Teaching and Learning for a Sustainable Future UNESCO 2010

MODULE 8: HEALTH EDUCATION

INTRODUCTION
The issues of development, environment and health are closely entwined. This reflects the complex links between the social, economic, ecological and political factors that determine standards of living and other aspects of social well-being that influence human health. A healthy population and safe environments are important pre-conditions for a sustainable future. However, at the beginning of the 21st century, the education of many children and young people around the world is compromised by conditions and behaviours that undermine the physical and emotional well-being that makes learning possible. Hunger, malnutrition, malaria, polio and intestinal infections, drug and alcohol abuse, violence and injury, unplanned pregnancy, HIV/AIDS and other sexually transmitted infections are just some of the health problems we face. As a result, education policymakers and teachers must embrace health promotion activities to achieve their goals. Schools must be not only centres for academic learning, but also supportive venues for the provision of essential health education and services (Adapted from Improving Learning Outcomes by Improving Health and Nutrition: Incorporating the FRESH Approach in National Action Plans for Achieving Education for All, UNESCO, 2001). This module provides an overview of the holistic nature of health and the New Public Health movement. It also provides examples of the ways in which health can be taught as a cross-curricular theme through a focus on health education as a process of achieving the goals of healthy people, healthy communities and healthy natural environments.

OBJECTIVES
To analyse the multi-dimensional nature of health and the New Public Health; To recognise the importance of a broad and positive view of health to a sustainable future; To appreciate the impact of infection with HIV/AIDS on social and economic development and the roles of the teacher in relation to this To contrast traditional approaches to health education with FRESH and Health Promoting School approaches; and To identify initiatives that can promote the FRESH and Health Promoting School approaches.

ACTIVITIES
1. The New Public Health

2. Madlusuthes Farm 3. An holistic view of health 4. A FRESH start to health education 5. The Health Promoting School 6. HIV/AIDS Preventive education 7. Reflection

REFERENCES
Chief of State School Officers (2006) Assessment Tools for School Health Education: Pre-Service and In-Service Edition, Health Education Assessment Project, Santa Cruz CA. Davis, J. and Cooke, S. (2007) Educating for a healthy, sustainable world: An argument for integrating health promoting schools and sustainable schools, Health Promotion International, 22(4), pp. 346-53. Joint Committee on National Health Education Standards (2006) National Health Education Standards: Achieving Health Literacy, American School Health Association, Kent, Ohio. Meeks, L., Heit, P. and Page, R. (2005) Comprehensive School Health Education: Totally Awesome Strategies for Teaching Health, 5th edition, McGraw-Hill, New York. Queensland Government (2006) Health Promoting Schools Toolbox, Department of Health, Brisbane. Tones, K. and Green, J. (2008) Health Promotion: Planning and Strategies, Sage, London. Whalen, S., Splendorio D. and Chiariello S. (2007) Tools for Teaching Health, Jossey-Bass, San Francisco.

INTERNET SITES
Health Promoting Schools European Network Health Promoting Schools New Zealand Health Promoting Schools Scotland Health Promoting Schools South Africa International Healthy Cities Foundation Shape-Up Europe

The Healthy Schools Programme UK UNAIDS UNICEF Skills-based Health Education Programme World Health Organisation (WHO) WHO Health Factsheets Index WHO Healthy Cities WHO Health Promoting Schools

CREDITS
This module was for UNESCO written by John Fien and integrates some materials and activities developed by Helen Spork and Rob ODonoghue in Teaching for a Sustainable World (UNESCO UNEP International Environmental Education Programme).

