fr.
400
Rs.
55286
2
DONORS TO DEENA SEVA SANGHA THROUGH MARIA.G.ZILIOLI
§EYA_ASHRAM_z_5TH_MAINi_SRIRAMPURAMi_BANGALORE_=_560002
£^2M_12§8_r_JyNE_1993
DONATIONS TO SCHOOL HEALTH PROGRAMME
Date
7/91
Name
Currency
H&P Bubendorfer/Liechtenstein
S.Fr.1,500
Rupees
24,752
for Equipment
11/91
- do -
7,650
Total
32,402
For Furniture
8/92
Aid Organisation
’Help to Help Yourself’
Liechtenstein/Europe
8/92
H&P Bubendorfer/Liechtenstein
S ;Fr. 3,444. 75
S.Fr.4,533o25
Total
71 ,843
95,037
1 ,66,900 j S , 2.1 3
Co-Curriculam Activities
6/92
p
1 CLo-J
O
V
—
—
Br. Rik Merens
CARITAS CISTERCIENSIS V.Z.W.
Antwerpse/ Belgium
K
- do - Drint'ing Water for
1.8 5 , T i 3
35,828
B.Fr. WO.OOoZ
X48,569
Seva Ashram School
Total
84,397
S.Fr.9.500
Fr.
B.
100.000
Rs.
7,650
3
22^252-I2_225yA_SEVA_SANGHA_THROUGH_MARIAiG_.ZILIOLI
SEVA ASHRAM - STH MAIN, SRIRAMPURAM, BANGALORE - 560021
£52M_1988_-_jyNE_1993
SCHOOL HEALTH PROGRAMME ENDOWMENT FUND
DATE
NAME
CURRENCY
RUPEES
1/89
1/89
Bertuletti/Italy
Dr.Richard Silvia/Switzerland
5,000
4,550
1/89
1/89
Rota/ Italy
Mignani Andreina/ltaly
3,000
2/89
Saetti & Conti/ltaly
4/89
Martinelli Alfio/ltaly
4/89
Belingheri/Italy
4/89
Simonini/Italy
10,000
2,000
7/89
Maria.G.Zilioli/Italy
15,070
7/89
Dr.Weber
S.Fr.
300
3,000
7/89
Jochheim Helene/Germany
D.M.
5000
43,078
8/89
Friends of India/ltaly
U.S.3
4000
66,000
8/89
Fr. Paul/Belgium
1,000
11/89
11/89
Martinelli Alfio/ltaly
4,055
4,980
1,000
2,000
10,000
12/89
1/90
Paterno/Italy
Rorary Club,Pinerolo/Italy
Saetti & Conti/ltaly
$
1000
16,759
$
250
4,187
1/90
1/90
Lugli Alfonso/ltaly
Ferrari/Italy
$
$
100
50
1 ,670
692
3/90
5/90
Odette Bonfils/France
Collegues of Conti/ltaly
$
350
5,998
5/90
5/90
Collegues of Saetti/Italy
Manessi Claudio/ltaly
$
$
250
400
4,289
6,855
12/90
12/90
Galvan Lucia/^taly
$
400
Galatron SRL/ltaly
$
1,800
7,250
32,623
4/92
4/92
Scaglia/Italy
Simonini/Italy
$
$
400
320
11,168
8,934
8/92
Friends of India/ltaly
$
7,245 2,01,689
10/92
Rorary Club Pinerolo/Italy
$
1,000
868
'
28,000
5 ,05,715
U.S.3
S.Fr.
D.M.
Hs.
17,565
300
5,000
63,523
DEENA SEVA SANGHA SCHOOL HEALTH PROGRAMME ENDOWMENT FUND
Date
Name
Rupees
1988-1992
Donation Through Maria.G.Zilioli
5,04,715
1988
Action Aid/ England
1,00,000
Interest
12,320
1990
CEBEMO/ Holand
1,35,570
1988 -1991
Accumulated Interest
1,72,000
1992
Interest
77,800
10,02,405
5
°2y2R§_TO_DEENA_SEyA_SANGHA_THRCUGH_MARIA_tG.ZILIOLI
§§Y^_ASHRAM_-_5TH_MAINi_SRIRAMPURAM±_BANGALORE_-_560001
FR0M_2988_2_JUNE_1.293
SCHOOL FOR SPECIAL EDUCATION ENDOWMENT FUND
Date
Name
Currency
2/92
Bertuletti/Italy
2/92
Scaglia/ltaiy
U.S.S
500
Rugees
12,675
500
Total
3/90
Marilda & Bruno/ltaly
3/90
Altemani Maurizio/Italy
3/90
Consonni/ Italy
13,175
$
100
1,680
2,500
5
$
400
100
6,760
3/90
Santagada/Italy
12/91
H&P Bubendorfer/Liechtenstein
S.Fr. 1000
1 ,690
18,231
1/92
School Children/ltaly
9/92
Belgium Friends
$ 1000
B.Fr.51000
25,907
42,840
Total
99,608
U.S.S
2100
S.Fr.
1000
B.Fr. 51000
-
Rs.
3000
SS^^-jP-S^^A^SEVA^/WGH.^THROyG^MARIA^G.ZILIOLI
SE_'/A_ ASHRAM -STH MAIN, SRIRAMPURAM, BANGALORE - 56000'!
£B2M_1288_=_jyNE_i293
SCHOOL HEALTH PROGRAMME BUILDING FUND
NAME
12/90
12/90
Friends of India/ltaly
Rotary Club Pinerolo/ltaly
12/90
12/90
Mignani Mario/ltaly
Se.etti Conti/ltaly
$ 1,500
27,186
12/90
Lugli Alfonso
Mattiuz/ Italy
$
$
100
450
1 ,780
8,156
$ 1,300
1 ,427
23,952
12/90
a
■ rupees
DATE
CURRENCY
U.S. 3 1,000
1,90,308
17,945
42,265
12/90
1/91
Giacomina/ltaly
1/91
Spelgatti/Italy
11/91
1/91
Fr. Murata/japan
Fr. Werners Johanni/Germany
9/91
Pius Koppal/Switzerland
S.Ff. 5,000
9/91
Pfarrgen St.Martin/Germany
D.M.
8,000
1,25,167
12/91
Rotary Club/Italy
Galvon Lucia
1,000
843
25,900
12/91
$
$
12/91
12/91
Roveda Palmira
Vaccari Patrizia
5
$
4,200
85
1,08,808
2,202
12/91
1/92
Bettoli Franco/ Italy
Lugli Alfonso/Italy
$
$
300
100
7,590
2,345
1/92
1/92
Friends of India/ltaly
Ulf B.Felt/Sweden
$
3,500
89,225
500
1/92
2/92
Moriggi Bruno/Italy
Martinelli Alfio/ltaly
$
$
200
654
5,060
16,844
8/92
8/92
L.E.D./Liechtenstein
Gina Zilioli/Italy
S.Fr.
$
9,000
887
1,87,650
24,672
11/92
11/92
H&P Bubendorfer/Liechtenstein
Barbara Fronmelt/Liechtenstein
S.Fr.
S.Fr.
2,400
3,000
46,440
58,050
Saetti Conti & Friends/ltaly
3,000
7,200
'• - -.
Total
28,725
86,021
21,839
11,60,257
U.S. $ 16,119
S.Fr.
19,400
D.M.
8,000
•fc.■ 2,73,425
7
DgNgRS_TO_pEENA_SEVA_SANGHA_THROUGH_MARIA_.GiZILIOLI
SEVA ASHRAM-5TH MAIN, SRIRAMPURAM, BANGALORE - 560001
FROM 1988 - JUNE 1993
SCHOOL_ByiLpibE_FUNp
Date
Name
Currency
2/92
4/92
EMMAUS INTERNATIONAL/FRANCE
EMMAUS INTERNATIONAL/FRANCE
U.S.8 40,000
$ 40,000
10,36,269
11,50,011
80,000
21,86,280
Total
R Rupees
✓
HIGH SCHOOL
BUILDING_FUND
Date
Name
Currency
Rupees
D.M.6,000
1,06,366
D.M.5,000
U.S.8
350
88,400
10,190
700
750
20,380
21,834
12/92
Pharrgem St.Martini/Germany
2/93
1/93
Jochheim Helene/Germany
Beschi Martino/Italy
1/93
Golven Lucia/ltaly
1/93
Saetti Conti Nadia/Italy
1/91
Maria.G.Zilioli/Italy __
36,575
Total
2,83,745
8
8
I
U;S.S
1,800
D.M.
Rs.
11,000
36,575
/
8
P2^25§_I2_2§§^a_seva_sangha_through maria.g^zilioli
22YA_ASHRAM_=_5TH_MAINi_SRIRM4PURAMi_BANGALCRE_=560001
FQ0M_W88_-_JUNE_1993
CONTRIBUTIONS
Name
Date
8/89
3/91
6/91
TO DEENA SEVA SANGHA
Maria.G.
(Towards
Maria.G.
(Towards
Currency
Zilioli/Italy
Electronic Typewriter)
Zilioli/ Italy
High School Building)
EMMAUS/ Japan
(Towards Electric Cyclostiling
Machine)
Rupees
5,000
5,000
U.S.S 1.500
Total
24,580
34,580
22!)iI£i22II2y_I2_2yZ“
4/89
Iris Follimi/Switzerland
Deena Seva Sangha Scholarship
12/90
Voltolin/ Italy
Girls Education
12/90
900
$
100
Rina/ Italy
Girls Education
1 ,780
793
8/90 Franca Zilioli/ Italy
— Girl’s Marriage
$
45
1,239
4,712
39,292
Total
U.S. $ 1.600
Rs.
12,932
9
2S^^^_I2_DEENA_SEyA_SANGHA_THROyGH_MARIA.G._ZILIOLI
§§vA_ASHRAM_=_5TH_MAINi_SRIRAMPyRAMi_BANGALORE_-560001
SPO^SCRS_FOR_CHILDREN
ST. ANDALS GIRLS HOME
Name
Date
Currency
Rupees
US $
it
n
8/91
1/92
ti
n
245
4,8.09
1 ,900
6,313
n
n
720
18,259
4/92
4/92
n
n
40
1,116
n
n
8/92
1/93
n
n
fi
n
1/93
n
n
1/90
3/91
1/91
8/91
Garbati Luigi/ Italy
300
300
1/93
1,866
50,817
261
4,809
5,741
n
225
n
250
244
6,335
n
n
n
190
5,453
1,170
29,128
250
4,606
250
250
244
6,442
6,335
280
8,036
1 ,274
32,209
250
4,606
Bertoia Baldreghi/ Italy
8/91
n
n
1/92
n
n
8/92
n
n
1/93
H
n
1/91
8,370
8,610
1,420
n
1/92
8/92
—1/91
20
Dr. Galli Emilio/ Italy
rt
261
Mario Cattaneo/ltaly
. -----
6^,J90
6,790
8/91
1/92
n
n
n
250
250
6,442
n
8/92
1/93
n
n
244
n
it
1.90
6,790
5,453
1,184
29,626
6,335
2
2 -
Date
Name
3/92
Luisa Nocentini/ Italy
rt
rt
6/93
8/92
US
Currency
Rugees
265
7,390
S
7,500
Mariglia Chiavai/ Italy
265
14,890
265
7,390
Total
1 ,64,060
US
Rs.
56,024
3,340
DONATIONS TO DEENA SEVA SANGHA THROUGH MARIA.G. ZILIOLI
§FVA_ASHRAM_-_5TH_MAINi~SRIRAMPURAM_s__BANGALCRE_-_560_021_
FRGM_1988_=_jyNE_1993
A SUMMARY OF THE SUB - TOTALS AND GRAND TOTALS
1. School Health Programme
Rs.50,000
Budget
1988 - 1994
S.Fr62,000
Rs.
50,000
10,90,710
11,40,710
2. Donations to School Health
Programme
U.S.S
3,043
71,971
D.M.
S.Fr.
70
400
1 ,440
6,435
55,286
55,286
Rs.
1,35,132
3. Donations to School Health
Programme
S.Fr.
9,500
1,91,652
B.Fr. 100.000
84,397
7,650
7,650
Rs.
2,83,699
4. School Health Programme
Endowment Fund
U.S.$
S.Fr.
17.565
300
3,96,114
D.M.
Rs.
5.000
63,523
4’3, 078
63,523
3,000
5,05,715
5. School For Special
Education Endowment Fund
U.S.S
S.Fr.
2,100
1,000
48,712
B.Fr.
51,000
42,840
Rs.
3,000
3,000
18,231
1,12,783
...........2
'
2
6. School Health Programme
Building Fund
16,119
3,83,504
S.Fr.
19,400
3,78,161
D.M.
Rs.
8,000
2 ,73,425
1,25,167
2,73,425
11,60,257
J
•
7. Seva Ashram School
Building Fund
u.s.s
30.000
21,86,280
8. Seva Ashram High School
Building Fund
u.s.s
1.800
52,404
D.M.
Rs.
11 .000
36,575
1,94,766
36,575
2,83,745
9. Sponsors for St. Andal's
Girls Home
U.S.SS
6,024
1,60,720
Rs.
3,340
3,340
1,64,060
10. Sponsors for Sadhananda
Boys Home (Amount transferred
to another Institution)
U.S.S
10.487
2,90,197
U.S.S
1 .500
24,580
Rs.
10.000
10,000
11. Contribution to Deena Seva
4
Sangha
I
34,580
12. Contribution to Children
u.s.s
Rs.
145
3,019
1,693
4,712
. . .3
15
22^2B§_IQ-2§§^A_SEyA_SANGHA_THROUGH_MARIA iGiZILIOLI
SEVA_ASFffiAM_=_5TH_MAINi_SRIRAMPyRAMi_BANGALORE_-560021
FROM 1988 - JUNE 1993
GRAND TOTAL
U.S. $
Swiss Fr.
D.M.
Belgium Frs.
1.38.783
36,17,501
92.600
16,88,189
___ 24.070
3,64,451
1.51.000
1,27,237
57,97,378
Rupees
5,04,492
5,04,492
Total
63,01,370
DEENA SEVA SANGHA SCHOOL HEALTH PROGRAMME
1 992 ~ 1993
A REPORT
♦
THE DEENA SEVA SANGHA SCHOOL HEALTH PROGRAMME AIMS AT
PROVIDING A COMPREHENSIVE HEALTH CARE FOR CHILDREN FROM
LOWER SOCIO - ECONOMIC STRATA . THE OBJECTIVES OF THIS
PROGRAMME are outlined BELOW
PROVIDE
1.
TO
FOR
CHILDREN
2.
IDENTIFY AND TREAT ANY MENTAL HEALTH
CHILDREN
PROBLEMS
3.
TO
PROVIDE
HEALTH
EDUCATION TO CHILDREN
-A.
TO
PROVIDE
SPECIAL
CARE
o.
TO PROVIDE OPPORTUNITIES
IN CHILDREN
6.
TO DEVELOP AS A MODEL SCHOOL
RESOURCE
CENTRE
PRIMARY HEALTH CARE
|N
FOR OISABL-EO children
FOR DEVELOPMENT
HEALTH
OF
CREATIVITY
PROGRAMME
AND A
IT MAY
BE NOTED THAT THE ABOVE OBJECTIVES HAVE EMERGED
AS A NEED
AND NOT IN COMPLIANCE WITH ANY SET PLAN FOR
THE
SCHOOL HEALTH PROGRAMME .
EXPANSION OF WORK IN ACCORDANCE WITH THE OBJ EC TN
OUTLINED
PRIMARY HEALTH CARE
t PROVIDE
TO SCHOOL CHILDREN
Q. REGULAR TREATMENT CF
MINOR WOUNDS/AILMENTS
IN FORM OF A SMALL OUTPATIENT DEPARTMENT
b. MEDICAL EXAMINATION OF ALL
CHILDREN ANNUALLY
C.
A NUTRITION REHABILITATION
MALNOURISHED CHILDREN
d. ANNUAL IMMUNISATION
PRIMARY/ Ml POLE SCHOOL
PROGRAMME
£ SCREENING , EARLY
LEPROSY CASES .
g. PEWORMING
A YEAR.
h. DENTAL
2. HEALTH
12.0
ERRORS AND OTHER
DETECTION/AND TREATMENT
OF PRIMARY/ MIDDLE SCHOOL
CLINICS
FOR
AGAINST TETANUS
e. SCREENING THE CHILDREN FOR REFRACTIVE
OCULAR PROBLEMS
#
DAIL'/
OF
•
CHILDREN T^ICS
iN SCHOOL
EDUCATION FOR CHILDREN
a. INTRODUCTION
OF REGULAR
HEALTH EDUCATION CLASSES
b. IMPLEMENTATION OF CHILD-TO-CHILD PROGRAMME
HEALTH EDUCATION
TO
TEACHERS
d. HEALTH. EDUCATION
TO
COMMUNITY / PARENTS
c.
•
3. TO IDENTIFY AND
a- P5YCOLOGICAL
IMPROVE MEwwHEALTH
PROBLEMS
IN CHILDREN
ASSES KENT
b. COUNSELLING
c- STIMULATION
PROGRAMME
FOR
' SLOW
*
LEARNERS
I
d. TRAINING
4. TO
OF YOLUNTEERS IN SKILLS
FOR COUNSELLING
PROVIDE SPECIAL CARE FOR THE DISABLED CHILDREN
a. MENTALLY
RETARDED - SPECIAL SCHOOL
ORTHO PAE DICALLY HANDICAPPED C|N COLLABORATION WITH THE
ASSOCIATION OF THE PHYSICALLY HANDICAPPED? PHYSIOTHERAPY/
APPLIANCES/SURGERIES
VISUALLY
IMPAIRED -
ATTEMPT
TO TRAIN THEM |N
BRAILLE
5. TO PROVIDE OPPORTUNITIES
. IN CHILDREN
a.
-
HOLIDAY CAMPS
b. OUTINGS
PAINTING
c-
6. TO
FOR
MAY '<3Z
DEVELOPMENT
AND
OF
CREATIVITY
OCTOBER’RS
FOR CHILDREN
COMPETITION
DEVELOP AS
A
MODEL
TRAINING PROGRAMME
SCHOOL HEALTH
PROGRAMME
CENTRE
FOR HEALTH WORKERS/HE ALTH VOLU NTEE
b- DEVELOP RELEVANT HEALTH EDUCATION MATERIAL AND STRATEGIES
c- SENSITIVE MEDICAL 6TUDENT.S/HSA LTH WORKERS TO THS
SCHOOL HEALTH FRCSRAMMS. POTENTIAL
c*.
_
CHILD-TO-CHILD
KAk nataka
e. trying
for
PROGRAMME
GOVERNMENT
RESOURCE CENTRE FOR
recognition
50HE BASIC CONCEPTS
1.
AIMIN6 TO BUILD THE CHILDS ABILITY TO BE AND REMAIN HEALTHY
IN THEIR SOCIO-ECONOMIC AND CULTURAL ENVIRONMENT-
2. REALISATION
HEALTH 15 NOT JUST THE ABSENCE OF SICKNESS, BUT IS A
OF THE CHILD'S FULL POTENTIAL, THE ASPECTS OF WHl
ARE PHYSICAL, MENTAL, SOCIO AND
SPIRITUAL ASPECT.
3.
THIS PROCESS HAS LITTLE TO DO WITH DOCTORS , DRUGS AND
DISPENSARIES WHO PLAY THEIR FART WHEN HEALTH BREAKS DOW
4.
THIS PROGRAMME HAS A LCTT TO DO WITH EDUCATIONAL PROGRAMMES
FOR HEALTH IN WHICH LIFE WORKERS, TEACHERS AND CHILDREN WILL
PLAY A MAJOR PART.
5. OUTSIDE RESOURCES SHOULD BE DRAWN UP TO PROVIDE
INFORMATION
AND SKILLS
FOR
THIS PROCESS.
COMPONENTS OF THE PROGRAMME
1.
THE SCHOOL ENVIRONMENT
PROVISION OF BASIC FACILITIES UKE-
SAFE DRINKING WATER, CLEAN, SIMPLE
AND USABLE
LATRINES-
2- THE TEACHERS- A
LIVING
(
commitment to prepare children for
NOT ONLY TO SUBJECTS OR EXAMS.
a. THEY MUST HAVE A BASIC UNDERSTANDING OF
-HEALTH AND HEALTHY LIVING
— COMMON MINOR ILLNESSES OF CHILDREN
-NORMAL MENTAL, PHYSICAL, PSYC©LOGICAL AND SOCIAL
DEVELOPMENT AND PROBLEMS ASSOCIATED WITH IT
b. THEY MUST HAVE SKILLS IN IDENTIFYING
THE ABOVE.
PROBLEMS
RELATED TO
I
c.
3.
THEY MUST BE ABLE TO MANAGE SIMPLE PROBLEMS EITHER ON
THEIR OWN OR REFER IT TO THE NECESSARY AGENCY.
CHILDREN ~ TO BE ANIMATED IN GROUPS BY TEACHERS TO DISCUSS/
UNDERSTAND HEALTH ISSUES USING METHODOLOGY GWEN IN
a- THE CHILD TO CHILD PROGRAMME
b. HELPING HEALTH WORKERS LEARN
fTALC)
HEALTH ISSUES CAN ALSO BE UNDERSTOOP THROUGH GROUP MTlVTTlfiS
LIKE NUTRITION GARDEN, MARKET SURVEYS, VISITS TO INSTITUTIONS,
DISCUSSIONS WITH 4M/EST RESOURCE PEOP-E ETO.
MEDICAL SUPPORT Q. REGULAR .SCREENING PROGRAMMES TO IPCNTIFY EARLY DISEASE
DISABILITY PROBLEM THROUGH
I. REGULAR MEDICAL CHECK. UP .
li. SPECIALIST CAMPS i EYE , TB , ENT , DENTAL , SKIN AND
LEPROSY BTC.
b. REGULAR
IMMUNISATIONS :
DT/TT / TABC
ETC.
C. FOLLOVJ up OF ILLNESSES/problems DETECTED SY THE
METHOD
ABOVE
health education REGULAR LAR.GE GROUP OR CLASSROOM LEVEL SESSIONS OF
HEALTH EDUCATION ON RELEVANT THEMES
IDENTIFIED BV
ABOVE ACTIVITIES CAN BE INTRODUCED INTO SCHOOL.
CURRICULUM.
THESE COULD BE FILM SHOWS, EXHIBITIONS, TALKS
DEMONSTRATIONS
By trained personnel from
OTHER AGENCIES.
COUNSELLING
AND
SERVICES -
FOR PS YCO LOGICAL ANO SOCIAL
CHILDREN AND THEIR BARENTS .
PRO&LEMS
INVOLVING
CMH PROGRAMME
'
r---------------------- ------------------- —i
CLINICAL
PSYCOLOGIST
CMH
STIMULATION
(2) TEACHERS
PROGRAMME
I--------- ----------------- 1-------------------------- 1
CLINICAL
PSYCOLOGIST
ASSISTANT
PSYCOLOGIST
STIMULATION
TEACHER
SCHOOL FOR SPECIAL EDUCATION
. HEADMISTRESS
• SPECIAL TEACHER
• ASSISTANT
• HELPER
S H P - STAFF (June "si)
,----------------------------J------------- ;------------ ,
CONSULTANT
CO-ORDINATOR
HELPER CUM COOK
[
LINE WORKERS
SOCIAL WORKERS
SHP- STAFF (June 'si)
DIRECTOR
SOCIAL WORKER
PROGRAMME DEVELOPER
PHYSIOTHERAPIST
CHILD-TO-CHILD PROGRAMMER
OFFICE ASSISTANT
HELPER CUM CO
Gor^ h Dufourstrassc 30
Postfach 311
CH -3000 Bern 6
Tel. *41 [31] 350 04 04
Fax +41 (31) 368 17 00
officc.bernrapromotionsante.ch
Avenue de la Gare 52
Case postale 670
CH -1001 Lausanne
Tel. *41 (21) 345 15 15
Fax *41 (21) 345 15 45
officcrapromotionsante.ch
L^^C^^idheitslorderung Schwerz
Promotion Sanle Suisse
Promozione Salute Svizzera
Health Promotion Switzerland:
Model for Outcome Classification
Guidelines for the classification of outcomes in Health Promotion
and Prevention
Berne, July 2004
Authors
University Institute for Social and Preventive Medicine, Lausanne : Spencer, Brenda
University Institute for Social and Preventive Medicine, Bern: Cloetta, Bernhard; SporriFahrni, Adrian
Health Promotion Switzerland: Broesskamp, Ursel; Ruckstuhl, Brigitte; Ackermann, Gunter
A-
1.0
Introduction
It is generally held that projects and measures of health promotion will influence a
population’s health in a positive way. The way this works is extremely complex and cannot
be explained in terms of simple correlations between cause and effect. Some of the reasons
put forward are the following:
Generally, health promotion aims at improving the health of the population or of
individual population groups. This is normally done by exerting a positive influence on
health determinants and other relevant factors.
It is rare to see immediate effects of health promotion projects, as they only become
apparent after some time.
A multitude of external influences makes it difficult to directly attribute health outcomes to
implemented measures.
As a result, it is generally not possible to provide direct epidemiological evidence of
individual health promotion projects.
Nevertheless, in order to facilitate the systematic recording of project outcomes, a system of
categories has been developed. It is called the ' Model for Outcome Classification in Health
Promotion and Prevention’ and has been developed on the basis of the well-known outcome
model for health promotion by Don Nutbeam’. It is based on the basic assumption that
health, as the ultimate goal of prevention and health promotion, cannot be achieved directly,
but is attained through intermediate stages.
’ Nutbeam, Don (2000): Health literacy as a public health goal: a challenge for contemporary health education
and communication strategies into the 21st century. Health Promotion International 15, 259-267.
Health Promotion Switzerland
Model of outcome categories
3/22
2.0
Overview of the model of outcome categories
Outcome levels
Infrastructures and
services
Factors influencing
health determinants
Health promotion
measures
A1
\
Development of
health promoting
services
\
\
I
B1
(p.9)
01
Health promoting physical
environment
(P-17)
A2
\
Advocacy
Networking organizations
\
\
Health promoting strategies in
policy and organizational
practice (p. n)
C2
Health promoting social
environment
(p. 18)
Groups
Communities
Population
Individuals
Health Promotion Switzerland
A3
/
Social mobilization
/
A4
/
Development of
individual skills
/
/
Health status of the
population
Health promoting services
B2
Legal system
Administration
Organization
Networks
Health determinants
B3
Health promoting
social potential and
commitment (p. 13)
B4
Health-related life skills
(p. 15)
C3
Health promoting individual
resources and behavioural
patterns
D
Health
increased
- healthy life
expectancy
- quality of life in terms
of health
lower
- morbidity
- premature mortality
(p. 19)
Model of outcome categories
4/22
3.0
The four columns of the model of outcome categories
Since health promotion always aims at the improvement of health, we begin by explaining the
right side of the outcome model, i.e. by focussing on the improvement of health (Column D).
Improvement in the health of a population (Column D)
In terms of a bio psychosocial understanding of health, this is the place for recording the
actually intended, ultimate goal of health promotion. Results such as an increased healthy life
expectancy for the population or a lower rate of preventable (or premature) morbidity depend on
many factors (behaviour and circumstances), which interact in a complex manner. Such
outcomes can only be achieved over an extended period of time and can be supported by
epidemiological evidence.
Changes in health determinants (Column C)
Changes in health determinants are recorded in this column. This is the field to register
indicators that cover conditions that research has shown to affect public health directly or
significantly, as the case may be. Results shown in this column must have a broad impact
range. In most cases, they also have to show a long-term impact, i.e. they must remain stable
overtime. Outcomes on this level may, in general, be verified through epidemiological data.
Change in factors influencing health determinants (Column B)
This is the field into which direct results of health promotion strategies are entered. The
categories and sub-categories offer room for indicators that have the potential to exert a positive
impact on the health determinants.
Measures for health promotion (Column A)
Measures constitute actions that are directed towards reaching the goals of the project, which
thus render the project possible, and enable it to progress. It is not absolutely necessary to
consider this column when documenting the goals and outcomes.
When assigning a place for the recording of planned, and actually obtained outcomes of
health promotion projects (as well as for unintentional results) both column B and C are
important. Each one of these columns is further divided into categories and sub
categories. Demonstrable improvements in the population’s health are to be recorded in
column D.
Health Promotion Switzerland
Model of outcome categories
5/22
Simple associations of effects, for example A2 to B2 to C2 to D, may be the exceptions; more
complicated associations are to be expected. For example, advocacy measures (A2) can lead
directly to a binding engagement on the part of decision makers (B2), which may be followed by
the creation of structures and services (B1). These, in turn, can strengthen the individual healthrelated life skills (B4), which, over time, can lead to enhanced individual health resources (C3).
These enhanced health resources, in turn, demonstrably contribute to the improvement of
health (D):
The model provides a system for the recording of both planned outcomes (project goals) and
actually achieved results. It thus provides a basis for further reflection. It may point to
concentrations or gaps, facilitates the estimation of effects and their association with each other,
and is also an aid for the correct recording of relevant theoretical and empirical findings. Thus,
the model serves, on the one hand, to guide programs and projects systematically, and, on the
other hand, to justify the employed means to the public. A further benefit for individual projects
consists in the fact that the model facilitates a comparison of their particular outcomes with
other projects.
Health Promotion Switzerland
Model of outcome categories
6/22
4.0
What is an outcome?
An outcome is a clearly detectable change of a determinant or a characteristic following a
measure applied within a project. In the case of positive outcomes, it means the following:
• The presence of a desired characteristic which did not exist before
• The change of an existing characteristic in the desired manner
• The diminution or disappearance of a pre-existing unwanted characteristic
This may be with regard to determinants and characteristics relevant to the health of individuals,
population groups or organizations; legal regulations, public opinions, physical or social, natural
or man-made environments can be equally affected. As a rule, outcomes refer to the project’s
intended goals. Yet, outcomes, whether of positive or negative nature, can be unintended as
well. The question of reaching the target group is of particular importance for the discussion of
the outcome: it is important that the outcomes appear within the targeted groups or structures,
and not at random (e.g. in persons who are easy to reach but for whom a change is not urgent).
It is important to distinguish between outcome and measures. In this sense, we are not
concerned with the intended or accomplished measures (interventions and activities), but with
the intended and actually achieved results (outcome).
5.0
Application of the model
The model is applied in both the planning phase and the evaluation phase of a project. The
following steps are guidelines for both phases:
• Even though the model focuses on the results, it allows for the main implemented
measures to be placed in the measures categories A1-A4 (there are no sub-categories
in this column).
• Each one of the health-relevant project outcomes (planned or achieved) is placed in one
(and only one) of the sub-categories. The descriptions of the categories and sub
categories, as well as the examples, are intended as help for the correct assignment of
outcomes.
• Column B is the starting point. It is here that any health promotion project must show
outcomes. In most cases, if there are no outcomes in column B, no outcomes in column
C are possible.
• After recording the essential outcomes in the appropriate spaces, the process of
reflection begins. The following questions may be helpful:
In which of the categories and sub-categories are the outcomes accumulating? Do
potential accumulations correspond to intended goals?
Which of the categories and sub-categories are lacking outcomes? Does this
correspond with the planning?
How do different outcomes correlate (outcome models, associations of effects)? Are
these associations theoretically or empirically based, or are they mere guesswork?
Health Promotion Switzerland
Model of outcome categories
7/22
6.0
The measure categories
This is the level where the measures implemented by a project can be recorded. The distinction
between measures and goals/outcomes is pivotal. In this sense, the 'training course of
vocational skills teachers’ is a measure, whereas an outcome could be formulated like this: '45
teachers successfully finished their training course '.
This model focuses on the outcome dimension. The option to differentiate or sub-divide the
measure categories was therefore not taken. Users may find it helpful to assign the measures to
the measure categories, but it is not absolutely necessary. The model, as it is used by Health
Promotion Switzerland, allows for the systematic listing of project results but has dispensed with
the listing of measures.
A1 Development of health-promoting services
The planning and implementation of
infrastructure services and provision for health
promotion and prevention belong to this
category. These may be aimed at the
population and/or professionals.
Examples
• Development of a range of counselling and advice
services
• Implementation of programmes which promote
physical activity
• Training of disseminators
• Creation of a user-friendly and publicly accessible
data bank about health-related subjects, health
promotion projects and players
A2 Advocacy, cooperation of organizations
-> This deals with measures aimed at spreading
and sustaining health promotion concerns in
politics, administration and organizations.
-> Measures may include advocacy and lobbying,
coordination and cooperation.
Examples
• Development of institutional/organizational
networks
• 'Lobbying' and 'Advocacy'
• Creation of national/regional coordination centres
or platforms
A3 Social mobilization
-> In contrast to A2, these measures do not
address formal organizational units, but aim at
the ultimate beneficiaries of health promotion,
i.e. the public, or certain population groups.
Examples
• Initiation of self-help groups
• Community work/work within a neighbourhood
• Participation procedures in communities
• The ‘Slow-up Movement’ is promoted to further
nationwide coverage
A4 Development of individual skills
-> These measures address individuals directly.
They include health-related information,
education, advice, promotion and training, and
they are aimed at the development of healthrelated personal life skills.
Health Promotion Switzerland
Examples
• Organizing programs which promote physical
activity compatible with daily life
• Stress management programs
• Nutrition and exercise advice
• Public information event relating to ‘Agenda 21 ’
• Information campaigns dealing with social
influences on health
Model of outcome categories
8/22
7.0
Outcome categories and sub-categories
7.1
Health-promoting services - B1
We understand the term 'provision' to mean the provision of services or products, which are
developed, operated and/or distributed by health promotion and prevention practitioners.
• 'Provision of services' could mean: Information and advice centres, counselling services,
platforms for exchange between professionals
• ‘Products' could mean: leaflets, brochures and other printed material, internet platforms,
video games, articles warning against harmful influences, tools for exercising healthfavourable behaviour etc.
