Implementation of Health Promoting Schools in Northern Part of Asia Pacific Region

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Implementation of Health Promoting Schools in
Northern Part of Asia Pacific Region

• Professor Shiu-hung LEE
• Emeritus Professor of Community Medicine
• The Chinese University of Hong Kong

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INTRODUCTION
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Asia Pacific Region

• A very diverse region with rapid changes in
  cultural, social, health, economic and political
  development
• Reforms in the health care systems to improve
  equity, efficiency and responsiveness

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Brief Review of Health Challenges in the Region
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Common Issues

• Demographic transitions
• Epidemiological transitions
• Lifestyle and behaviour
• Health care reforms

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The New Horizon in Health in the Western Pacific
Region
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New Horizons in Health

• WHO Regional Office for the Western Pacific, 1993
• Promotion of healthy lifestyle
• Prevention of injuries
• Promotion of adolescent health
• Health promotion programme with focuses on
  settings such as home, school, workplace, city,
  island or community
• Development of health promoting schools in the
  Pacific Five Year Plan
• 15 countries and areas developed health promoting
  schools (97-98)

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Examples of Implementation of Health Promoting
Schools in the Northern Part of the Asia Pacific
Region
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Number of Schools in China
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Three Phases of Implementation
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• Phase I (Prior to 1980s)
• Phase of Education and Publicity

• Activities
• Health education and publicity
• Prevention and control of infectious diseases
• Immunization campaigns

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• Activities
• Three important documents published
• The Peoples Republic of China School Health
  Working Guidelines
• The National Standard of School Health
• An Integrated Approach on Prevention and Control
  of Common Issues in Schools Children

• Phase II
• (1980s to early 1990s)
• Phase of Preparation

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Phase II (1980s to early 1990s)

• Six areas of basic requirements set out
• Health management in schools
• Prevention and control of infectious and endemic
  diseases
• School environment
• Health protection
• School curriculum
• School health service

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• Phase III
• (1990s Present)
• Phase of actual implementation of health
  promoting schools

• 1994
• Adopted action plan of health promoting schools
  of the WHO Regional Office for the Western
  Pacific
• Issued guidelines for developing health promoting
  schools in China

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Phase III (1990s Present)

• 1995 Present
• Three important programmes established
  collaboration between M of H and WHO
• Establishment of experimental models of health
  promoting schools
• Development of 100 smokeless health promoting
  schools
• Initiated a programme of prevention of parasitic
  infections in health promoting schools

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Phase III

• World Banks Loan Project included Health
  Promoting Schools
• Activities Intervention programmes to correct
  unhealthy behaviour including
• Smoking
• Unbalanced diet
• Hypertension
• Lack of exercise
• Accidents and injuries
• Unsafe sex

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Phase III

• Accreditation System for health promoting schools
  established
• Award scheme
• Gold
• Silver
• Bronze
• 11 schools so far received gold award

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Examples of some successful Health Promoting
Schools in China
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Schools in Beijing East District
Example I

• Started in 1995
• 40 schools participated
• 21 schools received Awards

Gold 7 Silver 6 Bronze 8
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Six steps of Implementation of Health Promoting
Schools

• Schools to apply to the District Health Promoting
  Schools Coordinating Committee
• Annual Conference held for headmasters and
  teachers of newly joined schools
• Establish Health Promoting School Working Group
  and action plan in each school

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Six steps of Implementation of Health Promoting
Schools

• Self-assessment by each school for the possible
  award
• Apply to District Health Promoting School
  Co-ordinating Committee for evaluation by
  external team of health promoting school experts
• District Committee to announce result of
  evaluation at annual conference and set out
  annual plan for coming year

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Experience after 5 years Implementation

• Leadership and commitment by District Government
  prerequisite for success
• Strong composition and support by members of
  District Health Promoting Schools Co-ordinating
  Committee essential
• Need to ensure Health Promoting School Working
  Group capable to implement the 6 areas of action
  of health promoting schools as set out by
  Government

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Experience after 5 years Implementation