ACTIVITY 1: THE NEW PUBLIC HEALTH

WHAT IS HEALTH?
Traditionally, health is defined as the absence of illness. However, it can be said that this sort of definition is similar to defining peace as the absence of war or love as the absence of hate. Just as it is possible to have a positive view of peace and love, we can have a positive view of health. Such a positive view of health has evolved over the last two decades from international discussions organised by the World Health Organisation (WHO). This view adopts a socio-ecological, rather than a biomedical, approach to health. Thus, WHO defines health in this positive way: Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Source: World Health Organisation. This socio-ecological view of health is known as the New Public Health. It is not only a positive view of health it is also a broader, multi-dimensional view. Identify the differences between the old or narrow view of health and the broader perspective of the New Public Health. The socio-ecological view of health does not deny the importance of basic health care. As annual World Health Reports show, many people around the world, especially children, still suffer needlessly from many preventable diseases. In fact, statistics on child mortality show that the two most dangerous things a child can do in most parts of the world is to breathe air and drink water. This is because respiratory and diarrhoeal diseases are the two major causes of death of children under five years of age in the South. Similarly, WHO estimates that 6 million people in the world are irreversibly blinded by trachoma, and nearly 150 million people are in urgent need of eye care if blindness is to be prevented. Yet, trachoma is a preventable infection caused by poor socioeconomic conditions such as over-crowding and unsafe water and sanitation. The New Public Health approach focuses on preventing diseases not just curing them. That is, the New Public Health pays attention to the economic inequalities, social problems and environmental issues that cause many diseases and so addresses the root causes of disease. It does this by establishing policies, services and education programmes that can prevent many diseases from occurring in the first place. This is not only good for the health of individuals and their communities (social sustainability), it also contributes to ecological and economic sustainability. The New Public Health approach helps improve ecological sustainability by creating

conditions of clean air and water and effective waste management. It contributes to economic sustainability because prevention of disease is very much cheaper than expensive medical and hospital treatment.

ACTIVITY 2: MADLUSUTHES FARM

Begin by opening your learning journal for this activity. The New Public Health encourages health for all by addressing the root causes of illhealth that are found in unhealthy living conditions. It is now being widely practised in rural villages and cities, in countries of both the South and the North, and in homes, schools and workplaces. This activity investigates how the New Public Health was used to improve health and living conditions in a village in Africa. The case study of Madlusuthes Farm comes from South Africa (where it was developed by the Share-Net educational partnership) but the concepts and principles are relevant to many parts of the world. Investigate health and living conditions on Madlusuthes Farm. Q1: Q2: Q3: Name five social and environmental problems on the farm. Identify how these problems might affect the health of Mba, Joe and their children. Recommend one action that could be taken to prevent or fix each of these health problems.

NEW PUBLIC HEALTH SOLUTIONS

Mba, Joe and their children of Madlusuthes Farm recently joined their neighbours in a Community Problem Solving exercise to address local health problems. The projects they developed were based on New Public Health approaches. Investigate these New Public Health projects and assess their impacts on Madlusuthes Farm. Q4: Identify two other problems (that you did not analyse in Questions 1-3) which were addressed in the New Public Health projects implemented on Madlusuthes Farm. Analyse the health impacts and solutions to these problems.

THE BANGKOK CHARTER

The global context for health promotion has changed in the years since the Ottawa Charter. For example, new challenges to health are coming from: increasing inequalities within and between countries; new patterns of consumption and communication; climate change; and rapid urbanisation.

Recognising this, improving health is a core focus of the Millennium Development

Goals (MDGs). Of the eight MDGs, four relate to health: 1. Eradicate extreme poverty and hunger Reduce by half the proportion of people living on less than one dollar a day; Reduce by half the proportion of people who suffer from hunger.

4. Reduce child mortality Reduce by two thirds the mortality rate among children under five.

5. Improve maternal health Reduce by three quarters the maternal mortality ratio.

6. Combat HIV/AIDS, malaria and other diseases Halt and begin to reverse the spread of HIV/AIDS; Halt and begin to reverse the incidence of malaria and other major diseases.

As a result, the World Health Organisation facilitated the development of a new agreement that complements and builds upon the values, principles and action strategies of health promotion established by the Ottawa Charter. It is called the Bangkok Charter and was agreed by a conference of world experts who met in Bangkok in 2005. The Bangkok Charter contains four key commitments: 1. To make the promotion of health central to the global development agenda 2. To make the promotion of health a core responsibility for all of government 3. To make the promotion of health a key focus of communities and civil society 4. To make the promotion of health a requirement for good corporate practice.

ACTIVITY 3: AN HOLISTIC VIEW OF HEALTH

Begin by opening your learning journal for this activity. The New Public Health projects implemented on Madlusuthes Farm are examples of the types of social, economic and ecological initiatives that contribute to a positive and holistic view of health. According to the holistic view of the New Public Health, a sustainable future will be populated by: healthy people, living in healthy communities, within the resource opportunities and limits of healthy natural environments.

This holistic view of health means that the health of people, the health of communities and the health of the natural environment are inextricably linked at local, national and global scales. Q5: Identify the school subjects that could teach these different aspects of health.