Projects often begin with the development of such provisions. Thus, the first result is often the
creation of services and products. The outcome model, however, only accounts for results
relating to effects and benefits (outcomes), and not to the mere availability of services and
products (outputs).
Provisions can be directed at specific target groups in the population, at mediators (i.e. at
persons who convey these services to population groups) and at health promotion
professionals.
B1-1
Awareness of the service
Examples
-> Awareness
of the
service
and
its
characteristics by all relevant target groups
-> To distinguish: the characteristics of the
service will be recorded in this category, as
compared with the characteristics of the
person in B 4-1,.
•
•
•
•
•
B1-2
The potential users know the name and the
appearance of the service
They remember the type of service being provided
They know when and how they can make use of
the service
Mediators (such as specialized centres, the mass
media) know the service, and draw the attention of
potential users to it
Key players know about the service (e.g. local
authorities or the media)
Accessibility of the service and reaching of target groups
-> Temporal accessibility (opening times)
-> Local accessibility (distance from the service)
-> Attractiveness (appearance and image which
is adapted to the target group psychologically,
socially and culturally)
■> Affordability
-> Congruence between intended and actually
reached target group
Health Promotion Switzerland
Examples
•
•
•
•
The target group is able to handle the internet
game without problems
The opening times of the advice centre are
convenient for the target group
The internet platform appeals to the members of
the network
The campaign reached 85% of the intended target
groups
Model of outcome categories
9/22
B1-3 Use of the service and satisfaction with it
-> Number and profile of the service users
-> Frequency, length of time, and type of use of
services
-> Satisfaction of the users refers here to a
subjective, “intuitive" evaluation (as opposed
to B1-2 and B1-3, which is more concerned
with ’’objective facts “
This refers to both the global satisfaction with
the service and specific elements
-> This, too, refers to the satisfaction with
outcomes and effects of provided services,
and not to the satisfaction with process
indicators
B1-4
Sustainability of the service
Examples
•
•
•
•
•
Examples
-> Secure and stable organizational basis
-> Networking with potential mediators and other
providers in the area of activity
-> Take-over or continuation of the service or of
its idea by other providers
•
•
•
•
•
Health Promotion Switzerland
The persons making use of an information system
are part of the defined target group
The service is used to 85% of its capacity
20% increase in telephone information given by the
advice and counselling service, as compared with
the previous year
High satisfaction with a course in a continuing
education programme
95% of the clients are willing to recommend the
service
The exercise program is integrated into an
existing organisation or institution
The providers of the continuous education
program are networking with others
The service is designed for long-term use (e.g.
financing is assured, local/temporal aspects etc.)
The public recognizes the range of available
services as meaningful and necessary
Further specialized centres have taken over the
concept of the service, and now offer it as well
Model of outcome categories
10/22
7.2
Health-promoting public policy
and organizational practice - B2
Policy in the present context includes strategies and efforts
• by the state sector (communities, cantons and federal government).
• by the public and private sector (institutions, organizations, federations and networks)
It intends to direct national or corporate structures. It includes at least targets and goals,
measures, personnel and material resources, as well as regulations for the interaction between
all concerned players. The main players of such a policy are not primarily experts in health
promotion and prevention. The experts only motivate these main actors to strive for self
organization and activity, with the goal to achieve conditions favourable to health.
B2-1
Binding engagement of decision-makers and/or key persons
-> A key person has influence in certain areas
and institutions and may act as spokesperson
-> Influence, power, and prestige may take effect
politically,
publicly or through
private
connections
-> Thus, influence can be exerted by public
figures (from politics, economy, culture, sports,
sciences)
-> Binding, i.e. public or written endorsements
Examples
•
•
•
•
•
B2-2
Examples
Action-relevant, binding documents
•
-> This refers to the drawing-up of documents
such as basic principles, models, plans,
concepts, laws, ordinances, regulations and
similar proposals
-> These products are finalized, negotiated and
agreed upon by decision-makers, and are
ready to be implemented
•
•
•
•
Health Promotion Switzerland
The management pledges publicly to become
involved in the subject of health promotion
A written consent exists concerning plans to
develop a health promotion project for the
company
Parliament (federal, cantonal or communal level)
has submitted a postulate to the government,
demanding the drafting of a programme for the
prevention of violence
Several well-known personalities from different
sectors of public life pledged publicly to support
this cause
Several organisations and institutions decided to
create a network towards achieving certain
common goals
The management has implemented guidelines for
company-specific health promotion
The local council approved the plan proposing
measures for the promotion of quality of life in the
community
The trade association agreed upon basic
principles and procedures concerning the
promotion of health within the affiliated companies
The network of health-promoting hospitals opted
for the creation of a coordination centre and made
a decision as to the method of its funding
A decision was made by the contracting parties in
favour of the cantonal AIDS Prevention Program
Model of outcome categories
11/22
B2-3
Successful organizational changes
Financial, material and personnel resources
are invested in the HP project
-> Working conditions, working relationships or
work procedures were changed
Examples
•
•
•
•
•
•
•
B2-4
A group concerned with health in the workplace
started to operate in a institution or organisation
The Commission for Health Promotion was
granted a yearly credit of SFR 10,000 by the
municipal council
There are new, more flexible working time
regulations making it easier to maintain the work
life balance
There are new regulations facilitating the
complaints procedure regarding mobbing in the
work-place
The ban on using building material harmful to
health is being enforced
Threshold values for the use of loud speaker
systems are being upheld
The person in charge of implementing the national
HP initiative within the company has the necessary
resources at his disposal
Successful exchange and cooperation
-> This category refers to the existence of
information exchange and cooperation in the
context of health promotion concerns
-> An important aspect consists in the
collaboration between sectors
Examples
•
•
•
•
Health Promotion Switzerland
The transport authority now collaborates regularly
with the health authority
The cantonal delegate for health promotion is
regularly invited to participate in consultations of
other departments
The inter-sectoral network for health promotion
receives efficient support from its coordination
centre
The systematic, trans-sectoral information
exchange operates in a satisfactory manner for all
concerned
Model of outcome categories
12/22
7.3
Health-promoting social potential and commitment - B3
Social potential refers to the ability of small or larger population groups to stand up for their
concerns in a competent manner, or more generally, to find solutions for collective problems.
These are the main points signalling 'empowerment'. The term 'commitment' refers to the
motivational aspect of these abilities, namely the willingness to become active, and the
confidence that this commitment to a common cause is worth the effort.
The development of these abilities through the use of interventions, in particular campaigns with
the mass media, can be divided into the following levels: Knowing - Accepting - Supporting Adopting -Participating. The first phases of this process are also termed “Sensitizing”.
This category refers exclusively to population groups, and not to health promotion professionals!
B3-1
Existence of active groups focusing on health-promoting concerns or themes
-> This concerns interest groups or bottom-up
citizen initiatives These groups are capable of
functioning autonomously without external
intervention
They are able to externalise activities
Examples
•
•
•
•
•
B3-2
A self-help group was set up
The parent initiative for 'Safe Ways to School'
holds its inaugural session
The initiative decided to adopt an action
program for the coming year
The informal working group of the region's
decision-makers meets regularly in order to
exchange health-relevant social topics
The neighbourhood group discusses health
concerns repeatedly
Enlisting of n ew players
This refers to participation in the sense of
cooperation,
co-development
and
co
management
-> As a result of the mobilization efforts, persons
who were inactive until now, start to enlist in
the project. On the one hand, these should be
members of groups who used to be
underprivileged/underrepresented
in
this
sector (e.g. women,
migrant women,
marginalized people). On the other hand, this
could be private commitment on behalf of
public figures (e.g. a community leader, a wellknown female athlete,...)
Health Promotion Switzerland
Examples
•
•
•
Persons who were inactive until now, became
involved in the concern
The executive board includes two representatives
each of three previously underprivileged groups
Young people helped to review and redesign the
program for an event
Model of outcome categories
13/22
B3-3
Awareness of the concern by population groups
-> Here the concern includes ideas, statements
of needs, propositions, requests, programs
-> This is about the external effects of the subject
matter, in that as many as possible of those
concerned know about it, discuss it and form
an opinion about it
-> The concern may be propagated by official
agencies (e.g. local authorities), private
organizations (e.g. health groups) or grass
roots groups
To distinguish: This is about public awareness
of a topic; the awareness of a service
(provision of a service, product) is attributed to
B1-1
B3-4
Examples
The topic of health promotion is repeatedly taken up
and debated in the local newspaper and radio
45% of the residents know that the subject is
presently discussed in public and that it is a very
important topic
During an event focusing on the subject of HP, all
essential positions were expressed
The topic is regularly discussed in the different daily
newspapers
•
•
•
•
Acceptance of a concern by population groups
-> This concerns the social norm, i.e. what is
generally considered to be right
-> A health promotion concern should at least be
recognized as being legitimate or as
something ‘to be taken seriously’ by the
majority of the population
-> Ideally, it should be seen as being a priority by
a majority of the population
-> To distinguish: The concern is here the
characteristic of a population group as
compared to the characteristic of an individual
as in B4-2.
Health Promotion Switzerland
Examples
•
•
•
80% of the residents think the topic is at least quite
important
The essential opinion leaders/the most important
peers among the students stress the concern
repeatedly and publicly
The number of active requests from the population
for information about the topic (submitted to the
initiators or other competent bodies/organizations)
has markedly increased
Model of outcome categories
14/22
7.4
Individual health-related life skills - B4
By health-related life skills we understand knowledge, attitudes, beliefs or values, as well as
skills that are significant for one's own health. Included are skills dealing with oneself as a bio
psychosocial being, and skills dealing with one’s social and physical environment. That means
that an individual would act in a health promoting way if he/she had the motivation and the
ability to do so.
B4-1
Factual health-relevant knowledge and capacity to act on knowledge
-» On the one hand, this refers to concrete
knowledge of facts, topics and contents that
improve the individual’s capacity to act
On the other hand, it is also about knowledge
of procedures, methods and strategies
-> To distinguish: Here it is the characteristic of
the person as compared to the characteristic
of the service in B1-1
B4-2
Examples
• Students know where to get specialized advice and
counselling
• Employees know the nutrition slogan of “5 a day"
• City residents know which of the social factors in
their neighbourhood have an impact on their
health
• Parents and teachers know that the “Children’s
Health" initiative was started in their city
Positive attitudes towards a health-relevant topic
-> In order to act on knowledge, the gained
information has to be judged positively and
appear sufficiently worthwhile and useful
-> The same goes for conduct to be avoided:
there needs to be a positive attitude towards
alternatives
-> To distinguish: Here it is the characteristic cf
the person as compared to the characteristic
of a population group in B3-4
Examples
•
•
•
•
•
B4-3
Young men assess the messages about nutrition
aimed at them as being positive
Women recognize the benefit of regular
preventive medical check-ups
Party-goers accept the fact that saying No to
unknown party drugs is beneficial to their health
Men (e.g. from migrant populations) have a
positive attitude towards the use of condoms
40% of the adult population feel that the
procedures of ‘Agenda 21’ are important for their
health
New personal and/or social skills
-> Personal skills refer to the performing of
actions which one can do by oneself alone and
for oneself (e.g. to make a difficult decision or
to clarify one's feelings)
-> Social skills refer to interactions or
communications with other persons, thus they
require a counterpart (individual or group)
-> See also “life skills"
-> To distinguish: collective changes in B2-4
Health Promotion Switzerland
Examples
•
•
•
•
The apprentices are able to apply a problem
solving model to a topic relevant to themselves
The course participants decline invitations to join
others in drinking alcohol, when they intend to
drive a car
In conflict situations, the course participants are
able to take steps to avoid escalation
With support, the course participants are able to
follow the steps of the stop-smoking program
Model of outcome categories
15/22
B4-4
Strengthened self-confidence regarding a health-relevant topic or an activity
-> This concerns the trust in one’s ability to effect
change with a positive outcome, i.e. the trust
that a certain action in my specific case will
indeed be effective and that I will also be able
to accomplish it in my every day life
-> In general, it is the feeling of having enough
knowledge for informed decision-making, and
to be really able to assess the pros and cons
for oneself
-> To distinguish: In contrast to B3-4, this refers
to the self-confidence of the individual
Examples
•
•
•
•
Health Promotion Switzerland
Visitors to the open-air swimming pool feel
reassured that the skin protection measures
taken against sun radiation are effective
The course participants of the stop-smoking
program are convinced that the program is
effective, and feel confident that they can carry
it through
Young women trust themselves to be able to
decline unprotected sex during a future
encounter
Each target person is convinced that the
recommended action will indeed result in the
desired positive effect for him/herself
Model of outcome categories
16/22
7.5
Health-promoting physical environment - C1
By material environment we understand
• the natural physical environment as well as
• the man-made and altered environment
C1-1
Reduction of pollution caused by physical-chemical influences
-> The production or the discharge is reduced at
source or the target group will benefit from
effective protective measures
-> The issues here are actual radiation such as
electromagnetic waves, sound and noise but
also other harmful substances such as ozone
and fine dust particles in the air, nitrate in the
water, additives or residues in foodstuffs
C1-2
• People living on a main thoroughfare are less
exposed to noise due to speed limits, noise-proof
windows, protective walls and a tunnel
• Noise exposure inflicted on club-goers was reduced
• The threshold values for mobile phone antennae
were not exceeded
Conservation and improvement of natural resources
Here natural resources refer to basic life
sustaining resources such as water, air, forest,
sufficient living space, recreational areas close
to residential areas
-> To distinguish: This refers to outcomes in the
holistic ecological sense, in contrast to C1-1,
where the central factor is the reduction of the
individual exposure
C1-3
Examples
Examples
•
•
•
The grassland area within the urban agglomeration
was preserved and did not fall victim to a planned
building project
The water quality of a lake used by swimmers has
improved
A forest close to the city was officially declared a
recreational area and was cleaned up by the local
school children, thus becoming a place for rest and
recreation
Health-promoting installations and products
-> This refers to services, installations and
products which sustain health and well-being
-> They go beyond purely preventive effects and
offer
health-favourable
possibilities
for
recreation, relaxation, life-balance, activities or
challenge
-> It is established that they promote more
health-favourable choices
-> Generally, the service and product providers
are not experts in the field of health promotion
and prevention (in contrast to B1)
To distinguish: This refers to man-made
material resources in contrast to C1-2, which
deals with 'naturally present’ resources
(nature).
Health Promotion Switzerland
Examples
•
•
•
An interconnected network of safe bike paths
prompting bike traffic away from the road
Playgrounds and sports fields in a neighbourhood
are aimed at different target groups, which results in
additional use
Sports- and exercise-friendly measures and
installations in a company (e.g. showers for joggers
or bicycle riders) are taken up
Model of outcome categories
17/22
7.6
Health-promoting social environment - C2
By the term social environment, we understand widely available social support services, and the
climate in which social interactions take place (social climate). In other words, the whole social
structure (community, company) is involved and not just some selected and isolated features.
C2-1
Social support, social networks, social integration
-> Improvement of social support in the target
groups
-> Events, services and installations are available
throughout the social structure. They
promote
contact,
encounters
and
exchange with other people, and
encourage mutual help,
facilitate the utilization of professional
support and assistance and/or
promote the integration of marginalized
population groups
-> In contrast to B1, these services are offered by
non-professional health promoters
C2-2
Examples
• The support of socially disadvantaged people in the
community has improved
• Community centres in neighbourhoods are being
used by different population groups
• The residents of an area are being socially supported
and are aware of the support
Social climate
Examples
-> The social climate is the expression of the
dominant mood in a social structure (a
company or a community,...)
-> Changes in the social climate of a company or
community can manifest themselves in several
ways: the nature of the interaction between
partners at different levels in a hierarchy
(supervisors - co-workers, politicians citizens), in the degree of trust, and the
identification with the community or company
(feeling of togetherness, see also "Social
Capital")
-> To distinguish: This refers to collective
changes of a social structure. Similar changes
in knowledge, attitude and conduct of
individual persons or small groups are
assigned to B4
C2-3
•
•
•
•
A positive psychosocial culture is increasingly
prevalent in Swiss companies. This promotes
well-being in the work place and lowers the stress
level
The residents of the city feel generally safe
There are visible manifestations of solidarity
Community life is marked by mutual esteem and
acceptance
Equal opportunity for good health
-> Equal opportunity for good health means
having equal access to health-promoting
resources in terms of social
health
determinants
-> In this context, it could mean access to work,
education, income, status, appreciation,...
Health Promotion Switzerland
Examples
•
•
•
Differences in income and education are less
marked
Unemployment in the target groups is declining
Access for migrants to educational services is
improved
Model of outcome categories
18/22
7.7
Health-promoting individual resources and
behavioural patterns - C3
Individual resources here mean internal psychological strengths and abilities. The term
behaviour ‘pattern’ suggests that particular modes of behaviour are interconnected with each
other and must always be considered in context.
C3-1
Dealing appropriately with risks
-> Reduction and/or cessation of a harmful risk
behaviour
-> Reinforcement
of
behaviour
modes,
orientations, attitudes and feelings which
promote prevention
-> Increased personal protection against risks
C3-2
• The proportion of smokers has decreased
• The population opts for better protection against
direct sun radiation
• More drivers tend to slow down in a residential
area
• More bicycle riders wear helmets
Coping with the demands of daily life
Appropriate strategies when dealing with strain
and stress. These might occur in connection
with material problems or other persons
-> Rules applied in conflict situations, the
willingness to make compromises and to find
common solutions as well as the appropriate
kind of cooperation - particularly in cases of
conflicting interests and differences in power
within the hierarchy (e.g. between superiors co-workers, or politicians - citizens)
C3-3
Examples
Examples
• Stress-coping strategies are increasingly applied in
daily life
• Increasingly, students resolve their conflicts in
school without resorting to violence
• The elderly can continue (without discomfort) to
climb stairs, visit friends,...
• Parents are physically able to play and romp with
their children, and go on bicycle tours,...
Improvement of health-relevant behaviour and behavioural patterns
-> Healthy modes of behaviour such as exercise,
relaxation, appropriate nutrition, ability for
social contact
-> Positive attitudes towards life such as
optimism, ability to experience pleasure, zest
for life, sense of coherence
Health Promotion Switzerland
Examples
• More and more young men opt for health-conscious
nutrition
• Elderly people in Switzerland exercise more in their
daily lives
• It can be demonstrated that high school students in
Switzerland smoke less
Model of outcome categories
19/22
8.0
Health
Ultimately, health promotion and prevention always aim at improving the health of the
population or individual population groups. According to the definition of health by the WHO, it
refers to a sustained improvement of the mental, physical and social well-being. Today’s state
of knowledge of the health sciences supports such an understanding of health as well.
Here, indicators to be measured are, on the one hand, a higher healthy life expectancy of the
population, or a greater number of years without illnesses and disabilities, as well as indicators
of the higher health-related quality of life. On the other hand, these are indicators of a
decreasing rate of preventable (or premature) morbidity as well as premature mortality.
In this sense, it is rarely possible to directly attribute measurable, lasting changes in the health
of the population to individual health-promoting projects. Such changes are rather the result of a
great number of health-impacting factors, i.e. factors stemming from both the sector of individual
behaviour and the (living, learning and working...) conditions. Thanks to numerous studies, we
know today which of these factors are proven to have a negative or positive impact on the
health of the population. These are the so-called health determinants. Changes of these
determinants as outcomes of health-promoting interventions are recorded in column C. At the
same time, it should be noted that positive outcomes reached in the area of one or several
health determinants can be 'neutralized' by simultaneous, negative impact of other interventions
and sectors on these or other health determinants.
Example
•
•
•
•
•
Health Promotion Switzerland
The healthy life expectancy of the Swiss
population has risen
The proportion of 75 year old persons without
chronic illness or disability has risen
Older people show a consistently good level of
fitness
The proportion of 40 to 50 year old people with
back problems interfering with their everyday lives,
decreased significantly
The suicide rate of young people is declining
Model of outcome categories
20/22
9.0
Empowerment and participation in the model of outcome categories
As so far described, the basic principles of empowerment and participation have not appeared
in the outcome model. The reason for this is that these terms cannot be assigned
unambiguously to one outcome category of the model. This will be explained as follows:
Empowerment
Empowerment designates not only the outcome of an intervention, but, in the first place, an
approach to intervention, or even more generally, an attitude present at the time of intervention2.
On the one hand, empowerment should be recorded in the same space as the measures, but it
will also appear in some of the outcome categories, which refer to the population (in particular in
B3and B4).
Participation
It is very similar in the case of participation. This has become an important element or sign of
quality of health promotion measures. Beyond that, it may then also become an outcome in the
sense that willingness and ability to participate in social activities and to exert influence
becomes manifest or has been reinforced (e.g.B4).
2 See: Stark, W (2003) Empowerment. In Bundeszentrale fiir gesundheitliche Aufklarung (Hrsg.) Leitbegriffe der
Gesundheitsforderung. Schwabenheim a.d.Selz: Fachverlag Peter Sabo, 28-31.
Health Promotion Switzerland
Model of outcome categories
21/22
10.0 Annexe: Concise overview of the outcome columns B and C
Health promotion
measures
Ouh:cw- b vet's
A1
Development of
health promoting
services
Infrastructures
and services
Legal system
Administration
Organisation
Networks
A2
I
Advocacy
Networking
Organisations
Factors influencing
health determinants
B1 - Health-promoting services and provisions
1. Awareness of the service
2. Accessibility of the service and reaching of target
groups
3. Use of the service and satisfaction with it
4. Sustainability of the service
B2 - Health-promoting public policy and organizational
practice
1. Binding engagement of decision-makers
2. Action-relevant, binding documents
3. Successful organisational changes
4. Successful exchange and cooperation
j A3
?!
Groups
Communities
Population
Individuals
Socia> mobilization
Health determinants
C1 -Health-promoting physical environment
1. Reduction of pollution caused by physical
chemical influences
2. Conservation and improvement of natural
resources
3. Health-promoting installations/ products
C2 - Health-promoting social environment
1. Social support/Networks/lntegration
2. Social climate
3. Equal opportunity for good health
B3 - Health-promoting social potential and commitment
1. Existence of active groups
2. Enlisting of new players
3. Awareness of the concern by population groups
4. Acceptance of the concern by population groups
C3 - Health-promoting individual resources and
behavioural patterns
A4
Development of
individual ski :s
Health Promotion Switzerland
B4 - Individual health-related life skills
1. Knowledge and capacity to act on knowledge
2. Positive attitudes towards the topic
3. New personal and/or social skills
4. Strengthened self-confidence
Model of outcome categories
Health statue, of
the population
1. Dealing appropriately with risks
2. Coping with the demands of daily life
3. Improvement of health-relevant behaviour
and behavioural patterns
j D
g Health
« increased
!; - healthy life
expectancy
• quality of life in terms
of health
lower
s - morbidity
l( - premature mortality
I
22/22
Networking Session
August 9, 17.30
Room D
NGO Ad Hoc Advisory Group on Health Promotion
Session Outcome:
Agree on the way forward, including the mechanisms
and processes to achieve effective outreach and
partnership involving health promotion
AGENDA
1. Introduction of NGO Ad-Hoc Advisory Group on Health Promotion
2. Outreach to the Regions, Countries, Community Grassroots
• Examples from Advisory Group members
3. The Way Ahead Partnerships for the future
• Identify issues which impact on health and on which we can
work in partnership (Expanding and Consolidating our
Network)
4. Conclusions and Recommendations
Overview of the model
for results classification
Effect levels
Infrastructures
and services
Health promotion
measures
A1
B1
Development of
health promoting
services
Health promoting services
A2
Legal system
administration
Organization
Networks
Advocacy, cooperation
of organizations
A3
Groups
Communities
Population
Individuals
Factors influencing
health determinants
Social mobilization
Gesundheitsfdrderung Schweiz
Promotion Santd Suisse
Promozione Salute Svizzera
Health determinants
Health status of
the population
C1
Health promoting physical
environment
B2
Health-promoting public
policy and organizational
practice
C2
Health promoting social/
societal environment
D
C3
Increased
- healthy life
expectancy
■ quality of life in
terms of health
lower
- morbidity
- premature mortality
B3
Health promoting social
potential and commitment
A4
B4
Development of
individual skills
Health-related life skills
Health promoting individual
resources and behavioural
patterns
Health
0
3
i
5
Authors: Cloetta, Bernhard; Spencer, Brenda; Ackermann, Gunter; Broesskamp-Stone, Ursel; Ruckstuhl, Brigitte; Sporri-Fahrni, Adrian
© Health Promotion Switzerland Guidelines: www.heaithpromotion.ch
C.C>
H- -S3
NEWSLETTER
Volume 1
August 9, 2005
THE 6th GLOBAL
CONFERENCE ON HEALTH
PROMOTION
NEWSLETTER ONE
Welcome to the first edition of the Newsletter at the 6th Global
Conference on Health Promotion. I’m sure you will support our idea of
giving an opportunity to some of our ‘New Generation’ young people
present with us in Bangkok to provide an early snapshot of what is
happening both in and around the conference. Their short articles are not
meant to be ‘definitive, strategic imperatives!’, but rather their personal
reports on some of highly successful, challenging work that is being
achieved in Health Promotion and reported at the conference. They will be
trying to capture some of the commitment, energy, passion and delivery
that are at the top of all our agendas. Please enjoy their reports in the spirit
in which they are written. We will have more tomorrow.
Mike Shaw
GENDER AND HEALTH
PROMOTION: A
MULTISECTORAL APPROACH
Gender biases in health
promotion may impact on the
effectiveness of health promotion
projects for women. Such biases
have been successfully addressed
in several countries. To overcome
health promotion messages being
targeted at women as the primary
caregiver, which may lead to lower
than expected health promotion
outcomes, immunisation education
in Ghana has targeted both men
and women. As a result men have
taken greater responsibility for
children’s health. Vaccination rates
have increased, as has earlier
vaccination of children. In Pakistan,
the Women’s Health Project has
addressed the lack of female
health care personnel, which may
act as a significant barrier to
women’s health. In four provinces,
thousands of village women have
been recruited and trained as ‘Lady
Health Workers’, expanding the
availability of workers who may
understand the specific problems
of women and may provide greater
access
and
acceptability for
women.
Dale Bampto
.
2
HEALTH OF THE
MARGINALIZED
Marginalization
is
a
term used to cover a broad
range of peoples such as the
displaced,
disabled
and
indigenous peoples. The key
themes that overlap each of
the marginalized people are
the poor health status of these
groups.
One effective health
promotion
intervention
to
assist
the
marginalized
occurred for the indigenous
people of New Zealand, the
Maori people. In response to
the concerns for the well being
of marginalized Maori women
and their babies, the Women’s
Health League established
Tipu Ora.
BACK TO THE FUTURE
A previous understanding in
development countries (e g
Malaysia, Indonesia) was that “If I
don’t do development my child
will die at the age of three, but if I
do development people will die
from cancer at the age of 30.”
This
mentality
is
however
changing towards a more positive
understanding
that there
is
reason for taking human health
The activities of the
program
include
family
support and advocacy and
building
relationships with
health
professionals.
The
philosophy for Tipu Ora is for
“Maori to be healthy as Maori”.
Many Maori health models
and principles including selfdetermination, Maori cultural
affirmations, interconnected
ness,
extended
family
relationships
and
empowerment.
This program has led to
significant health gains and
has improved Maori health
outcomes. The health of a city
is the sum total of all citizens,
including marginalized groups.
Braden Leonard
into
consideration.
“Good
governance” is complex but
important, not least at the local
level. There is need to develop a
conscious
leadership
that
influence
governance
and
decision making. The key issues
are to learn from the past,
everything goes back to the eco
system, be creative, and change
takes time but timing is even
more important.
Asa Pettersson
3
EMERGING HEALTH ISSUES
This informative presentation
on the widening spectrum of
tasks which health promotion
faces in today’s world since the
Ottawa Charter tried to make
clear what emerging health risks
and trends would soon be at the
forefront, an especially crucial
topic in a world where the “the
spectrum and scale of influences on
population health is widening.”
This was primarily done by
showing the important interplay
of personal initiatives, healthy
environments and support
systems, a synergy of which is
required for a sustainable global
society in an era of globalisation.
The problems of SARS and the
Avian bird-flu were addressed,
the question being how health
promotion can help to counter-act
these pandemics.
Several solutions were
proposed:
the creation of
Development preparedness plans
and a institutional infrastructure
to deal with these issues,
collaboration with the media to
prevent the spread of panic in
emergency
situations,
an
emphasis on developing an inter
sectoral collaborative approach
with synergistic arrangements,
and
finally,
raising
this
awareness through the Bangkok
Charter by handing it to Kofi
Annan at the approaching
Millennium summit.
Kirk W. Duthler
HEALTH IN NEW URBAN
SETTINGS
Mr Dinesh Mehta proposed
his idea for a “Healthy Slums”
program. He established in his
presentation that health standards in
urban slum areas are vastly inferior
to standards in poor rural areas
despite the availability of better
health facilities. Yet, people living
in the urban slums are not
necessarily poor. Quite contrary to
that, they sometimes have incomes
twice the level of the poverty line,
but even with more money, they are
unable to afford an appropriate level
of health care and are therefore
relegated to living in slums. The
proposed program would stress the
importance of targeting the slums
with a well-focused education
campaign
in
areas
such
as
prevention, diagnosis, and treatment
and to strengthen capacity of local
government and stakeholders. Mr
Mehta also highlighted the idea of
sustainable finances for health
promotion as many past programs
he had worked in are now non
existent due to inadequate funding.
Napatr Thanesnant
4
DRAFT BANGKOK CHARTER
Process for Receiving feedback.
1. Feedback to be channeled
through discussion groups
and summarized by chair
and rapporteurs.
2. All suggested additions to
be balanced by suggested
deletions.
3. Feedback to be received by
secretariat at
wolbangk@who.int by
19.30 Monday and
Tuesday.
4. Finalisation group to meet
Monday, Tuesday and
Wednesday evening at
18.30 at Prince Palace
Hotel.
5. Next version available
early morning Wednesday.
Comments on this version
to be provided
electronically (as above) or
placed in boxes at
reception at Prince Palace
Hotel or Royal Princess
Hotel by 19.30.
6. “Final” version to be
available early Thursday
morning.
7. Final version to be read to
Plenary Thursday 14.00.
Your chance to witness tangible evidences of “Healthy Thailand”
Gain insight into Thailand’s healthy initiatives and enjoy Thai hospitality.
Join one of the inspiring study tours in Bangkok and selected provinces
specially arranged for all delegates of the 6th Global Conference on Health
Promotion. Come and visit our health-promoting school, healthy community,
healthy marketplace, healthy day care center, Thai traditional medicine, and
comprehensive health promotion/ treatment/ rehabilitation program.
Depart from UNCC on Thursday, 10 August 2005 at 13.00 hrs.
Please REGISTER NOW! at field trip counter on Ground floor
for more information.
Co 1V) H - 5X
HEALTH PROMOTION FOUNDATION ACT,
B.E. 2544 (2001)
ThaiHealth
Thai Health Promotion Foundation
(Tentative Translation)
HEALTH PROMOTION FOUNDATION ACT,
B.E. 2544 (2001)
BHUMIBOL ADULYADEJ, REX.
Given on the 27<h Day of October, B.E. 2544
Being the 56th Year of the Present Reign;
His Majesty King Bhumibol Adulyadej is graciously pleased
to proclaim that:
Whereas it is expedient to have a law on the Health
Promotion Foundation;
Whereas it is aware that this Act contains certain provisions
in relation to the restriction of rights and liberties of persons, in respect of
which section 29 in conjunction with section 31 and section 48 of the
Constitution of the Kingdom of Thailand so permit by virtue of the
provisions of the law;
Be it, therefore, enacted by the King, with the advice and
||nsent of the National Assembly, as follows:
Section 1. This Act is called the “Health Promotion
Foundation Act, B.E. 2544 (2001)”.
Section 2. This Act shall come into force as from the day
following the date of its publication in the Government Gazette.
Section 3. In this Act:
“alcoholic beverages” means alcoholic beverages under the
law on alcoholic beverages;
1
“tobacco” means tobacco under the law on tobacco;
“tax” means taxes under the law on alcoholic beverages and
tobacco stamp duties under the law on tobacco;
“health promotion” means any act which is aimed at the
fostering of a person’s physical, mental and social conditions by means of
supporting personal behaviours, social conditions and environments
conducive to physical strength, a firm mental condition, a long life and a
9
good quality of life;
“Foundation” means the Health Promotion Foundation;
“Committee” means the Committee of the Health
Promotion Foundation;
“Performance Appraisal Committee” means the
Performance Appraisal Committee for the Foundations performance;
“Manager” means the General Manager of the Health
Promotion Foundation;
“Ministers” means the Ministers having charge and control
of the execution of this Act.
Section 4. The Prime Minister, Minister of Finance, and
Minister of Public Health shall have charge and control of the execution
of this Act.
CHAPTER I
®
Establishment of the Foundation
Section 5. There shall be established a Foundation called
the “Health Promotion Foundation”.
