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School Health



I Introduction



Today's feature article combines two pieces on school health.



In the first, "Fostering Intersectoral Collaboration for School Health Programs," Karen Woods reports on a presentation from this year's Health Promotion Summer School in Toronto. The speaker, Jack Jones, of WHO's Department of Non-Communicable Disease Prevention and Health Promotion--School and Youth Health Promotion Group, spoke on the concept of health- promoting schools, emphasized intersectoral collaboration as an essential pre-requisite for a successful school health promotion strategy and made some comments about effectiveness.



Michelle Brownrigg contributed our second piece, "The Active Healthy School Communities Initiative." The report on this Ophea project shows concepts from Karen's article in action.



If you have a resource or point of view to add to this article, let us know by writing to [email protected]. More information on our Letters to the Editor column can be found in the OHPE News section of OHPE 268.0 (http://www.ohpe.ca/ebulletin/ ViewAnnouncements.cfm?ISSUE_ID=268&startrow=1).

II Fostering Intersectoral Collaboration for School Health Programs



Written by Karen Woods, Master's student in the Exercise Sciences, Behavioural Stream, Faculty of Physical Education and Health and research assistant for the Physical Activity Research Program, Department of Public Health Sciences (http://www.phs.utoronto.ca/activeyouth). Her research interests include health behaviour, particularly physical activity, among youth and school health.



A. Introduction



I had the pleasure of attending a session at the 2003 Health Promotion Summer School in Toronto entitled "Fostering Intersectoral Collaboration for School Health Programs." This session was part of the summer school's community mobilization stream. Mr. Jack Jones, member of the World Health Organization's (WHO) Department of Non-Communicable Disease Prevention and Health Promotion--School and Youth Health Promotion Group, was the presenter. Mr. Jones presented some general information about the concept of health-promoting schools, emphasized intersectoral collaboration as an essential pre-requisite for a successful school health promotion strategy and made some comments about effectiveness. An overview of these thoughts is presented below.



B. Growing support



The rapidly growing support for the worldwide Health Promoting Schools (HPS) movement is based on the realization that school physical and psycho-social environments have an enormous influence on youth health and learning, and that schools are also an important channel through which to send a variety of health messages. There are many different steps required to create an HPS environment all of which require one key ingredient: intersectoral collaboration. (For more information, please visit our previous articles on comprehensive school health for more details: OHPE 280.1 (http://www.ohpe.ca/ebulletin/FullFeature.cfm?ID=280&keywords=school&sear... RES) and OHPE 96.1 (http://www.ohpe.ca/ebulletin/ViewFeatures.cfm?ISSUE_ID=96&startrow=181).



B. Two levels of intersectoral collaboration



Two levels of intersectoral collaboration are important. At the policy/government level (international, provincial or national), collaboration should, at a minimum, occur between education and health sectors, the purpose being to partner, share responsibility, incorporate different perspectives and ultimately to provide some forward momentum at the government and community levels. At the local level, collaboration should include a broad variety of stakeholders who can work together to address multiple health issues and different needs in the community, even in the absence of a provincial or national policy about comprehensive school health. Mr. Jones introduced two WHO tools--one for each level of collaboration described above--The Rapid Assessment and Action Planning Process (RAAPP) and Local Action: Creating Health Promoting Schools.



1. Rapid Assessment and Action Planning Process



The RAAPP is subtitled "A Method and Tools to Enable Ministries of Education and Health to Assess and Strengthen their Core Elements of Capacity to Promote Health Through Schools." The resource notes that "[a] committed, in-country core team is required to conduct the RAAPP. The team is inter-ministerial, including representatives from the education and health ministries. The team collects data and develops plans to improve national capacity to improve school health programs. The team is led by a focal point, a high-level official with the ability to garner support for the process and a coordinator." It is through this analysis and planning process that intersectoral partnerships are developed. The only limitation of the resource is that it does not address how to bring the appropriate stakeholders to the table to participate in the process. A fairly high level of commitment is required just to use the tool. More information about the tool is available at http://www.who.int/school_youth_health/media/en/454.pdf.



2. Local Action: Creating Health Promoting Schools



The second tool, for mobilizing intersectoral school communities, is called "Local Action-- Creating Health Promoting Schools." This one is for use at the community level. It helps school administrators, teachers and community leaders to assess their capacities and resources and ultimately generate a local action plan for a HPS. The early steps in the recommended process involve assembling a small core group of people to support the project and then increasing the support base by widely advertising and advocating for the project. The tool includes guidelines for how to do this. Of note is the information on making the case for school health promotion, which can help recruit intersectoral partners. More information about this resource is available at http://www.who.int/school_youth_health/media/en/88.pdf.