THE OTTAWA CHARTER

The holistic views in the New Public Health have evolved over the last two decades as a result of a series of WHO conferences. One of the most significant was held in Ottawa, Canada in 1986. The Ottawa Charter signed at this meeting agreed that the fundamental conditions and resources for health include: Peace Shelter Education Food Income A stable ecosystem Sustainable resources Social equity and justice

The Ottawa Charter outlined five strategies for ensuring that all people have the right to these health resources:

1. Developing Healthy Public Policy

Including health as a major consideration in all policies and legislation (e.g. transport, environment, housing, education, social services) because they all influence health. Building co-operation of all governments and policy makers across all sectors and at all levels to consider the health consequences of their decisions and to accept their responsibilities for health.

2. Creating Supportive Environments

Building responsibility of all nations, regions, communities and individuals to take care of each other and their natural environments. Conserving natural resources and protecting natural and built environments. Generating safe, satisfying and enjoyable living and working conditions. Supporting health lifestyles.

3. Strengthening Community Action

Empowering communities. Strengthening public participation and community ownership and control over the direction of health matters. Providing full access to information, funding and support.

4. Developing Personal Skills

Supporting personal and social development. Providing information, education and enhancing life skills.

5. Reorienting Health Services

Broadening the role of health services from being authoritative and individualistic to shared responsibilities and partnerships for health, and shifting from a dominant clinical and curative orientation to one that emphasises prevention with a focus on the social, political, economic and environmental components connected to health.

ACTIVITY 4: A FRESH START TO HEALTH EDUCATION

Begin by opening your learning journal for this activity.

FRESH: FOCUSING RESOURCES ON EFFECTIVE SCHOOL HEALTH

Good health and nutrition are both essential inputs and important outcomes of basic education. First, children must be healthy and well-nourished in order to fully participate in education and gain its maximum benefits. Early childhood care programmes and primary schools that improve childrens health and nutrition can enhance the learning and educational outcomes of school children, especially girls, and thus for the next generation of children as well. In addition, a healthy, safe and secure school environment can help protect children from health hazards, abuse and exclusion. International agencies such as WHO, UNICEF, UNESCO and the World Bank believe that there is a core group of cost effective strategies for making schools healthy for children and so contribute to the development of child-friendly schools. These agencies have launched a new approach to health education called FRESH (Focusing Resources on Effective School Health).

BACKGROUND TO FRESH
Ensuring that children are healthy and able to learn is an essential component of an effective education system. This is especially relevant to efforts to achieve education for all in the most deprived areas. Increased enrolment and reduced absenteeism and drop-out bring more of the poorest and most disadvantaged children to school, many of whom are girls. It is these children who are often the least healthy and most malnourished, who have the most to gain educationally from improved health. Effective school health programmes that are developed as part of community partnerships provide one of the most cost-effective ways to reach both adolescents and the broader community and are a sustainable means of promoting healthy practices. 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 childfriendly schools and thus to the promotion of education for all.

FOCUSING RESOURCES ON THE SCHOOL-AGE CHILD

A childs 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 countrys 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, it: Q6: responds to a new need; increases the efficacy of other investments in child development; ensures better education outcomes; achieves greater social equity; and is a highly cost effective strategy.

Which of these benefits of a FRESH approach to school health are most important in your school? Why?

A FRESH FRAMEWORK FOR AN EFFECTIVE SCHOOL HEALTH AND NUTRITION PROGRAMME

The FRESH framework is a 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 strategies then there would be a significant immediate benefit, and a basis for future expansion. In particular, the aim is to focus on strategies that are feasible to implement even in the most resource poor schools, and in hard-to-reach rural areas as well as accessible urban areas, that promote learning through improved health and nutrition. The four components of the FRESH framework that should be made available together, in all schools, include: Q7: Q8: Health-related school policies Provision of safe water and sanitation Skills-based health education School-based health and sanitation services.

Identify two examples of policies, programmes or activities in your school that support the four elements of the FRESH framework. Identify two examples of policies, programmes or activities you could change or improve to better support each of the four elements of the FRESH framework in your school.

A SUPPORTIVE ENVIRONMENT
The four core strategies in the FRESH framework require a supportive environment for successful implementation. A supportive environment includes: Effective partnerships between teachers and health workers and between the education and health sectors.

Effective community partnerships. Pupil awareness and participation.

