Health-Promoting Schools Initiative in the Americas. (Health Education).

Health promotion and health education in schools is a pressing priority, and ensuring the right to health and education for all children is a responsibility shared by all. It is an investment that each society should make in order to generate and augment the creative and productive capacity of all young people and a sustainable social, healthy and peaceful human future.

Until the early 1990s, school health programmes in Latin America and the Caribbean were characterized by efforts directed at improving conditions of hygiene and environmental sanitation, preventing communicable diseases, treating specific diseases and performing periodic medical examinations or screening tests. These multiple interventions often lacked operational strategies to facilitate the integration of the various related components within a conceptual framework that would make it possible to achieve the objectives common to the health and education sectors.

This past decade, considerable progress has been made on the formulation and implementation of integrated school health programmes in almost all countries of the region. In the midst of new relationships and government services, a new vision of public health has evolved, as well as regional initiatives directed to improve school health programmes. At the same time, the role of the educational communities in improving the health conditions, wellbeing and comprehensive development of children and adolescents has acquired significant recognition and support.

The Pan American Health Organization, Regional Office of the World Health Organization (PAHO/WHO), launched the Health-Promoting Schools (HPSs) Regional Initiative in 1995 to strengthen health promotion and education, where children, parents, teachers and other members of the school community live, learn, work and play. Through technical cooperation with and among member countries, the Initiative aims to: build consensus between the health and education sectors; establish relevant partnerships to create, maintain and/or enhance healthy and supportive physical and psychosocial environments; and facilitate the learning of life skills for the adoption and maintenance of healthy lifestyles by school children and adolescents and those close to them.

The Initiative provides a comprehensive and multidisciplinary approach where children, in the context of their daily life within their family, community and society, are the central actors. The major focus is on the acquisition of knowledge and skills that facilitate self-reliance for individual, as well as for collective health-seeking behaviour, including preventing the adoption of risk behaviour and the maintenance of protective lifestyles. critical reflexive analysis of values, attitudes, behaviours, social conditions and lifestyles is encouraged. This strengthens those who favour health and human development, facilitates the participation of all members of the educational community, contributes to promoting socially egalitarian relations among genders, encourages the construction of citizenship and democracy, and strengthens traditions of solidarity, community spirit and human rights.

The Initiative addresses three main components: (2)

The first is comprehensive school health and life-skills education, which is directed toward the acquisition of knowledge, as well as toward the adoption and maintenance of abilities and skills that facilitate the achievement of an optimum level of health and quality of life. It takes into account the particular needs of students in each stage of their development, in accord with their individual social, cultural and gender characteristics, and is based on positive values known to strengthen their personal, family and community life skills and abilities.

The second component is healthy and supportive environments and surroundings, directed towards facilitating the development and strengthening of the capacity of the school to create and maintain environments and surroundings that are supportive for health and learning. It includes basic sanitation and clean water; clean and structurally adequate physical spaces, safe from accidents; support networks for healthy and safe psychosocial surroundings, free from physical, verbal and/or emotional abuse, assault or violence; and teacher training, health promotion, and individualized activities directed to promote health for parent-teacher associations and community organizations.

The third component is adequate health services and food and nutrition programmes and the promotion of an active life, which strengthen the relationship between the school staff, health team and key stakeholders of other relevant sectors, as well as increase their understanding of each other's roles and their capacity to complement and strengthen one other. It emphasizes early and appropriate attention to schoolchildren, and aims to detect, prevent and address in a proper and timely manner health problems, including risk factors and unhealthy behaviours and conditions. It encourages the adoption and maintenance of protective lifestyles, including the consumption of healthy food and an active lifestyle.

According to a recent regional survey, (3) all Latin American countries are in the process of developing HPSs, with 82 per cent reporting to have specific policies related to the Initiative and school health plans that are applied predominantly in primary schools, and 57 per cent having implemented actions related to the three components of the Initiative.

An essential aspect or these schools is multi-setorial work and the creation and maintenance of strategic alliances or effective associations that involve all parties interested in the health and development of the school-age population. The formation of Mixed National Commissions, comprised mainly of representatives of the health and education sectors, has proven to be a mechanism that facilitates intersectorial coordination necessary to disseminate and implement comprehensive school health programmes and the HPS strategy. These Commissions exist in 65 per cent of the countries that participated in the regional survey, rising to 75 per cent if consideration is given to other modalities of intersectorial work, such as technical committees or mixed groups that operate in some of the countries surveyed.

Based on PAHO/WHO guidelines to member States, Latin American and Caribbean countries are in the process of defining the accreditation processes, including minimum requirement criteria and guidelines, certification documentation issued by the Ministries of Health and Education, monitoring and reporting mechanisms and requirements, and recommended period of accreditation. For a school to be accredited as an HPS, it needs as a minimum to have initiated a planning process, implemented a number of health promotion activities and have the participation of of the school community.

Regional and national networks support the organization and expansion of HPSs in each country of the region, and facilitate the sharing of successful experiences by supporting the opening and establishment of channels of multi-directional and multidisciplinary communication for the improvement of education and health in a school setting. The construction and consolidation of these two networks have proven important for the exchange of regional and national knowledge, ideas, resources and experiences of significance for the strengthening of HPSs throughout the Americas.

