Upscaling Health Promoting Schools in the SDGs Era

Faten BEN ABDELAZIZ, Didier JOURDAN, Goof BUIJS, Yuka MAKINO

Building a shared future in a fractured world starts with education and health

Ms. Julia Gillard and Dr. Tedros Adhanom Ghebreyesus, January 2018, Devex

Outline of Today’s Presentation

1. Background

2. Outline of the WHO Priorities for Health

Promoting Schools

3. Upscaling Health Promoting Schools in

Different Context

4. Moving Forward

Background

Fact1: Estimated Top Five Causes of Death among Adolescent by Sex and Age, 2015

Estimated 1.2 million adolescents died in 2015, over 3000 every day,

mostly from preventable or treatable causes.

Road traffic injuries were the leading cause of death in

2015.

Reference: WHO Global Accelerated Action for the Health of Adolescents (AA-HA!): Guidance to Support Country Implementation http://apps.who.int/iris/bitstream/10665/255416/1/WHO-FWC-MCA-17.06-eng.pdf?ua=1

Fact2: Noncommunicable Diseases (NCDs) and Risk Factors among Children and Adolescent

Combined, the number of obese five to 19 year olds rose more than tenfold globally, from 11 million in 1975 to 124 million in 2016

Reference: NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. Lancet.

Fact3: Schools Provide an Efficient and Effective Way to Reach Large Numbers of People

Over 90% of children of primary school age and over 80% of children of lower secondary school age were enrolled in school globally in 2015 (UNICEF 2018)

Evidence that HPS have positive effects on a range of students’ health outcomes (Langford et al. 2014)

Behaviours and habits develop in early childhood –children acquire basic knowledge and experiences that influence their lifestyles in adulthood (Cooper et al. 2013)

Promoting healthy behaviour of schoolchildren contributes to enhancing the lives of other family members and the community (WHO 2017)

Fact 4: Key Milestones – Health Promoting Schools

1995

2000

1996

2007

2015

Launched the European Network of Health Promoting Schools

Launched the Mega Country Health Promotion Network

Agreement between WHO, UNESCO, UNICEF, World Bank

Technical Meeting ofBuilding School Partnership for Health,

Education Achievements and Development

Technical Meeting of Global School Health Initiatives: Achieving Health and Education

Outcomes

1992

Nine points were identified as being vital for successful implementation of school health programmes and HPS initiative

Consensus on the core components of effective school health programmes

Encompass the 11 most populous countries in the work, and encourages adoption of

true HPS

Launched Global School Health Initiative

Create Health Promoting Schools concept

Try to increase the number of Health-Promoting Schools

Launch the interagency initiative called Focusing Resources on Effective School Health (FRESH) and FRESH framework

Health Promoting Schools (HPS)

Health Promoting Schools (HPS) are schools that constantly seek to strengthen its capacity to promote healthy living, learning and

working conditions

Implementation Gap for Health Promoting Schools

Lack of focal point for HPS at national level

Limited funding resources

Lack of institutionalized capacity building for teachers

Challenges of working across sectors

Unreliable monitoring mechanisms and evaluation of impact on health and education

Lack of common performance indicators to support progress assessment

Unclear accountability mechanism

Outline of the WHO Priorities for Health Promoting Schools

Health Promoting Schools in the Context of the SDGs

2.2: End all forms of malnutrition, address the nutrition needs of adolescent girls

3.7: Ensure universal access to sexual and reproductive health-care services, including for family planning, information and education

4.7 Ensure all learners acquire the knowledge and skills needed…to promote … human rights, gender equality, peace and non-violence

5.6 Ensure universal access to sexual and reproductive health and reproductive rights

6.2 Achieve access to adequate and equitable sanitation and hygiene for all and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations

16.2 End abuse, exploitation, trafficking and all forms of violence against and torture of children

Health Promoting Schools in the Context of the GPW 13 (2019-2023)

The strategic direction of planning, monitoring and evaluation of WHO’s work during the period.

Decrease in the number of children subjected to violence in the past 12 months

25% relative reduction in tobacco use among persons aged 15

7% relative reduction in the harmful use of alcohol, as appropriate within the national context

Halt and begin to reverse the rise in obesity (5-19 years)

Increase coverage of the HPV vaccine among adolescent girls by up to 50%

Increase coverage of the second dose of to 90%

Global Priorities for Health Promoting Schools

Set Norm and Standard

Monitoring & Evaluation

Provide Evidence-based Policy Options

Country Support

Global Standards for Health Promoting Schools

School Health Policy Options related to WASH, Diet Physical Activities, Adolescent Health, Violence Prevention, Immunization, Childhood Obesity Prevention , Life Skills Education to Prevent Noncommunicable Diseases (NCDs)