Source: Adapted from WHO, UNICEF, UNESCO and World Bank (2000) Focusing Resources on Effective School Health: A FRESH Start to Improving the Quality and Equity of Education, World Education Forum, Dakar, Senegal.

ACTIVITY 5: THE HEALTH PROMOTING SCHOOL

Begin by opening your learning journal for this activity. The traditional content focus in health education involves learning about the human body, food nutrition, the importance of work and exercise and the problems of smoking, drugs and alcohol. These topics are very important. However, just learning about health is not enough. To be effective, health education has to go beyond learning about health to include a whole-of-school approach that involves both the formal and hidden curriculum. This is why WHO focuses its school health education programmes on what it calls Health Promoting Schools. Definitions of Health Promoting Schools vary across schools, regions, and countries according to local needs and circumstances. However, in general, a Health Promoting School can be characterised as a school that is constantly strengthening its capacity as a healthy setting for living, learning and working. A Health Promoting School: Fosters health and learning with all the measures at its disposal. Engages health and education officials, teachers, teachers unions, students, parents, health providers 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 individuals well being and dignity, 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 pupils; and works with community leaders to help them understand how the community contributes to, or undermines, health and education. Source: World Health Organisation. Investigate the differences between traditional school health education and the activities of a Health Promoting School, and the nature of the health education curriculum provided by your school. Review the results of your school assessment:

Q9: Q10:

Identify three strengths of your school as a Health Promoting School. Identify three areas where new or refocused initiatives would increase the holistic nature of health education in your school.

ACTIVITY 6: HIV/AIDS PREVENTIVE EDUCATION

Begin by opening your learning journal for this activity. AIDS stands for Acquired ImmunoDeficiency Syndrome. It is the name of the disease that people get in the late stages of infection caused by contracting the Human Immunodeficiency Virus (HIV). It is because the two are different, but linked, that we use the term HIV/AIDS to refer to the condition. A person who is infected with HIV can look and feel healthy for up to ten years or more before signs of AIDS appear. But HIV steadily weakens the bodys defence (immune) system until it can no longer fight off infections such as pneumonia, diarrhea, tumours and other illnesses. All of which can be part of AIDS. Unable to fight back, most people die within three years of the first signs of AIDS appearing. HIV/AIDS is a major concern for teachers and education systems. In the mid-1980s when it was just beginning to spread, HIV/AIDs was seen as a disease for adults, mostly men, whose sexual behaviour or drug use made them vulnerable. However, the disease quickly became an epidemic, and women, young people and even newborn children became infected. As a result, teachers in many parts of the world now find that they are teaching young people who are at risk and, maybe, many who are HIV positive. Some even find that they are teaching very young children who were born with the disease. In fact, schools in some parts of the world report that the number of children in their schools is declining from Grade 1 to Grades 2 and 3 with such children often dying around the age of seven or eight. As a teacher in Africa interviewed for this programme said: We start First Grade with seven classes of 40 pupils. It is just heart-breaking to know that we will only have five, or at the most, six classes of them in Third Grade. What can you teach a little one you know may not be alive within two years? And many other children shun them out of false fears or because of what their parents or neighbours tell them? All you can do is love them. HIV/AIDS is such a major problem that teachers often feel at a loss about what they can do to help their students in this important area of health education. Nevertheless, within the limits of their abilities and cultural traditions, teachers have a very important role to play in preventative health education. As the Secretary-General Mr Kofi Anan, said in the millennium Report to the General Assembly in 2000: In too many countries, an official conspiracy of silence about AIDS has denied people information that could have saved their lives. We must empower young people to protect themselves through information and a supportive social environment that reduces their vulnerability to infection. Source: Millennium Report to the General Assembly, 2000. Given the absence of a vaccine to prevent the spread of the HIV/AIDS virus and the seeming inability of medical science to find a cure that most countries and people can afford to buy, education is one of the most effective ways to combat the epidemic.

This activity provides an introduction to some of the issues teachers may face and encourages critical thinking about appropriate educational policies, programmes and activities. Q11: Identify three issues that teachers in your school (or country) face in teaching about HIV/AIDS in schools.