The Latin American Network of HPSs was created in the First Regional Meeting of the Network in 1996 in San Jose, Costa Rica, with an initial membership of 11 countries. The second meeting, in Mexico in 1998, was attended by all Latin American countries, including Cuba and the Dominican Republic, while the third was held in Quito, Ecuador in September 2002, where all Latin American countries, except Mexico and Argentina, participated and exchanged updated information regarding the status and trends of HPSs. The fourth meeting is to be convened in San Juan, Puerto Rico in 2004.

The Caribbean Network of HPSs was created in Barbados in 2001 with an initial membership of 14 Caribbean countries. These networks still need to be promoted and strengthened, as only 29 per cent of the countries reported the establishment of national networks and only 47 per cent reported participation in the Latin American Network. (3)

This past decade, PAHO/WHO has dedicated special efforts for the development of HPSs in the region. Technical cooperation has focused on sensitizing policy makers about the regional strategy and in conducting regional and subregional meetings and training activities directed to technical personnel for the implementation of the strategy at the country level. Among these efforts are: the analysis and updating of joint policies between the education and health sectors, including a review of the current legislation and policy that define sector mandates and responsibilities for school health; and the development, implementation and evaluation of plans and programmes to implement the components of health promotion and education in the schools.

This also includes incorporation of a "gender approach" into the study content area; curriculum design, with innovative and comprehensive school health education content and methods, and especially the learning of life skills; training of teachers and other health and education sector personnel; production and dissemination of educational materials; and the development and delivery of health services and school feeding programmes.

The most significant challenge to continue the development of the HPS Initiative and the strengthening of comprehensive school health programmes and activities is the mobilization of human resources and materials necessary to implement the Initiative.

This would require the involvement of the society as a whole, the international and technical cooperation agencies, political decision makers, private and public communication sectors, as well as teachers and parents. There is an immediate need to encourage community leaders, decision makers and influential persons to become advocates for the Initiative, to provide the critical visibility and leadership to mobilize public opinion, and to engage key social actors to provide the necessary resources. Its success depends to a great extent on the commitment of the countries, as well as on the leadership role assumed by all sectors involved.

Quantity of Health-Promoting Schools by Countries

Argentina           2,100   2.6%
Brazil                N/R    N/R
Bolivia               N/R    N/R
Colombia            1,248   1.4%
Costa Rica             23   0.3%
Cuba                  561   5.1%
Chile               2,934  18.4%
Ecuador               N/R    N/R
El Salvador         3,875  38.9%
Guatemala           1,725   6.1%
Honduras            2,498
Mexico              1,322   0.7%
Nicaragua             N/R    N/R
Panama                N/D    N/D
Paraguay               17   0.1%
Peru                3,377   5.8%
Dominican Republic    N/R    N/R
Uruguay               500  10.3%
Venezuela             N/D    N/D

Percentage: relation of HPS with the total number of schools.

N/R: not reported.

N/D: no data.

Source: PAHO/WHO Regional Survey of Health-Promoting Schools Regional
Initiative (2001.)

Note: The categorization of HPSs varies among countries. Uruguay:
approximate number. Nicaragua: does not have HPSs but implements health
promotion activities in schools.

Note: Table made from bar graph

Notes

(1.) Pan American Health Organization (1998) Health in the Americas. Volume I, Scientific Publication No. 569. Washington, DC: PAHO/WHO.

(2.) Organizacion Panamericana de la Salud (1998) Escuelas Promotoras de la Salud. Entornos Saludables y Mejor Salud para las Generaciones Futuras. Washington, DC: OPS/OMS.

(3.) Organizacion Panamericana de la Salud (2003) Organizacion Mundial de la Salud. Las Escuelas Promotoras de la Salud en America Latina: Resuitados de Encuesta 1995-2001. Washington, DC: OPS/OMS. In press.

RELATED ARTICLE: A Typical Health-Promoting School

Implements policies that support individual and collective well-being and dignity, and provides multiple opportunities for growth and development for children and adolescents within the context of learning and success for the school community, including teachers, students and families;

Implements strategies that encourage and support learning and health, fostering these with every element at its disposal, engaging health and education officials, teachers, school administrators, parents, health providers and community leaders in the development of planned school health activities. Examples include: comprehensive health education and life-skills training; reinforcing protective factors while reducing risk behaviours; and providing access to school health care, nutrition, and physical activity;

Involves all school and community members, including parents and nongovernmental organizations (NGOs), in making decisions and carrying out interventions to promote learning, healthy lifestyles and community health promotion projects.

Creates a plan of action to improve the physical and psychosocial environment throughout the school and surrounding community, such as policies and regulations for spaces free from smoke, drugs, abuse and any form of violence, as well as providing appropriate access to clean water and sanitary facilities and choice of healthy foods; and strives to set examples through the creation of healthy school environments and by spreading activities beyond the classroom and into the community;

Implements actions to assess and improve the health of students, school personnel, families and community members; and works with community leaders to ensure access to nutrition, physical activity, counselling, health care and respective referral services;

Provides relevant and effective teacher training and health education materials; and

Establishes a local health and education committee, with the active participation of parent-teacher associations, NGOs and other community organizations.

Josefa Ippolito-Shepherd, Ph.D., is the Regional Health Promotion and Health Education Advisor, Health-Promoting Schools Regional Initiative, Unit of Healthy Settings, Area of Sustainable Development and Environmenal Health, of PAHO, based in Washington, D.C., United States.