C. Effectiveness



To date, much of the literature and information on HPS is philosophical or theoretical in nature. The lack of effectiveness data does not necessarily mean that HPS don't work. Rather, it is more a reflection of the fact that there are many barriers to creating HPS. High on the list of barriers are inadequate resources and difficulty merging the perspectives of the health sector and the education sector with respect to school health. Both of these barriers exemplify the need for more intersectoral collaboration as described above. The WHO developed, promotes and uses the resources described above to deal with these barriers. They have also begun to summarize studies that emphasize the link between health and various positive outcomes, such as better academic performance, reduced absenteeism and enrollment retention, reduction of social and gender inequities, improved staff morale and health, disease reduction and cost-effectiveness, in their document Education For All: Thematic Study on School Health and Nutrition (please see the OHPE 321.2 for more information).



D. Conclusion



Overall, the most important concept to consider when planning, implementing and evaluating HPS initiatives is intersectoral collaboration. Only when intersectoral collaboration is achieved at multiple levels can HPS initiatives take root and only through intersectoral collaboration can they be proven to be effective. This is the key to witnessing improved health outcomes, increased education and learning, improved physical and psychosocial environments, economic efficiency, social equity and many other important outcomes.



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III The Active Healthy School Communities Initiative



Written by Michelle Brownrigg, Executive Manager, Public Affairs, Ophea.



A. Introduction



In the fall of 2002, the Minister of Health and Long-Term Care announced a $2 million investment in the Active Healthy School Communities (AHSC) Initiative, to be managed by the Ontario Physical and Health Education Association (Ophea). Over the next three years, Ophea and many other partners will work to support the development and implementation of the AHSC Initiative.



The concept underlying the AHSC Initiative is that all members of the community work together to increase access and opportunities for active, healthy living among all children and youth. Schools serve as the hub or centerpiece of active healthy living for children and youth but are supported and enhanced by the surrounding community. In turn, the school supports and enhances the overall community. This community-development and capacity-building approach serves to maximize the strengths and resources of that community and to avoid the overburdening of any particular sector.



Through the AHSC Initiative, OPHEA will work closely with partners to foster and support active healthy school communities to enable children and youth to lead active healthy lives. Specifically, OPHEA will coordinate the following activities: partnership building, evaluation of the AHSC model through a research and demonstration project, a provincial recognition program and programming and communication.



B. Partnership Building



On April 23, 2003, OPHEA invited provincial representatives from health, education, recreation and other organizations to attend a provincial forum. The purpose of the forum was to share information about the AHSC initiative and, more importantly, to gather input from forum participants to help shape the implementation of the various components of the initiative. At the close of the day, it is was our hope that participants would

* identify where the AHSC Initiative is integrally connected to their own organizational mandates, and

* identify action-oriented opportunities to work together in relation to this initiative.



Proceedings from the day are in development and will be shared once complete.



OPHEA has met individually with the Ministry of Education, Ministry of Health and Long-Term Care and Ministry of Tourism and Recreation. A coordinated meeting with all three ministries will tentatively be taking place in early July.



C. AHSC Research and Development Project



As part of the AHSC initiative, Ophea is coordinating a research and demonstration project to develop and test a comprehensive, community-driven approach to school health concerns. Ophea has brought together a multidisciplinary group of academic experts affiliated with Ontario universities in the fields of education, physical activity, nutrition and health promotion to form a research advisory group to inform the development and study of an Ontario AHSC model. The model will be piloted in school communities across the province and will take into account learnings from an extensive literature review and discussion document detailing effective international and national school health promotion approaches. Ophea will present a review of the AHSC Initiative and some of the key learnings from the international literature review and will discuss details of the AHSC model and research and demonstration project as part of the communications activities.



A research consultant has also been hired to conduct a literature review of effective active healthy school community models from around the world and produce a discussion document to support the demonstration project. An evaluation consultant will be engaged in the near future to develop methodology for the implementation and evaluation of an AHSC model based on learnings from the literature review.



D. AHSC Recognition Project



The recognition program component of the AHSC initiative is being built on the successes of the current Active Schools program. A multisectoral advisory group has been established to assist in its development. A researcher from the Ontario Institute for Studies in Education, at the University of Toronto, has also been hired to conduct a detailed review of recognition models and factors that contribute to behavior change. Key learnings from the current Active Schools program are being compiled through an evaluation survey and needs assessment. In addition, the Nutrition Resource Center has been collaborating with Ophea to incorporate nutrition elements into the development of the recognition program.



E. Communications



A communications agency has been selected through an RFP process. This agency is currently in the process of researching and developing a communications plan to support the implementation of the AHSC Initiative.



As part of the communications activities for this initiative, OPHEA will be communicating the proceedings from the forum, the results of the literature review and a report on the background and findings from the Research and Demonstration project in fall 2003.



For additional information about the Active Healthy School Communities Initiative, please contact Michelle Brownrigg, Executive Manager of Public Affairs, at (416) 426-7120 or [email protected].