The Foundation shall be a juristic person having the
following objectives:
(1) to promote and encourage health promotion in the
population of all ages in accordance with the national health policy;
2
“tobacco” means tobacco under the law on tobacco;
“tax” means taxes under the law on alcoholic beverages and
tobacco stamp duties under the law on tobacco;
“health promotion” means any act which is aimed at the
fostering of a person’s physical, mental and social conditions by means of
supporting personal behaviours, social conditions and environments
conducive to physical strength, a firm mental condition, a long life and a
(2) to create awareness of hazardous behaviour from the
consumption of alcoholic beverages, tobacco or other health-deteriorating
substances and to create belief in health promotion amongst people of all
classes;
good quality of life;
W
“Foundation” means the Health Promotion Foundation;
“Committee” means the Committee of the Health
(3) to support campaigns for the reduction in the
consumption of alcoholic beverages, tobacco and other health-deteriorating
substances, and create public awareness of the relevant legal provisions;
(4) to conduct studies and research, or encourage the
conduct of the study and research, training or organisation of meetings
with regard to health promotion;
Promotion Foundation;
“Performance Appraisal Committee” means the
Performance Appraisal Committee for the Foundation’s performance;
“Manager” means the General Manager of the Health
(5) to develop the ability of a community in fostering
health promotion by the community or private organisations, public
benefit organisations, Government Agencies, State enterprises or other
State Agencies;
Promotion Foundation;
“Ministers” means the Ministers having charge and control
(6) to support campaigns for health promotion by various
activities as a means by which members of the public can improve their
health, spend spare time fruitfully and reduce their consumption of
alcoholic beverages, tobacco and other health-deteriorating substances.
of the execution of this Act.
Section 4. The Prime Minister, Minister of Finance, and
Minister of Public Health shall have charge and control of the execution
of this Act.
CHAPTER I
®
Establishment of the Foundation
Section 5. There shall be established a Foundation called
the “Health Promotion Foundation”.
The Foundation shall be a juristic person having the
following objectives:
(1) to promote and encourage health promotion in the
population of all ages in accordance with the national health policy;
2
Section 6. The Foundation shall consist of the followingo
money and property:
£
(1) Foundation levy collected under section 11;
(2) money and property received and transferred under
section 43;
(3) Government subsidy;
(4) subsidies from the private sector or other organisations,
including foreign sources or international organisations and money and
property donated to it;
(5) fees, maintenance charges, remuneration, service
charges or incomes from its operation;
(6)
fruits of the money or income accruing from the
properties of the Foundation.
3
Section 7. The activities of the Foundation are not subject
to the law on labour protection, law on labour relations, law on State
enterprise labour relations, law on social insurance and law on monetary
compensation, but the Manager, officials and employees of the foundation
shall receive remuneration of not less than that prescribed by the law on
labour protection, law on social insurance and law on monetary
Section 11. The Foundation shall have the power to
arrange for the collection of Foundation levy from persons under the
duty to pay taxes under the law on alcoholic beverages and the law on
tobacco at a rate of two percent of the tax collected from alcoholic beverages
and tobacco under the law on alcoholic beverages and the law on tobacco.
compensation.
In calculating the Foundation levy at the rate prescribed in
paragraph one, any fraction of one satang shall be disregarded.
Section 8. The Foundation shall have its principal office
in Bangkok Metropolis or in a province prescribed by the Minister by a
Section 12. For the benefit of collecting and remitting
Foundation levy:
publication in the Government Gazette.
(1) the Excise Department and Customs Department shall
be the bodies carrying out the invoicing of Foundation levy for remission
as revenues of the Foundation without having to remit to the Ministry of
Finance as national revenues, and this shall be in accordance with the
regulations prescribed by the Finance Minister;
(2) the Foundation levy shall be deemed to be a tax, but
shall not be included in the calculation as a value of tax.
Section 9. The Foundation shall have the power to carry
out various activities within the boundaries of its objectives under section
5 and such powers shall include:
(1) to have ownership, possessory rights and real rights;
(2) to create any rights or enter into any juristic acts or
both within and outside the Kingdom;
(3) to seek benefits from properties of the Foundation;
(4) to disseminate and publicise information in order to
campaign and raise public awareness of the dangers from the consumption
of alcoholic beverages, tobacco or other health-deteriorating substanc^
and of health promotion to the extent of disseminating and providing
information on the relevant laws;
(5) to do any other act necessary for or in furtherance of
the attainment of the objectives of the Foundation.
Section 10. The Foundation has the status of a State
Agency, which is not a Government Agency or State enterprise under the
Section 13. Persons under a duty to pay taxes under the
law on alcoholic beverages and law on tobacco shall have the duty to
remit Foundation levy at the rate prescribed under section 11 together
|jfh the payment of taxes in accordance with the regulations prescribed
by the Finance Minister.
Section 14. In the case where a person under the duty to
pay taxes under the law on alcoholic beverages and the law on tobacco has
received an exemption or a tax refund, there shall also be an exemption
from or refund of the Foundation levy in accordance with the regulations
prescribed by the Finance Minister.
law on budgetary procedure, and the incomes of the Foundation are not
to be remitted as national revenues.
4
Section 15. In the case where a person under the duty to
remit Foundation levy fails to remit the Foundation levy or remits after
5
the prescribed time period, or remits the Foundation levy at an amount
insufficient of that required, not only will there be an offence under this
Act, but there shall also be an additional payment at the rate of two percent
per month on the amount of money unremitted or remitted after the
prescribed time period or the amount that remains to be remitted, as the
case may be, calculated from the date due for remission to the date of
remission of the Foundation levy, but the additional money calculated
shall not exceed the amount of the Foundation levy and this additio^j
sum of money shall also be deemed to be a Foundation levy.
In calculating the time period under paragraph one, a
fraction of one month shall be counted as if it were one month.
Section 16. The Foundation shall have the power to
expend money from the Foundation in accordance with the rules and
procedures prescribed by the Committee as the following expenditures:
(1) expenditures in the operation of the Foundation;
(2) expenditures in the conduct of activities under section
5 and section 9;
(3) other expenditures in accordance with the rules
prescribed by the Committee.
(4) members ex officio, viz, a representative of the Office
of the National Economic and Social Development Board, representative
of the Office of the Permanent Secretary to the Prime Minister’s Office,
representative of the Ministry of Finance, representative of the Ministry
of Transport and Communication, representative of the Ministry of the
Interior, representative of the Ministry of Labour and Social Welfare,
representative of the Ministry of Education, representative of the Ministry
Public Health and representative of the Ministry of University Affairs;
(5) eight qualified members appointed by the Council of
Ministers from persons selected from those with knowledge, ability and
experiences in the fields of health promotion, community development,
mass communication, education, sports, art and culture, law or
administration, provided that of this number, at least half of whom from
persons in the private sector.
The Manager shall be a member and secretary, and the
Manager shall appoint an official of the Foundation as assistant secretary.
The selection of qualified members shall be in accordance
with the rules, procedures and conditions prescribed by the Committee.
Ministers from persons with qualifications under (5) as the Second ViceChairman;
Section 18. Qualified members must have the
qualifications and must not have the prohibited qualities as follows:
£
(1) being ofThai nationality;
(2) being of more than seventy years of age;
(3) not being a bankrupt, an incompetent or quasi
incompetent person;
(4) not having been sentenced to imprisonment by a final
judgement except for an offence committed through negligence or a petty
offence;
(5) not being a holder of a political position, a member of
a local assembly, a local administrator, an executive member or holder of
a position with responsibility in the administration of a political party, a
counsellor of a political party or an official of a political party;
6
7
CHAPTER II
Management of the Foundations Affairs
-
Section 17. There shall be a Committee called the
“Committee of the Health Promotion Foundation,” consisting of:
(1)
(2)
(3)
the Prime Minister as Chairman;
the Public Health Minister as the First Vice-Chairman;
a qualified person appointed by the Council of
(6) not being a person with behaviour in conflict or
inconsistent with the objectives of the Foundation under section 5;
(7) not being a person having an interest in the activities
conducted with the Foundation, or in activities in conflict or inconsistent
with the objectives of the Foundation, regardless of whether it was direct
or indirect, with the exception of persons who carry out activities for the
benefit of the public and do not seek for profit.
Section 19. The qualified members shall hold office for a
term of three years.
In the case where a qualified member vacates office before
the expiration of the term, there shall be an appointment of another
qualified member to fill the vacancy, except where there are less than
ninety days remaining in the term of office, and the person appointed to
fill the vacancy shall be in office for the remaining term of the qualified
Section 21. The Committee has the powers and duties to
conti ol and supervise the operation of the Foundation for the attainment
of the objectives prescribed by section 5. Such powers include:
(1) to determine administration policies and approve an
action plan for the Foundation;
(2) to approve an annual action plan, an annual financial
olan as well as an annual budget for the office;
™
(3) to prescribe rules and procedures for the appropriation
of money to be expended as subsidies to a variety of activities;
(4) to raise funds;
(5) to supervise the performance and administration of
general affairs and to issue rules or regulations of the Foundation in the
following matters:
(1) death;
(2) resignation;
(3) being removed by the Council of Ministers by reason
of neglect of duties, improper behaviour, or lack of proficiency;
(4) being disqualified or being under any of the
(a) the work organisation of the Foundations office
and the scope of duties of each respective section of work;
(b) the qualifications and prohibitions required of the
Manager and rhe rules for the selection of the Manager;
(c) the prescription of positions and the qualifications
required for the positions of officials and employees of the Foundation;
(d) the prescription of scale of salaries, wages and other
remuneration of officials and employees of the Foundation;
(e) the selection, recruitment, appointment, removal,
isciplines and disciplinary penalties, vacation of office, filing of a
complaint and malting of an appeal against the punishment of officials
and employees, including procedures and conditions for the employment
of employees;
(f) the administration and management of finance,
procurement and property of the Foundation, including the accounting
and deletion of property from an account;
(g) the provision of welfare and other fringe benefits
prohibitions under section 18.
to officials and employees;
members already appointed.
At the expiration of the term under paragraph one, if the
new qualified members have not yet been appointed, the qualified
members having vacated office at the expiration of the term shall remain
in office for continuing the performance of work until the newly appointed
qualified members take office.
The out-going qualified members may be re-appointed^
Section 20. In addition to the vacation of office at the
expiration of the term, a qualified member vacates office upon:
8
9
(h) the scope of powers and duties, and rules relating
to the performance of duties, of an internal auditor.
allowance or othei remuneration in accordance with the rules prescribed
by the Council of Ministers.
Section 22. At a meeting of the Committee, the presence
of at least one-half of the total number of members is required to constitute
Section 25. The Foundation shall have one General
Manager appointed by the Committee.
The Manager must be a person able to work for the
^^undation on a full-time basis, and must have the qualifications and
Wust not be under the prohibitions as follows:
(1) being ofThai nationality;
(2) being of not more than sixty years of age on the date of
appointment;
a quorum.
At a meeting of the Committee, if the Chairman is not
present or is unable to perform duties, the First Vice-Chairman shall preside
over the meeting. If the First Vice-Chairman is not present or is unable
to perform duties, the Second Vice-Chairman shall preside over the
meeting. If the Second Vice-Chairman is not present or is unable to
perform duties, the members present shall elect one amongst themselves
to preside over the meeting.
In the performance of duties, if any member is directly or
indirectly interested in the matter to be considered by the Committee,
that member shall disclose it at the meeting, and the meeting shall consider
whether that member should be present at the meeting and have a vote in
the matter, in accordance with the rules prescribed by the Committee.
The decision of the meeting shall be by a majority of votes.
In casting votes, each member shall have one vote. In the case of an
(3) being a person with knowledge, ability and experiences
suitable to the affairs of the Foundation;
(4) not being under any of the prohibitions under section
18(3), (4), (5), (6) or (7).
Section 26. The Manager shall hold office for a term of
four years, and may be re-appointed, but must also have the qualifications
and must not be under the prohibitions under section 25 on the date of
re-appointment, but may not serve for more than two consecutive terms.
equality of votes, the presiding Chairman shall have an additional vote as
0 ,
a casting vote.
Section 23. The Committee has the power to appoint
qualified persons with a specialisation as advisors to the Committee and
has the power to appoint a sub-committee for considering or performing
any particular act as entrusted by the Committee.
At a meeting of the sub-committee, section 22 shall apply
mutatis mutandis.
Section 24. The Chairman, members, advisor to the
Committee and members of a sub-committee shall receive a meeting
10
Section 27. In addition to the vacation of office at the
expiration of the term, the Manager vacates office upon:
(1) death;
(2) resignation;
(3) occurrence of an event stipulated in an agreement
between the Committee and the Manager;
(4) being removed by the Committee by reason of neglect
of duties, improper behaviour, or lack of proficiency;
(5) being disqualified or having any of the prohibition
under section 25.
11
The resolution of the Committee for the removal of the
Manager from office under (4) shall be passed with the supporting votes
of not less than two-thirds of the number of existing members, exclusive
of the Manager.
Section 28. The Manager shall have the following powers
and duties:
(1)
to administer the affairs of the Foundation fA1
compliance with the law and the objectives of the Foundation;
(2) to study, analyse and appraise the Foundation ’s
performance, including the submission of targets, action plans, projects,
the annual action plan of the Foundation, and the financial plan and
annual budget to the Committee;
(3) to prepare a report and accounting matters of the
Foundation, and to submit an annual performance report;
(4) to supervise the work performed by officials and
employees of the Foundation for compliance with the regulations;
(5) to perform any other duties as entrusted by the
Committee.
Section 31. Officials and employees of the Foundation
must have the qualifications and must not be under the prohibitions as
follows:
(1) being of Thai nationality;
(2) being of not less than eighteen years of age and not
more than sixty years of age;
(3) being able to work for the Foundation on a full-time
ftsis;
(4) having the qualifications or experiences suitable to the
objectives as well as the powers and duties of the Foundation;
(5) not being a Government official or an employee of a
Government agency, an official or employee of a State enterprise or other
State agencies or an official or employee of a local government organisation;
(6) not holding any position in a partnership, company or
organisation carrying out a business in conflict or inconsistent with the
objectives of the Foundation;
(7) not being under any of the prohibitions under section
18(3), (4), (5), (6) or (7).
Section 32. An official or employee vacates office upon:
Section 29. The Manager must be accountable to the
Committee for the administration of the affairs of the Foundation.
a
The Manager shall represent the Foundation in acts vis-a?
vis third persons. For this purpose, the Manager may delegate his or her
power to any person to perform any particular act on the Managers behalf,
in accordance with the regulation prescribed by the Committee.
(1) death;
(2) resignation;
(3) being disqualified or being under any of the
prohibitions under section 31;
(4) being removed by reason of failing a work appraisal;
(5) being removed or dismissed by reason of disciplinary
q
breach.
Section 30. The Committee shall determine the salary
scale or other benefits of the Manager.
12
The cases of (4) and (5) shall be in accordance with the
rules and procedure prescribed by the Committee.
13
Section 33. The accounting of the Foundation shall be
conducted by reference to international practice and in accordance with
the forms and rules prescribed by the Committee.
Section 34. There shall be an internal audit with respect
to the finance, accounting and procurement of the Foundation, with a
corresponding audit report for submission to the Committee, at least
once a year.
tW
For the purpose of the internal audit, there shall be an
official of the Foundation acting as an internal auditor with direct
answerability to the Committee, in accordance with the regulations
prescribed by the Committee.
Section 35. The Foundation shall prepare a financial
statement, which must include at least a balance sheet and an operation
account to be submitted to the auditor within one hundred and twenty
days as from the end of each accounting year.
At an interval of every year, the Office of the State Audit or
an outsider appointed by the Committee with the approval of the Office
of the State Audit shall be the auditor and appraise dispositions of money
and property of the Foundation. In this instance, opinions shall be
analytically presented as to the extent to which such dispositions hajA
corresponded to the objectives, proceeded in an economical fashion and
*
met the targets. An audit report shall subsequently be prepared and
submitted to the Committee.
For these purposes, the auditor shall have the powers to
inspect all account books of the Foundation, inquire the Manager, internal
auditor, officials and employees of the Foundation and instruct such
persons to furnish that additional account books, documents, and evidence
of the Foundation as is necessary.
Section 36. The Foundation shall prepare an annual report
for submission to the Minister, the House of Representatives and the
Senate for consideration within one hundred and eighty days as from the
end of the accounting year. This report shall state the work of the
Foundation in the past year together with the financial statement and
auditors report.
CHAPTER III
Performance Appraisal of the Foundation
Section 37. There shall be seven members of the
Performance Appraisal Committee for the Foundation, consisting of a
Chairman and six qualified members appointed by the Council of
Ministers by the advice of the Finance Minister from those with knowledge,
ability and experiences in the fields of finance, health promotion and
performance appraisal. Of this number, there shall be at least two persons
who specialise in performance appraisal.
The Performance Appraisal Committee shall appoint a
person, as it deems suitable, to act as a secretary.
Section 18, section 19, section 20, section 22 and section
4 shall apply to the Performance Appraisal Committee and the conduct
f Performance Appraisal Committee meetings mutatis mutandis.
«
Section 38. The Performance Appraisal Committee has
the powers and duties as follows:
(1) to appraise the Foundation’s policies and activities;
(2) to monitor, inspect and appraise the performance of
the Foundation;
(3)
to report the performance, with its suggestions, to the
Committee in an interval of every year.
14
15
The Performance Appraisal Committee shall have the power
to require any person to furnish documents or evidence related to the
Foundation, or summon any person to make a statement of facts to form
part of its consideration in the appraisal.
the law on alcoholic beverages and law on tobacco shall apply to the
settlement of cases under this Act mutatis mutandis.
Transitory Provisions
Section 39. In the performance of duties under this Act,
the Performance Appraisal Committee may appoint a sub-committee to.
consider and submit opinions in any subject, or delegate the performandb1
Section 43. Upon the establishment of the Foundation
fttder this Act, the operations under the objectives of the Health Promotion
of any matter as it deems suitable.
Foundation pursuant to the Royal Decree Establishing the Health
Promotion Foundation shall be deemed to have been terminated, and the
Minister in charge and control of that Royal Decree shall proceed under
section 44(2) of the Public Organisation Act, B.E. 2542 (1999) in announcing
the cessation of the Health Promotion Foundations operations in the
CHAPTER IV
Penalties
Section 40. Any person under the duty to remit Foun
dation levy who does not remit the Foundation levy or remits an
insufficient amount of that required shall be liable to imprisonment of
not exceeding one year or a fine of five times to twenty times the amount
of Foundation levy that has to be remitted, or both.
Section 41. In the case where an offender liable to a penalty
under this Act is a juristic person, the managing director, manager or ar^
person responsible for the operation of that juristic person shall also be
liable to the penalty provided for that offence, except where it can be
proven that the act was committed without his or her knowledge or
consent.
Government Gazette.
The businesses, properties, rights, debts, budget, incomes,
revenue and work performers of the Health Promotion Foundation
established pursuant to the Royal Decree Establishing the Health
Promotion Foundation, B.E. 2543 (2000) shall be assigned to the Health
Promotion Foundation under this Act.
Section 44. The Manager of the Health Promotion
foundation under the Royal Decree Establishing the Health Promotion
^Foundation, B.E. 2543 (2000) who holds office at the date which this Act
comes into force shall provisionally perform duties as a Manager under
this Act until the appointment of a Manager under this Act, provided
that this does not exceed one hundred and twenty days from the date at
which this Act comes into force.
Section 42. Of the various offences under this Act, the
Director-General of the Excise Department or a person delegated by the
Director-General of the Excise Department shall have the power to make
a settlement. The provisions in relation to the settlement of cases under
16
Section 45. In the initial period, the Committee shall
consist of members under sections 17(1), (2) and (4) and the person
performing the duties of a Manager under section 44 shall be a member
and secretary, to perform the duties of the Committee under this Act
17
until the appointment of qualified members under sections 17(3) and
,
(5)
provided that this does not exceed ninety days from the date at which
this Act comes into force.
In conducting the appointment of qualified members under
paragraph one, the members under sections 17(1), (2) and (4) shall
prescribed the rules, procedures and conditions in the selection of qualified
members to be nominated to the Council of Ministers for further
appointment.
"
Countersigned by:
Pol. Lt. Col. Thaksin Shinawatra
Prime Minister
e
18
_____________ Thai Health Promotion Foundation
_______
979 34th Fl, S.M. Tower, Phaholyothin Rd., Samsennai, Phayathai, Bangkok 10400
Tel. 66 (0) 2298-0500 Fax. 66 (0) 2298-0501 www.thaihealth.or.th
1B WORLD HEALTH ORGANIZATION
FIFTY-SEVENTH WORLD HEALTH ASSEMBLY
Provisional agenda item 12.8
A57/11
8 April 2004
Health promotion and healthy lifestyles
Report by the Secretariat
1.
This document is submitted in response to the decision by the Executive Board at its
111th session to defer consideration of the agenda item on health promotion.1
2.
In 1989, resolution WHA42.44 on health promotion, public information and education for
health urgently called upon Member States to develop, in the spirit of the Declaration of Alma-Ata and
the First and Second International Conferences on Health Promotion, strategies for health promotion
and health education as essential elements of primary health care and the Director-General to provide
support to Member States in strengthening national capabilities in all aspects of health promotion. In
1998, resolution WHA51.12 on health promotion urged Member States to adopt an evidence-based
approach to health promotion policy and practice, using the full range of quantitative and qualitative
methodologies, and requested the Director-General to give health promotion top priority in WHO.
3.
Since 1986, the five international conferences on health promotion, cosponsored and organized
by WHO,’ have been instrumental in guiding the development, direction and global practice of health
promotion. Strategies, models and methods in health promotion are limited to neither a specific health
issue nor a specific set of behaviours, but apply to a variety of population groups of all ages, risk
factors, diseases and settings. Efforts put into improving education, community development policy,
legislation and regulations are as valid for the prevention of communicable diseases_as-thev~are--for
tackling the major risks' for noncommunicable diseases (unhealthy diet, tobacco use, sedentary,
lifestyle and alcohoTabuseJand for preventing injury, violence and mental illness. The adoption of the
WHO Framework Convention on Tobacco Control, the work towards a global strategy on diet,
physical activity and health, and the Move for health initiative are major global steps to reducing these
common risks.
4.
Mental health promotion constitutes an important component of overall health promotion. In
view of the stress and conflicts that individuals and communities face, greater efforts are needed to
promote mental health. WHO is reviewing the evidence of effectiveness of activities that promote
mental health, especially those with relevance to low- and middle-income countries, and will use the
findings to define best practices for countries with different resource levels and diverse cultures.
' Decision EBlll(l).'^
’ First International Conference on Health Promotion: the move towards a new public health (Ottawa, 1986); Second
International Conference on Health Promotion: healthy public policy (Adelaide, Australia, 1988); Third International
Conference on Health Promotion: supportive environments for health (Sundsvall, Sweden, 1991); Fourth International
Conference on Health Promotion: new partners for a new era - leading health promotion into the 21 st century (Jakarta,
1997); Fifth Global Conference on Health Promotion: health promotion - bridging the equity gap (Mexico City. 2000).
.457/11
5.
Health promotion is important for attaining the health-related United Nations Millennium
Development Goals, contributing to the reduction in child mortality; improvement of maternal healttf;
prevention and control of H1V/AIDS, tuberculosis and~TnaIanaT~arrd^cess~to~better~samiation and
clean drinking-water. Achieving these Goals will need greater recognition of the inextricable links
between health, development and poverty reduction and improved access to major health services;
health promotion will be crucial for mobilizing society in this task through advocacy and suitable
strategies.
6.
Insufficient evidence on the effectiveness of health promotion contributes to limited allocation
of resources, and consequently underfunded interventions and less effective health promotion. Special
efforts are therefore needed to collect sound evidence, particularly in developing countries.
PROGRESS
7.
Member States in all regions have strengthened national capabilities for health promotion, but
progress has been uneven. Most countries do not have the policies, human or financial resources, or
institutional capacity for sustainable, effective health promotion to counter risks and their underlying
determinants. Major tasks lie ahead, including building national capacity, strengthening evidence
based approaches, innovating strategies and means of financing, and preparing guidelines for
implementation and evaluation.
8.
The Regional Committee for Africa adopted a strategy on health promotion for the African
Region (resolution AFR/RC51/R4) in 2001, and has developed guidelines for its implementation. The
Regional Office for the Americas has had follow-up meetings and established three groupings of
countries to strengthen and advocate health promotion with particular emphasis on settings and
healthy municipalities. The Regional Office for Europe has set up a centre for investment for health
and development in Venice (Italy) and has an active intercountry network. The Regional Office for the
Eastern Mediterranean works actively on health promotion, healthy lifestyles and health education,
prevention and control of noncommunicable diseases, and the basic development needs approach. The
Regional Office for South-East Asia, too, emphasizes capacity building; it held an interregional
workshop to identify the prerequisites for and to prepare guidance on strengthening capacity for health
promotion at local and national levels in Bangkok in February 2003. It also surveyed country capacity
for health promotion and health education, and networked countries with a focus on standards for
health promotion and health education. The Regional Office for the Western Pacific created its
Regional Framework for Health Promotion 2002-2005, with extensive support materials, including a
catalogue of teaching and learning materials and financing opportunities in the Region. Several
countries, such as South Africa and Sudan, are formulating national health promotion policies and
strategies.
9.
Progress in reviewing and building evidence of the effectiveness of health promotion, and in
translating evidence into policy and practice, with due regard to cultural and regional diversities, is
being made through the Global Programme on Health Promotion Effectiveness, a multi-partner project
coordinated by the International Union for Health Promotion and Education in collaboration with
WHO. Partners include many national public health institutions, such as the Centers for Disease
Control and Prevention (Atlanta, Georgia, United States of America), the Netherlands Institute for
Health Promotion and Disease Prevention and the African Medical and Research Foundation; the
Swiss Agency for Development and Cooperation provides strong support. WHO is working on some
30 projects from more than 15 Member States in all regions to document successes and to plan,
implement, and evaluate interventions with methodological rigour.
2
A57/11
10. In addition to a report for the European Commission on the evidence of the effectiveness of
health promotion' and information accumulated over the past 25 years in the developed countries in
North America, Australia and Europe, more evidence of effectiveness in other Member States is
becoming available and will be documented by the Global Programme (see paragraph 9). Examples
include reduction in the prevalence of smoking in the Republic of Korea; increased participation in
sports activities in Singapore; reduction of salt intake in Japan; in Thailand, a fall in new HIV
infections from 143 000 in 1991 to 23 676 in 2002 - successes in the prevention and control of HIV
infections have also been recorded in Brazil and Uganda; and, in one part of Bangladesh, about 70% of
residents switched their source of water from contaminated wells to safe wells. Other examples will be
presented in the reports of the technical meeting on the Global Programme on Health Promotion
Effectiveness (Hong Kong Special Administrative Region, China, 22-25 October 2003) and of the
WHO component of the Programme.
11. The Global School Health Initiative takes an integrated approach that combines school health
policy, skills-based health education, a safe and health-supportive school environment and school
based health and nutrition services to tackle major risk factors. School health programmes with these
elements are cited as viable public health interventions in every region. WHO, UNESCO, UNICEF,
the World Bank and Education International are promoting these components in a joint initiative to
focus resources on effective school health. The Initiative serves as an interagency model for working
towards both the health and sector-specific goals of each agency. WHO is also working with
Education International and two WHO collaborating centres (Centers for Disease Control and
Prevention, Atlanta, Georgia, and Education Development Center, Boston, Massachusetts, United
States of America) to train thousands of teachers to use modem, interactive methods to educate adults
and students about preventing HIV infection and related discrimination in countries with high rates of
infection. WHO recently launched a global school-based health surveillance system, a survey element
of which generates internationally comparable data for monitoring the prevalence of important health
factors among 13-15 year-old students.
12. WHO developed a policy framework on active ageing, which takes a health promotion
approach. The document, which was WHO’s contribution to the United Nations Second World
Assembly on Ageing (Madrid 2002), is based on the fact that health is of paramount importance if
older people are to remain a resource for their families, communities and economies.12
13. In order to find innovative ways of financing health promotion, the International Network of
Health Promotion Foundations held two meetings (Bangkok, March 2002 and Budapest, April 2003).
As a result, several countries have decided to establish such foundations, for example through
imposing a dedicated tax on tobacco and alcohol, most recently Malaysia and Thailand.
14. International collaboration has been facilitated by establishing networks, including six regional
networks for integrated prevention and control of noncommunicable diseases, the WHO Mega
Country Health Promotion Network (linking the 11 most populous countries) and the International
Network of Health Promotion Foundations. These networks offer forums for exchanging ideas and
experience, advocating in-country policy support for health promotion and prevention of
noncommunicable diseases, debating current topics in health promotion, and influencing the global
health agenda.
1 The evidence ofhealth promotion effectiveness: shaping public health in a new Europe, Parts 1 and 2, Vanves,
France, International Union for Health Promotion and Education, 2000, 2nd edition.
2 Document WHO/NMH/NPH/02.8.
3
A 5 7/11
15. Alcohol consumption raises complex issues. Some evidence attests to beneficial effects of
moderate consumption of alcohol, but, overwhelmingly, data show its high contribution to the global
burden of disease through its damaging effects across all sectors of society as the direct or underlying
cause of many illnesses and accidents, violence and impaired health. Young people are particularly
likely to abuse alcohol. Special attention needs to be paid to the messages conveyed in information
relating to alcohol, including marketing and advertising, in particular on the impact of alcohol on the
health and well-being of young people.
16. In line with WHO priorities, actions are under way to integrate health promotion into health
systems. It is intended that, at a preparatory interregional workshop, to be held in November 2003, an
outline plan on integrating health promotion into health systems will be prepared for the financial
period 2004-2005.
FUTURE ACTION
17. WHO will support Member States in raising awareness of determinants of health, fostering
health-inducing environments and strengthening capacity at nationafand local levels for planning and
implementing comprehensive health promotion that is sensitive to gender, culture and age, particularly
in developing countries and tor poor anti marginalized groups. Special attention will be given lo the
organization'of health promotin'within healtlfservices and systems. Training in health promotion will
be strengthened including training of health personnel and, where necessary, curricula will be revised
to incorporate the new expanded concept of health promotion. Particular attention will continue to be
paid to young people in and out of school, and to major risks including unhealthy diet, physical
inactivity and behaviours that encourage transmission of infectious diseases, and their broader social,
economic and other determinants.
18. Work will continue on mobilizing and informing public opinion in order to influence policyand decision-makers towards health-supportive policies and legislation and the promotion of healthy
lifestyles. Continued attention will be given to health promotion in specific settings, such as the
workplace, schools and the community - the Healthy Cities project exemplifies this setting-based
approach.
19. Working with Member States and the international community, WHO will continue to provide
technical support and guidance for the design, implementation and evaluation of evidence-based
projects worldwide, and to disseminate the successes and lessons so learned through publication of
guidelines and articles in peer-reviewed journals. Special attention will be paid to promotion of mental
health, an area where evidence is particularly lacking. With an expanded evidence-base, WHO will
examine the cost and effectiveness of health promotion interventions.
20. WHO will collaborate with all concerned parties, using the International Network of Health
Promotion Foundations, to develop sustainable means of financing health. For example, insurance
provisions by the public and private sectors need to be examined as a potential funding source of
health promotion; indeed, all new options will need to be identified and scrutinized.
21. The potential contribution of social security in preventing major risks and promoting healthy
lifestyles will be explored in a joint workshop to be held with ILO, the International Social Security
Association and other key partners, for which a critical review paper has been written.
4
A57/11
22. Within the framework of the health-related Millennium Development Goals, WHO is preparing
a consultation on health promotion in development, with a focus on poverty reduction, in order to
deepen understanding of the design, delivery and assessment of activities, particularly for
disadvantaged populations. WHO will also promote intersectoral collaboration and coordination,
including not only health and other ministries but nongovernmental organizations, civil society, and
academic, research and professional institutions.
23. Attention will be paid to: strengthening national and regional networks to respond to threats to
health at national, regional and global levels; exchange of information, by traditional and modem
means of communication; and building concerted health actions through mechanisms such as the
WHO Framework Convention on Tobacco Control, the global strategy on diet, physical activity and
health and the Move for health initiative. WHO will promote collaboration and coordination through
the designation of WHO collaborating centres, particularly in developing countries, and through a
rigorous and coordinated partnership with those centres.
24. Interaction with the private sector, increasingly a key player in health issues, will be furthered.
Health can be more readily improved by making healthy choices easier and more available and
affordable. There is a strong need for the private sector to contribute increasingly to the aims of health
promotion and healthier choices.
25. In order to respond to the many global changes and trends that directly or indirectly affect health
and well-being, to assert WHO’s leadership in health promotion, and to make health promotion more
relevant to the demands of the new century, the Sixth Global Conference on Health Promotion will be
convened in 2005. This conference of policy-makers and invited experts will build on the
developments, experience and evidence accumulated since the first such conference in Ottawa in 1986,
and is intended to provide a blueprint to meet the health promotion needs of today’s society, both
nationally and globally. It will also be a major forum for disseminating results and lessons learned
from previous studies of the effectiveness of health promotion.
26. At its 113th session the Board, noting the importance of continued efforts to strengthen national
capacity for health promotion, and the benefits of promoting equity and healthy lifestyles,
unanimously adopted a resolution on health promotion and healthy lifestyles.
ACTION BY THE HEALTH ASSEMBLY
27. The Health Assembly is invited to note the report, and to consider the draft resolution contained
in resolution EB113.R2.
5
he 5
(ftohaC Conference on JfeaCth (promotion
7-11 jHugust 2005
United Nations Conference Centre
Bangdef, Pdadand
1. Wealth
2. Wealthy
3. Wealthy
promoting school
community
Market Place
Participants will observe a food
safety programme in which student
volunteers carry out surveillance of
illegal food additives and
contaminants with appropriate
technology in order to enhance
food safety promotion in school
and nearby community.
Bangkok Metropolitan
Administration (BMA) is the first
local government that joined
healthy cities initiatives and
making continuously progress
towards the goals.
Tropical fruits, vegetables, flowers,
and wide varieties of foods found
in oriental market places are
attractive to many people.
Participants will find out more
about the country-wide "Clean
Food Good Taste" Programme.
4. Wealthy Day
Care Centre
(for pre-school
children)
This day care centre for pre
school children is a training and
demonstration centre for health
personnel responsible for child
development. Wide range of
activities are programmed for
ensuring proper child development
in all important aspects including
physical, mental, social and
spiritual aspects.