Global School Health Survey (GSHS), Global School Health Policies and Practices Survey (G-SHPPS), Health Behaviour in School-aged Children (HBSC) study

Upscaling Health Promoting Schools

in Different Context

Experiences in European Region (SHE network)

Over 40 countries in European region have national

HPS programmes

Connected via SHE network since 1992

Shared set of SHE core values and pillars

4 European conferences with policy statements

Experiences in European Region (SHE network)

In 2013: 34,000 schools identify as HPS:

Scotland, Wales, Portugal 100%

Slovenia 50 %

Lithuania, Russia 20 %

Poland, Croatia, Austria 2 - 10%

Some countries 0 %

Experiences in European Region (SHE network)

2/3 countries have national HPS policy as part of

educational policy

Different education systems and cultural contexts

Mainly high and middle income countries

Health education mainly integrated in other subjects

(62%)

Experiences in European Region (SHE network)

Paris declaration 2016:

Support and enhance collaboration among

education, health and social sectors

Make every school a health promoting school

Strengthen existing networks (including SHE)

Strengthen monitoring and evaluation of policies and

strategies

Filling the Gap between Research and Policy

The UNITWIN programme enhances the capacity of higher education & research institutions through the exchange and sharing of knowledge at a global level.

UNESCO chair Global Health & Education

Objectives of the UNESCO Chair

The aim is to strengthen the relationship between universities, policy makers, practitioners and civil society (south, north, west, east).

Via universities’ core business: contribution to knowledge base (research) knowledge dissemination and capacity building (MOOCs, training programmes, fact sheets…)

Via a strong connection with UN agencies and existing networks

Three Key Challenges for Research

1. Research paradigms & Ethical issues

2. Designing and evaluating meaningful intervention research initiatives

3. Understanding the implementation process

Knowledge production &

Knowledge transfer

Three Key Challenges for Research

TraditionalPrevention

• “Top down”

• Expert driven

• Individualistic

• Quantitative eval.

• “RCT”

• Health outcomes

• Effects – but not transferable to real life contexts

Traditional Health Promotion

• “Bottom up”

• User driven

• Structure

• Qualitative eval.

• Case studies etc.

• QoL, wellbeing

• Realistic – but limited health effects

Health PromotionVersion 2.0

• Dialogue

• “Co-creation”

• Supersetting

• Quanti. + quali.

• Complex interventions

• Health, social and QoL

• Evidence appearing from studies in real life

B. Brunn Jensen 2018

Toward a renewed epistemology for research… a step forward the western paradigms

Intervention-research

Participation & co-creation; A positive & broad health concept; Empowerment & action competence; Setting & synergy.

Understanding the Enactment Process

What happens during the implementation process when education and public health policies are enacted into school and community practices?

Framework of Translation Sociology

Focus on the contexts, mechanisms and outcomes of the implementation process

Context and cultures

Patterns of implementation

Understanding the Enactment Process

Understanding the implementation process when prevention policies are

enacted into school practices

• Actors• Networks

• Mechanisms• Levers

• Obstacles

An international research

project within the « Global

Health and Education »

UNESCO chair

Knowledge production (model)

Knowledge dissemination (guidelines for implementation

and training, fact sheets)

What happens during the

implementation process?

Education and Public Health policies

Schools and communities practices

?

Moving Forward

SDGsWhole sector approach

GPW13Ensure healthy lives and well-

being for all at all agesContribute to country impact

The SDGs era and Priorities…….

Health Promoting Schools: • Lack of common performance indicators to support progress assessment• Gap between health and education sectors• Importance of context and different system, implementation process

The Standards for Health Promoting School

“The Standards for Health Promoting School is guided by the key features for Health Promoting Schools (HPS) to provide guidance on key actions required to establish

and run a health promoting school as a setting, while considering the ecosystem of child and adolescent

environments.”

The process for Development of the Global Standards for Health Promoting Schools (Ongoing)

Experts at a global level with a balance between

people from the different continents.

The contributors are from the education and health

sectors in order to ensure the comprehensibility of the

standards for all the stakeholders and the civil society.

The evidence-based knowledge and the experiences of

the experts involved in Health Promoting Schools in

the different regions will be taking into account

together via a process of literature review and

consultation.

Conclusion

Health Promoting Schools have positive effects on a range of students’ health outcomes;

Lack of common performance indicators to support progress assessment of Health Promoting Schools;

Existence of gap between health and education sectors;

Importance to consider context and different system as well as implementation process;

Political opportunities for Health Promoting Schools: SDGs and GPW13;

Ongoing process of development of the global standards for Health Promoting Schools.

Thank you.