• The project in Beijing East District has
  demonstrated
• Health Promoting Schools an important component
  of quality education
• An effective way to implement the school health
  regulation
• Fundamental approach to improve health through
  primary health care

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Tobacco UsePreventionAn ImportantEntry
Pointfor the Developmentof Health Promoting
Schools
Example II
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• A Collaboration Project of WHO, Zhejiang
  Province, Health Education Centre, Jiaxing Health
  Office, and Zhejiang Bureau of Education
  Participating Schools 4
• Timing 1998 June 2000

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• Objective Integrate tobacco prevention into the
  health promoting schools
• Schools provide an efficient and effective way to
  reach large numbers of the population school
  personnel, families and community members, as
  well as students
• Students can be reached during childhood and
  adolescence, influential stages in their lives
  when lifelong behaviours such as tobacco use are
  formed

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• The issue of tobacco use can be addressed
  consistently during successive years from the
  earliest grade through secondary school
• Addressing prevention of tobacco use can enhance
  attention to the use of alcohol and other
  substances, and other relevant risk factors among
  students
• Schools provide a channel to the community to
  introduce tobacco use prevention information and
  technologies and take the lead in advocating
  policies and services that reduce tobacco use

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• Method of study a comparative study about the
  effect of tobacco use prevention programme
  between the experimental group and the control
  group of schools

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Strategies used

• Adopt health promotion as an integrate part of
  the schools day to day education management
  activity
• Use teaching and moral education as 2
  important pitters for health primary school
• Establish 3 teams of school administrators,
  school doctors and class teacher plus student
  teachers to promote health promoting school
• Ensure participation of 4 groups of people,
  students, teachers, parents and community

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Strategies used

• Integrate health promoting into 5 major areas
• Major holiday or health exhibition activities
  e.g. participated in World No Tobacco
  Dayactivity
• School, family and social education e.g. pledged
  to become no smoking generation
• Daily life activity
• Health Service
• Health Education and Publicity materials
• Health promotion activity to focus on various
  forms of anti-smoking activities

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Results

• 4 schools received WHO health promoting school
  bronze award
• Development of health promoting school on a
  systematic and scientific basis
• Prominent improvement of the schools physical
  environment
• Formed an essential team in health promoting
  school activity
• Increase the knowledge and confidence of the
  people in anti-smoking work in the trial schools

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Effectiveness of the Project
A. Knowledge on tobacco and health
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• Understanding the harmful effect of Tobacco on
  health
• Increased to 72.11 in trial schools
• But impact in control schools not clear
• Suggest age of students could be a factor
  accounting for the difference

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• Knowledge and skills on Anti-smoking
• Increase in trial group of schools
• Suggest health education should start early in
  school children

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• The study has demonstrated that anti-smoking in
  schools has the strong support of the community
  and knowledge on tobacco and health and
  anti-smoking skills has obviously improved after
  the study

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Luoyang Primary School Accident and Injury
Prevention Project supported by the World Bank
Loan Fund
Example III
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Objective

• To enable the students to understand the traffic
  regulations
• To increase the students awareness to observe the
  traffic rules
• To reduce or minimize traffic accidents leading
  to injuries

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Target population

• All student, teachers and leaders

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Strategies

• Policy support and involvement of leaders
• 2 Working Groups health promotion and health
  protection
• Working Groups composed of headmaster (convener)
  and local government representatives
• Monitor Working Plan ensuring full participation
  by all people

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• Extra and Intra curriculum activities to increase
  students awareness and practice on safety
• Increase physical education lessons
• To include knowledge on safety
• Lessons on traffic safety, accident prevention
  and first-aid
• Cycling under 12 not allowed
• Seminars, broadcast announcements
• Establish junior safety ambassador
• Adhering safety practice on the street after
  schools

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• Collaboration with traffic police in promoting
  road safety
• Parents education on road safety

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Results

• No traffic accident occurred in school children
• Students knowledge and adherence on road safety
  practice greatly enhanced
• Parents knowledge on road safety increased from
  80 to 100

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Health Promoting Universities in China
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Health Promoting University

• Smokeless Universities
• Tongji University ????
• Peking University ????