5. Wai
(Traditional
(Medicine and
/‘Ifeatment/
Wealth Care
<Reliafflitation of
NarcoticJidelicts
The Institute of Thai Traditional
Medicine was founded in order to
revive and developed the body of
knowledge of Thai traditional
medicine, folk medicine as well as
herbs for the purpose of
application, promotion, research
and quality control.
Municipality
San Sook Municipality is well
known for along time as an
efficient local government that
spent a lot effort to ward
sustainable development of this
infamous resort area.
Depart from UNCC at 13.00 hrs. For
reservation at registration counter until
8 August 2005 at 12.00 hrs.
Wealth
for/lIDS
Community
Promoting
10. Wealthy
9. Mental
8. Wealth care
patients
Please come and have a look at
one of Thailand's success stories
on health promoting hospital
located at the renown ancient
capital of Ayutha not too far from
Bangkok, Wang Noi Hospital.
After a long and serious
endeavors in applying the healthy
hospital concept, Wang Noi
Hospital has both explicit and tacit
knowledge to share.
Thanyarak Institute is responsible
for treatment and rehabilitation of
drugs dependent persons including
those who are HIV positive.
(promotion in
7. Wealth
Wospital
6. Wealth (Promotion
Wat Phrabat Namphu is a good
example of private organization
responsibility in coping with AIDS
in Thailand. It is operated by a
strong team-work consisted of
Buddhist monks, physicians,
nurses, Thai and international
organization volunteers.
In this Muslim community at
Chawai community of Angthong
province, a mental health
promotion based on Islamic
concept, community affection,
unity, assistance, and participating
toward comprehensive community
development is developed.
12. Wealth
Promoting School/
11. Wealthy
Child(Development
Wospital/
Center
Wealthy
Community
The people at (Jbonrat District of
Khonkaen province have set an
example of a community that
stand out for their cultural and
social integrity and their world
view that •nurture peaceful and
sustainable livelihood.
li
Id. Civil
nelworf^and
Wealth
Promotion
The Restaurant Association of
Samut Songkram Province plays
a proactive role in catalyzing and
linking all stakeholders of safety
food chain. This network has
expanded its work to collaborate
with young students
areas including conscience and
awareness raising campaign for
local environment and natural
resources preservation and
ecological tourism support.
Wat Sanaeha School is a model
for health promoting school and
an outstanding school with
environmental conservation
programme. Another attraction is
Wat Houi Jorakae Child
Development Centre, a model
child care center and an
outstanding child development
center of the region.
HEALTH EDUCATION FEVER
Fever is not a disease. It is only a symptom - a response to a problem somewhere in the body. It indicates the
body's ability to fight a problem. It can eliminate many disease-causing micro-organisms by itself. We need to support
the body and this ability.
Fever can be an indicator of the type of disease - e.g., the step ladder pattern in Typhoid, the chills, rigors and
regularity of fever in Malaria, the low grade evening temperatures in TB, etc.
Fever weakens the body, apart from that due to disease. Fever may cause Fits, Delirium, and Dehydration
especially in infants. This has to be treated actively.
Body temperature rises in summer due to high environmental temperatures, leading to heat-exhaustion and heat strokes.
This can damage vital organs of the body.
Onion is the simplest remedy. Eat onion, carry an onion with you, sniff onion to reduce the effects of summer heat. Also,
drink a lot of water or buttermilk, or any fresh fruit juices with a pinch of salt in it.
SUPPLEMENTARY MEASURES
Water in an earthen pot cools because it diffuses through the pores in the pot to the surface and evaporates. The heat
needed for its evaporation is taken from the water inside, which therefore becomes cool. Water in the pot cools better
when it is full of water, in an airy, ventilated place, and in the shade.
Our body is similar. Sweat comes on to the surface from water inside the body, and cools it by evaporation.
1. Drink plenty of water. Have a normal bath.
2. Wear very light clothing. Cover only when chills are present.
3. Take adequate rest.
4. Sit at door, window, under shade of tree/roof, where there is adequate flow of air.
5. Eat well. Take easily digestible foods, like Ganji, Fruits, Soups, etc. (Fever consumes energy.)
3
HERBAL REMEDIES - FEVER
- REMEDIES (A)
FOR ADULTS :
BOIL IN ONE GLASS WATER - REDUCE TO HALF. THIS IS A KASHAYAM (DECOCTION). ADD JAGGERY AND MILK TO
TASTE -they give energy too.
1.
Cumin seeds (Jeera) 1 teaspoonful + Pepper 4-5 seeds
2.
Dhub grass (Darbe hullu) one handful + Cumin seeds 1 teaspoonful
3.
Neem (Baevu chekke) bark one rupee size +’ Cumin seeds 1 tsf
FOR CHILDREN : MAKE AS ABOVE.
4. Tulsi seeds 1 tsf
5.
Ajwain seeds 1/z tsf
5. 1 tsf of Ajwain leaf juice, can be given directly, or with honey.
EACH IS ONE DOSE. TO BE TAKEN BEFORE FOOD - ON EMPTY STOMACH.
THREE TO FOUR DOSES PER DAY CAN BE TAKEN
EARS PAIN / BLOCKED / DISCHARGE
SINUS INFECTION
EAR INFECTION
COLDS AND COUGHS
SUPPLEMENTARY MEASURES
Drink plenty of water. The body is trying to throw out the infective agent, or allergen through its secretions. Help
this process.
2. Steam inhalation half an hour after food directly hydrates the respiratory tract and removes phlegm (Kapha), while
eliminating the micro-organisms by its heat. A few crushed leaves of Eucalyptus (Niligiri) or a few drops of its oil
put into this water has additional anti-septic effect.
1.
3.
Respiratory infections are spread through AIR. So, cover your mouth while coughing to prevent spread to others.
4.
Remove phlegm (Kapha) to help yourself and dispose it off safely to prevent spread to to others.
5.
Eat easily digestible foods. Eat well. Avoid iced/cold foods and those that do not agree with you.
In chronic cough conditions like Asthma, Bronchitis and Allergies, the precipitating triggers also need to be identified
and the person helped to prevent attacks by avoiding them.
The respiratory tract also needs to be strengthened with Pranayama and other breathing exercises.
COUGHS AND COLDS________________________
Kashayam (Decoction) of any of the following :
1. Jeera + Pepper + Dry ginger + pinch of Turmeric.
2. Methi (Fenugreek) 4 parts + Dry ginger 1 part.
3. Adhatoda leaf dry powder, 1 teaspoonful
- REMEDIES (B)
OR
To be taken directly,
4. Tulsi leaf juice + Honey in equal parts
5. Pomegranate, dry flower powder half spoon in Honey
6. Ginger powder + Pepper powder in Honey.
7. Adhatoda dry leaf powder + Honey.
OR
Prepare as Indicated:
8. Steam 3 to 4 leaves of Adhatoda (like IDLI), extract juice and drink.
9. Put handful of Tulsi leaves in boiling water taken off th,e stove, cover with lid and allow to cool. Squeeze
leaves, strain and drink.
10. Half centimeter size Turmeric root dipped in coconut oil or ghee to be burnt and inhaled.
11.Gum or one rupee coin sized bark of Drum-stick tree to be crushed and made into omelette with egg. Eat
without salt.
EACH IS ONE DOSE. THREE TO FOUR DOSES ARE REQUIRED PER DAY, TO BE TAKEN BEFORE FOOD.
9
II
DIGESTIVE SYSTEM
HEALTH EDUCATION
Diarrhoea and Dysentery indicate bad food and water hygiene. It is very contagious and spreads easily.
1. Eat only fresh and hygienic food. Avoid stale, uncooked and unprotected food.
2. Prepare food in a hygienic manner. Wash all vegetables, foodstuffs, containers, knives, ladles etc., used for
cooking. Store well protected from flies, insects, dust, and vermin.
3. Wash hands, eating utensils, serving utensils etc.
4. Keep surroundings clean, and avoid open defecation, urination.
5. Ensure sanitary disposal of Kitchen, and other food wastes.
Healthy eating habits, and plenty of water and fibre in the diet is preventive.
VOMITING
-REMEDIES (C)
1. Cardamom (Ilaichi) plain or roasted. Chew directly, or paste in water.
2. Mentha (Pudina) leaves crushed with sugar candy.
3. Lemon seed powder - one pinch, or, lemon juice with sugar.
4. Tulsi leaf powder with Coriander (Dhaniya) seed powder 1:1 with honey, is especially useful in children.
5. Juice of stem of plantain tree with Honey - one cup.
6. For vomiting of Bile (Pittha) 1:1 of clear ginger juice and honey.
IZ
DIARRHOEA (Neeru Bedhi)
-REMEDIES (D)
Diarrhoea is the passing of frequent, large, watery stools.Replacement of the water, salts and energy lost is the
mainstay of treatment.
1. O.R.S., Buttermilk with salt, Rice ganji with salt, etc
2. Guava ( Seebe kayi) decoction. A handful of tender leaves, or, one small unripe crushed fruit in 6 glasses of
water reduced to 3 glasses. One glass thrice a day.
A teaspoonful of leaf/fruit paste - drink water with it.
3. Sapota (Chikku) decoction or paste. Same as above.
4. Pomegranate (Dalimbe) decoction. Same as above.
5. Mango seed kernel powder - one tablespoonful in curds, buttermilk or water, with a teaspoonful of honey.
Tender mango leaf dried powder is equally effective.
6. Dried raw banana powder 1 tea’spoonful in sour curds.
Juice of Plantain stem is also effective.
DYSENTERY (Amashanke Bedhi)
Is a condition where small frequent stools are passed with blood and/or mucus. There is pain and frequent urge to
pass stools. It is caused by infection of the intestines and their inflammation due to Bacteria, Amoeba, Viruses, etc.
REMEDIES (E)
ALL THE REMEDIES LISTED IN "DIARRHOEA" ARE USEFUL. ALSO,
1. Fenugreek/Methi seeds (Menthya) one teaspoonful in sour curds.
2. Aloe vera (Lole sara) one tablespoonful with Menthya.
3. A handful of tender leaves of Gooseberry (Amla) in a glass of buttermilk.
4. Periwinkle (Nitya pushpin) leaves, 5 to 6 made into a decoction.
>3
INDIGESTION (Ajeerna), STOMACH PAIN AND FLATULENCE
This occurs due to excess, improper or untimely eating.
- REMEDIES (F)
A tablespoon of Ajwain. (Omum) boiled in a litre of water with a pinch of Black/rock salt (Saindra lavana/ Kala
Namak). Half to one glassful.
2. Ginger, Pepper, Jeera, Hing (Asafoetida) and Black/rock salt made into a decoction in proportions used for Rasam
(Saaru).
3. Saunf and Ajwain powder in ratio 1: 2 mixed with equal quantity of Jaggery powder, one to two teaspoonfuls after
food.
4. Rice, Ragi, Rawa burnt during cooking and stuck to the bottom of the cooking vessel. One to two tablespoonfuls
after food.
1.
GASTRITIS AND ULCERS (Hotte Hunnu)
- REMEDIES (G)
This is injury caused to the stomach when it produces too much acid, because of Spicy, Irregular food, and Stress,
Worry, Alcohol, Tobacco and drugs.
1. Methi, one teaspoonful soaked overnight in a glass of water and taken on empty stomach in the morning.
2. Banana stem juice half glass with equal quantity of water taken as above.
3. One tablespoonful of Aloe pulp washed in water with equal quantity of water, taken as above.
4. Marble sized pills made of Turmeric powder and Honey, as above.
CONSTIPATION and PILES ( Mala Baddhate, Moolavyadhi)
-REMEDIES (H)
This is very hard stools not passed daily/regularly, caused by inadequate fibre and water in the diet. Also, missing
of meals, inadequate food/water intake and disordered action of the bowel muscle due to illness.
1. Methi, one teaspoonful soaked in a glass of water overnight and taken on empty stomach in the morning.
2. One tablespoonful of Triphala Churna in hot milk or water at night.
3. One tablespoonful of Isabgol powder in water at night.
Piles is a result of severe constipation, when the blood vessels at the anal end swell up, create pain, and bleed.
1. A handful of tender Tamarind leaves chewed and followed by plenty of water at night. A decoction of the same
may also be taken.
2. Remedies for constipation are also helpful.
3. Local application of Neem and Turmeric paste helps in healing.
4. Aloe pulp with Castor oil and Turmeric applied locally also heals.
5. A tsf of Methi soaked overnight in a glass water and taken on empty stomach early in the morning.
INTESTINAL WORMS ( Hotte Hula/ Krimi)
These are due to eggs entering the intestines through uncooked food or cooked unhygienically. Hook wbrm larve
enter through the skin of the feet. They are parasites in the intestines and affect the nutrition, apart from causing other
disease.
There are many types. The common ones are, Round worm (Jantu Hula), Hook worm (Kokke Hula), Tapeworm (Ladi
Hula) and Thread/pin worms (Krimi).
• REMEDIES (I)
1.
2.
3.
4.
5.
6.
Papaya seeds dried in shade, 1 to 3 teaspoonfuls of the powder taken with food upto thrice daily (3 to 5 days).
Neem root-bark powder half teaspoonful or Decoction for one week in the morning, on empty stomach.
Neem leaves paste, marble sized, with a pinch of Turmeric and Salt, taken as above.
Pumpkin seeds (lOOgms) in Ghee, as above.
Brinjal leaf paste, as in Neem leaf paste above.
Betel=nut (Supari) powder, half tsf for children, one for adults.
JAUNDICE (Kaamale)
There are many varieties, some very dangerous. There is fever, yellow eyes and urine, with vomiting, loss of appetite
and lack of energy.
This is a viral disease of the liver, affecting food ingestion, digestion and absorption. The commonest variety is Hepatitis A
that is water-borne and occurs seasonally as epidemics. The treatment for this variety is,
- REMEDIES (J)
1. Phylllanthus neruri ( Bhoovi Amla I Kiru Nelli/ Nelada Nellikai) whole plant washed and crushed to size of
marble, taken on empty stomach.
2.1 cup of juice of tender leaves of Castor plant (Avadala yele) - white variety with plenty of sugar.
3. One tablespoonful of tender Mehandi leaf juice and Jeera with plenty of sugar/ glucose water.
HEALTH EDUCATION
Since the disease is contagious, take precautions in food and water.
The Liver is not functioning well. So, food is not digested or absorbed. Give large quantities of water, Glucose. Sugar, and
fruit juices. Mooli (moojangi) in curds with sugar helps rejuvenation of liver function, given thrice daily.The treatment has to continue for a week or two.
Getting blood tested to ensure it is not of a dangerous variety is important.
Liver stimulants like Chiretta (Bhuvi nimb / Nelada Baevu), Kiru Nelli, Kalmegh etc., and a regulated diet with very little
fat need to be continued for a month.
TOOTH, GUM PROBLEMS and MOUTH ULCERS (Bayi Hunnu)
These occur due to food particles rotting overnight in the teeth. They cause and are also the result of digestive problems.
Brush teeth and wash the mouth after each meal and especially before going to bed at night.
1. Use Neem, Mango, Karanj (Honge) or Babul Itwigs to brush teeth.
- REMEDIES (K)
2. Rinse mouth with decoction of Neem, Pipal, Banyan and Babul powdered bark.
3. The powder of the above with salt and Clove (Lavanga) makes a good tooth powder.
4. Clove oil or chewing clove reduces dental pain.
5. Applying Honey heals mouth ulcers faster.
J7
SKIN
The skin is the largest organ of the body. It covers and protects internal organs while maintaining body
temperature through sweating and other skin structures like hair and oil glands.
Any damage to the skin affects these functions. Internal disorders of the body can also manifest on the skin.
HEALTH EDUCATION
1.
Personal hygiene is essential to skin health. (Wash, Bathe, keep clean)
2.
Adequate care of the skin and its structures ( Hair and Nails) prevents infections. ( Cut, Trim, Clean regularly)’
3.
Protection with clothing, footwear, gloves, etc., prevents damage from the
Environment and work situations.
GENERAL TREATMENT-REMEDIES (L)
Neem (Baevu) leaves, bark and seed oil are all effective both internally and externally.Paste, Decoction,
Infusion or Powder can be used.
Turmeric (Haldi) adds to its anti-septic properties, while a pinch of salt enhances its effect.
2. Pongemia oil and leaves are effective for external application.
3. Decoction of Dhub grass (Darbe hullu) and Infusion of Tulsi leaves taken internally are used to remove internal
toxins.
Pastes of both Dhub grass and Tulsi are useful external applications.Turmeric adds to their antiseptic effect.
4. Any edible oil could form the base to preserve the properties of these preparations for long periods of time.
Bees wax can be added to make ointments of the same.
5. Sandal paste with Turmeric is useful to prevent scarring.
1.
SPECIFIC TREATMENT
INJURIES - CUTS AND ABRASIONS________________________________________________________ - REMEDIES (M)
Clean with soap and water / Neem leaf decoction.
Crush washed leaves of Tridax procumbens (Attike soppu) and apply locally. It acts like a tincture Iodine dressing.
Turmeric can be added to the paste.
Neem paste can be also applied.
Turmeric and Lime powder (Chuna) paste stops bleeding in wounds if one can stand the temporary burning
sensation it creates.
ITCHING______________________________________________________________________________ - REMEDIES (N)
Itching could be due to external or internal contact with allergens ( substances that do not agree with the body and
treated as' foreign7).
Use Dhub Grass / Neem decoction internally. Tulsl infusion helps.
Ajwain. Ginger. Jeera and digestive decoctions reduce allergic itching.
Use oil prepared from Neem leaves externally. ( Neem leaves fried in edible oil, crushed and decanted. The neem
leaf decant is also useful).
SCABIES (kajji)
- REMEDIES (O)
Scabies is caused by the itch-mite which burrows into the skin. It is common in children when hygiene is bad, and
spreads to all family members through contact, clothing and other personal items.
Take bath in water in which Neem or Guava leaves are boiled.
Apply Neem and Turmeric paste all over the body after bath on three consecutive days.
Wash all clothes, bed clothes and towels etc in hot water and ensure complete drying in the hot sun. Hot-ironing
also helps.
Decoctions for itching can also be taken.
BOILS, ABSCESS, WOUNDS and BEDSORE ( Kura, Keevu hunnu, Gaaya)
These are caused by bacteria, which destroy the skin and underlying tissue.
Sometimes, Fungi can also cause the problem.
Clean with Neem infusion.
- REMEDIES(P)
Use any of the General remedies listed above.
In delayed healing and non-healing. Use any of the following:
Grated raw Papaya applied directly to the wound removes all dead material (slough) and promotes faster healing.
Juice of the touch-me-not plant promotes quick healing.
The General remedies can than’be used.
Additional oral intake of Neem, Tulsi, Vacha (Baje) in Honey and nutritious food having a high protein content
(sprouted grains) hastens healing.
Bedsores can be avoided by meticulous care of skin in bed ridden persons. Massage of skin with spirit(used for injections)
strengthens the skin.
ECZEMA (Isubu)
- REMEDIES (Q)
This is an inflammation of the skin due to internal or external allergy. The eczema may be wet (watery or pus
discharging) or dry (crusting and peeling).These take a long time to heal and recur seasonally or on exposure to the
allergen.
Pongemia (Honge/Karanji) oil application is the simplest remedy.
Also, equal parts of Neem and Mehndi (Goranti) leaves are boiled in little water till no water remains and made into
a paste with Karanji oil for application.
Protection against and avoiding allergen if known is preventive.
RINGWORM (Hulakaddi)
- REMEDIES (R)
This is cause by fungus. Locally apply Neem leaf paste or in oil.
Mehandi leaf juice in curds.
Juice of touch-me-not plant.
Hygiene of the skin and clothing is important for cure. Avoiding dampness and wet clothing prevents it.
WARTS AND CORNS
These are caused by viruses or injury with skin thickening and take 2 to 3 weeks to heal.
Rub the com/wart,with raw ginger daily for a week or two.
Mix Lime (Chuna) and Cooking Soda in equal proportions and apply.
Apply the milky juice of Euphorbia hirta (Dudhi ghas).
Apply Aloe vera (Lole sara) juice daily.
- REMEDIES (S)
URINARY DISORDERS
- REMEDIES (T)
Pain, Burning and frequency are the common problems. Rarely, stones in the Urinary tract cause problems.
These are due to inadequate intake of water and excess acid being sent out.
1. Dhaniya kashayam - 1 teaspoonful in a glass water, boiled to half.
2. Jeera kashayam similarly made.
3. Banana stem juice, especially for stones.
4. One teaspoonful each of onion juice and honey.
WOMENS' DISEASES
- REMEDIES (U)
These are related to menstruation, and the menstrual cycle, affecting the women from menarche to menopause.
The major causes are Anaemia (Rakta Heenate), Malnutrition and Hygiene.
GENERAL REMEDIES
1.
The bark of ASHOKA tree can be taken in any form, swaras, decoction, or arishtam.
2.
Shoe flower (Dasavala) arishtam - good for all menstrual problems.
Take sufficient number of flowers. There should be no water. Place these petals and jaggery in alternate
layers in the ratio 3:2. Close container and preserve for 21 days. Strain out the juice.
Dose : Two teaspoonfuls twice a day during periods.
3.
Iron tonic - for anaemia.
Heat half a kilo of Jaggery till it becomes a stringy liquid (Paakam).
Into this, put one glassful of Drumstick leaf juice, and one tablespoonful each of Jeera, Saunf, and
Cardamom powder. Heat till it becomes thick and is free of water.
Dose : One teaspoonful twice daily before food.
4.
Mix equal quantities of fine bark powder of Babul, Pipal and Fig tree.
1 tsf twice daily in milk for 21 days. This regulates the cycle.
5. Remove the inner seeds, etc from Fig or Pipal fruit and take it filled with jaggery, early morning, empty
stomach.
6.
Take Aloe pulp with equal quantity of Jaggery, early morning on empty stomach.
HEALTH EDUCATION
The Menstrual cycle is a normal process in the life of any woman.
It 'Can cause problems due to physical problems cited above, or, even stress of overwork, wrong postures during work
and inadequate exercise and rest.
It is easily disturbed by emotional stress too.
Irregular or ineffective menstruation is mainly due to anaemia and stress. The remedies are, 1,2,3 above.
For painful menstruation and white discharge along with it, even before and after, use remedies 4,5,and 6.
For White discharge, which is mainly due to anaemia and infection, use remedies 1 to 3 above, and any of the
remedies listed for Dysentery.
Local cleaning and Hygiene in case of infections can be done using Kashayam made of remedy no. 4.
In addition, those used for cleaning cuts and wounds, i.e., Neem, Turmeric etc are effective.
29
Growing Up
Education in Human Sexuality
*
why. Body and sexual hygiene have to be
taught.
At this age boys and girls need to know what
is biologically different about their bodies and
Adolescence
Adolescence is simply a transition stage from child
hood to adulthood. It is a stage which all young
people go through to become biologically and sexu
ally mature. In girls it may start as early as 9 or 10
years and in boys it begins around 12 or 13 years.
Adolescence is a time of rapid change in the body,
emotions, attitudes, values, intellect and relation
ships.
Adolescent changes are triggered by hormones
of the pituitary gland and the gonads. The hor
mones bring about the development and mainte
nance of the secondary sex characteristics. (See
Chapter VII for changes in the male and Chapter
VIII for changes in the female).
Adolescents are passionate people and are apt
to be carried away by impulse. They can experi
ence irrepressible joy or inconsolable sadness, gre
gariousness or loneliness, altruism or selfcentredness, insatiable curiosity or boredom, con
fidence or self-doubt. During growing up the maxi
mum change occurs in adolescence.
An adolescent is expected to
— establish a new social and working relation
ship with peers of both sexes as well as with
adults;
— adjust to sexual maturity and changing roles;
— decide on future goals;
— prepare for responsible citizenship;
— develop a philosophy of life with moral beliefs
and standards;
— develop his/her own sense of identity.
According to Eric Erikson, 'Before the adoles
cent can successfully abandon the security of child
hood, and dependence on others, he must have
some idea of who he is, where he is going and what
the possibilities are of getting there'.
The transition can be stormy or calm. A great
deal depends on the groundwork laid in prepara
tion for this change. During the early developmen
tal years the child is guided mostly by parents and
teachers. The rapport that they build up during
these years will help the relationship during ado
lescence. The adolescent stage spans over almost
ten years, so it is divided into two sub-stages: Early
and Late Adolescence.
— become independent of his/her parents;
D. Early Adolescence (9-14 Years of Age)
General Traits
*
❖
This is a period of rapid physical growth for
females with development of the primary and
secondary sex characteristics along with matu
ration of reproductive functioning. The physi
cal growth of boys begins a couple of years
later.
Dramatic physiological changes occur like the
menarche in females and nocturnal emissions
in males.
*
Adolescent growth spurt occurs. If nutrition
and health care are adequate, they attain adult
height and sexual maturity earlier than in pre
vious generations.
#
Wide variations in height and development are
typical of this stage within individuals of the
30
Education in Human Sexuality
same sex. The rate of growth varies — for some
it is rapid and for others slow.
*
*
The levels of maturity of females and males
vary greatly.
Both girls and boys develop strong affections
('crushes') for a person
a. of the same sex,
b. who is an achiever or a leader in their eyes,
c. who may be of their age or older.
* Adolescents can detect what will irritate their
parents and teachers and so deliberately adopt
that behaviour. This could include
a messy room,
sloppy dressing,
rude behaviour,
profane language,
loud music,
incessant talking on phones,
avoiding homework and housework.
How Adults Can Cope With Adolescents
❖
*
Rapid body changes affect the self-concept and
the personality of the young adolescent.
At times, body growth is uneven leading to
awkwardness. During this period youngsters
either learn to accept their bodies or to dislike
them and this has implications on their sexual
adjustment in later life.
Behaviour Patterns
The behaviour of b,oys and girls varies greatly. It
also varies among individuals of the same sex. This
is due to the wide variations in physical develop
ment of adolescents in this age group.
*
Both boys and girls feel awkward and selfconscious.
*
Girls are anxious about menstruation, pimples,
breast size and general appearance.
*
Boys are anxious about their height, beard,
pimples, voice break, penis size and noctur
nal emissions.
*
Both boys and girls spend a lot of time look
ing in the mirror, dressing up, and trying to
make themselves attractive to the opposite sex.
*
Since girls develop earlier than boys, they seek
the attention of older boys and form more so
cial relationships than boys of the same age.
*
Both boys and girls question authority, become
more assertive and yet are very dependent on
adults.
Adults must understand that teenagers have tre
mendous tasks to cope with within a short time.
Too many things are happening at once. There are
growth spurts, new feelings and needs, social awk
wardness and painful self-consciousness. Teenag
ers require a lot of space or else their clumsiness
may result in spilling drinks, knocking over stools,
or bumping into people. They are self-conscious
about pimples, teeth, body shape, their hair, etc.
Even if they do not acknowledge it, teenagers need
the help of adults i.e parents and teachers.
This is a difficult time for adolescents and a very
trying one for adults. It is, however, a natural phase
which all adolescents pass through, and it can be
made less stressful and confusing if the adults are
clear about what they should do and how they
should go about it. In dealing with adolescents,
parents and teachers should :
— Understand and accept this phase.
— Accept the restlessness and discontent of ado
lescence.
— Allow the adolescent to be independent.
— Allow the adolescent to make his/her own
decisions and overlook his/her mistakes if any.
— Support the adolescent by placing trust and
confidence in him/her and by recognising that
he/she can make sound judgments.
— Avoid scolding and labelling the adolescent in
front of friends; provide positive suggestions
and praise.
— Avoid correcting the adolescent all the time.
-— Avoid needless criticism as adolescents are not
sure of themselves and need adult understand
ing; criticise the specific act under question and
Growing Up
not the person.
— Avoid preaching and saying: 'I told you so', or
'It serves you right.'
— Clearly express their own values to the ado
lescent.
— Avoid invading the adolescent's privacy.
— Avoid giving conflicting messages; state clearly
'Yes' or 'No' or 'It is your choice' and give jus
tification for the answer.
— Clarify rules and expectations regarding home
work, chores, responsibilities, hours to come
home, etc.
— Develop good relations with adolescents by be
ing flexible and rethinking on some issues that
may need change.
— Keep all communication doors open.
— Shower continuous love and affection on the
adolescent.
31
Value Building
Values that are to be built up are common to both
the early and late adolescent stage and are hence
taken up together in the age group 14 to 19 years.
Education in Human Sexuality
*
The anatomy, physiology and functions of the
reproductive organs in the male and in the fe
male should be dealt with in detail.
*
Boys and girls should be prepared for the on
set of puberty.
*
Hygiene of the genitals, body odour, pimples,
nutrition and exercise should be dealt with.
*
Myths and misconceptions should be clarified.
E. Late Adolescence (14 -19 Years of Age)
General Traits
*
*
This is a period of rapid physical growth for
boys with development of the primary and sec
ondary sex characteristics along with matura
tion of reproductive functioning.
* They are anxious about their educational and
vocational goals.
Girls at the beginning of this stage are taller
than boys. However, the boys outstrip the girls
by the end of this stage.
*
Teenagers are establishing their own personal
identities. They have to free themselves from
childhood ties with parents and find their own
personalities.
*
Their emotions are strong and fluctuating.
*
They can be angry, aggressive and rebellious.
They question authority and break rules.
*
Boys tend to be boisterous and show off their
muscle power or use foul language.
*
Little things about their appearance, work or
relationships with the opposite sex can make
adolescents very happy or very sad. If they do
not have much support at home or at school,
their sadness can result in depression. Chronic
❖
The needs and urges of an adolescent are sexu
ally oriented.
*
Emotional changes are dramatic and are
characterised by mood swings.
*
*
* They want to identify with a peer group, and
peers exert a strong influence on each other.
The need to be independent and assertive on
the one hand and to build up relationships and
establish themselves socially on the other in
tensifies.
They are preoccupied with themselves and
they have the notion that other people s
thoughts are focused on them.
Behaviour Patterns
32
Education in Human Sexuality
depression may lead to suicidal behaviour.
❖
Boys are awkward and clumsy. They are con
cerned about their body image. They are anx
ious about their height, muscles, body hair,
voice change, size of genitals, erection and
ejaculation.
5k
Delinquent behaviour is quite common at this
stage and can lead to antisocial or criminal ac
tivities. These may include destroying school
or public property, thieving more for excite
ment than a need for the item robbed, driving
rashly and causing accidents, or forming gangs
and challenging each other. Boys feel a strong
need to prove their masculinity.
*
Sex-related behaviour can also take extreme
forms. Shy individuals may avoid any form of
boy-girl relationships. Others may indulge in
eve-teasing and flirting.
sk
Ragging is something that can start off as teas
ing, having fun, friendly leg-pulling, but can
lead to extremes if it does not stop there. An
individual or a group can make a victim's life
miserable by persistent ragging or extreme
physical and mental torture. Many victims have
not been able to cope with the embarrassment,
humiliation and torture to which they are sub
jected. To escape this cruelty some have even
been known to commit suicide. Sometimes the
ragging itself can lead to death. It is unfortu
nate that many members of the group may
realise that ragging has gone beyond limits and
may feel sorry for the victim but do not have
the courage to stop the ragging or to appeal to
those involved.
How Adolescents Cope
Adults who want to help adolescents to cope with
their changing emotions or situations leading to
negative emotions and to help build up their self
confidence, should understand the difficulties of
adolescents and guide them through their grow
ing years.
sk
Sexual urges may result in masturbation, view
ing of pornographic material (magazines, blue
films etc.) or visiting commercial sex workers.
sk
Teenagers, especially boys, are active in sports
and they play aggressively.
1.
sk
Experimentation is common at this stage. Peers
encourage and sometimes force their friends to
try out smoking, drinking alcohol, using drugs,
and having sex.
‘■k
Adolescents display different behaviour with
adults and with their peers. When with adults
on a one-to-one basis, they are more reason
able, understanding, and willing to cooperate.
But when they are in peer groups they are en
tirely different and are quite the opposite.
(a) Anger: Anger can come on suddenly or can be
built up because each incident that added to the
anger was not resolved at the time. If anger flares
up suddenly it is worthwhile to control it and take
stock of
5k
personal feelings;
sk what needs to be done to diffuse the anger and
not spoil relationships;
sk
# Those brought up in families with strong ties,
firm values and a good support system may
not always exhibit strong negative behaviour
patterns. But adolescents from broken homes,
with parents who are disturbed, or who are
addicted to alcohol or drugs, or who give their
children plenty of money but no time, may be
more likely to exhibit strong negative
behaviour patterns.
Coping with emotions or situations leading
to negative emotions
ways of avoiding the situation that caused the
anger.
It is not wrong to feel angry but the expression
of anger should not hurt anyone. Therefore, while
ventilating anger:
sk
Do not use abusive language which will insult
or demean a person or his/her background.
Growing Up
*
*
Do rfot^attack the person physically or ver
bally; instead address the issue that' has
brought on the anger.
Deal with the situation and forget it. Do not
carry over anger or bear a grudge. This is not
good for relationships.
* Take deep, slow breaths.
❖
Withdraw from the situation temporarily if
possible and take time to cool down.
* Talk about the situation to a non-involved, ob
jective person, or write down your feelings in
a diary.
33
*
relationships with friends, parents, loved ones;
*
falling in one's self-expectations.
To cope with failures one has to :
❖
Analyse the reasons for failure.
* Accept failure as a natural part of life and not
personalise it.
❖ Set realistic goals.
*
Achieve these goals by setting a motivation
plan by oneself or with the help of people that
matter.
(d) Ridicule or 'Put-downs': 'Put-downs' are words
or body language used to hurt, embarrass, belittle,
tease, or rag someone and make him/her feel bad.