THE SCALE OF THE PROBLEM

The most authorative group in the world on the topic is the Joint United Nations Programme on HIV/AIDS (UNAIDS). UNAIDS is an international interagency group comprising UNICEF, UNDP, UNFPA, UNESCO, WHO, UNDCP and the World Bank. Each of these agencies has its own HIV/AIDS programme as well as contributing to UNAIDS. UNAIDS publishes a biannual report on the scale of the problem and the actions being taken to address it. The 2008 report of the number of people affected by HIV/AIDS around the world reveals that the incidence of the HIV/AIDS epidemic is starting to stabilise, as the following points show: In 2003, there an estimated 38.7 million people around the world were living with HIV. This had dropped to 33 million people in 2007. However, in 2007, there were still 2.7 million new HIV infections and 2 million AIDS-related deaths last year. The rate of new HIV infections has fallen in several countries, but globally these favourable trends are at least partially offset by increases in new infections in other countries. Globally, women account for half of all HIV infections, a percentage which has remained stable for several years. There are enormous variations in different world regions in the number and percentage of people living with HIV, new infections and AIDS deaths. People living with Region Sub-Saharan Africa South & South East Asia East Asia Latin America North America HIV 22 million 4.2 million 740 000 1.7 million 1.2 million New Infections 2007 1.9 million 330 000 52 000 140 000 54 000 AIDS Deaths 2007 1.5 million 340 000 40 000 63 000 23 000 Adult Prevalence % 5% 0.3% 0.1% 0.5% 0.6%

Western & Central Europe Eastern Europe, Central Asia Caribbean Middle East & North Africa Oceania Total

730 000 1.5 million 230 000 380 000 74 000 33 million

27 000 110 000 20 000 40 000 13 000 2.7 million

8 000 58 000 14 000 27 000 1 000 2 million

0.3% 0.8% 1.1% 0.3% 0.4% 0.8%

Source: UNAIDS Global Report 2008. Most concerning for educators is the incidence rates for children. The 2008 UNAIDS Global Report indicated that: 2 million children under 15 were living with HIV in 2007. There were also 370,000 new infections and 270,000 deaths from AIDS of children under 15 years. Q12: Which of the following maps and graphs of the scale and distribution of HIV/AIDS has the most implications for your teaching? Why? Adults and children estimated to be living with HIV/AIDS as of end 2007. Spread of HIV over time in Sub-Saharan Africa, 1985 to 2003. Projected new adult infections a comparison between no intervention and a timely upscale of intervention. Use the interactive map at the Global Atlas of Infectious Diseases to create your own map and/or diagram to illustrate another aspect of the HIV/AIDS epidemic.

Review the situation in your country.

HIV/AIDS AS A DEVELOPMENT ISSUE

HIV/AIDS is not just a health problem. It is also a development problem. Since the epidemic began, it has killed millions of adults in the prime of their working and parenting lives, decimated the workforce, fractured and impoverished families, orphaned millions, and shredded the fabric of communities. The impacts on peoples lives and through them to the social fabric and opportunities for economic activities, means that the epidemic is a major threat to plans for a sustainable future. That is, in addition to the extraordinary human suffering it causes, AIDS poses serious problems to a nations health and productivity as well as the fabric of family and community life.

HIV/AIDS increases poverty and threatens social stability

Although both the rich and the poor can be infected by HIV, the poor have fewer resources to cope and are therefore more likely to experience negative consequences. These include reductions in household assets, per capita food consumption, and school attendnace.

HIV/AIDS compromises public health spending

In many cases, HIV/AIDS can disproportionately drain the resources of already-fragile health systems by compromising health care services for overall community needs. In addition, HIV leads to increased prevalence and incidence of other diseases, including tuberculosis (TB) and sexually transmitted infections (STIs).

Basic human rights of people living with HIV/AIDS have been violated
In many countries, people living with HIV/AIDS, and others considered to be vulnerable to the disease, such as refugees, migrants, ethnic minorities, prostitutes, injecting drug users and men who have sex with men suffer discrimination and mistreatment.

The economic costs of HIV/AIDS

Workers in their most productive years (15-49) suffer the greatest economic costs of HIV/AIDS. The loss of skilled workers harms individual households and vital sectors such as education, transport, and agriculture. Source: World Bank. Q13: Which two aspects of HIV/AIDS as a development issue are the biggest challenges to a sustainable future in your country? Why? Investigate specific aspects of HIV/AIDS as a development issue: HIV/AIDS, human rights and law HIV/AIDS and its impacts on rural development HIV/AIDS and the costs of drug treatments HIV/AIDS, security and humanitarian response

WHAT DO TEACHERS NEED TO KNOW?