• Environment
• Tsinghua University ????

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Peking University
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Peking University
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• Smoking is a wicked impoliteness.Its an
  impertinent, antisocial act.Smokers poison the
  air for miles and suffocate respectable citizens
  who dont design to defend themselves by
  retaliating in kind.Who would ever enter the room
  of a smoker without-feeling ill!
• -John Wolfgaune Von Goethe (1749-1832)

??????? 1999??? ?????????????
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Peking University
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Tsinghua University
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Tsinghua University
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Tsinghua University
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Health Promoting Schools

• Health Promotion Board to be responsible for the
  promotion of health and the implementation of
  various health promotion and health education
  programmes

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Health Promotion Board

• Operates the School Health Service
• Integrated programme for the students including
  dental health, immunization and screening
• Schools are visited by teams of health care
  professional once a year
• HEALTH ZONE established to provide information on
  health education, health promotion and disease
  prevention

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Future Direction

• Evaluation of the service by a consultancy team
  from the Harvard University
• Develop output indicators
• Focus on new approaches and innovative ideas
• Emphasis on target groups and the major issues of
  health problems in the school children

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Health Promotion Board
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Malaysias Health Vision

• Malaysia is to be a NATION OF HEALTHY
  INDIVIDUALS, FAMILIES AND COMMUNITIES through a
  health system that is equitable, affordable,
  efficient, technologically appropriate,
  environmentally adaptable and consumer-friendly,
  with emphasis on quality, innovation, health
  promotion and respect for human dignity and which
  promotes individual responsibility and community
  participation towards an enhanced quality of life

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Mission of the Ministry of Health Malaysia

• The mission of the Ministry of Health is to build
  partnerships for health to facilitate and support
  the people to
• Attain fully their potential in health Motivate
  them to appreciate health as a valuable asset
• Take positive action to improve further and
  sustain their health status to enjoy a better
  quality of life

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Existing Programmes

• Public Health Programme
• Family Health Development
• Disease Prevention and Control
• Oral Health
• Food Quality Control
• Health Promotion and Education
• Medical Care Programme
• Research and Technical Support Programme
• Management and Finance Programme

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Human Resource Its Utilization
55 of doctors in private sector responsible for
21 of hospital beds. 45 doctors in public
sector responsible for 79 of hospital beds in
the country (1995)
70 patients managed by public sector
specialists are complex cases compared 25 of
such cases managed by specialists in private
sector
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Health Promoting Schools

• Similar to that of Singapore, based on the former
  British model
• Integrated programme of screening, immunization
  and dental service
• Quality of service not uniform, varies with
  different states

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Eight Goals of Health System
Weaknesses of the existing health care system

• Wellness Focus
• Person Focus
• Informed Person
• Self-Help
• Care provided by home or close to home
• Seamless, continuous care
• Services tailored as much as possible
• Effective, efficient and affordable services

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Promoting the Health Paradigm
Future Direction

• Promote different thinking about health,
  wellness, illness
• To extent possible
• Identify manage
• Change Approach
• Move from

Health screening Predictive testing Health risk
factors Early interventions for illness Passive
proactive Involve individuals, Families
and communities Diagnose and treat to predict
manage
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Problems and Difficulties in the Implementation
of Health Promoting Schools in Northern Part of
Asia Pacific Region
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Resources

• Physical
• School environment
• School canteen
• Teaching facilities
• Supporting facilities in health education
• Human
• Teachers
• Parents
• Others
• Financial
• World Bank Loan Fund
• ????

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• Capacity Building
• Training of teachers, parents
• Sustainability
• Net-working

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Conclusion
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• Good start, national guidelines and standards
  established
• Need to develop innovative and in depth
  programmes
• Need to sustain the movement
• Need to base on scientific evidence
• Need to address the major health problems of
  students

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• Need to conduct more research on health problems
  in children, and the impact of health promoting
  schools on students, parents and the community
• Need to evaluate the effectiveness of health
  promotion in schools
• Establish net-working of health promoting schools
  to disseminate knowledge and share experience and
  to promote further development

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THANK YOU