Calling names that are racist, casteist or sexist are
* Send a letter to the person explaining how you
often used as 'put-downs'. 'Put-downs' are used
feel.
by peers to exert negative pressure on individu
als. They are also used on a weaker or a quieter
(b) Rejection : Rejection from a peer group is not
member of the group to derive pleasure and power.
easy to handle and may leave the adolescent feel
ing very low and depressed. The adolescent can
Adolescents can respond to ridicule in a posi
cope with rejection by:
tive or a negative way. Sometimes a negative re
:::
Look at the situation from the viewpoint of the
person who brought on the anger.
*
introspecting and rationalising;
❖
not compromising on values;
(e) Conflicts: Conflict simply means fight, struggle
or hostility. Conflicts occur when:
*
talking to friends, elders or the person who is
rejecting him/her;
*
People view things differently regarding expec
tations, goals, male/female roles, etc.
*
looking for people or areas where one is ac
cepted and appreciated.
*
Priorities of values differ;
sponse can work. Figure 6.1 gives these responses.
* Self-esteem or status is threatened.
(c) Failure : To achieve, to succeed, and to be ad
mired by members of the peer group is a desire of * Personalities clash.
all adolescents. Some feel hopeless or even de
pressed when they fail or reach any place other
Common areas of conflict between adolescents
than the first. Some highly motivated achievers are
and adults, especially parents, are:
poor losers.
Failure can occur in :
&
athletics, sports, any competitive event;
*
academics or careers;
— keeping in tune with current fashion
— sexuality behaviour
— personal expenses
— religion
— interpersonal relationships
— choice of a career
Education in Human Sexuality
34
Discuss it
with the
person
Ignore it
Treat it as
a joke
Tell someone else
(compiain about it)
Strike back
with words
(sarcasm or
put-downs)
Strike back
with actions
(fights, vandalism)
Treat it
as good
advice
Write a note
to the person
Fig. 6.1: Coping with put-downs
Growing Up
— general freedom.
35
off than themselves.
Conflicts have to be resolved or they can ruin
relationships. They may be resolved by talking,
rationalising, compromising, rearranging priori
ties, or accepting the situation.
* Talking to friends or to The Samaritans Hot
Line in Mumbai—a 24-hour service is available
at Telephone Nos. (022) 309 20 68 and (022)
307 34 51.
(f) Stress and anxiety: Stress and anxiety are inevi
table when people are faced with the demands of
living. A certain amount of stress is necessary for
an individual to function adequately. But when the
stress exceeds a person's coping capacity it has
adverse effects.
❖ Thinking positive — taking stock of all the
good things that happened in their lives or that
life has to offer them.
Adolescents face much stress because of the in
escapable physical and psychological changes they
are undergoing.
Reasons for not expressing emotions: While it is natu
ral for people and especially adolescents to express
their emotions, socially their upbringing may pre
vent them from doing so.
* Not being alone — having people around
them.
Coping with stress would need
(a) Social rules : In our society the unwritten rules
of communication discourages the direct expres
sion of most emotions.
sk
Maintaining good physical and mental health.
*
Developing a good sense of humour and hav
ing fun.
'Don't get angry'
Developing a positive outlook on life.
'There's nothing to worry about'
(g) Depression and silicide : Depression is a state of
extreme dejection, a mood of hopelessness, a feel
ing of inadequacy often accompanied by lack of
vitality, vigour or spirit. It leads to lack of interest
in normal activities such as eating, sex, work,
friends, hobbies, or entertainment. There may be
loss of weight, insomnia, an agitated or retarded
state of mind, decreased sex drive, fatigue, feel
ings of self-reproach, and inability to think or con
centrate.
'Control yourself, don't get excited'
'For heaven's sake, don't cry'
(b) Social roles : The expression of emotions is ini
tiated by the requirements of social roles.
Salespersons must smile no matter how obnox
ious the customer.
* Mothers have to love their child.
Continued depression can lead to thoughts of
death and suicide.
Depression is caused by a combination of fac
tors i.e. inability to cope with anger, rejection, fail
ure, stress, anxiety along with low self-esteem and
a lack of social support.
People who are contemplating suicide can STOP
and help themselves by:
*
Stopping self-pity—there are others far worse
Teachers are paragons of rationality.
*
Sex-role stereotypes discourage people from
freely expressing certain emotions —
Men don't cry, are rational, are aggressive.
Women are prone to tears, are irrational, intui
tive, and submissive.
(c) Inability to recognise emotions : The capacity to
recognise and act on certain emotions decreases
36
Education in Human Sexuality
without practice. If one has suppressed anger,
love, or other emotions, then expressing and
responding to these emotions becomes difficult.
(d) Fear of self-disclosure : The expression of feel
ings makes emotional self-disclosure risky.
There is always a chance that emotional hon
esty could be used against one either out of cru
elty or thoughtlessness.
2.
To boost one's self-esteem :
=k
It is good to examine one's values. The values
one believes in and which one acts upon should
not be different. Hence, self-respect and hon
esty are very important.
*
It is essential to make time for reflecting on
one's thoughts and feelings. Pursuing enjoy
able activities and interests help.
*
It is necessary to set realistic goals for oneself.
Goals should neither be too high nor too low.
Planning goals from today to the next month,
to the future helps in achieving them. Putting
down these goals on paper with a reasonable
time frame, circling them or scoring them off
as they are achieved, and displaying this sheet
in a prominent place will remind one of what
one hopes to do.
*
It is an asset to develop one's abilities to the
fullest and thereby take pride in oneself and in
one's work.
Building up self-confidence
Building up confidence in one's own abilities can
help adolescents to cope with their changing ex
periences. Confidence can be built up by :
=k
Developing self-esteem;
=k
Developing decision-making skills;
sk
Resisting negative peer pressure.
(a) Developing self-esteem : Self-esteem is how one
feels about oneself.
High self-esteem means:
sk Believing in oneself
(b) Decision-making : Everyday living requires the
making of decisions. The quality and appropriate
ness of such decisions can affect an individual's
well being.
sk Accepting one's weaknesses and strengths
Examples of decisions requiring a great deal of thought:
* Respecting and liking oneself and others
*
Trusting oneself
*
Making one's decisions based on what one feels
is right for oneself.
Low self-esteem means:
❖ Lacking self-confidence
*k Being unable to accept oneself
*
Not respecting or liking oneself and others
sk
Distrusting oneself
•k
Letting others make one's decisions as one feels
that what others think is more important.
— Should I smoke?
— What career should I pursue?
— Should I take drugs?
— Should I have sex?
Examples ofdecisions that do not require a great deal of
thought:
— Can I skip breakfast?
— Should I go to a movie?
— Should I have a haircut today?
— Doi take a train or a bus?
Factors that influence decision-making are :
❖
Values
— What is right for me?
— Which is more important of the two?
Growing Up
❖
Goals
— Where do I want to go?
— Will the consequences fit into my plan?
*
Needs/Wants
— Do my wants conflict with my needs?
*
Standards/Expectations
— Will it fit into my culture?
— Will it meet the expectations of people I care
about?
— How will it affect the people among whom
I live?
— Do I want to live up to these expectations?
*
Resources
— Do I have enough money, time, physical,
mental or psychological capabilities?
Lifestyle
— Will it fit into my lifestyle?
— Will it change my lifestyle?
— Doi want to change my lifestyle?
— Can I change it?
*
Life stage
— Does it fit my stage in life?
— Am I too young, too old?
— Does my economic situation support it?
Steps in decision-making:
*
Identify the problem.
*
Gather information about the situation.
*
Weigh the alternatives.
* Think about the possible consequences.
*
Review one's values.
*
Make a decision i.e. choose the best alterna
tive.
*
Announce the decision made and the justifica
tion for making it clearly to those involved in
cluding the person(s) who may be responsible
for creating the problem. Do this boldly and
confidently.
*
Stick to the decision with conviction.
37
(c) Resisting negative peer pressure : Peer pressure
occurs when one's peers, i.e. people of about the
same age, try to influence how one thinks or acts.
Peer pressures can be good or bad. Either of these
can influence one's judgment and actions.
Positive peer pressures cause one to :
— participate in school activities (sports, plays).
— achieve goals (good grades, a good job).
— keep the body healthy.
Negative peer pressures cause one to :
— use alcohol or other drugs.
— skip school or classes.
— vandalise property.
— have sex.
— disobey parents.
— pick on people for ragging, eve teasing, or other
antisocial acts.
Negative peer pressures can be very damaging
both emotionally and physically. The need to be
long to a peer group is so strong in adolescents
that they succumb to the influences and pressures
of their peers.
Some commonly used techniques for exerting
negative peer pressures are:
— using coercion
— using deception
— giving wrong or partial information
— using bribes
— taking bets and challenges
— gross lying
— personal rejection
— using faulty logic
— stressing positive aspects of a particular act
and glossing over the negative
— using put-downs
— criticising, 'you are old fashioned', 'you are
a sissy'.
How to handle peer pressure-.
* Adolescents should know themselves and
should be clear about their values.
* Adolescents should know how to make their
Education in Human Sexuality
38
own decisions.
H= Adolescents should learn to say 'NO' to peer
pressure.
Hi Take interest in the partner's activities, lifestyle
and background.
H:
Take responsibility for one's decisions and ac
tions.
Hi
Keep a sense of humour.
Hi
Listen carefully to what the partner is saying.
H:
Refuse to compromise on one's values regard
ing sex, experimentation, family or self.
When one says "NO' to peer pressure regarding
harmful behaviour, one usually :
— feels good about oneself; one's self-confi
dence and self-esteem increase;
— gains the respect of others;
— stays out of trouble.
At this stage of their lives, adolescents start
forming their opinions about themselves, their
peers, and their own parents and comparing
them. If they find that their parents are lacking in
certain qualities or have double standards, they
may either be bold enough to criticise their par
ents and turn to their peers; or they may suppress
their own opinions. This can cause conflict in their
minds.
3.
Boy - girl relationships
Studies show that adolescents want and seek guid
ance on how to develop a friendship with a mem
ber of the opposite sex. Many young people hesi
tate to develop a friendship with a member of the
opposite sex for fear of being misunderstood or
rejected.
Why does developing a friendship with a mem
ber of the opposite sex become difficult? This is
due to :
— lack of the necessary interpersonal skills;
— ignorance about different facets of sexual
attraction;
— social taboo on fearless and free mixing;
— a misconception that friendship necessarily
implies a desire for cohabitation.
In a boy-girl relationship, as in any other rela
tionship, it is important to :
H5
Communicate honestly and clearly to the part
ner.
❖
Be positive in outlook.
A boy-girl relationship is most often accompa
nied by sexual attraction. The sex drive can be at a
— mental level (thought, fantasies, dreams)
— physical level (sexual urges).
Individuals who get sexually attracted send sig
nals through non-verbal behaviour such as :
— touching
— facial expression
— tone of voice (not words)
— distance
— posture
— rate of speech
— number of errors (due to embarrassment or anxi
ety).
The sex drive can lead to physical contact. This
may involve mild body contacts (touching, brush
ing, holding hands, kissing on cheek or forehead);
or heavy body contacts (petting, fondling, stimu
lating genital areas, or intercourse).
Boy-girl relationships may experience momen
tary sexual attractions. The danger is of premature
sexual involvement which culminates in sexual
intercourse leading to a possible unwanted preg
nancy.
Another issue young people should be aware of
is peer pressure and insistence in sexual matters.
Some boys and girls have been egged on by their
friends to experiment with sex. Such pressures
should not be succumbed to when they conflict
with one's own values.
Growing Up
at will.
A mature boy-girl relationship is possible if the
youngsters
❖ develop healthy attitudes to sex;
* develop respect and healthy attitudes towards
members of the opposite sex;
& There is a will to take responsibility for the con
sequences.
Disadvantages offree sex :
*
& realise that love is partnership and not owner
ship;
❖ know that it is wrong to treat persons as sex
objects.
Some principles and restrictions on sexual behaviour :
Sexual behaviour must not include coercion or de
ception.
39
Sex is a physical and an emotional involve
ment. Both are important in a satisfying rela
tionship. If one person cares more than the
other, then the separation will cause a great deal
of pain and hurt feelings.
❖ One can get involved with a married person,
leading to secrecy, deceit, conflicts, demands
and tensions.
*
No coercion such as :
Pregnancy can lead to motherhood at an im
mature age.
Using one's authority to compel the subordi
nate in an institution or work situation.
Abortions can lead to health risks and psycho
logical strain (See Chapter XIII on Abortion).
Taking advantage of a person's poverty, help
lessness, weakness.
STD and HIV/AIDS infection can be health
risks (See Chapter XVI on Sexually Transmit
ted Diseases and Chapter XVII on HIV/AIDS).
Blackmailing.
❖
❖
Asking for sexual favours in exchange for
'friendship' or assistance.
No deception such as :
*
*
Enticing a person into sex through false prom
ises, marriage, for example.
Pretending to be pregnant in order to entrap a
boy into marriage.
Free Sex: Premarital sex is on the increase in urban
colleges.
Arguments in favour offree sex are :
❖
There is love.
*
There is no coercion or deception.
❖
There is mutual consent.
❖
There is an understanding about breaking up
It may have an effect later on in marriage
owing to
— lack of virginity
— unfulfilled expectations.
Ingredients of a relationship :
A mature relationship can be characterised by car
ing, sharing, mutual respect, accepting highs and
lows, accepting strengths and weaknesses, com
municating without reservation, understanding,
taking responsibility.
An immature relationship is emotional, demand
ing and is characterised by more taking than giv
ing, smiling when pleased, tantrums when things
do not go as desired, holding back communication,
complaining, lying, scheming.
4.
Hurdles in development
Adolescents are surrounded by influences and
temptations detrimental to their physical and emo
40
Education in Human Sexuality
tional well being. They get attracted to or get co
erced into smoking, drinking alcohol, and drug
abuse. The media and negative peer pressures ad
versely affect adolescents who become vulnerable
to these habits.
ing reduces the sperm count in males. This can
lead to infertility.
*
In some cases men show a reduced sex drive.
❖
Nicotine causes the blood vessels to constrict
in both men and women thereby interfering
with the sex response.
:k
Women who smoke heavily during pregnancy
are liable to give birth to babies with lighter
weight than normal.
(a) Smoking
Smoking is considered as a status symbol and a
sign of virility. It is a habit that can develop easily
and is hard to break. Smoking is injurious to health;
it affects the respiratory tract, causes throat irrita
tion, and eventually cancer of the lungs/throat and
heart attacks.
(b) Alcohol
Adolescents must leam to say 'NO' to peer pres
sures that encourage smoking. It is better not to
start the habit. More and more adults are giving
up smoking. Public and private offices, public
transport systems, etc. have 'No' Smoking signs.
Public awareness regarding smoking is now
spreading.
Why do teenagers drink?
If smoking has become a habit then a few sub
stitutes may help break it. Habitual smokers can
substitute a cigarette by chewing gum or a sweet.
A pencil held between two fingers in place of a
cigarette may help.
sk It is readily available.
The following suggestions may help a heavy
smoker to cut down the number of cigarettes he
smokes daily.
5k
Do not buy a pack of cigarettes.
❖
Do not light a cigarette from another person's
lit cigarette.
5k
Do not cany' a lighter or a match box.
5k Have a puff or two of a cigarette and throw
away the rest.
5k
Cut a cigarette into half and smoke that. This
way two cigarettes smoked will seem like four.
Effects of heavy smoking on sexual and reproductive
health :
=k There is a strong indication that heavy smok-
5k
It represents for them
— a symbol of adulthood
— a defiance of authority
— a declaration of virility
— a sign of being one with the group.
sk
It is relatively inexpensive as compared to
drugs.
=k
It is seemingly safe.
5i:
It starts as social drinking and becomes a com
pulsion.
sk It helps escape from problems.
Prevention : The personality and character of young
people needs strengthening by developing selfesteem and decision-making skills. It is necessary
to teach the young to resist negative peer pressures.
All effects of habitual or excessive drinking
should be discussed in detail with them.
An ancient Hebrew legend tells the difference
between moderate and irresponsible drinking.
When Noah planted grape vines, Satan revealed
to him the possible effects of alcohol. He slaugh
tered a lamb, a lion, an ape, and a pig. He explained:
The first cup of wine will make you mild like a
lamb; the second will make you feel brave like a
Growing Up
causes great anxiety to the man.
— causes sex crimes including rape and incest.
— results in unwanted pregnancies and STD due
to impaired judgment and not using contra
ceptives.
lion; the third will make you act like an ape; and
the fourth will make you wallow in the mud like a
pig.' (Ginott, 1969, p.190)
Adolescents who decide to drink must learn to
handle themselves.
Jk
Alcoholics suffer a disruption of normal sex
life. Constant heavy drinking will cause the
liver to overproduce an enzyme that destroys
the male hormone testosterone. This may lead
to impotence and infertility. In women, it causes
premature menopause. It may also cause ex
cessive menstrual and inter-menstrual bleed
ing.
:k
Domestic disharmony is often the result of ex
cessive drinking by one of the partners. The
children of such parents are affected due to
constant exposure to quarrelling at home by
the parents. Children are physically abused and
many of them find it difficult to grow into
healthy adults.
They should know when they have had
enough, that is they should know their limit.
*
They should sip the drink slowly and not gulp
it down. One glass of drink should last as long
as possible. They should discourage refills.
They should not get into competitive drinking.
*
They should not drive when intoxicated. Many
teenagers have been responsible for accidents
due to drunken driving.
=k
They should not make fools of themselves. If
they are high and are losing control of their
body balance and senses, they should retire
quietly.
Effects ofalcohol on sexual and reproductive health and
family life : The effect of alcohol consumption will
vary from individual to individual. Each individual
will have to find out for herself/himself what
amount of alcohol will be a small dose and what
amount will be excess.
*
#
❖
Small amounts of alcohol help one to
— relax;
— overcome fear or anxiety;
— reduce inhibitions.
Excess alcohol acts as a depressant on the cen
tral nervous system
— concentration and judgment are impaired;
— caution and inhibitions are reduced;
— self-control is lessened;
— senses are dulled;
— sensitivity to pain is reduced when alcohol is
consumed in large quantities.
Large doses of alcohol leading to addiction
— causes inability to have an erection. Unfortu
nately with the first problem of sexual fail
ure, the man's virility is questioned; this
41
Can a person addicted to alcohol get help?
Yes, provided the person is willing and determined
to give up the habit.
Medical assistance and psychological counsel
ling are available at the centres mentioned in Ap
pendix 4. Alcoholics Anonymous gives help
through group therapy.
(c) Drug abuse
Drug abuse is a serious problem with adolescents.
Drug awareness is very essential.
The drugs prescribed by doctors are of medical
necessity. The use of drugs that are not medically
required is considered as drug abuse.
The drugs considered here include marijuana
(grass, pot, ganja), sedatives (barbiturates, valium),
stimulants (amphetamines, cocaine), opiates
(opium, pethidine, morphine, heroin, fortwin). A
common characteristic shared by these drugs is the
potential for habituation and addiction.
Adolescence is a phase where a great deal of ex
Education in Human Sexuality
42
perimenting takes place. Adolescents have a re
sponsibility to decide whether or not to take drugs.
To exercise this responsibility they should be
able to evaluate all the facts related to the use of
drugs and explore some of the myths connected
with drugs.
Some Facts :
❖
sk
All the abovementioned drugs have a poten
tial for addiction.
All of them will seriously affect one's physical
and mental health.
sk
The chances are that one will progress from
drug to drug usually to more potent and haz
ardous ones.
sk
Their use, even occasional, is likely to get one
into trouble at home, with authorities, and with
society at large.
sk
When under the influence of drugs there is a
possibility that one may indulge in hazardous
activities which one would normally have
avoided e.g. driving dangerously, visiting pros
titutes etc.
❖
Most of these drugs are expensive and often
beyond the means of a teenager.
❖
Continued abuse of these drugs can lead to all
sorts of problems in school or college and in
relationships with friends, teachers, and rela
tives.
sk
Continuing to use drugs requires a steady
stream of money. It is well known that users
often end up indulging in other antisocial
behaviour such as stealing, prostitution, or
even murder in order to procure money for
buying drugs.
Young people should know that the following
statements ARE NOT TRUE :
5k
Only those with significant personal or family
problems can get addicted.
5k
Drugs give one courage to face unpleasant situ
ations and improve mental and physical per
formance.
5k
Experimental and occasional use does not lead
to addiction.
On the contrary, some drugs can be so danger
ous that even one exposure may lead to addiction
or even mental derangement or physical illness.
Table VI-A presents some of the commonly used
drugs and the effects they have on individuals.
It is important for one to be able to recognise a
drug user, as well as a drug pusher. This is neces
sary to avoid being 'accidentally' introduced to the
habit without one's knowledge.
Some users are dull and drowsy for no appar
ent reason, they do poorly at work and frequently
have a poor social reputation. Others may put up
a facade of bravado thereby giving the impression
of being 'grown up'.
Pushers are those who sell these drugs and, as
one can surmise, they have a lot to gain economi
cally by inducting a new user. They have been
known to use all kinds of means, fair and foul, to
go to places where young people collect and to sell
their drugs. Adolescents should report such push
ers to their authorities so that these criminal and
socially destructive activities are curbed.
Effects ofdrugs on sexual and reproductive health: Dif
ferent drugs have different effects on individuals
depending upon the amount taken, how it is taken,
and how often it is taken. The effects of some of
these drugs on the sexual and reproductive health
of individuals are mentioned here.
Amphetamines: High doses of amphetamines taken
by intravenous injection, lead to sexual problems.
Men have difficulty in achieving and maintaining
an erection and in achieving an orgasm. Women
often have no orgasm.
Barbiturates : Large doses of barbiturates depress
the nervous system whereby the sexual ability is
Growing Up
reduced and sexual activity is sharply diminished.
'NO'.
Heroin: Heroin addicts prefer isolation, their sexual
desire or drive is low. Their sensory stimulation is
also low. In women addicts, it causes cessation of
menstruation, cessation of ovulation and sterility.
If women do get pregnant, their babies are bom
addicted and require medical treatment.
(d) Media fantasies
LSD (Lysergic Acid Diethylamide): LSD is a halluci
nogen : the addicts have distortions of reality and
report a wide range of sexual activity whilst
crouched in a comer or lying immobile. LSD taken
during pregnancy enters the placenta and can harm
the developing baby.
Marijuana : Marijuana causes damage to the repro
ductive system. Women addicted to marijuana
have been known to show menstrual irregularities.
Infertility, and perhaps sterility, can also occur.
Spanish fly : This is not an aphrodisiac as is com
monly believed. In fact it is poisonous. It produces
urogenital irritation which indirectly causes an
erection in males and vaginal lubrication in fe
males. Spanish fly does not produce erotic or sexual
interest. Large doses lead to stomach pain, distur
bances in urinating, damage to kidneys or blad
der and in extreme cases even death.
Can a person hooked on drugs get help? Yes, it is pos
sible to get off the habit. It is difficult with some of
the drugs but with persistence and determination
it is possible.
&
Admit that you have a problem.
*
Talk to your parents, teachers or other adults
whom you trust and ask for their help.
*
Medical and psychological help is available at
local drug addiction centres. Locate such a
centre for help
*
Persevere with the course of treatment ad
vocated.
The best way to stop the problem is not to start
on drugs but to know the facts and learn to say
43
Fantasies to some extent are normal and all ado
lescents indulge in them.
For some adolescents Indian heroes and hero
ines from the cinema become role models. These
film characters are stereotypical and are far re
moved from reality. Adolescents who try to emu
late them or who long for a relationship with a
person that fits these roles are in for disappoint
ment. Many young married people have been dis
illusioned when their partner has not matched up
to their 'filmi' ideal.
Many films depict the macho image in their he
roes making them aggressive and taking advan
tage of females. Females are shown to appreciate
their roles. In real life situations, boys emulate the
'filmi' heroes often leading to threatening situa
tions for the girls.
5.
Dangers associated with sex
Sexual abuse, STD and HIV/AIDS are dealt with
in detail in Chapters XV, XVI and XVII respectively.
Unplanned and unintended pregnancies are taken
up in Chapter XIII on Abortion.
How Adults Can Cope with Adolescents
Guidance from caring adults is essential. Such
guidance helps youngsters to maintain order in
their lives during this period of rapid change. No
matter how adults feel — anxious, ashamed, afraid
— about adolescents, they have a duty to provide
them with knowledge, protection and support.
The help given to the adolescent must be subtle
and diplomatic.
*
Give helpful criticism — address the event; do
not attack the person.
* Have a problem-solving approach. Weigh the
pros and cons of the problem/situation with
adolescents and help them solve their prob
lems.
Table VI-A : COMMON DRUGS—SYMPTOMS OF ABUSE
Methods of use
Symptoms of use
Hazards of use
Marijuana
Hashish
Pot, Grass,
Reefer, Weed,
Colombian hash,
Hash oil,
Sinsemilla, Joint,
Chiba, Herb, Spliff
Most often smoked,
can also be
swallowed in
solid form
Sweet, burnt odour
Neglect of
appearance
Loss of interest,
motivation
Possible weight
change
Impaired memory perception
Interference with psycho
logical maturation
Possible damage to lungs,
heart, reproduction,
and immune systems
Psychological dependence
Cocaine
Coke, Snow,
Toot, White lady,
Blow, Rock
CRACK
Most often smoked
or inhaled;
also injected or
swallowed in
powder, pill
or rock form
Restlessness,
anxiety
Intense, short-term
high followed by
depression
Intense psychological
dependence
Sleeplessness, anxiety
Nasal passage damage
Lung damage
Death from overdose
Amphetamines
*
Dextroamphetamine
Methamphetamine
Speed, Uppers,
Pep pills, Bennies,
Dexies,
Moth, Crystal,
Black beauties
Swallowed in pill or
capsule form, or
injected into veins
Excess activity
Irritability,
nervousness
Mood swings
Needle marks
Loss of appetite
Hallucinations, paranoia
Convulsions, coma
Brain damage
Death from overdose
Nicotine
Coffin nail,
Butt, Smoke
Found in cigarettes,
cigars, pipe and
chewing tobacco
Smell of tobacco
High carbon mon
oxide levels
Stained teeth
Yellow fingers
Cancers of the lung, throat,
mouth, oesophagus
Heart disease, emphysema
Barbiturates
Pentobarbital
Secobarbital
Amobarbital
Barbs, Downers,
Yellow jackets,
Red devils,
Blue devils
Swallowed in pill form
or injected into veins
Drowsiness
Confusion
Impaired judgment
Slurred speech
Needle marks
Constricted pupils
Infection
Addiction with severe
withdrawal symptoms
Loss of appetite
Death from overdose
Nausea
Quaalude
Sopor
Ludes
Soapers
Swallowed in pill form
Impaired judgment
and performance
Drowsiness
Slurred speech
Death from overdose
Injury or death from car
accidents : severe interaction
with alcohol
Stimulants
Drugs that
stimulate the
central nervous
system
•Includes lookalike drugs that
contain caffeine,
phenylpropanol
amine (PBA)
& ephedrine
Depressants
Drugs that
slow down the
central nervous
system
Drug name
E ducation in H uman S exuality
Street names
Type of drug
Narcotics
Natural or
synthetic drugs
that contain or
resemble opium
Dilaudid Percodan
Demerol Methadone
Codeine
Swallowed in pill or
liquid form, injected
School boy
Morphine
Heroin
Hallucinogens
Injected into veins,
smoked
Needle marks
Most often smoked
can also be inhaled,
(snorted), injected or
swallowed in tablets
Slurred speech
blurred vision,
incoordination
Confusion, agitation
Aggression
Anxiety depression
Impaired memory perception
Death from accidents
Death from overdose
LSD
Acid, Cubes,
Purple haze
Usually swallowed
Dilated pupils
Illusions,
hallucinations
Mood swings
Breaks from reality
Emotional breakdown
Flashback
Mescaline
Psilocybin
Mesc cactus
Magic mushrooms
Usually swallowed in
their natural form
Booze, Hooch,
Juice, Brew
Swallowed in liquid
form
Impaired muscle
coordination,
judgment
Heart & liver damage
Death from overdose and
accidents
Addiction
Inhaled or sniffed,
often with use of
paper or plastic
bag or rag
Poor motor
coordination
Impaired vision,
memory and
thought
High risk of sudden death
Drastic weight loss
Brain, liver, and bone
marrow damage
Gasoline
Airplane glue
Paint thinner
Dry cleaner fluid
Nitrous oxide
Laughing gas,
Whippets
Inhaled or sniffed by
mask or balloons
Abusive, violent
behaviour
Lightheadedness
Death by anoxia
Neuropathy, muscle
weakness
Amyl nitrite
Butyl nitrite
Poppers, Snappers,
Rush, Locker room
Inhaled or sniffed from
gauze or ampoules
Slowed thought
Headache
Anaemia, death by anoxia
Source : Healthwatch. The Afternoon Despatch & Courier, 20 February 1995, p. 17
G rowing Up
Angel dust.
Killer hog weed.
Supergrass,
PeaCee Pill
Alcohol
Substances
abused by
sniffing
Swallowed in pill or
liquid form
Addiction with severe
withdrawal symptoms
Loss of appetite
Death from overdose
PCP
(Phencyclidine)
Drugs that
alter
perceptions
of reality
Inhalants
Drowsiness
Lethargy
46
*
*
Education in Human Sexuality
stay at home.
Avoid back and forth arguments. The situation
only deteriorates and makes matters worse.
Adolescents should learn from adults to dis
tinguish between events that are merely un
pleasant or annoying and those that are seri
ous or tragic.
Adults need to be clear about the extent of free
dom they want to give, and the limits they wish to
set for adolescents.
The limits should never be arbitrary or whimsi
cal. They should be anchored in values and aimed
at character building. The limits should be dis
cussed with the adolescent in the hope of arriving
at a consensus, though this may not be achieved.
Such discussions should result in clear and explicit
ground rules on:
— time limit and frequency of parties or out
ings with friends;
— dress code;
— pocket money and personal expenses;
— home chores and responsibilities;
— academic achievements.
Maturity cannot come to adolescents by blindly
obeying adults. They must leam to make their own
decisions, build up their own values, and live their
own lives.
Stereotype Adult Messages Sent to Adoles
cents
Parents and other adults consciously or other
wise often convey messages which car. influence
the attitudes of adolescents. For example:
* Boys can enjoy sexual liberties, while girls need
to be sheltered and protected.
* Boys may be carefree while girls need to shoul
der household responsibilities.
* Boys may have a career, while girls should
#
Boys who are not attracted towards girls are
not manly enough.
#
Girls need to show their femininity by being
coy, dependent, and sensitive.
❖
Boys may not show their feelings.
*
Girls who may have been sexually abused
should suffer in silence rather than bring shame
upon their families.
❖
Girls should be married as soon as possible.
These messages can lead to negative attitudes
and effects on adolescents. They can :
— curb the development of the personality;
— create double standards in society;
— create gender bias, (i.e. discrimination
against females;
— cause pain and heartbum to the affected
party.
Some Common Questions Asked,by Boys and
Girls During Late Childhood and Adolescence
The fifty questions given below were commonly
asked by girls and boys during their discussions
on human sexuality. This list is by no means ex
haustive. The answers to all the fifty questions oc
cur in the text of this book. For easy reference, the
chapter number that has the answer to the ques
tion is given in brackets at the end of each ques
tion. For example : What exactly is menstruation?
(VUI) This means that the answer to the question
'What exactly is menstruation?' will be found in
Chapter VHI.
1. What exactly is menstruation? (VUI)
2. What care should be taken at the time of men
struation? (VUI)
3. What should one do when the periods are not
regular? (VUI)
Growing Up
47
Are there special diets/exercises/customs etc 33. What is homosexuality? (XIV)
34. What is circumcision? (VH)
to be followed during menstruation? (VUI)
35. What is the Rh Factor? (IX)
5. From where does the woman bleed? (VUI)
6. Why do different girls get menstruation at dif 36. What are wet dreams? (VU)
37. What is rape? (XV)
ferent ages? (VEH)
7. What is the normal duration of menstrual peri 38. What happens to a girl who is raped? (XV)
39. What happens to a boy who rapes a girl? (XV)
ods? (VUI)
8. Why do some girls have pain during their men 40. Who are prostitutes? (XV)
41. What is meant by VD? (XVI)
struation? (VUI)
9. Why do boys not get periods as girls do? (VII, 42. Who are eunuchs? (VU)
VUI, IX)
43. How does one become a eunuch? (VU)
10. What is white discharge? Is it normal to have 44. Does the size of a boy's penis have anything to
do with his masculinity? (VII)
it? (VUI)
11. What is menopause? (VUI)
45. Why do some mothers get all daughters only
or all sons only? (IX)
12. What is intercourse? (IX)
13. How frequently can a couple indulge in sexual 46. Why can't some women get babies? (IX)
47. Who is a lesbian ? (XIV)
intercourse? (IX)
14. Can one have intercourse during menstruation 48. Who is a transvestite? (XIV)
and pregnancy? (VIII, IX)
49. What is masturbation? (XIV)
15. Does a pregnant woman get her menstrual pe 50. What is AIDS? (XVII)
riods ? (IX)
Education in Human Sexuality
16. What is meant by orgasm and coitus? (IX)
17. Do girls become pregnant by kissing a boy? (EX)
* Adolescents need help in building up their self18. How do sperms get into the vagina?(LX)
esteem.
19. What is family planning? (XII)
20. Is the withdrawal method a safe one? (XII)
* They need to develop skills in
21. What are the different methods of family plan
ning? (XII)
— decision-making
22. What is abortion? What is miscarriage? What
— resisting negative peer pressure
is curetting? (XUI)
— handling negative emotions
23. If a girl does not get her periods, does that mean
— protecting themselves from eve-teasing, rape,
she cannot have a baby? (VUI)
and sexual harassment (for girls and boys)
24. Why is there a feeling of nausea during preg
— building up and maintaining healthy and
nancy? (IX)
satisfying relationships.