One of the questions of concern to teachers relates to how much information they need to know about the causes and possible treatment for HIV/AIDS. This is an important question but the answer varies according to the social, cultural and religious contexts in which they work, the patterns of HIV/AIDS in their country or area, and the development needs and interests of their students. UNAIDS provides an excellent Frequently Asked Questions web service for teachers and others who need information on HIV/AIDS written in non-medical terms. There are over thirty questions answered at this site, including:

How is HIV spread? What is safe sex? What is safe needle use? Can you get AIDS from casual contact with an infected person? How can you recognize if someone is infected with HIV? How can you tell if I am in a safe relationship? Are there people who are more likely to be infected with HIV than others? What should you do if I think I might already have HIV? What should you do if you think you know of someone who has HIV or AIDS?

Research the UNAIDS Fast Facts web site to find answers to questions that are important to you and your students. As well as websites provided by UNAIDS and its member-agencies, UNAIDS recommends the following websites as very useful for clearly written information on HIV/AIDS written for ordinary people rather than doctors and health specialists. British Broadcasting Corporation This site is provided by the British Broadcasting Corporation and discusses basic issues such as: What is HIV and AIDS? How is it passed? How can HIV be tested? Precautions for people administering first aid, and many others. The Body This page on The Body website is especially written for people who have just found out that they are HIV-positive, and provides much information that is both useful and comforting. The Body is a USA website, so much of the practical information on where to find help is aimed North Americans. The site also has Spanish information. Q14: Q15: What are the best sources of information on HIV/AIDS for teachers in your country? What are the best sources of information on HIV/AIDS for young people in your country?

YOUTH, AIDS AND EDUCATION

Some experts have argued that HIV/AIDS education should emphasise the development of responsible behaviour and value orientations. The development of a personal moral code is very important and schools can do much to support families and religious leaders in helping young people develop a strong sense of morality and commitment to themselves, their families and their friends. Preventive education programmes are also needed because youth is a time for experimenting with ideas and practices. Some of these, such as experimenting with sex and drugs, are associated with HIV infection and AIDS. Young people are, therefore, particularly vulnerable to infection. In many countries the highest rates of

new infections are among young people, and many existing sufferers probably contracted the virus when they were in their teens or early twenties. HIV infection is on the rise among young people aged 12 to 19. Indeed, every minute five more adolescents throughout the world become infected with HIV. However, youth is also a period of accelerated learning, and a time when young people can acquire the necessary knowledge, beliefs, attitudes, values and skills that can help them to behave in ways conducive to health and well-being and to avoid situations likely to lead to their infection with HIV. School and community-based education and health efforts can thus serve as effective strategies to help young people avoid HIV infection and other health problems. Unfortunately, according to the World Health Organisation (WHO), formal education on sexual matters is inadequate or non-existent in many regions of the world, or is provided too late in adolescence. As a result, UNESCO, WHO and UNAIDS have sponsored national and regional meetings around the world to provide opportunities for governments to share experiences and plan improved educational programmes. For example, the regional meeting for Central Asia and the Trans-Caucaus region held in Almaty, Kazakhstan, in 1998 concluded: The education system can and must play a critical role in educating about the risks of HIV infection and effective means to avoid it, as well as to promote tolerance and compassion for those who are infected with the virus. The emergence of the AIDS pandemic is an urgent reason for nations worldwide to carefully plan broad-scale programmes in education systems to prevent the transmission of HIV among young people and to cope with the impact of HIV/AIDS on the demand, supply, process and quality of education. With sufficient resources and political will, millions of new infections can be avoided and the relentless infection of an adolescent every 12 seconds brought to a halt. Source: Final Report: Force for Change Improving Preventive Education and Health Services within the School System, UNESCO/WHO/UNAIDS Regional Seminar for Central Asia and Trans-Caucasus, Almaty, Kazakhstan, 7-15 July, 1998. The UNESCO Programme of Education for the Prevention of Drug Abuse and HIV/AIDS has published very good guidelines for the development of effective school-based preventive education programmes. These include: Integrate HIV-related issues into education about reproductive health, life skills, substance use, and other important health issues Prevention and health programmes should not only teach young people the biomedical aspects of reproductive health but they should also learn how to cope with the increasing complex demand of relationships, based on the life skill approach Prevention and health programmes should begin at the earliest possible age and certainly before the aspect of sexual activity Prevention and health programmes should extend to the whole educational setting, including: students, teachers and other school personnel, parents, the community around the school, as well as the school system

