2.2 The role of schools

Since the school years are a formative time in the development of a human being, the school setting provides an efficient means of improving young people’s health, self-esteem, life skills (abilities related to effective decision-making, communication, understanding emotions, critical thinking, coping with stress, etc.), and behaviour. In addition to providing a site where interventions against many specific diseases can efficiently and economically be implemented, schools can also provide the setting to introduce health information and technologies to the community and can lead the community by advocating policies and services that promote health.

School health programmes delivered through health-promoting schools can address many of the major challenges to health throughout the world. These include HIV/AIDS and sexually transmitted diseases; violence and injury; unintended pregnancy and poor reproductive health; helminth infections; poor nutrition and food safety; poor sanitation and water control; lack of immunization; poor oral health; malaria; respiratory infections; psychological problems; problems associated with the lack of physical exercise; and alcohol, tobacco, and illicit drug use.

School health programmes that coordinate the delivery of education and health services and promote a healthy environment could become one of the most efficient means available for almost every nation in the world to improve significantly the well-being of its people. Consequently, such programmes could become a critical means of improving the condition of humankind globally. However, school health programmes are underdeveloped in practically every nation. Scant resources - money, time, qualified professionals, public and political will, supplies - plague school health programmes worldwide.

Unfortunately, the concept of a comprehensive approach to school health programmes, or of a “health-promoting school”, is more advanced than its practice. While terminology and definitions may differ, most of the world’s countries recognize and address three areas of school health programmes - health services, health education, and a healthy environment. However, the responsibility for these activities seldom rests with a single institution. In recent years, many countries have attempted to organize the planning and development of these traditional areas, as well as other related areas, into a more integrated approach to school health programmes.

2.3 School health programmes: a definition

The definition of school health and more particularly school health programmes has evolved markedly in the last 40 years. Although traditionally school health programmes were defined as encompassing school health education, school health services, and a healthy school environment (which included both the physical and psychosocial aspects of environment), neither the interrelationships among these elements nor the manner in which they can and should reinforce each other was emphasized, either in theory or in practice.

In the late 1980s, the definition of school health programmes was elaborated in response to the changing roles of and changing responsibilities within schools. The following eight specific components of school health programmes were identified (23):

· school health services
· school health education
· school health environment (physical and psychosocial)
· health promotion for school personnel
· school-community projects and outreach
· nutrition and food safety
· physical education and recreation
· mental health, counselling, and social supports.

This revised definition served as the basis for a comprehensive approach to school health. Health and education professionals began to realize that successful health promotion through schools is not the result of the success of these components individually; it is a reflection of an organized, coherent approach to a wide range of health issues, implemented through comprehensive and holistic strategies. Schools that approached health in this manner began to be called “health-promoting schools”.

During the past decade, the following three strands of thought have come together that can further refine the concept of school health programmes - and set the stage to advance their development, implementation, and success:

· school health programmes must be founded on organized and mutually reinforcing components;

· schools are dynamic organizations that can respond to changing needs and environments;

· successful health promotion programmes are built upon five areas: policy, supportive environments, community action, personal skills development, and a reorientation of health services.

At this stage, there is a need to unite the best of current theory and practice in a flexible definition of school health programmes that emphasizes the relationships among and within programme components. Therefore, school health programmes are defined with respect to environment, services, and education. Within each area, several implications of the concept of comprehensive school health programmes are elaborated.

Environment

The school health environment should consist of:

· a physical, psychological, and social environment that is developmentally oriented and culturally appropriate, and that enables students to achieve their potential;

· a healthy organizational culture within the school;

· productive interaction between the school and the community of which it is a part.

Services

School health services should include:

· preventive, curative, and referral services (established referral networks extending beyond the school are essential);

· nutritional and food safety services;

· counselling, psychological, and social services;

· safe water and sanitation services;

· health promotion services for staff.

Education

School health education should include:

· academic skills and knowledge development (that make full use of a range of pedagogical techniques, including active learning, peer education, and inquiry-based learning);

· health and nutrition education;

· life skills education;

· staff education through training and development of school personnel.

This definition of school health programmes is designed to provide guidance to policy-makers, planners, educators, and health professionals. In practice, however, it must be recognized that each country and school has its own unique strengths and constraints. Consequently, each school should begin building its programme from its point of strength.

It should be noted that the definition comprises components of school health programmes and does not specify individual roles and responsibilities within the school system. For example, health education could be provided by a teacher or by other health professionals. Health education could take place in a class for health education or could be integrated across the entire curriculum. Moreover, although provision of safe water and sanitation are services, they are also essential elements of a healthy environment. The definition is therefore flexible and designed to be readily adapted to differing circumstances.

However, it is a fundamental truth of both health and education that neither is possible if the environment is so compromised that it presents risks instead of opportunities. To take one example, at the present stage in history, considering the state of development and available technology, the Expert Committee strongly believes that a functioning latrine is a fundamental condition for a school, without which it is difficult to conceive of either health or education being achieved.