25. How does the baby come out of the mother's
body? (IX)
* Adolescents need to learn about
26. What are twins? (IX)
— sexual and reproductive health
27. What are Siamese twins? (IX)
— safe sex
28. Why are some babies bom dead? (IX)
— different forms of sexual behaviour
29. What is a Caesarean operation? (IX)
— the harmful side of sex.
30. Why are some babies bom in the seventh or
eighth month? (IX)
* Anything and everything adolescents bring up
31. Why are some children bom defective? (IX)
and want to know about should be discussed.
32. How do unmarried girls get children? (IX)
4.
48
Education in Human Sexuality
VALUE BUILDING
1. Sexuality is a natural and healthy part of living.
2.
All persons are sexual.
3.
Sexuality indudes physical, ethical, spiritual, social, psychological, and emotional dimen
sions.
4.
Even' person has dignity and self-worth.
5.
Individuals express their sexuality in varied ways.
6.
In a pluralistic society, people should respect and accept the diversity of values and
liefs about sexuality that exist in a community.
7.
Sexual relationships should never be coercive or exploitative.
8.
Sexual relationships should be based on mutual trust, honesty, commitment and respect.
9.
All children should be loved and cared for.
10.
All sexual decisions have effects or consequences.
11.
All persons have the right and the obligation to make responsible sexual choices.
12.
Individuals and society benefit when children are able to discuss sexuality with their
parents and/or other trusted adults.
13.
Young people explore their sexuality as a natural process of achieving sexual maturity.
14.
Premature involvement in sexual behaviour poses risks.
15.
Sexual behaviour must be responsible and self-disciplined.
16.
Abstaining from sexual intercourse is the most effective method of avoiding pregnancy
and preventing STD and HIV / AIDS.
17.
Young people who are involved in sexual relationships need access to information about
health care services.
be
Growing Up
49
E Youth (19 + Years of Age)
General Traits
tual age at which young people marry is rising.
This is the period of transition from adolescence
to adulthood.
With greater opportunities available to girls for
education and jobs in the cities, girls are becoming
more independent and are making more decisions
on their own. They choose to develop interests,
pursue careers and postpone marriage. Some of
them may marry late in life and there are some who
decide not to marry at all. A single man is more
readily accepted in society than a single woman.
Yet more women than before are living single lives
and are coping with the challenges that go with
this lifestyle.
Youth take on a more responsible role.
*
This is the age for making decisions about
careers and lifestyles.
Many show a greater involvement in com
munity activities.
:k This is also the time to start thinking about se
lecting a partner, courting and marriage. Girls
may be more likely to discontinue their stud
ies and get married. On the other hand, some
young people delay marriage as they are too
busy building up their careers and financial
security.
In joint families single women or men go rela
tively unnoticed by society. In nuclear families be
ing single becomes prominent.
Singleness is dealt with in Chapter XI, 'Prepa
ration for Marriage and Singleness'.
Youth and Marriage
Value Building
One of the most important events in life is mar
riage. Young people start dreaming about marriage
at this stage. There is also pressure from the par
ents and society to have a partner and settle down
in marriage. The practice in some places is to get
young people married even before the legal age.
As people become educated, they become aware
of the drawbacks of early marriages, and the ac
Youth should build up the same values as Adoles
cents.
Education in Human Sexuality
The emphasis at this stage is on preparation for
marriage, family planning, and family life.
References
Carrera, M., Sex — The Facts, The Acts and Your Feelings,
London : Mitchell Beazley Publishers, 1981.
Christian Medical College, Adolsense : Preparing for Adult
hood, Vellore. India : Resource and Reference Centre,
Psychosocial Aspects of Aids (undated)
Ginott, H., Between Parent and Teenager, New York : The
Macmillan Company, 1969.
Ministry of Education, Values, Influences, and Peers, Ontario,
Canada : Curriculum Ideas for Teachers, 1984.
Papalia, D. and Olds S.W., Human Development, Tokyo :
McGraw - Hill Kogakusha Ltd., 1978.
Sathe, S.A., Sex Education—Some aspects. Paper presented
at a Workshop on Sex and Sexuality, FPAI - SECRT, Pune,
Family Planning Association of India, 14-17 August 1992.
Scriptographic Communications Ltd., Peer Pressure, Ontario,
Canada : 1987.
Scriptographic Communications Ltd., Understanding Adoles
cence, Ontario, Canada: 1988.
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February 1999 - Draft
WHO/SCHOOL/98._
WHO/HPR/HEP/98._
Dist.: General
Original: English
WHO INFORMATION
SERIES ON
SCHOOL HEALTH DOCUMENT
PREVENTING
HIV/AIDS/STD AND
RELATED
DISCRIMINATION:
AN IMPORTANT
RESPONSIBILITY
OF HEALTH
PROMOTING
SCHOOLS
World Health Organization
UNAIDS
Geneva, 1998
mm
UNESCO
WHO Information
Series on
School Health
PREVENTING
HIV/AIDS/STD AND
RELATED
DISCRIMINATION:
AN IMPORTANT
RESPONSIBILITY OF
HEALTH
PROMOTING
SCHOOLS
The development of this document is a joint effort of the Department of Health Promotion, Social Change
and Mental Health Cluster and the Office of HIV/AIDS and Sexually Transmitted Diseases.
This document is published jointly with United Nations Educational, Scientific and Cultural Organization
(UNESCO), the Joint United Nations Programme on HIV/AIDS (UNAIDS) and Education International (El),
Brussels, Belgium which are working with WHO to promote health through schools worldwide.
WHO gratefully acknowledges the generous financial support for the printing of this document from: the
Division of Adolescent and School Health, National Centre for Chronic Disease Prevention and Health
Promotion, Centres for Disease Control and Prevention, Atlanta, Georgia, USA; and the Johann Jacobs
Foundation, Zurich, Switzerland.
A copy of this document can be downloaded from the WHO Internet Site at; http://www.who.ch/hpr
This document is not a formal publication of the World Health Organization (WHO), and all rights are reserved by the
Organization. The document may, however, be freely reviewed, abstracted, reproduced and translated, in part or in whole, but
not for sale or for use in conjunction with commercial purposes.
The views expressed in documents by named authors are solely the responsibility of those authors.
© World Health Organization, 1999.
ACKNOWLEDGEMENTS
This document was prepared for WHO by Sandra I. Aldana, California State University, Northridge
(USA), in collaboration with Jack T. Jones, School Health Team Leader, Department of Health
Promotion, Social Change and Mental Health Cluster (HSC/HPR), Geneva. It was revised with substantial
additional content by Louk Peters, Muriel van den Cruijsem, Jo Reinders and Goof Buijs, Netherlands
Institute for Health Promotion and Disease Prevention. The document was edited Matthew Furner, Pat
Drury, HSC/HPR and by Cynthia Lang, Education Development Center, Inc.
WHO would like to thank the following individuals who offered substantial comments and suggestions
during the document's preparation and finalization:
Mariella Baldo
UNAIDS
New York, USA
Sonia Bahri
Division for the Renovation of Secondary and Vocational Education
UNESCO
Paris, France
Isolde Birdthistle
Education Development Center, Inc.
Newton, Massachusetts, USA
A.P.
D.
Bundy
The World Bank
Washington DC, USA
Uyen Luong
UNFPA
New York, USA
Matilde Maddaleno
Adolescent Health Family Health and Population Program
WHO/PAHO
Washington, USA
T.E. Mertens
Office of HIV/AIDS and Sexually Transmitted Diseases, WHO
Geneva, Switzerland
Aune Naanda
Division for the Renovation of Secondary and Vocational Education
UNESCO
Paris, France
Leah Robin
Division of Adolescent and School Health
Centre for Disease Control and Prevention
Atlanta, Georgia, USA
Livia Saldari
Division for the Renovation of Secondary and Vocational Education
UNESCO
Paris, France
CONTENTS
FOREWORD
1.
2.
INTRODUCTION
1.1
Why did WHO prepare this document? ..............................................................
1.2
Who should read this document?
1.3
What are HIV, AIDS and STD?
1.4
Why prevent HIV/STD infection and related discrimination?
1.5
Why focus on schools?
1.6
How will this document help people promote health? ........................................
1.7
How should this document be used?
CONVINCING OTHERS THAT THE PREVENTION OF HIV INFECTION AND
RELATED DISCRIMINATION THROUGH SCHOOLS
IS AN URGENT PUBLIC HEALTH ISSUE
2.1
Argument:
For better or worse, schools already play a
significant role in the HIV pandemic...........................................
2.2
Argument:
HIV infection is in pandemic proportion...........................................
2.3
Argument:
HIV/AIDS is affecting millions of young people.............................
2.4
Argument:
HIV infection is a chronic disease that affects the physical,
psychological and social well-being of individuals who are
infected, their peers and families and community members.......
2.5
Argument:
Schools need to provide HIV education along with education
about sexuality, reproductive health, life skills, substance use
and other important health education issues, to maximize
investments in youth and education..................................................
2.6
Argument:
Schools can play an important role in educating community
members and working with them to determine the most
appropriate and effective ways to prevent HIV infection among
young people.........................................................................................
2.7
Argument:
Policies and curricula can provide highly visible opportunities
to demonstrate a commitment to equity, gender and human
rights........................................................................................................
3.
CONVINCING OTHERS THAT HIV PREVENTION INTERVENTIONS IN SCHOOLS
WILL REALLY WORK
3.1
3.2
Argument: We know how HIV infection is spread
Argument: Schools can help prevent and reduce the risk of HIV
infection among young people
3.3
Argument: HIV prevention interventions can have a broad impact on students' health
and the classroom environment
3.4
3.5
Argument: Sex education will not lead to early sexual activity
Argument: HIV prevention interventions in schools can benefit the entire
community as well as students
4.
PLANNING THE INTERVENTIONS
4.1
School and community involvement in planning
4.2
4.3
4.4
4.1.1
School Health Team
4.1.2
Community Advisory Committee
Situation analysis-
4.2.1
Purpose of conducting a situation analysis
4.2.2
Information needed
Political and cultural acceptability
4.3.1
Political commitment
4.3.2
Community commitment
4.3.3
Supportive school policies
Goals and objectives of HIV/STD prevention interventions in schools
4.4.1
Goals
4.4.2
Objectives
5.
INTEGRATING HIV/STD PREVENTION INTERVENTIONS
WITHIN VARIOUS COMPONENTS OF A SCHOOL HEALTH PROGRAMME
5.1
School health education
5.1.1
Knowledge, values, beliefs, attitudes, skills and related conditions
that influence behaviours associated with HIV/STD infection
5.1.2
Important considerations in planning education about HIV/STD
5.1.3
Selecting educational methods and materials for health education
5.1.4
Choosing educational options
5.1.5
Peer education and involvement
5.1.6
Training school personnel to implement health education
and other efforts to prevent HIV/STD infection and related discrimination
5.2
A healthy school environment
5.2.1
Policy for HIV-infected school staff, teachers and students
5.2.2
Universal infection-control precautions for teachers and students
5.2.3
Creating an environment that promotes HIV/STD prevention and fosters
understanding, caring and empathy for others
5.3
School health services
5.3.1
Caring and support
5.3.2
Other support
5.3.3
Treatment for HIV-related conditions
5.4
Family, school and community projects and outreach
5.5
Health promotion for school staff.
6. EVALUATION
6.1.1
6.1
Types of evaluation
Process Evaluation
6.1.2
Outcome Evaluation
6.2
Evaluating the planning and implementation of HIV/STD interventions,.
6.3
6.2.1
Evaluating HIV-related policies
6.2.2
Evaluating HIV/STD curriculum
6.2.3
Evaluating HIV/STD staff development programmes
6.2.4
Evaluating the school environment
6.2.5
Evaluating school health services
Evaluating student outcomes
.................................
..............................................................................................
BIBLIOGRAPHY
ANNEX 1
ANNEX 2
ANNEX 3
SCHOOL CURRICULA THAT WORK
OTTAWA CHARTER FOR HEALTH PROMOTION (1986)
INTEGRATING HIV/STD PREVENTION IN THE SCHOOL SETTING:
A POSITION PAPER (UNAIDS)
I
FOREWORD
Investments in schools are intended to yield benefits to communities, nations and individuals. Such benefits
include improved social and economic development, increased productivity and enhanced quality of life. In many
parts of the world, such investments are not achieving their full potential, despite increased enrolments and hard
work by committed teachers and administrators. This document describes how educational investments can be
enhanced, by increasing the capacity of schools to promote health as they do learning.
For better or worse, health influences education. Healthy children learn well. If children are healthy, they can take
full advantage of every opportunity to learn. But, children who cannot attend school because of poor health or
unhealthy conditions cannot seize the opportunities that schools provide. Similarly, schools cannot achieve their
full potential if children who attend school are not capable of learning well. Poor health and unhealthy conditions
jeopardize the value of school attendance.
This document is part of the WHO Information Series on school health promotion prepared for WHO’s Global
School Health Intiative. Its purpose is to strengthen efforts to help young people learn how to prevent HIV
infection, AIDS and Sexual Transmitted Disease (STD). Approximately 60% of today’s new HIV infections are
occurring among persons under 25 years of age. Young people learn about sexuality, HIV, AIDS and STD, in
school in informal as well as formal ways. Therefore, we must ensure that our formal sources of learning provide
accurate information that can reduce undue fear and prejudice and enable young people to protect themselves,
both now and in the future. The HIV pandemic continues into the 21st century because of ignorance and our
inability to help each other take better control over the circumstances that can lead to infection. Schools can help
overcome both of these barriers.
WHO’s Global School Health Initiative is a concerted effort by international organizations to help schools improve
the health of students, staff, parents and community members. Education and health agencies are encouraged
to use this document to prevent HIV infection, AIDS, STDs and related discrimination and to take important steps
that can help their schools become “Health-Promoting Schools".
Although definitions will vary, depending on need and circumstance, a "Health-Promoting SchoolD can be
characterized as a school constantly strengthening its capacity as a healthy setting for living, learning and
working (see box after the foreword).
The extent to which each nation's schools become Health-Promoting Schools will play a significant role in
determining whether the next generation is educated and healthy. Education and health support and enhance
each other. Neither is possible alone.
Dr Desmond O’Byrne
T.E. Mertens
Health Education and Promotion Unit
World Health Organization
Office of HIV/AIDS and
Diseases
World Health Organization
Awa Marie Coll-Seck
Qian Tang
Director
Department of Policy, Strategy & Research
UNAIDS
Director, ai
Division for the Renovation of Secondary and
Vocational Education
UNESCO
Sexually
Transmitted
HEALTH-PROMOTING SCHOOL
A Health-Promoting School:
•
fosters health and learning with all the measures at its disposal
•
engages health and education officials, teachers, students, parents, and
community leaders in efforts to promote health
•
strives to provide a healthy environment, school health education, and school
health services along with school/community projects and outreach, health
promotion programmes for staff, nutrition and food safety programmes,
opportunities for physical education and recreation, and programmes for
counselling, social support and mental health promotion
•
implements policies, practices and other measures that respect an individual's
self-esteem, provide multiple opportunities for success, and acknowledge good
efforts and intentions as well as personal achievements
•
strives to improve the health of school personnel, families and community
members as well as students; and works with community leaders to help them
understand how the community contributes to health and education
1.
INTRODUCTION
This document, part of the WHO Information Series on School Health, is intended to help people use health
promotion strategies to improve health and prevent HIV/AIDS/STD and related discrimination. Based on the
recommendations of the Ottawa Charter for Health Promotion (Annex 2), it will help individuals and groups
move toward a new approach to public health, one that creates on-going conditions conducive to health and
healthy lifestyles, as well as reducing prevailing health problems.
While the concepts and strategies introduced in this document apply to all countries, some of the examples
may be more relevant to certain countries than others. Cultural variations are closely linked to HIV/STD risks
and planners need to consider them carefully in designing interventions.
1.1
Why did WHO prepare this document?
The World Health Organization (WHO) has prepared this document to help people care for themselves and
others, acquire the ability to make healthy decisions and have control over their lives, and ensure that society
creates conditions that allow all its members to attain health. (1)
It provides information that will assist individuals and groups to:
•
make a strong case for increased efforts to prevent HIV/AIDS/STD through schools
•
understand the nature of a Health-Promoting School
•
plan and implement HIV/AIDS/STD prevention and health promotion as part of developing a
Health-Promoting School
1.2
Who should read this document?
This document is directed towards:
•
Governmental policy-makers and decision-makers, programme planners and coordinators at local,
district, provincial and national levels, especially those from the ministries of health and education
•
Members of nongovernmental institutions and of other organizations and agencies responsible
for planning and implementing health and HIV/AIDS/STD interventions, especially programme
staff and consultants of national and international health, education and development programmes
interested in promoting health through schools
•
Members of the school community , including teachers and their representative organizations,
students, staff, parents, volunteers and school-based service workers
•
Community leaders, local residents, health care providers, social workers, development assistants,
media representatives and members of organized groups (e.g. youth groups and women's groups
interested in improving health, education and well-being in the school and the community)
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1.3
What are HIV, AIDS and STD?
The term “HIV’ stands for the Human Immunodeficiency Virus. This virus destroys the body’s immune system
so severely that it cannot fight certain diseases. While an HIV-infected person can live for many years without
major health problems, the virus' destructive effects will eventually result in Acquired Immune Deficiency
Syndrome, or "AIDS’.
People with AIDS become increasingly vulnerable to diseases and ultimately die from diseases that their
immune systems and medicines cannot fight. Research is showing that early treatment with a combination
of medicines can delay the development of AIDS in people infected with HIV.
Sexually Transmitted Diseases, or "STDs” is a general term for infectious diseases that are spread through
sexual contact. HIV/AIDS can be regarded as an STD. Other major STDs are syphilis, gonorrhea and
chlamydia. The highest rates of STDs are usually found in the 20-24 age group, followed by the 15-19 age
group. (2)
1.4
Why prevent HIV/STD infections and related discrimination?
Today, HIV infection is one of the major causes of disease and death among persons aged 25-44. It has
already taken millions of lives and caused enormous personal, social and economic losses throughout the
world. Education about HIV can help to prevent new HIV infections and reduce suffering and economic loss
Furthermore, ignorance and lack of information about HIV/AIDS fuels a great deal of prejudice, causing
individuals to fear contact with people who may be infected with HIV or who have AIDS. Since health is a
fundamental human right, society is obliged to help dispel biased attitudes and prejudices that affect society’s
overall well-being.
1.5
Why focus efforts on schools?
The school is a priority setting because it offers substantial opportunities to prevent infection and
discrimination:
•
Schools provide an efficient and effective way to reach large numbers of the population, including young
people, school personnel, families and community members.
•
Schools can provide interventions that help reduce infections and related discrimination.
•
Students can be reached at influential stages in their lives when lifelong behaviours are formed.
•
Schools can provide a channel to the community to introduce HIV/AIDS prevention information and
technology and advocate policies that reduce discrimination.
1.6
How will this document help people promote health?
This document is based on the latest scientific research and experience related to HIV/AIDS prevention, but
it is more than a technical document. It is designed to help people address the broad range of factors that
must be changed to prevent and reduce risk behaviours and conditions that lead to HIV infection, and help
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schools become Health-Promoting. This document will help individuals and groups to carry out five major
tasks.
Create Healthy Public Policy
This document provides information that can be used to argue for increased local, district and national support
for tobacco use prevention interventions in schools. It also provides a basis for justifying decisions to increase
such support.
Develop Supportive Environments
This document describes physical, psychological and social enhancements to the school and community
environment that can help reduce the spread of HIV infection and related discrimination. It also describes how
parents, teachers, community leaders and others concerned about HIV/AIDS/STD interventions in schools
can support these changes in schools.
Reorient Health Services
This document describes how existing health services can be enhanced and made more accessible to to
complement school health promotion efforts.
Develop Personal Skills
This document identifies information and skills that young people must acquire in order to reduce the risk of
infection and avoid conditions that can lead to HIV infection. It also identifies the skills that others need to
create conditions conducive to preventing HIV/AIDS/STD and developing Health-Promotion Schools.
Mobilize Community Action
This document identifies essential actions that the school, in collaboration with the community, must take to
promote health and prevent the spread of HIV/STD infection, mobilize community support and strengthen
school health programmes. It also provides arguments and facts that can be communicated through the mass
media to call attention to the problem of HIV/AIDS/STD and to the important role schools can play in
prevention.
1.7
How should this document be used?
Information in Section 2 and Section 3 can be used to argue for HIV/STD prevention interventions in schools.
Section 4 creates a strong basis for local action and for planning interventions relevant to the needs and
circumstances of the school and community. Section 5 provides specific details about how to integrate
HIV/AIDS/STD interventions into various elements of a Health-Promoting School.
Section 6 provides
information to use in evaluating and improving efforts to prevent HIV/STD infection and related discrimination.
For specific guidance on planning, implementing and evaluating, this document should be used in conjunction
with the WHO document "Local Action: Creating Health-Promoting Schools." Local Action: Creating Health
Promoting Schools provides practical guidance, tools and tips from Health-Promoting Schools around the
world and can help tailor efforts to the needs of specific communities.
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2.
CONVINCING OTHERS THAT THE PREVENTION OF HIV/STD
INFECTION AND RELATED DISCRIMINATION THROUGH SCHOOLS
IS AN URGENT PUBLIC HEALTH ISSUE
The following arguments can be used to convince others of the importance of implementing HIV prevention
interventions in schools and the need for increased investment in such efforts.
Argument: For better or worse, schools already play a significant role in the
HIV pandemic
2.1
Intentionally or otherwise, schools play a significant role - for better or worse - in contributing to or hindering
the prevention of HIV/STD infection and related discrimination. Examples of the rotes they play are listed
below.
For the better, schools:
•
provide access to education about HIV/AIDS/STD to students, staff and community members
•
work with communities to determine the most appropriate and effective ways to educate young
•
people about HIV/AIDS/STD
take part in national and community initiatives to prevent HIV/AIDS/STD
•
develop policies about HIV that support the rights of students and staff to team and work in schools
•
develop policies that support the provision of HIV/AIDS/STD education
•
provide education to young children to reduce fear about HIV/AIDS
•
provide education to pre-adolescents to explain how HIV is and is not spread and how HIV affects
•
provide education to adolescents, before they are faced with sexual decisions, to help them acquire
•
integrate HIV/STD education into education about reproductive health, life skills, alcohol/substance
•
use and other important health issues
include HIV/STD education in other relevant subject areas such as home economics, family life,
•
enhance education about HIV/AIDS/STD through practices that foster caring, respect, self-efficacy,
families, communities and nations
the knowledge, attitudes, values, skills and support needed to avoid HIV/STD infection
science, social studies and other areas as suggested in official school policies
self-esteem, decision-making and through conditions that allow for the healthy development of
students, teachers and other staff
•
provide training about HIV/AIDS/STD for all teachers and school personnel
•
involve young people in HIV/AIDS/STD education in the classroom, through peer education and
•
•
teach boys and girls to respect themselves and one another
foster discussion of HIV/AIDS/STD, sexuality and other important health issues in the community and
through a variety of other learning experiences such as theatre, song and poster design
family
For the worse, schools:
•
•
are a source of rumour and misinformation about AIDS
permit individuals who are not adequately informed to address HIV/AIDS/STD with students and staff
•
ask or even require teachers to teach about HIV/AIDS/STD without providing proper training or tools
•
develop policies that prohibit the attendance of students and staff who are infected with HIV and
consequently generate unwarranted fear
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WHO Information Series on School Health
•
isolate students, teachers and staff whose families are infected or affected by HIV/AIDS
•
prohibit discussions about HIV/AIDS/STD lessons, creating suspicion and curiosity
•
prohibit teachers from providing sexual information along with education about HIV/AIDS/STD,
thereby restricting clear and accurate information about routes of transmission and differences in
•
sexual orientation
provide only sporadic, fragmented and inadequate opportunities for students to learn about
•
staff
exclude young people from being actively involved in developing and implementing learning
HIV/STD prevention, resulting in many unanswered questions and concerns among students and
experiences that could influence their health for the better, including education about sexuality and
•
HIV/STD prevention
help sustain gender inequality by not teaching young men and women how to interact with one
•
another respectfully
help sustain biased attitudes among students, teachers and staff by not acknowledging differences
in opinions, values and beliefs about sexuality, gender and equity
•
remain isolated from national and community HIV/AIDS/STD initiatives even though the issues
are highly relevant to young people
2.2
Argument: HIV infection is in pandemic proportion
During 1997, an estimated 5.8 million people became infected with HIV and 2.3 million persons dies from
AIDS.(2) By the end of 1997, the total numberof AIDS deaths since the beginning of the epidemic stood at
11.7 million. AIDS and HIV infection are a worldwide pandemic that requires a worldwide response.
2.3
Argument: HIV/AIDS is affecting millions of young people
HIV infection is one of the major problems facing school-age children today. They face fear if they are
ignorant, discrimination if they or a family member or friend is infected, and suffering and death if they are not
able to protect themselves from this preventable disease.
Since 1988, the number of children and
adolescents infected by HIV has increased sharply, in both urban and rural areas worldwide. An estimated
30 million people alive today are infected with HIV or have AIDS; at least a third of these are young people
aged 10-24. Every day an estimated 7000 young people become infected with HIV.(1) In many countries, 60
percent of all new infections are among 15-24 year olds who will likely develop AIDS in a period ranging from
several months to more than 10 years.(2) At present, women and adolescents are the primary groups
becoming infected with HIV in Latin America and the Caribbean. In Sub-Saharan Africa, adolescent females
are becoming infected in their early teens and peak infection rates occur before age 25. Even the young
people, neither infected by HIV nor orphaned because of AIDS are affected by the socio-economic
consequences from the epidemic in hard-hit communities and countries. These figures are a cause of great
concern to health professionals, educators and concerned community members because HIV infection is
preventable.
2.4
Argument: HIV infection is a chronic disease that affects the physical,
psychological and social well-being of individuals who are infected, their
peers, families and community members
Statistical data about HIV/AIDS does not adequately convey the loss experienced by families, communities
and nations. Physically, HIV and AIDS are an ordeal for those with the illness. A common cold can turn to
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topics. Yet, parents often lack factual information and/or have difficulty addressing these issues with adults
as well as with children///) Some parents rely on schools to educate their children in ways they themselves
cannot.
Opinions and needs vary from school to school and from community to community. It is clear that in any
community, however, schools alone cannot make decisions about the most appropriate way to help young
people learn about HIV prevention. Community members must be well informed and closely involved in
making such decisions. Schools need to educate their community members and create forums for debate and
discussion. Only then, together, can they make decisions that will equip young people with the knowledge and
skills necessary to prevent HIV/STD infection and related discrimination.
2.7
Argument: Policies and curricula can provide highly visible opportunities to
demonstrate a commitment to equity, gender and human rights
Schools, traditionally, are the institutions that model society. Within the context of this "model" society,
students learn skills needed to make decisions about complex issues. Schools promote objectivity, inquiry and
debate as a part of the learning process, and by their very nature can further discussion of social issues such
as equity, gender and human rights. HIV/AIDS challenges equity, gender and human rights. The school can
either be a place that practices discrimination, prejudice and undue fear, or it can be a place that
demonstrates, in a highly visible manner, society's commitment to three - - - concepts.
’
/
EQUITY. Schools can ensure that "every child and every adolescent has the right to education", especially
education that is necessary for survival. According to the Convention on the Rights of the Child, the right of
children, even those with impairments, to receive education should not be circumvented under any
circumstances//?) In response to the challenge of HIV, youth need to receive information about
HIV/AIDS/STD and the risk of HIV/STD infection//3) Pupils infected with HIV should have the same
educational opportunities as others. Equity also ensures that both boys and girls receive complete information
about HIV/STD and their prevention and that both young men and women are taught about risk behavior,
respect and care for partners, and communication and other behavioral skills.
GENDER SPECIFICITY. Worldwide, rates of HIV infection are increasing among women, who are more
vulnerable - physiologically, socially, economically and psychologically - to the disease.(13) In Africa, south
of the Sahara, there are already six women with HIV for every five men with HIV. (14) Yet in many places,
schools are apprehensive about providing sex education or discussions of sexuality because of cultural
demands to protect young women from sexual experience/?) Thus, women often lack the skills needed to
communicate their concerns with their sexual partners or to practice behaviours that reduce their risk of
infection. In addition, women are often subject to systematic interpersonal and institutional inequalities;
important methods of HIV/STD prevention, such as condoms, are controlled by men. Gender-specific
education can help women address such structural and interpersonal inequalities.
HUMAN RIGHTS. Schools can help ensure that everyone has access to the knowledge and skills that
can help avoid HIV/STD infection and related discrimination. Those who are economically, socially or legally
deprived have little or no access to HIV/STD prevention programmes. The school may be the only channel
for reaching the deprived (especially women) with knowledge and skills for their well-being. Professional
educators, regardless of moral or political convictions, are bound to protect and promote the human and civil
rights of all people and help people recognise the psychosocial damage caused when human rights are
denied, whether for reasons of religion, culture, gender or sexual orientation.
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?
CONVINCING OTHERS THAT HIV PREVENTION INTERVENTIONS IN
SCHOOLS WILL REALLY WORK
The following arguments can be used to convince others that HIV prevention efforts in schools are worthwhile
and help policy-makers and decision-makers justify their decisions to support such efforts.
3.1
Argument: We know how HIV infection is spread
The specific behaviours which spread HIV infection are well defined. Schools have been successful in
teaching young people that HIV is spread from an infected to an uninfected person through: unprotected
sexual intercourse; shared use of unsterilized drug injecting equipment, and skin piercing, tattooing and
shaving equipment; blood transfusions (though only in countries where blood screening is not routine); and
from an infected mother to her child during birth.or breast-feeding.(15)
3.2
Argument: Schools can help prevent and reduce the risk of HIV infection
among young people
Schools have been successful in helping young people acquire the knowledge, attitudes and skills needed
to avoid infection. Education, when it is appropriately planned and implemented, is one of the most viable and
effective means available for stopping the spread of HIV infection.
Evaluation studies of HIV/AIDS education have identified the characteristics of school programmes that are
effective in persuading students to adopt safer sexual practices. Effective programmes focus on specific risk
taking behaviour, are based on social learning theory, use active and personalised teaching methods, provide
instruction on how to respond to social pressures, reinforce social norms against unprotected sex, and offer
opportunities to practice communication and negotiation skills. Also, programmes that promote postponement
of sex and protected sex seem to be more successful than programmes that promote abstinence alone.(16)
Annex 1 describes curricula that have proven effective in reducing risk behaviours related to HIV/STD infection
among youth.
3.3
Argument: HIV prevention interventions can have a broad impact on students'
health and the classroom environment
HIV/AIDS/STD interventions in schools can teach children behaviours that will empower them to make healthy
choices related to sex and other health issues. They can provide children with opportunities to learn and
practice life skills, such as decision-making and communication skills, which in turn, can help enhance other
important areas of adolescent development. HIV/AIDS interventions that deal with personal beliefs and use
participatory techniques can also lead to closer bonds between the teacher and the classffZ) and
demonstrate to the school population and community that the school cares for its students.
3.4
Argument: Sex education will not lead to early sexual activity
Researchers in many different cultural and ethnic settings have studied whether sex education leads young
people to engage in sexual intercourse much earlier than they would if they had not received sex education.
A 1997 UNAIDS review of 53 studies, which assessed the effectiveness of programmes to prevent HIV
infection and related health problems among young people, concluded that sex education programmes do
not lead to earlier or increased sexual activity among young people. In fact, the opposite seems to be true.
Twenty-seven studies reported that HIV/AIDS and sexual health education neither increased nor decreased
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sexual activity and attendant rates of pregnancy and STDs. Twenty-two reported that HIV and/or sexual
health education either delayed the onset of sexual activity, reduced the number of sexual partners or reduced
unplanned pregnancy and STD rates. These findings did not support the contention that sexual health and
HIV education promote promiscuity. On the contrary, the review concluded that school-based interventions
are an effective way to reduce risk behaviours associated with HIV/AIDS/STD among children and
adolescents. (18)
3.5
Argument: HIV prevention interventions in schools can benefit the entire
community as well as students
In many places, schools are a vital, central component of the community; school decisions and actions directly
affect many community members. Families of children in the schools may lack education themselves but hope
to learn from their children. This is particularly true of migrant or lower socio-economic populations.
Young people, who are adequately informed can play a positive role in helping prevent HIV/STD. They can
spread their knowledge to family members and others in their communities through their daily interactions,
school/community projects, drama or print media; they can reach out to the community and foster discussion,
debate, reflection and learning.
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4.
PLANNING THE INTERVENTIONS
Efforts to prevent HIV/AIDS/STD and related discrimination can be an entry point for schools that want to build
their capacity to plan and implement a wide range of health promotion efforts. The first step is to recognize
HIV/STD prevention as a priority for both health and education. The next step is to plan the interventions:
determine which strategies will have the most significant influence on health, education and development and
how to integrate interventions with other health promotion efforts for maximum results.
This section describes key steps to consider in planning HIV/AIDS/STD interventions as an essential element
of a Health-Promoting School:
•
Establishing a School Health Team and a Community Advisory Committee
•
•
•
Conducting a situation analysis
Fostering political and cultural acceptability
Developing school policies, intervention goals and objectives
School and community involvement in planning
4.1
Health-Promoting Schools involve members of the school and the community in planning programmes that
respond to local needs and can be maintained with available resources and commitments. Linkages are
needed between school administrators, teachers, health care workers, youth workers, pupils and peer leaders.
Two important groups to involve in the planning process are: a School Health Team and a Community
Advisory Committee.