These guidelines are illustrated by several examples of best practicein school-based programmes. Research the UNESCO guidelines and case studies to identify approaches and activities that are most suitable in your school. Other sources of advice for schools and teachers wishing to respond positively to this health concern include: All UNESCO publications on AIDS and education. Many are in multiple languages, including Arabic, Chinese, Spanish, French, Portuguese and Russian as well as English. EDUCAIDS The Global Initiative on Education and HIV & AIDS. United Nations CyberSchoolBus Briefing Paper on HIV/AIDS A briefing Paper for students that provides stories of progress that is being made in the campaign against HIV/AIDS and related activities and resources UNICEF Skills-based Health Education Programme A programme of life skills-based health education focuses on sharing knowledge, attitudes and skills which support behaviours that help young people take greater control of their lives by making healthy life choices, gaining greater resistance to negative pressures, and minimising harmful behaviours. Contains sample curricula, manuals, videos and comic books.

The skills-based approach to HIV/AIDS education seeks to develop the abilities of young people to think critically about the issue and make appropriate lifestyle decisions. Among the skills needed for this are:

Communication
refusing undesired sex resisting pressure to use drugs resisting pressure to have unprotected sex insisting on/negotiating protected sex

Values analysis and clarification

acting on human rights, such as acting against discrimination

Decision making
identifying consequences of decisions and actions critical thinking

Stress management and coping

seeking trusted persons for help identifying and using health services Source: UNICEF. Q16: How can teachers and schools ensure that skills-based HIV/AIDS education is

treated from a New Public Health perspective rather than from the traditional, individualistic approach to health education?

ACTIVITY 7: REFLECTION
Begin by opening your learning journal for this activity. Completing the module: Look back through the activities and tasks to check that you have done them all and to change any that you think you can improve now that you have come to the end of the module. Q17: Why is the motto of healthy people living in healthy communities within the resource opportunities and limits of healthy natural environments central to the New Public Health? How could you adapt the activity on Madlusuthes Farm to a class that you teach? What learning objectives would you be able to achieve? Identify three ways in which a Health Promoting School can adopt an holistic approach to health education. What sources of support are there for the whole-of-school innovations required to build a Health Promoting School? (See Module 5 Activity 4)

Q18: Q19: Q20:

Healthy people

Healthy communities

Healthy natural environments

A holistic view of health

Benefits of a School Health, Hygiene and Nutrition Programme

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-aged 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.

Increases the efficacy of other 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 children enter schools fit, well and ready to learn. But school aged children continue to be at risk of ill health throughout their 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 the benefit of early development programmes, receive the attention they may need to take full advantage of their education opportunity.

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 schoolage can boost school enrolment and attendance, reduce the need for repetition and increase education attainment. Good health practices can also promote reproductive health and help avoid HIV/AIDS.

Achieves greater social equity

As a result of universal basic education strategies, some of the most disadvantages children girls, rural poor and children with disabilities are for the first time having access to school. But their ability to attend school and to learn 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.

Is a 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 nations population, including staff as well as students, 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 education investments.

Four Components of the FRESH Framework

Health-related school policies
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 school girls 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.

Provision of safe water and sanitation the essential first steps towards a healthy physical, learning environment
The school environment may damage the health and nutritional status of school children, 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. A realistic goal in most countries is 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.

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-aged 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.

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 recognised as important within the community. If these criteria are met then the community sees that 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 timing of meals or providing a snack to address short term hunger during school an important constraint on learning; and providing spectacles will allow some children to fully participate in class for the first time.

The Curriculum
Formal Curriculum
The formal curriculum is the planned programme of objectives, content, learning experiences, resources and assessment offered by a school. It is sometimes called the official curriculum.

Hidden Curriculum
The hidden curriculum involves all the incidental lessons that students learn at school. It is sometimes called the unofficial curriculum and includes the lessons about behaviour, personal relationships, the use of power and authority, competition, sources of motivation and so on that students learn at school. These lessons can be either positive or negative in terms of promoting a sustainable future. For example, a school with a comprehensive recycling policy and strict rules about non-violent resolution of conflict teaches students important lessons about the ecological and social dimensions of sustainable development. However, a school that over-emphasises elite academic performance at the expense of the personal, social and artistic aspects of student development is teaching some lessons about human worth that do not support an ethic of sustainability.