Promoting school health in Pakistan

June 2008: The notion of school health promotion is uncommon while debating the existing situation of schools in Pakistan. It is a common belief that schools are a nursery for unhygienic food and that they barely provide first aid to the students within the school setting. But school health promotion, in its true sense, goes beyond this restricted view.

Let us take a quick reconnaissance of health promotion in our schools. It would be interesting to know the percentage of educational institutions here with the facility of a doctor or a nurse within the premises. Is health education is even a part of their school curriculum?

Many, if not all, schools today have become the target market for the corporate world. Academic exercises that were the hallmark of school culture are now being organised by these business groups under the heading of "awareness programmes". Visit any school, especially in the urban areas, and notice the activities which were previously organised by students and teachers being arranged by these marketers who may in actuality be least concerned about the promotion of health among the children. Children for them are the consumers with the schools as the shopping malls.

In his introduction to Noam Chomsky's Profit Over People, Robert W. Mc Chesney writes: "Our time represents an era in which business forces are stronger and the more aggressive faceless organised opposition than ever before."

Our schools truly represent these words. The idea that seems to run in these business companies is that they sell anything and everything in schools.

Coming back to basic health resources in schools, most of the schools do not even have enough space to support a healthy lifestyle. The bungalow schools do not even have enough space for proper seating arrangements for the students let alone the open grounds for physical activities. A majority of the children here experience school life without actually being involved in any sports. They remain ignorant of the bliss of happily running around the huge school grounds during recess and participating in healthy sports competitions. It may sound like a faraway dream to the bungalow school student. In comparison, the public sector schools may not fall under the issue of spaciousness but a bigger question for them may be how to utilise their spacious grounds.

Besides loading up the children with heavy school bags, a by-product of the modern-educational system, children also have to carry the additional load water bottles, no matter which school they go to. No one questions anyone and no one is held accountable for it. It's just that the parents have lost faith in the drinking water made available at schools.

Food is another important aspect of a healthy school environment. Hardly any school here encourages the culture of eating home-cooked meals. Children are rarely encouraged to bring home-made food to classroom or school parties. The school canteens, not considered a part of school health promotion, offer all kinds of forbidden junk food usually inaccessible to the children at home.

Similarly vendors stationed outside the school gates are allowed to play havoc with the health of our young ones. One wonders whose responsibility it is to keep an eye on such enterprises outside the educational institutions.

A common complaint made by both students and parents alike is the amount of stress being put on them by the so-called "modern education system". The children along with their parents have to run from pillar to post in order to acquire knowledge. The unnecessary rush results in putting everyone under great stress, so much so that it becomes difficult for children to grapple with the situation and the inability to manage stress causes sever damage to their health which may lead to other life-threatening illnesses later on in life.

If the teachers could be educated about the basic health issues, they can be the first ones to not only identify the high-risk students but to also refer them to the right health professionals.

School health promotion calls for an integrative approach. The few schools that boast of having the services of nurses and doctors think that health promotion is their responsibility alone. But in order to approach holistic health promotion, we must realise that

all school members, including the parents, need to get involved in making a school one that promotes healthy practices. A school health nurse could play a vital role in achieving this goal.

According to the Alma-Ata declaration of 1978: "Schools could indeed provide efficient means of educating young people ... to build in them a good understanding of what health means, how to achieve it, and how it contributes to the social and economic development."

In Pakistan the prevalent notion of health is the absence of a clinically recognisable disease. However, WHO in 1947 defined health in terms of total wellbeing and discouraged the conceptualisation of health as simply the absence of disease. A commonly accepted definition of health given by the noted epidemiologist Milton Terris is taken as the beginning of the modern definition of health. "Health," according to him, "is a state of physical, mental and social wellbeing and the ability to function and not merely the absence of illness and infirmity."

Neither do we educate our children on health issues nor do we prioritise keep health promotion in our educational institutions. There are many ways to bring about a change. It should not, however, be an issue of scarcity of resources that may cause restrictions in initiating a change.

Organising health awareness programmes in school can also bring about a change in the teachers and students' attitude about promoting health in school. Physical education, regular grooming, counseling and a friendly attitude in students and teachers are all important ingredients of school health promotion.

A qualified as well as competent school health nurse can become a catalyst in promoting a healthy school lifestyle. There is also a great need to keep a check over what is being sold in the school canteen and what is on offer outside the school at chutti time.

We also need to revisit our school curriculum while keeping in mind how health friendly our schools have become in the recent past. Schools in fact can become the nuclei of the public healthcare system through which primary prevention may be achieved. If successful in inculcating healthy habits in our youth, we would eventually be educating a much larger number of people in society who can go on to become the ambassadors of a healthy lifestyle. Hence a mass level approach is achievable via child-to-child and child-to-parent health education models. Children brought up in a healthy environment can contribute towards a stronger nation.

By Saleema Gulzar (Dawn)
The writer is part of the nursing faculty at a private university hospital in Karachi

Your Comments
"its very important matter to work on it kindly help me as well for the promotion of this ."
Name: dr. a .raza
City, Country: Karachi, Pakistan

Your Comments
"As far i know there is only one organization by the name of Integrated Health Services also called IHS which is providing school health services in Pakistan. There is a dire need for more health institutions and the government to make organized efforst for it. I ve seen the difference in my children in whose school IHS conducts regular health education sessions. "
Name: Ahmed Gulzar
City, Country: Islamabad, Pakistan



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