4.1.1
School Health Team
A School Health Team is a group of people working together to maintain and promote the health of all people
who are working and learning at school. Potential members include: teachers, administrators, students,
parents and school-based service providers, such as members of the health services. The team should
include a balance of students and adults with various responsibilities in the school who are committed to the
idea of health and HIV/STD prevention Ideally, the team coordinates and monitors health promotion policies
and activities, including those related to HIV/AIDS. Since schools should implement programmes that respond
to important and relevant local needs, it is essential to involve students, parents, teachers and school
management in the planning process from the beginning.
•
Young people, involved in an early stage of planning, can help develop a programme that responds to
their specific needs and concerns.
•
•
Parents and teachers can help ensure that programmes are developed in a culturally appropriate manner.
Teachers and other school staff can help ensure that interventions are developed with consideration of
what they know and what they can do to establish HIV/STD prevention as an essential element of a
Health-Promoting School.
If a school does not have a School Health Team or group organised to address health promotion, the HIV/STD
prevention effort can provide the opportunity to form one. The School Health Team can include a balance of
students and adults who have various responsibilities in the school; members should be committed to the idea
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of health and HIV/STD prevention. The School Health Team, or selected members, can be responsible for
planning, designing and evaluating efforts to prevent and reduce HIV/STD. Active participation builds a sense
of ownership and involvement, which underpins community support and enhances the sustainability of the
programme.
4.1.2
Community Advisory Committee
A Community Advisory Committee can represent a wide spectrum of local groups and organizations that are
somehow linked to the school and provide information, arrange resources, give advice and provide support
for HIV/STD prevention. It is important for schools to work with outside groups and individuals who have an
impact on students' knowledge, attitudes and behaviours related to HIV/STD prevention.
The Community Advisory Committee should include men and women with a diversity of skills who:
•
are influential in the community or district
•
are interested in health promotion and HIV/STD prevention
•
•
are able to mobilize support and connections
represent the community's geographical areas as well as economic, social, ethnic and religious make-up
It may be beneficial to collaborate with existing community groups, such as a healthy city council or local AIDS
prevention committee.
Potential partners can include: representatives of local government and non
governmental organizations, businesses and vendors, media, religious leaders, community residents,
community youth agencies, social service providers, health service providers and sports figures.
To facilitate the efforts of the School Health Team, the Community Advisory Committee can help to:
•
determine local needs and resources
•
disseminate information about health and HIV/STD prevention
•
•
build community support
encourage community involvement
•
help obtain resources and funding for health and HIV/STD prevention interventions
•
reinforce learning experiences provided in school
The Community Advisory Committee and the School Health Team should work together to plan health
promotion efforts and coordinate the various components of a Health-Promoting School, such as health
education, health services, and community and family involvement so that all aspects of health promotion work
together for health and HIV/STD prevention.
Implementing HIV/STD prevention interventions provides an opportunity to form a Community Advisory
Committee that can subsequently address other health promotion issues.
4.2
Situation analysis
Policy-makers, decision-makers and interested groups at national, district and local levels should consider a
situation analysis to guide the development of Health-Promoting Schools and HIV/STD prevention
programmes. The School Health Team and Community Advisory Committee, once established, can start the
local planning process by conducting a situation analysis.
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4.2.1 Purpose of conducting a situation analysis
A situation analysis will help people better understand the needs, resources and conditions that are relevant
to planning interventions. A good situation analysis has several benefits:
Policy-makers and decision-makers need strong arguments, especially when their actions involve
•
allocating resources.
Accurate and up-to-date information can provide a basis for discussion, justification for action, setting
•
priorities and identifying groups in special need for interventions, such as children living in geographical
areas where HIV/STD infections and substance use are prevalent.
Data obtained through the situation analysis can help ensure that interventions are tailored to the specific
•
needs, experience, motivation and strengths of students, staff, families and community members. Data
also provide a baseline against which to measure trends in HIV infection and related behaviours, such
as condom use or shared needle use.
4.2.2 Information needed
Information about potential risk may be very important for convincing policy-makers and the public that
HIV/STD interventions are important in schools. Look for HIV and STD infection rates, where they are
available: current data about death caused by AIDS or substance use can also be useful. These data are
useful in determining the extent to which HIV, AIDS, STD and substance use are health problems in the
community or nation. Data on sexual behaviour, unintended pregnancy and (psycho-active) substance use
rates can help to determine the extent to which young people are at risk of HIV/STD infection in the community
or nation.
Data about knowledge, attitudes and skills are also important for planning effective education
programmes.(T9) These data may already be available from the local health unit or can be obtained by
conducting a survey. Many survey questionnaires exist and the local health agency may be able to provide
examples. These data are especially useful prior to beginning HIV/STD prevention interventions in schools.
The table below outlines the basic questions that might form the basis of a situation analysis and sets out the
methods for collecting data.
Methods for Data
Collection
Basic Questions
How prevalent are HIV and STD infections, unintended pregnancy
and substance use in the community or nation?
Review existing data from a
local health authority; or
sample survey by self report
How prevalent are HIV, STD infection and unintended pregnancy in
Same as above; data for
school-age children and young people?
infection rate and burden
How many people are thought to be affected by HIV/AIDS?
Same as above
Are there data on HIV infection rates or AIDS-related deaths among
school-age children, young people or adults in your community or
Same as above
nation?
What are the important behaviours, behaviour determinants and
Local health unit;
conditions that place young people and adults at risk for HIV
STD data; substance use
infection in the community?
data
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Do parents, teachers and young people have basic knowledge about
AIDS and HIV/STD infection?
What are the common attitudes and beliefs of teachers, parents and
youth towards AIDS and HIV/STD infection?
What are the common attitudes and beliefs of teachers, parents and
youth towards education about AIDS and HIV/STD infection?
Questionnaire;
Focus group discussions
Same as above
Same as above
Does any school HIV policy pertaining to privacy, learning and
employment exist, and are school staff, teachers and students
Interview with school officials
informed of its existence?
Are other health programmes and interventions being implemented
Interview with school and
in schools into which education about HIV/STD can be integrated?
community leaders
4.3
Political and cultural acceptability
4.3.1
Political commitment
The success of efforts to implement Health-Promoting Schools and education to prevent HIV/STD infection
depends on the will, commitment, support and action of health and education authorities. Endorsement and
support from leaders and senior officials are essential. Political and community leaders, as well as concerned
citizens, must be involved in supporting HIV/STD prevention interventions in schools.
Evidence of political commitment:
•
Public acknowledgement by a wide range of political, social and religious leaders of the
importance of HIV/STD prevention and the need for schools to play a significant prevention role
•
•
Clear sanction and support from the Ministries of Education and Health
Financial support to ensure that schools have sufficient resources to develop and implement
policies, curricula and training.
•
Demonstration of solidarity towards those infected and affected by HIV/AiDS in communities
and nations. (20)
4.3.2 Community commitment
Success also depends on the extent to which people in the community are aware of and are willing to support
health promotion efforts. From an early stage, schools need to obtain from parents and community members
about the design, content, delivery and assessment of the programme. Schools can then respond to their
concerns and get their commitment. Community group meetings, parent-teacher associations, formal
presentations, open houses, civic clubs and religious centres organised by the Community Advisory
Committee are useful vehicles for community involvement. Commitment and support of many parties on
various levels is needed to share expertise, facilities and resources. Partnerships with representatives from
sectors such as education, health, business, communication, recreation, voluntary service, nongovernmental
organisations and religious groups can demonstrate and provide commitment, resources and support for
health promotion and HIV/STD prevention.
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Communities can show their commitment by:
•
Acknowledging, openly, the importance of HIV/STD prevention: local health and education
officials, community leaders and other relevant groups can voice their views and lead the way
•
•
Allocating local resources, such as public money for HIV/STD prevention interventions in schools
Coordinating school interventions and activities with other programmes in the community, such as
community-based prevention programmes, substance use prevention programmes, local
testing/counselling agencies and hospice services.
•
Ongoing efforts to attract community attention to the problem, through HIV- and STD-related peer
education, dramas, print material and community forums
•
Involving existing councils, school boards and organisations, such as women's groups, youth
groups and civic groups to gain a critical mass of support
4.3.3 Supportive school policies
Developing supportive HIV/STD-related school policies is as important as designing HIV/STD education.
Supportive school policies guide the planning, implementation and evaluation of efforts to promote health and
prevent HIV/STD infection. School policies are brief documents that set out a clear set of school standards
on health and HIV/STD prevention. They incorporate the input of all relevant constituents of the school
community: students, teachers, parents, staff, administrators, nurses and counsellors. Policies need to:
meet national and local needs and standards and be adapted to the health concerns, norms and values
•
of different ethnic and cultural groups represented at school.
support collaboration and coordination between the health and education sectors and between the school
•
and community are essential for success.
address all components of a Health-Promoting School that will be modified through the programme.
•
Examples of supportive policies and regulations:
•
Policies that require HIV/STD training for all school personnel
•
Required coordination between health and education authorities at local and district levels in
planning and implementing HIV/STD interventions in schools
•
Policies for students and personnel that support privacy, attendance, employment and infection
control
•
Policies that support HIV/STD prevention and other health interventions for all levels of schooling,
starting in the earliest grade and continuing through the last grade.
•
Designation of a school-level coordinator with responsibility and authority to deal with issues and
concerns
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Communities can show their commitment by:
•
Acknowledging, openly, the importance of H1V/STD prevention: local health and education
officials, community leaders and other relevant groups can voice their views and lead the way
•
•
Allocating local resources, such as public money for HIV/STD prevention interventions in schools
Coordinating school interventions and activities with other programmes in the community, such as
community-based prevention programmes, substance use prevention programmes, local
testing/counselling agencies and hospice services.
•
Ongoing efforts to attract community attention to the problem, through HIV- and STD-related peer
education, dramas, print material and community forums
•
Involving existing councils, school boards and organisations, such as women's groups, youth
groups and civic groups to gain a critical mass of support
4.3.3 Supportive school policies
Developing supportive HIV/STD-related school policies is as important as designing HIV/STD education.
Supportive school policies guide the planning, implementation and evaluation of efforts to promote health and
prevent HIV/STD infection. School policies are brief documents that set out a clear set of school standards
on health and HIV/STD prevention. They incorporate the input of all relevant constituents of the school
community: students, teachers, parents, staff, administrators, nurses and counsellors. Policies need to:
meet national and local needs and standards and be adapted to the health concerns, norms and values
•
of different ethnic and cultural groups represented at school.
support collaboration and coordination between the health and education sectors and between the school
•
and community are essential for success.
address all components of a Health-Promoting School that will be modified through the programme.
•
Examples of supportive policies and regulations:
•
•
Policies that require HIV/STD training for all school personnel
Required coordination between health and education authorities at local and district levels in
planning and implementing HIV/STD interventions in schools
•
Policies for students and personnel that support privacy, attendance, employment and infection
control
•
Policies that support HIV/STD prevention and other health interventions for all levels of schooling,
starting in the earliest grade and continuing through the last grade.
•
Designation of a school-level coordinator with responsibility and authority to deal with issues and
concerns
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•
Policies about the content of curricula, including sensitive issues such as sexual abstinence, safe
sex, birth control, family planning, sexual harassment and sexual orientation
•
A code of professional ethics that protects students, teachers and staff from sexual harassment
and abuse.(21)
4.4
Goals and objectives of HIV/STD prevention interventions in schools
Using information gathered in the situation analysis, the School Health Team, in collaboration with the
Community Advisory Committee, can develop goals and objectives for health promotion and HIV/STD
prevention interventions.
4.4.1 Goals
Goals should describe in broad terms what the programme is to achieve. In a Health-Promoting School,
the overall goal of HIV/STD-related interventions is to prevent HIV/STD infection and reduce HIV-related
discrimination. A goal must be broken down into specific objectives so that everyone clearly understands
what needs to be done to achieve the goal.
4.4.2 Objectives
Objectives are steps for achieving the overall goal. Objectives may focus on health status, behaviour
and/or conditions, as well as measurable changes in knowledge, attitudes, skills and services. The
following list provides examples of objectives that could be developed for HIV/STD prevention
interventions in middle and/or secondary schools:
By
(insert date), the percentage of students who report that they engage in sexual intercourse without a
condom will be reduced from ... percent to at least... percent as evidenced by self reported information
collected in anonymous surveys of secondary school studentsr
By
(insert date), the percentage of students that are able to identify at least four ways that HIV is transmitted
will increase from ... percent to at least... percent as evidenced by pre- and post-test results among middle
school students.
By
(insert date), the percentage of students that participate in at least one school/community
project to prevent HIV/STD infection and related discrimination will increase from ... percent to at
least... percent as evidenced by student activity reports.
By
(insert date), the percentage of students who report that they are confident they can assert their
decision not to engage in sexual intercourse with pressuring partners will increase from ... percent to
at least... percent, as evidenced by pre-post tests of middle school students.
WHO Information Series on School Health
15
INTEGRATING HIV/STD PREVENTION INTERVENTIONS WITHIN
VARIOUS COMPONENTS OF A SCHOOL HEALTH PROGRAMME
e
A Health-Promoting School strives to use the school’s full organizational capacity to improve the health of
students, school personnel, families and community members. Such a school offers many opportunities to
promote HIV/STD prevention as an essential element for the attainment of health. HIV/STD prevention
interventions can serve as an entry point for developing or enhancing policies, planning groups and the
various components that serve as a framework for a Health-Promoting School. These components include,
but are not limited to:
•
school health education
•
healthy school environment
•
school health services / counselling and social support
•
school / community projects and outreach
•
health promotion for school staff
•
physical exercise, recreation and support (Sport ?)
Effectiveness of interventions integrated into each of these components depends on the extent to which they
are supported by people, policies and trained staff. Not every school will have the resources to integrate
HIV/STD prevention interventions into all of the components at one time. Each school has to establish its own
priorities, in collaboration with all parties concerned, to decide how thoroughly the components will be
addressed.
A Health-Promoting School enables students, parents, teachers and community members to work together
to make such decisions. It is important to start with small changes as soon as possible instead of waiting until
resources become available to address all of these components simultaneously.
School health education
5.1
Overall, school health education seeks to help individuals adopt behaviours and create conditions that are
conducive to health. Thus, the clear and precise delineation of behaviours and conditions that are to be
influenced is essential for the development of effective school health education efforts. Examples of
behaviours and conditions commonly addressed to prevent HIV/STD and related health problems are listed
below.
Common behaviours related to HIV infection
•
Sexual behaviours that increase risk for contracting HIV infection:
- vaginal intercourse without a condom with an infected person
- anal intercourse without a condom with an infected person
- semen or vaginal fluid taken into the mouth during oral-genital sex
- any sexual act that involves the contact of blood, semen and/or vaginal fluid between two or
more persons (15)
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WHO Information Series on School Health
•
Substance use behaviours that increase risk of HIV infection:
- sharing needles with HIV-infected persons or persons who do not know their health status
- using alcohol and other substances that lower inhibitions and increase the chances of
engaging in unsafe sexual practices or substance use
- failure to boil equipment if clean needles are not available
- failure to clean shared needles (by rinsing them twice with water, twice with bleach, twice with
water)
•
Perinatal behaviours that increase risk of infecting the unborn child:
- failure to obtain prenatal testing and treatment, when available, to reduce risk of infecting the
unborn child
- failure to assess risk of infection to child via breast-feeding
•
Transfusion or use of blood products/equipment that present risk of
infection:
- failure to consider the degree of risk before accepting blood in countries that do not conduct
routine testing of blood donations
- receiving donated blood of unknown origin in countries that have not achieved a safe blood
supply
- using needles, syringes or other drug injecting equipment that are not sterilized.
•
Behaviour involving instruments that present risk of infection:
- failure to clean instruments that may involve blood, such as tattoo, skin piercing and shaving
instruments, dental equipment and medicinal drugs administered through injectors
To help schools develop health education interventions to address such behaviours and conditions, WHO and
UNESCO have developed “School Health Education to Prevent AIDS and STD", a resource package
containing a Handbook for Curriculum Planners, Student Activities and a Teacher's Guide.
WHO Information Series on School Health
17
5.1.1
Knowledge, values, beliefs, attitudes, skills and related conditions that
influence behaviours associated with KIV/STD infection
In a Health-Promoting School, health education to prevent HIV/STD infection is designed to help students
acquire the knowledge, attitudes, beliefs, skills and support needed to make informed decisions, practice
healthy behaviours and create conditions conducive to health. The design must consider the developmental
level of the students, starting at primary levels and continue into secondary levels, building on and reinforcing
previous learning experiences.
Important knowledge, attitudes, values and skills related to the prevention of HIV and related discrimination
are described in the boxes below. Items are categorized for different developmental levels (young children,
pre-adolescents and adolescents). Close collaboration between education and health officials, as well as with
parents, students and community members, is necessary for schools to determine which is the most important
and appropriate content to provide to help their young people avoid HIV and STD infection.
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Young Children: Knowledge, attitudes, beliefs, values and skills related to
HIV transmission that are necessary for young children to acquire.
Knowledge: Students will learn that:
•
•
•
•
HIV is a virus some people have acquired
HIV is difficult to contract and cannot be transmitted by casual contact, such as shaking
hands, hugging, or even eating with the same utensils
people can be HIV infected for years without showing symptoms of this infection
many people are working diligently to find a cure for AIDS and to stop people from
contracting HIV infection.
Attitudes/Beliefs/Values: Students will demonstrate:
•
•
•
•
•
•
•
•
•
•
acceptance, not fear, of people with HIV and AIDS
respect for themselves
respect between adolescent males and females - tolerance of differences in attitude,
values and beliefs
understanding of gender roles and sexual differences
belief in a positive future
empathy with others
understanding of duty with regards to self and others
willingness to explore attitudes, values and beliefs
recognition of behaviour that is deemed appropriate within the context of social and
cultural norms
support for equity, human rights and honesty
Skills: Students and others will be able to:
•
•
acquire practical and positive methods for dealing with emotions and stress
develop fundamental skills needed for healthy interpersonal communication
Pre-adolescents: Knowledge, attitudes, beliefs, values and skills related to
HIV transmission that are necessary for pre-adolescents to acquire.
Knowledge: Students will learn:
•
•
•
•
•
•
bodily changes that occur during puberty are natural and healthy events in the lives of
young persons, and they should not be considered embarrassing or shameful
the relevance of social, cultural, and familial values, attitudes and beliefs to health,
development and the prevention of HIV infection
what a virus is
how viruses are transmitted
the difference between AIDS and HIV
how HIV is and is not transmitted
Attitudes/Beliefs/Values: Students will demonstrate:
WHO Information Series on School Health
19
•
•
•
•
•
•
•
•
•
•
commitment to setting ethical, moral and behavioural standards for oneself
positive self-image as a result of defining positive personal qualities and accepting
positively the bodily changes that occur during puberty
confidence to change unhealthy habits
willingness to take responsibility for behaviour
a desire to learn and practice the skills necessary for everyday living
an understanding of their own values and standards
an understanding of how their family values support behaviours or beliefs that can
prevent HIV infection
concern for social issues and their relevance to social, cultural, familial and personal
ideals
a sense of care and social support for those in their community or nation who need
assistance, including persons infected with and affected by HIV
honour for the knowledge, attitudes, beliefs and values of their society, culture, family
and peers
Skills: Students will be able to:
•
•
•
•
•
•
•
•
•
•
20
communicate messages about HIV prevention to families, peers and members of the
community
actively seek out information and services related to sexuality, health services or
substance use that are relevant to their health and well-being
construct a personal value system independent of peer influence
communicate about sexuality with peers and adults
use critical thinking skills to analyse complex situations that require decisions from a
variety of alternatives
use problem-solving skills to successfully master the decisions about issues that are
experienced by young persons
influence others in relation to sexual behaviour and other interpersonal activities in ways
that protect one's self-esteem, health and well-being
communicate clearly and effectively a desire to delay initiation of intercourse (e.g.,
negotiation, assertiveness)
appropriately use health products (e.g. condoms)
show empathy toward persons who may be infected with HIV
WHO Information Series on School Health
Adolescents: Knowledge, attitudes, beliefs, values and skills related to
HIV transmission that are necessary for adolescents to acquire._______
Knowledge: Students will learn:
•
•
•
•
how the risk of contracting HIV infection can be virtually eliminated
which behaviours place individuals at increased risk for contracting HIV infection
what preventive measures can reduce risk of HIV, STD and unintended pregnancies
how to obtain testing and counselling to determine HIV status
Attitudes/Beliefs/Values: Students will demonstrate:
•
•
•
•
•
•
•
•
•
•
•
understanding of discrepancies in moral code
a realistic risk perception
positive attitude towards alternatives to intercourse
conviction that condoms are beneficial in protecting against HIV/STD
willingness to use sterile needles, if using intravenous drugs
responsibility for personal, family and community health
support for school and community resources that will convey information about HIV
prevention interventions
encouragement of peers, siblings and family members to take part in HIV prevention
activities
encouragement of others to change unhealthy habits
a leadership role to support the HIV prevention programme
willingness to help start similar interventions in the community
Skills. Students will be able to:
•
•
•
•
refuse to have sexual intercourse
assess risk and negotiate for less risky alternatives
purchase and demonstrate the appropriate use of condoms
obtain and demonstrate the appropriate way to sterilise needles
5.1.2
Important considerations in planning education about HIV/AIDS/STD
Virtually every school will have students who have in the past or who are at present engaging in risky
sexual behaviour, whether by their own choice or forced by others. Students must be taught specific
ways to reduce the risk of HIV/STD infection.
Health education to prevent HIV/STD infection and related discrimination should be an important part
of a school health curriculum, integrated into various subject areas and included in the school's
extracurricular activities. School health education should be provided as a planned, sequential course
of instruction from the primary through the secondary levels, addressing the physical, mental, emotional
and social dimensions of health. It can be taught as a specific subject, as part of other subjects, or as
a combination of both.
Health education to prevent HIV/STD infection and related discrimination should be combined with
education about life skills, reproductive health and alcohol/substance use so that the learning
WHO Information Series on School Health
21
experiences will complement and reinforce each other. To link these issues, organize them into a school
health education curriculum and/or coordinate the simultaneous or sequential presentations of related
topics in different classes. Co-teaching, sharing teaching resources, referring students to related lessons
and involving students from different classes in group activities also link health, HIV/STD prevention and
other relevant topics.
Scientific terms and biological-technical details may seem important; however, for the purposes of health
education, they are less important than practical and basic information that will enable students to avoid
infection. It is more important for a student to learn how the virus is spread and how to negotiate safe
sex, for example, than to learn about the composition of the virus.
Students need to also learn about the fears that surround HIV/AIDS/STD. Some students may fear risk
when abstaining from sexual intercourse or engaging in common sexual activities such as masturbation.
Some students may experience fear when engaging in expressions of affection such as hugging, kissing
and touching genitals. Some students may fear being near or touching someone who may have acquired
HIV infection. Because of misconceptions about how HIV is and is not transmitted, some students may
suffer undue anxiety and concern. Students must be taught how the virus is and is not spread. When
they overcome fear, their understanding and empathy toward people who have HIV/AIDS can grow.
Interviews, informal discussions or questionnaires can be used to gain Useful information from
students and parents about values, beliefs and attitudes that may influence behaviours and
conditions associated with HIV infection. Information enhances understanding among teachers, other
school personnel and health workers, and allows them to focus interventions on the factors that
contribute most to HIV infection in the community. This information is also important in developing
complementary educational efforts such as those carried out by mass media, health workers,
religious groups and other organizations.
The influence of mass media is important to consider. Young people are frequently exposed to and
influenced by the media. While schools are teaching one set of messages, the media may be providing
quite different messages. School-based programmes should take into account information provided
through the mass media and take steps to refute unhealthy messages.
Three steps may be useful to schools as they tailor HIV/STD education to the specific needs of students
and others in the community:
• Secure the collaboration of education and health authorities and involve parents, students and
community members as well as local organisations in the information collection process.
• Identify specific behaviours and conditions most relevant to HIV/STD prevention in the community.
• Identify specific factors associated with the behaviours and conditions that are most relevant to the
community. Specifically delineate the knowledge, attitudes, beliefs, values and skills that students
need to acquire in order to practice healthy behaviours and reduce conditions that increase risk
of HIV/STD infection.
Integrating educational efforts to prevent HIV/STD and related discrimination into other school health
components, such as physical activity and health promotion for staff, will enhance the overall framework
of a Health-Promoting School.
5.1.3 Selecting educational methods and materials for health education
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Educational methods such as lectures, discussion, role-plays and audio-visual aids should be selected
to address specific factors, such as knowledge, attitudes and values, myths, skills and support related
to a particular behaviour. Materials need to correspond with the developmental level of students and be
sensitive to the cultural context.
Select an education method on the basis of how well it will influence a particular factor. For
example, a lecture is an effective way to increase knowledge, but less effective in influencing
beliefs and building skills. Discussions, debates and carefully prepared written materials can
be more effective than a lecture in dispelling the logic or foundation of local myths. Practice
sessions and role play exercises are more effective in building skills than lectures, discussions,
debates or written materials.
5.1.4
Choosing educational options
Education about HIV/STD prevention and sexual behaviour poses a major dilemma for many educators,
a dilemma fuelled by public pressures and the different beliefs and values of the state, various religions
and diverse parents. Several options are often proposed as schools try to determine the most appropriate
foci for HIV/STD education in a community. Each needs to be considered and discussed with teachers,
parents, students and members of the Community Advisory Committee; as a strategy to prevent HIV
infection, each option has its own strengths and limitations. The options are:
•
abstinence from sexual intercourse
•
non-penetrative sex
•
•
condom use
monogamy with an uninfected partner
•
abstinence from substance use
WHO Information Series on School Health
23
If schools choose to help students recognise all the options for prevention, they can teach students to
select options that correspond to their own standards, lifestyle, age and personal situation. Some options
will only be realistic for older students. If schools choose to promote only one option, they are likely to fail
to provide a viable option for a significant proportion of students. Thus, each option should be discussed
and careful considered. A combination of options is clearly a more complete and potentially effective
approach.
Abstinence from sexual intercourse
From a medical point of view, this practice is the safest, as it reduces the chances of infection with HIV
and STDs through sexual behaviour to zero and is in accordance with traditional values about young
people and sexuality held in many parts of the world. In practice however, young people in many
countries do have sexual relationships, or may be forced to have sex, so a significant number of them
may not find the option of abstinence acceptable or realistic. Many young people, who at first intend to
abstain from sex, cannot maintain that intention because of peer pressure or other personal or social
factors. Programmes that promote abstinence alone have proven largely ineffective in reducing sexual
activity or sexual risk taking.
Non-penetrative sex
Sexual behaviours that involve the exchange of semen, vaginal fluids or blood between partners can pass
HIV from an infected to a non-infected partner. These behaviours include vaginal and anal intercourse
without using a condom, taking semen or vaginal fluids into one's mouth in oral sex and any sex act that
involves blood contact. Abstaining from these risky behaviours virtually eliminates the chances of
contracting HIV infection but does not eliminate the chance of contracting other STDs. Kissing, hugging,
touching/caressing and non-penetrative sexual activities such as masturbation do not carry the risk of HIV
infection and are not likely to result in an STD. For many young people, however, and especially for
adolescent males, sex means vaginal intercourse, and they may not accept the option of non-penetrative
sex.
Condom use
A condom, used appropriately in connection with potentially risky sexual behaviour, reduces the risk of
HIV/STD infection considerably. In spite of what parents and other adults tend to think, adolescents tend
to be sexually active. In many countries, the average age of first sexual intercourse is about seventeen
years,(22) and in some countries the average age of initiation is even lower. Although young people
usually are monogamous within a given relationship, the relationship itself lasts for a short period of time.
Most young people who are sexually active can be called serially monogamous; they do not realize that
serial monogamy is identical to having multiple sexual partners. Acceptance of condom use is growing
and condoms are increasingly available throughout the world. Moreover, research shows that education
about condom use does not lead to increased promiscuity among young people. (23)
Monogamy
An exclusive sexual relationship with one person can protect against HIV/STD infection, provided that the
sexual partners are not already infected when entering the relationship and do not become infected during
the relationship. However, marriage, divorce and remarriage to another partner have become increasingly
commonplace in many countries. (24) Extramarital relationships pose a threat to people who rely on
monogamy to prevent HIV/STD infection. An overwhelming majority of people disapprove of extramarital
sexual relations, but in fact, most have extramarital affairs at some point during their marriages.24 In
24
WHO Information Series on School Health
polygynous societies, multiple sex partners are accepted and indicate a man’s social and economic
status. (24)
Substance and needle use
Drug use influences the spread of HIV directly and indirectly. An important drug use
behaviour that puts people at risk for contracting HIV infection in a direct way is needle use.
The behavioural objective in this case is to stop people sharing needles or to encouraging
them to clean shared needles prior to use. Infection through needles is not restricted to illicit
drug use and may also occur with medicinal drugs (administered in some countries through
injectors), or with preventive care (such as vitamin injections in some cases), or tattooing or
piercing. Modes of transmission vary greatly depending on the cultural context and the
adequacy of health care: the content of local interventions need to reflect local culture and
realities.
Misuse of alcohol and substance use can also increase risks indirectly by lowering people’s
inhibitions against engaging in unsafe sexual or drug-using behaviour.
5.1.5 Peer education and involvement
Participation and empowerment are key principles of a Health-Promoting School. Youth
should be involved in preparing of school health programmes, in carrying out the activities
and evaluating them in a structured way.
It is well known that young people get much of their sexual health knowledge from their peers.
Young people are often sensitive to peer pressure and can exert a strong influence on one
another. This influence can be negative, with young people encouraging each other to
engage in risk behaviours, or channelled to have a positive influence.
Research shows that when peers deliver prevention it enhances the effects of the
intervention. (25) Peers can contribute to HIV/STD prevention interventions in formal and
informal ways. Education sessions led by peers can help to spread messages about what is
safe behaviour and what is not. Young people can be effective educators: they can use
language and arguments that are relevant and acceptable to their fellow students. They are
capable of presenting information and skills in an informal way and in a safe atmosphere. For
these reasons, they are credible and may be able to offer more applicable solutions to
prevention problems among their peers.
Peer educators can sometimes reach groups that professionals cannot (e.g. intravenous
drug-using youth, youth in prostitution, migrant youth, gay youth and marginalised youth).
In some countries, the taboo on sexuality is very evident, and the distance between teachers
and students is vast. Peer educators, working with students, can provide an entry point for
HIV/STD education.
Peer education is an investment in young people. Peer educators can serve as role models
and form the basis for peer support networks. They can serve as counsellors and as opinion
leaders in setting the agenda, communicating values, promoting a positive social norm in
safe(r) sex and in life-skills training.
The work of peer educators has an impact on the peer educators themselves. It offers
opportunities for students to learn to care for others and to take control of their health. It can
have a positive influence on their self-esteem, skills and attitudes with regard to sexuality and
sexual health.
WHO Information Series on School Health
25
The role of a peer educator can extend far beyond the classroom. Peer programmes provide
an excellent way to link schools to community-based organisations and offer opportunities
to educate a vast number of people.(25) Students who are trained educators in HIV/STD
prevention can address classes in their school and community youth groups, answer
telephone hotlines and staff offices where students can drop by to discuss HIV/STD- related
concerns and issues. Peer educators are relatively low cost and typically there is an
abundant pool of potential volunteers.
In order to function effectively, however, peer educators need to be properly trained and
supervised. It is already known that peer educators who have only been trained to transmit
knowledge run the risk of being rejected by their peers because they are perceived as "knowit-alls”. They need skills in counselling, empathy, decision-making, resistance to group
pressure; assertiveness and building self-esteem. Follow-on coaching can support their
efforts once they begin to work as peer educators.
5.1.6 Training school personnel to implement health education and other
efforts to prevent HIV/STD infection and related discrimination
Teachers, who play a fundamental role in education, play an equally important role in
preventive education. Pre-service and in-service training for teachers is crucial if preventive
education is to be effective. Teachers and their representative organizations should be
involved in every stage of planning, implementing and evaluating HIV/AIDS training. In
particular teachers need to be trained to use participatory and interactive methods to ensure
that education about HIV/STD is effective, as well as culturally and ethically appropriate for
each community.
In all communities, the training of teachers should be of highest priority because, for better
or worse, teachers are role models for their students and other members of their community.
School personnel can be strong role models if they demonstrate their willingness to learn
about HIV/STDs, the capacity to show compassion and empathy towards individuals infected
and affected by HIV/AIDS and respect and understanding for others regardless of gender,
sexual orientation or life circumstances.(26)
An HIV/STD training programme for teachers and other school personnel should include,
besides a rationale for implementing HIV/STD education, guidelines that will support teachers
in:
• mobilizing support inside as well as outside the school
• giving financial and professional incentives
• designing training, based on needs of the teachers and the school situation
• establishing pre- and in-service training for teachers of all grade level
• providing sufficient time for on-going training. (21)
The training design should begin at a level that is appropriate for the knowledge, attitudes,
beliefs, values and skills of the teachers. However, in all cases it should include information
on:
•
26
allocation of personnel, time, resources and authority to a staff member who will
be responsible for initiating, managing and coordinating the training
WHO Information Series on School Health
•
•
•
•
development of a core group of trainers or training teams that will enable all
relevant teachers and school personnel to receive training in a timely manner
regularly scheduled follow-up sessions or other means by which to periodically
provide updates on HIV/STD or related health problems
supervision of coaching by experienced trainers for those teachers who would like
to have this kind of support
evaluation of the impact and effectiveness of the training and revision of the
training format as needed (20)
The content for training should specifically include:
•
•
•
•
•
•
•
•
•
•
•
•
accurate information about HIV/STD prevention
accurate information about sexual behaviour, beliefs and attitudes of young people
accurate information about alcohol and substance use in relation to HIV/STD
prevention
opportunities to examine the teachers’ own standards and values concerning
sexuality, gender roles and substance use
explanation of a wide variety of teaching methods (especially participatory teaching
methods)
practice that uses various methods to impart knowledge, develop attitudes and
build skills related to HIV/STD prevention and responsible sexual behaviour in a
way that is inspiring and effective
conflict management and negotiation skills
identification and discussion of gender specific issues
suggestions about ways to deal with cultural and religious traditions that may
present barriers to discussions about sexuality
lessons about how to promote compassion and appropriate guidance and care for
persons infected with HIV
skills necessary for identifying and referring students with sexual health problems
to appropriate services
integrating HIV/STD prevention and related topics into the existing curricula (7)
Curricula for HIV/STD prevention and other health-related issues may be available through
governmental and nongovernmental agencies and organisations, universities or teachers'
unions. Teachers and students themselves can also generate supplementary materials
specific to the local situation. Information about obtaining the WHO/UNESCO resource
package “School Health Education to Prevent AIDS and STD" is found in Section 5.1 School
health education and in Annex XX.
5.2
A healthy school environment
School environment plays a key role in determining the success of HIV/STD prevention
programmes. Creating an environment that fosters understanding, caring and empathy for
others contributes greatly to positive values, beliefs and attitudes about HIV/STD prevention
among students, teachers, staff and the community. To create an environment that supports
education about HIV and other STDs, schools must consider policies and practices, including
rules, guidance and referral to services.
5.2.1
Policy for HIV-infected school staff, teachers and students
A Health-Promoting School is a place that promotes a caring and supportive environment for
individuals who work and study there. Students and teachers who are infected with HIV
should not fear any restrictions based solely on their HIV status. There is no acceptable
WHO Information Series on School Health
27
reason for denying education to a student infected with HIV, or denying employment to a
teacher infected with HIV/AIDS. For students and school personnel infected with HIV, it is
necessary to create and/or uphold policies and regulations on attendance, confidentiality,
support services and care and referral services.
Policies for HIV-infected students and school personnel may state points such as these:
•
•
•
•
•
•
•
Confidentiality and privacy of HIV-infected persons should be guaranteed.
Full attendance and equitable, safe and humane treatment for students and school
personnel with HIV/STDs should be paramount.
Decisions about educational and working environment, such as use of special aids
or necessity to accommodate persons with HIV, must be documented and
individualised;
Special services can be provided to assist those with limited strength or whose
illness hampers their educational and/or working performance.
Policies and procedures on intervention and prevention of harassment should exist
to promote an environment that fosters respect and compassion as well as social
growth for all students and school personnel.
HIV-related disability definitions should conform to prevailing laws, where
applicable.
Requirements and procedures established through collective bargaining must be
respected.
Policies help ensure the social, emotional, psychological and physical well-being of HIV-infected
students and school personnel. By serving all people equitably, the school promotes understanding,
respect and compassion among its students, staff and community.
Efforts to develop policy for school personnel infected with HIV should aim to ensure that employers
cannot take action against an employee based solely on his or her HIV status. Policy in terms of
employment must not be influenced by HIV status. Reasonable accommodations should be made
for employees who are able to perform the tasks of their position with reasonable assistance. These
might include: job-related aids or services, change in work site, periodic rest periods and flexibility
with occasional absences. (7)
5.2.2 Universal infection-control precautions for teachers and students
Universal infection-control precautions are practices that schools, like other organisations, need to
follow to prevent a variety of diseases. Precautions should include policies on caring for wounds,
deaning-up blood spills and disposing of medical supplies.(7) While these precautions are valuable
in preventing certain diseases, such as flu, chicken pox or ear infections, schools must recognise that
HIV is more difficult to transmit. HIV/STD infection is not transmitted by casual contact, such as
shaking hands, hugging or using toilet seats or eating utensils. Even kissing and deep kissing does
not transmit HIV. Universal precautions are simply policies that schools put into place as safeguards
for emergency situations. Schools should inform both personnel and students about the infection
control policy in order to diminish fears and address concerns through open discussion.
5.2.3 Creating an environment that promotes HIV/STD prevention and
fosters understanding, caring and empathy for others.
A Health-Promoting School, rather than creating fear and tension among its students, teachers and staff,
promotes values of mutual respect, acceptance and offers a safe, trustful environment. Teachers,
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administrators, staff and students actively display these values inside and outside the classroom. Teachers
demonstrate to students that HIV-positive individuals and people who associate with HIV-positive individuals
are not to be feared. For example, a teacher might openly hug an HIV-positive student upon his or her return
to the classroom after hospitalisation. Promoting activities in school, like World AIDS Campaigns and AIDS
Awareness Day, are ways to support people who are infected or affected by HIV/AIDS. Such activities create
understanding of HIV and its broad implications. As educators, people who are HIV infected or who have AIDS
have had a great impact in correcting misunderstandings and in promoting solidarity. In many countries, the
high prevalence of HIV and STD among homosexuals and men who have sex with men increases already
existing homophobia and discrimination. Promoting gender equity and respect for different beliefs, cultures,
religions and sexual orientation helps ensure that all teachers, students and staff feel accepted.
In addition to providing a social climate that promotes understanding and solidarity, a Health-Promoting School
provides a physical environment that contributes to HIV/STD prevention. Examples include offering adequate
information about HIV/STDs in the school library, mounting posters in the hall and instituting security
regulations to ensure safe travel to and from school. The school can provide facilities for storing medication
needed by students and staff. Some schools have worked with local health services to make condoms
accessible to students who need them.
5.3
School health services
A Health-Promoting School can serve as a point of delivery of a wide variety of support services not
available to students, teachers, staff and the community. Not all schools can provide such school
health services, yet where resources are available consider the following services.
5.3.1 Caring and support
Health-Promoting Schools can maintain and support the mental health of students
and staff in a manner that complements the prevention of HIV/STD infection and
promotes physical health. An individual's psychological well-being, including selfesteem and self-confidence, is critical to making healthy decisions and avoiding health
risk behaviours. School counselling programmes and support services that help students,
school personnel and families cope with HIV/STD-related problems are important
components of a Health-Promoting School.
Support services can address a range of health issues and involve a variety of
professionals to deliver services. The AIDS epidemic, emphasising the importance of
many of these services, has created the need for additional services of this type.
Collaboration among teachers, administrators and parents is necessary for optimum
provision of support services and to ensure they are available equally to students, staff
and teachers.
Support services include:
•
•
referring students to school and community-based support services for physical and mental health
counselling or social support in areas of adolescent development, sexuality, peer pressure, identity
formation, illness and death;
•
•
developing peer networks to promote acceptance of a range of healthy sexual attitudes and behaviours;
providing factual and up-to-date information on HIV/STDs and its prevention;
•
providing places for students in which fear and anxiety about HIV/STDs can be expressed without ridicule
or judgement (27)
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Ideally, these services are easily accessible, do not have a waiting list and offer contact with the service
provider on a regular basis.
5.3.2 Other support
School health services serve a vital role in meeting the diverse needs of the students, teachers and staff.
Where available, one of the most effective ways in which a school can serve its students is by providing
opportunities for referrals to an appropriate source of care, such as antibody testing or treatment of HIV-
related conditions.
Out of school support
Close cooperation between community services, especially those aimed at youth, and school health services
is necessary to ensure that referral services are directly available to students and staff. Schools can identify
resources by developing and updating a referral list of appropriate organizations and contacting
representatives of those organizations. Such a list might include: support groups for people with AIDS, home
nursing, HIV-test counselling, drug treatment, emergency day care and other sources of assistance. School
can also help to generate support services when community resources are inadequate.
Antibody testing
HIV-antibody testing is another area in which school health services can play an active role. Issues associated
with youth and HIV testing are complex and varied. Pre-test and post-test counselling are crucial, and
counselling techniques appropriate for adults are sometimes not appropriate for young people. (27) All such
efforts should be confidential.
5.3.3 Treatment for HIV-related conditions
The needs of HIV-infected youth differ greatly from the needs of HIV-infected adults. Often, HIV infection will
result in severe bacterial infections. Mental and motor deficiencies are found in a large number of children with
HIV. Also associated with the progression of HIV infection are: slowing motoric activity, impaired intellectual
ability, poor concentration and problem solving, and difficulty in merging visual-motoric abilities. It is important
to have procedures for monitoring a student's condition. Where available, school health services may help
in:
•
administration of medication
•
special feeding programmes, as recommended
•
•
neurological assessments
counselling or social support for peer and family relations
Schools should observe the confidentiality of infected students and school personnel and disclosed
information to staff on a need-to-know basis only. The school nurse, in close collaboration with the
student's physician, can help develop a care plan for an infected student that identifies the services
needed as well as the roles and responsibilities of the school. The plan also identifies staff persons
responsible for services and supervision and is revised as appropriate. As resources permit, a staff
person can be responsible for coordinating support services as well as reporting changes in the
student's physical or mental health status to parents and care providers. This staff person can help
ensure that the student's educational needs are met during periods of absence due to hospitalisation
or poor health.
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5.4
Family, school and community projects and outreach
A Health-Promoting School that addresses health promotion and HIV/STD prevention by engaging students,
school personnel, families and community members in collaborative and integrated efforts to improve health,
both in the school and through school/community projects and outreach.
The family and community also provide settings where students can understand, practice and share what they
learn about health and HIV/STD prevention in the classroom. Offering the potential to support and reinforce
HIV/STD prevention interventions and health promotion, parents and community members must work together
with school staff in order to create conditions that allow everyone to obtain good health. Students are most
likely to adopt healthy sexual behaviour patterns if they receive consistent information and support through
multiple channels, such as parents, peers, teachers, community members and the media. A Health-Promoting
School needs to strengthen community links and involve parents and the wider community as much as
possible. Community members and parents, in turn, should be justified in feeling that their school is open and
receptive to their ideas and participation.
Cooperation and coordination between the school health programme and the community are likely to be most
successful when dynamic, positive and productive school/community links exist. Schools and communities
can benefit from partnerships with local businesses and representatives from agencies and organisations,
such as local health departments and youth-serving agencies. The school, for instance, can utilise specialist
services in the community to obtain advice and support in preventing HIV/STD infection and promoting health
in school. Commercial organisations and businesses can advise on health choices or provide donations in
support of HIV/STD prevention. Collaboration is especially important with national and local youth
organisations in an effort to gain support for HIV/STD prevention. Partnerships between schools and
organisations may include jointly scheduled activities, or coordination of resources and collaboration under
a mutually agreed mission.
School/community projects provide a way for students to become actively involved in the learning process.
They provide a forum where the community can acquire specific health-related knowledge, a prerequisite for
enabling community members to take control of their behaviours and those conditions that prevent HIV/STD
infection. Various ways to involve the students in their own learning process are described in Section 5.1.5,
Peer education and Involvement.
Drama is a powerful way to reach families and members of the community. Historically a way of conveying
information to large groups of people, drama provides an opportunity for audiences to experience abstract
concepts visually. It allows for easy-to-understand language and dialects.
Drama creates a forum for
communication about sensitive issues in a culturally and socially acceptable manner. Able to reach many
people in various locations, it is an excellent method to use when conveying information to youth because it
allows for creativity as well as participation. When schools involve youth in a drama presentation about
HIV/AIDS, and other health issues, they must be very clear about the health message conveyed. Character
development provides insight about perceptions that others have about HIV/AIDS or other health issues, and
also helps develop respect and appreciation for experiences of people from different backgrounds. (28)
5.5
Health promotion for school staff
In a Health-Promoting School, health promotion is not limited to students. It is also provided for teachers and
nonteaching staff. All school personnel need to learn how to avoid HIV/STD infection and encouraged to
show solidarity with people living with HIV/AIDS. There are several reasons why school health promotion for
staff is important. School personnel can help identify policies and practices that support or undermine their
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31
health and well-being. A school health promotion programme for staff can help develop policies that support
their health and find ways to change policies that are not conducive to the health of teachers and other staff.
These efforts benefit the school: healthy teachers are better able to fulfill their responsibilities and serve as
strong role models.
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EVALUATION
6.
Evaluation, a powerful tool that can inform and strengthen school health programmes, can be used to plan
as well as to document the effects of action. Most evaluations seek to provide information about the extent
to which the programme is being implemented as planned and producing the intended effect.
Evaluation helps to:
•
provide information to policy-makers, sponsors, planners, administrators and participants about the
•
implementation and effect of the programme
provide feedback to those involved in project planning to determine which parts of the programme are
•
working well and which are not
make improvements or adjustments in the process of implementation
•
demonstrate the value of the efforts implemented by the school, parents, students and community
•
members
document experience gained from the project so that it can be shared with others
Responsible officials, members of the school health team or their designees should regularly review the
implementation process and assess the effectiveness of school health interventions. All groups affected by
the programme should have the opportunity to provide input. Based on the results of information gathered
from evaluation, those involved in planning and carrying out the interventions will make decisions about the
programme and its various components.
An evaluation is useful and complete only when its results are reported, communicated to those who are
involved, and used to improve programme efforts.
Types of evaluation
6.1
Two main types of evaluation are most relevant to school health programmes: process and outcome
evaluation.
6.1.1
Process evaluation
Process evaluation assesses how and how well the interventions are being implemented. Process evaluation
answers questions such as these:
•
To what extent are the interventions being implemented the way they were intended?
•
To what extent are the interventions reaching the individuals in the target group?
Evaluation is an important activity that is often limited because of scarce resources: time, personnel or budget.
When resources for evaluation are scarce, schools may find it more feasible to conduct a process evaluation
rather than an outcome evaluation. Too often, programmes rush to study their impact on youth without fully
understanding whether or how well the intervention was implemented. Process evaluation can show that the
intended programme is effectively implemented before outcome evaluation is attempted.
6.1.2 Outcome evaluation
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Outcome evaluation measures the extent to which the programme achieves specific objectives. It can
demonstrate the benefits of school health promotion programmes or illustrate the need for further
programmes. Outcome evaluation can demonstrate changes in behaviour, increases in knowledge, changes
in attitude or belief, increased confidence to use new skills and improvements in social or environmental
conditions that are relevant to the prevention of HIV infection and related discrimination. Brought to the
attention of the community, the evaluation results can help reinforce commitment and convince others to
support the programme.
6.2
Evaluating the planning and implementation of HIV/STD interventions
6.2.1
Evaluating HIV-related policies
School health HIV-related policies (addressed in Chapters 4 and 5), can be assessed to determine
what exists and what the policies cover. Content and process can be assessed by comparing
adopted policy with policy guidance that may be available from the local health agency or other
relevant organisations. Expert appraisal of the medical content of the policy can ensure that facts
and medical research are accurately reflected. Persons for whom the policies are intended can be
surveyed for their insights as to the value of the policy.
Here is a checklist that schools can use to evaluate a school's HIV-related policies.
Does a school policy exist that:
□ expresses the goal of preventing the spread of HIV infection and minimizing the negative
impact of HIV/AIDS?
□ offers rationale for educating students and school personnel about HIV/STD infection?
□ addresses the placement of HIV/STD in the curriculum?
□ encourages the integration of HIV/STD issues into relevant subject areas?
□ outlines the amount of time that should be devoted to education about HIV/AIDS/STD?
□ requires that HIV/STD lessons are taught sequentially from primary school through
secondary school, taking into account the students’ ages and developmental stages?
□ establishes a supportive school environment that does not discriminate against students
or teachers based on their sexual orientation or gender?
□ ensures that teachers are protected from criticism or censure if they address controversial
topics like HIV/AIDS and sexuality in a manner consistent with school policy?
For HIV-positive students and staff, does a policy exist to:
□ protect their privacy and confidentiality?
□ outline appropriate hygienic precautions about exposure to blood?
□ ensure that students’ and teachers’ rights to education and employment are upheld?
□ guarantee nondiscrimination as it relates to staff, students and family?
EJ ban discriminatory comments among students and staff (28)
□ include emergency leave for illness or bereavement of school personnel, students and
related family members?
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6.2.2
Evaluating HIV/STD curriculum
Proposed curricula should be carefully reviewed. Curriculum review committees are perhaps the best
way to evaluate curriculum content. By combining experts with teachers, students and community
leaders, the committee can achieve a balance of opinions so that curricular content can be
developed with consideration for community values. Here is a checklist that schools might use to
assess important aspects of curriculum development.
Does the curriculum:
D integrate HIV/AIDS education across the core curriculum and within comprehensive school
health education?
□ provide all students, at each grade level, with age- and gender-appropriate learning
experiences, and consider cultural and religious beliefs?
□ include the prevalence of HIV/STD infection among young people in the nation/area and
the extent to which young people practice behaviours that place them at risk of infection?
□ define curriculum objectives that reflect the needs of students, based on local assessments
and relevant research?
□ include lessons that provide opportunities to address a range of preventive options, e.g.,
delaying sexual intercourse, condom use, no use of drugs, use ofclean needles?
□ include opportunities to practice skills for avoiding HIV/STD infection, pregnancy and drug
and alcohol use?
□ address the use of effective teaching strategies in the design of the curricula?
□ provide opportunities for parents and the community to learn about and reinforce education
about HIV/STD?
□ help students recognize their attitudes and feelings about HIV and people living with AIDS?
6.2.3 Evaluating HIV/STD staff development programmes
Whether students will improve their HIV/STD-related knowledge, skills and attitudes depends to a
large extent on their teacher’s ability to communicate effectively and teach about complex and
sometimes taboo topics. Training can be provided in in-service workshops or continuing education
programmes. (See 5.1.6)
Survey instruments that can be used to evaluate staff development activities include surveys
to assess: educators' needs; general attitudes among educators towards people with HIV or
AIDS; confidence in teaching abilities; comfort with sensitive issues; and HIV/AIDS
knowledge. These can be administered pre- and post-training. Below is a checklist to assess
important aspects of HIV-related training.
Does training for school personnel include:
□ training objectives and content that will meet identified needs of the teachers?
□ allocation of authority, personnel, time and resources to a staff member who will be
responsible for initiating, managing and coordinating the training?
□ follow-up sessions or other means by which to periodically provide updates on HIV
and other important health problems?
□ consistency with the HIV/STD and substance use education offered in the
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curriculum?
□ practices to increase teachers' comfort with discussing sexual behaviour, intravenous drug
use and slang terms?
□ ways to deal with cultural and religious traditions that perhaps hinder discussion about sex
and sex-related matters in the school?
□ innovative participatory techniques, skill-building exercises, and HIV/AI DS-related
topics integrated into the existing curriculum?
□ referral skills and ways to access health and social services?
□ methods to assess the impact and effectiveness of the training, with revisions in the training
format made as needed?
6.2.4
Evaluating the school environment
School environment strongly affects the success of classroom interventions. (See 5.2) The following
checklist may be helpful in evaluating the degree to which the school is creating an environment that
supports principles and interventions related to HIV/STD prevention.
□ Does the physical and psycho-social environment:
□ provide information about HIV/AIDS in the school library?
□ sponsor school assemblies or after-school programmes designed to promote HIV
prevention?
□ display posters and relevant materials as part of a public awareness programme?
□ place HIV/STD prevention high on the agenda for meetings of parent/community/school
groups?
□ maintain a school/community task force to develop programming to prevent HIV/AIDS/STD
and related discrimination?
□ provide resource materials for parents to supplement school programmes? (25)
□ provide opportunities for students and staff to openly address their fears through
discussion?
EU promote values of mutual respect, acceptance and trust?
□ host positive activities like the World AIDS Campaign and AIDS Awareness Day events?
6.2.5 Evaluating school health services
Services for those infected or affected by HIV/AIDS can support individuals in need and contribute to
a positive school environment. The following checklist may be helpful in evaluating the extent to which
health-related services are available.
□ Does the school provide or facilitate access to:
□ school counselling programmes and social support to guide students, staff and families
through HIV/STD-related problems?
D counselling or social support in the areas of adolescent development, sexuality, peer
pressure, identity formation?
□ Referrals for students and staff to appropriate nonschool-based physical and mental
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health services, where those services are available?
□ confidential or anonymous HIV-antibody testing with pre-and post-test counselling?
Are health services in the school or agencies to which the school refers:
D offered by providers who are trained in skills to work with young men and women,
married and unmarried, in a supportive, nonjudgemental way?
□ organised to overcome barriers that often discourage adolescents, including lack of
confidentiality, transportation, inconvenient appointment times and high costs?
□ integrated with other relevant services in the community?
6.3
Evaluating student outcomes
When the school has determined that HIV-related policies, curricula, and/or interventions have been
adequately implemented, and resources are available, the School Health Team may be ready to
conduct outcome evaluation. This evaluation can determine any changes that have occurred over
a specific time period: from before an intervention is implemented (data collected during the needs
assessment called baseline data) to after implementation, and demonstrate that the changes
occurred as a result of the intervention. Pre- and post-tests can help to compare behaviours, skills,
attitudes and knowledge after the intervention. Tests can also be used to compare groups that
receive the interventions with those who do not.
Outcomes that are directly tied to the objectives should be measured. It may be most feasible to concentrate
on outcomes for which records already exist (e.g., items that have already been collected in the needs
assessment should be relatively easy to collect again). The table below, from the Handbook for Evaluating
HIV Education Programs (prepared by the Centers for Disease Control and Prevention/Division of
Adolescent and School Health) provides examples of outcome data that can be used to evaluate HIV/STD-
prevention interventions. (29) The handbook provides specific guidance on evaluation design and
measurement tools. Another reference that offers helpful details about outcome evaluation is School Health
Education to Prevent AIDS and STD: A Resource Package for Curriculum Planners, prepared by WHO
and UNESCO. (30)
Examples of Outcome Data
Evidence
Category
Behaviour
Skills
Attitudes
For Students’
HIV Education
For Teachers’ HIV Staff
Development
Reported activities while in high-risk
Appropriate use of recommended
situations
classroom procedures
Ability to display refusal skills in
Ability to respond appropriately to
simulated high-risk situations
students’ questions about sensitive
relating to HIV infection
topics
Perceptions about one’s personal
Confidence in being able to modify
susceptibility to HIV infection
students' high-risk behaviours
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Knowledge
Knowledge about the routes by which
HIV is/is not transmitted
Knowledge about the instructional
principles relevant to modifying
students' attitudes
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ANNEX 2
OTTAWA CHARTER FOR HEALTH PROMOTION (1986)
The first International Conference on Health Promotion, meeting in Ottawa this 21st day of
November 1986, hereby presents this CHARTER for action to achieve Health for All by the year
2000 and beyond.
This conference was primarily a response to growing expectations for a new public health
movement around the world. Discussions focused on the needs in industrialized countries, but took
into account similar concerns in all other regions. It built on the progress made through the
Declaration on Primary Health Care at Alma-Ata, the World Health Organization's Targets for Health
for All document, and the recent debate at the World Health Assembly on intersectoral action for
health.
HEALTH PROMOTION
Health promotion is the process of enabling people to increase control over, and to improve their health. To
reach a state of complete physical, mental and social well-being, an individual or group must be able to
identify and to realize aspirations, to satisfy needs, and to change or cope with the environment. Health is,
therefore, seen as a resource for everyday life, not the objective of living. Health is a positive concept
emphasizing social and personal resources, as well as physical capacities. Therefore, health promotion is
not just the responsibility of the health sector, but goes beyond healthy life-styles to well-being.
PREREQUISITES FOR HEALTH
The fundamental conditions and resources for health are:
•
•
•
peace,
shelter,
education,
•
food,
•
income,
•
a stable eco-system,
•
sustainable resources,
•
social justice, and
•
equity.
Improvement in health requires a secure foundation in these basic prerequisites.
ADVOCATE
Good health is a major resource for social, economic and personal development and an important dimension
of quality of life. Political, economic, social, cultural, environmental, behavioural and biological factors can
all favour health or be harmful to it. Health promotion action aims at making these conditions favourable
WHO Information Series on School Health
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through advocacy for health.
ENABLE
Health promotion focuses on achieving equity in health. Health promotion action aims at reducing differences
in current health status and ensuring equal opportunities and resources to enable all people to achieve their
fullest health potential. This includes a secure foundation in a supportive environment, access to information,
life skills and opportunities for making healthy choices. People cannot achieve their fullest health potential
unless they are able to take control of those things which determine their health. This must apply equally to
women and men.
MEDIATE
The prerequisites and prospects for health cannot be ensured by the health sector alone. More importantly,
health promotion demands coordinated action by all concerned: by governments, by health and other social
and economic sectors, by nongovernmental and voluntary organization, by local authorities, by industry and
by the media. People in all walks of life are involved as individuals, families and communities. Professional
and social groups and health personnel have a major responsibility to mediate between differing interests in
society for the pursuit of health.
Health promotion strategies and programmes should be adapted to the local needs and possibilities of
individual countries and regions to take into account differing social, cultural and economic systems.
HEALTH PROMOTION ACTION MEANS:
BUILD HEALTHY PUBLIC POLICY
Health promotion goes beyond health care. It puts health on the agenda of policy makers in all sectors and
at all levels, directing them to be aware of the health consequences of their decisions and to accept their
responsibilities for health.
Health promotion policy combines diverse but complementary approaches including legislation, fiscal
measures, taxation and organizational change. It is coordinated action that leads to health, income and social
policies that foster greater equity. Joint action contributes to ensuring safer and healthier goods and services,
healthier public services, and cleaner, more enjoyable environments.
Health promotion policy requires the identification of obstacles to the adoption of healthy public policies in non
health sectors, and ways of removing them. The aim must be to make the healthier choice the easier choice
for policy makers as well.
CREATE SUPPORTIVE ENVIRONMENTS
Our societies are complex and interrelated. Health cannot be separated from other goals. The inextricable
links between people and their environment constitutes the basis for a socio-ecological approach to health.
The overall guiding principle for the world, nations, regions and communities alike, is the need to encourage
reciprocal maintenance - to take care of each other, our communities and our natural environment. The
conservation of natural resources throughout the world should be emphasized as a global responsibility.
Changing patterns of life, work and leisure have a significant impact on health. Work and leisure should be
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a source of health for people. The way society organizes work should help create a healthy society. Health
promotion generates living and working conditions that are safe, stimulating, satisfying and enjoyable.
Systematic assessment of the health impact of a rapidly changing environment -particularly in areas of
technology, work, energy production and urbanization - is essential and must be followed by action to ensure
positive benefit to the health of the public. The protection of the natural and built environments and the
conservation of natural resources must be addressed in any health promotion strategy.
STRENGTHEN COMMUNITY ACTION
Health promotion works through concrete and effective community action in setting priorities, making
decisions, planning strategies and implementing them to achieve better health. At the heart of this process
is the empowerment of communities - their ownership and control of their own endeavours and destinies.
Community development draws on existing human and material resources in the community to enhance self
help and social support, and to develop flexible systems for strengthening public participation in and direction
of health matters. This requires full and continuous access to information, learning opportunities for health,
as well as funding support.
DEVELOP PERSONAL SKILLS
Health promotion supports personal and social development through providing information, education for
health, and enhancing life skills. By so doing, it increases the options available to people to exercise more
control over their own health and over their environments, and to make choices conducive to health.
Enabling people to learn, throughout life, to prepare themselves for all of its stages and to cope with chronic
illness and injuries is essential. This has to be facilitated in school, home, work and community settings.
Action is required through educational, professional, commercial and voluntary bodies, and within the
institutions themselves.
REORIENT HEALTH SERVICES
The responsibility for health promotion in health services is shared among individuals, community groups,
health professionals, health service institutions and governments. They must work together towards a health
care system which contributes to the pursuit of health.
The role of the health sector must move increasingly in a health promotion direction, beyond its responsibility
for providing clinical and curative services. Health services need to embrace an expanded mandate which
is sensitive and respects cultural needs. This mandate should support the needs of individuals and
communities for a healthier life, and open channels between the health sector and broader social, political,
economic and physical environmental components.
Reorienting health services also requires stronger attention to health research as well as changes in
professional education and training. This must lead to a change of attitude and organization of health services
which refocuses on the total needs of the individual as a whole person.
MOVING INTO THE FUTURE
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Health is created and lived by people within the settings of their everyday life; where they learn, work,
play and love. Health is created by caring for oneself and others, by being able to take decisions and
have control over one's life circumstances, and by ensuring that the society one lives in creates
conditions that allow the attainment of health by all its members.
Caring, holism and ecology are essential issues in developing strategies for health promotion. Therefore,
those involved should take as a guiding principle that, in each phase of planning, implementation and
evaluation of health promotion activities, women and men should become equal partners.
COMMITMENT TO HEALTH PROMOTION
The participants in this Conference pledge:
to move into the arena of healthy public policy, and to advocate a clear political commitment
to health and equity in all sectors;
to counteract the pressures towards harmful products, resource depletion, unhealthy living
conditions and environments, and bad nutrition; and to focus attention on public health issues
such as pollution, occupational hazards, housing and settlements;
-
to respond to the health gap within and between societies, and to tackle the inequities in health
produced by the rules and practices of these societies;
to acknowledge people as the main health resource; to support and enable them to keep
themselves, their families and friends healthy through financial and other means, and to accept
the community as the essential voice in matters of its health, living conditions and well-being;
to reorient health services and their resources towards the promotion of health; and to share
power with other sectors, other disciplines and, most importantly, with people themselves;
to recognize health and its maintenance as a major social investment and challenge; and to
address the overall ecological issue of our ways of living.
The Conference urges all concerned to join them in their commitment to a strong public health alliance.
CALL FOR INTERNATIONAL ACTION
The Conference calls on the World Health Organization and other international organizations to advocate the
promotion of health in all appropriate forums and to support countries in setting up strategies and programmes
for health promotion.
The Conference is firmly convinced that if people in all walks of life, nongovernmental and voluntary
organizations, governments, the World Health Organization and all other bodies concerned join forces in
introducing strategies for health promotion, in line with the moral and social values that form the basis of this
CHARTER, Health For All by the year 2000 will become a reality.
CHARTER ADOPTED AT AN INTERNATIONAL CONFERENCE
ON HEALTH PROMOTION
The move towards a new public health
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WHO Information Series on School Health
November 17-21, 1986 Ottawa, Ontario, Canada~|
Annex 3
Integrating HIV/STD prevention in the school setting:
a position paper
(XX)'
I . Rationale
Young people (10 to 24 years) are estimated to account for up to 60% of all new
HIV infections worldwide. Many young people can be reached relatively easily
through schools; no other institutional system can compete in terms of number of
young people served. Prevention and health promotion programmes should extend
to the whole school setting, including students, teachers and other school
personnel, parents, the community around the school, as well as school systems.
Such activities are a key component of national programmes to improve tire health
and development of children and adolescents.
2. HIV/STD Prevention and Health Promotion
HTV/STD-related programmes provide an opportunity to strengthen and accelerate
existing health promotion activities in schools. Education to prevent HIV/STD
should be integrated into education about reproductive health, life skills,
alcohol/substance use, and other important health issues; included in other subject
areas as appropriate and established by official policies; enhanced by school
practices that foster self-esteem, caring, respect, decision-making, self-efficacy,
and conditions that allow for the healthy development of students and staff. This
is done, inter alia, through materials development, teacher training, supervision,
and the participation of parents and communities.
3. Policies
Developing and monitoring a range of policies will be essential for effective
programmes. This includes policies on: human rights (right to education, to non
discrimination, to confidentiality, to protection of employment, to protection from
exploitation and abuse); access to school by students and school workers living
with HIV/AIDS; pre- and in-service teacher training; community/parent
participation; content of curricula and extra-curricular activities, and link with
health services capable of providing diagnosis and treatment of STD for young
people as well as the means of protection against unwanted pregnancy and
HIV/STD, including contraceptives and condoms. Policies are developed at
different levels, according to the degree of centralization of the school system.
WHO Information Series on School Health
43
4. Learning How to Cope
For young people to develop healthy and responsible behaviour patterns, and avoid
infection, it is not sufficient to lean the biomedical aspects of sexual and
reproductive health.
Equally important is learning now to cope with the
increasingly complex demands of relationships, particularly gender relations and
conflict resolution; how to develop safe practices, and now to relate with the
increasing number of people living with HIV and AIDS.
5. Age
Prevention and health promotion programmes should begin at the earliest possible
age, and certainly before the onset of sexual activity. They should reach students
before most of them leave or drop out of school, particularly in countries where
girls tend to leave at a younger age. This means that age-appropriate programmes
should start at primary school level.
6. Life Skills
A life skills approach is important in such programmes. Skills that enable young
people to manage situations of risk for HIV/STD infection are also essential for
the prevention of many other health problems. Such skills include how to respond
adequately to demands for sexual intercourse/offers of drugs; how to take
responsible decisions about difficult options; how t apply risk reduction
techniques; how to refuse unprotected sex when sexually active, and how to seek
appropriate support and care, including health services and counselling.
7. Response of School Systems
Although prevention education through school settings is recognized by almost all
countries as necessary, significant institutional, political, religious and cultural
barriers to its implementation will need to be resolved. In each country, the
school system as a whole must respond to HIV/STD and AIDS, in close
collaboration with the Ministries of Education, Health, Youth and other
government sectors, teachers’ associations and other NGOs and the wider
community.
8. UNAIDS Action
UNAIDS will (i) facilitate the strengthening of national capacity to develop,
implement, monitor and evaluate programmes that integrate HIV/STD prevention,
health promotion and non-discrimination into school policies, curricula as well as
extra curricular activities, and training; and (ii) identify effective and innovative
policies, strategies and action in this area.
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WHO Information Series on School Health
9. Goals By the Year 2000
By the year 2000, UNAIDS will aim to:
•
increase significantly the number of countries which have developed detailed
policies and implemented programmes for non-discrimination and HIV/STD prevention
in the school setting; and
•
increase towards full coverage the percentage of young people attending school,
who learn how to avoid discrimination and reduce the risk of infection.
WHO Information Series on School Health
45
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WHO Information Series on School Health
Europe, USA, Africa and Asia relating to sexual health, AIDS and contraception. XI International
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WHO Information Series on School Health
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Position: 2595 (2 views)