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Successful Pilots in China Leads to Growth of Health-Promoting Schools Project

Students at Shu Ghang Middle School in Ningbo.

Government officials in China are expanding an HHD-supported Health-Promoting Schools project to include 50 additional schools in 11 cities across the Zhejiang Province because of the success of earlier pilots.

The project extension – conducted by the Health Education Institute of Zhejiang Province with help from WHO and HHD – is expected to reach as many as 90,000 students with curriculum and messages on psycho-social development, nutrition, tobacco use prevention, oral health and injury prevention. HHD has provided technical assistance and evaluation through training, school visits and interviews targeting school administrators, students, teachers and parents.

According to WHO, a Health-Promoting School is one that constantly strengthens its capacity as a healthy setting for living, learning and working. The goal of WHO's Global School Health Initiative, launched in 1995, is to increase the number of schools that can truly be called "Health-Promoting Schools" by mobilising and strengthening health promotion and education activities at the local, national, regional and global levels.

The Chinese culture has helped the concepts behind Health-Promoting Schools take root in communities and among families through its children. Parents and teachers have stated during interviews that the “one-child” tradition in China gives children much power over influencing health behaviors within the family.

Students have described in interviews how they shared the health information they learned in school with family members at home. In some cases, students have used what they learned about tobacco to persuade parents and grandparents to quit smoking.

And although the curriculum focuses on specific areas such as nutrition, the topics often become entry points to address a broader range of health issues, such as smoking – even among faculty. One headmaster at a pilot school focusing on nutrition interventions said that he was encouraged to quit smoking in public so that he could be an example in his Health-Promoting School. “Only when the headmaster is healthy can students be healthy,” said the headmaster of another Health-Promoting School in an interview.

The initial pilot on nutrition ran from April 2000 to May 2002 in the Zhejiang Province. In March 2003, WHO and the Health Education Institute of Zhejiang Province met to arrange follow-up actions and timelines needed to scale up the original pilot. In October 2003, the Zhejiang Provincial Health Bureau and Zhejiang Provincial Education Bureau announced a coordinated implementation for launching more Health-Promoting Schools across the province.

The document issued by the Zhejiang Provincial Departments of Health and Education was sent to local officials in each of the 11 cities as an official call for support to enable each school to initiate its work plan.

"The joint document of the Zhejiang Provincial Health Bureau and Zhejiang Provincial Education Bureau is a historic event," said Carmen Aldinger, Associate Director for HHD Global Programs and a member of the China WHO school nutrition pilot project team from 2000 through 2002. "Their cooperation is commendable and can be seen as a model for joint efforts for other projects across China." HHD will continue to provide technical assistance and evaluation services for the expanded project, she said.

Zhejiang Province's scaled-up implementation of Health-Promoting Schools will target primary schools, junior and senior high schools and occupational schools in Zhejiang Province, located just outside Shanghai. The slate of new participants was hand-picked by the Health Education Institute of Zhejiang Province to represent a cross-section of the province's 43 million residents.

Between May 31 and June 11, Aldinger met with representatives from WHO and the provincial Health Education Institute of Zhejiang Province to learn about the progress of start-up activities. During her visit, she and other representatives visited 10 schools, conducting interviews with headmasters, teachers, students, and parents in three of the schools about their planning and initial activities for implementing Health-Promoting Schools.

Interviews revealed that all schools have a work plan in place and a working committee dedicated to the success of the program. Committee members were chosen to be part of each prestigious pilots based on their regular work and responsibilities. An important part of their role was to integrate interventions into their regular activities, Aldinger said.

Reports from students and their parents have added anecdotal evidence about the project's success. In one of the interviews, one mother reported that her child asked her to buy nutritious food, while another mother said that a teacher’s encouragement helped her daughter to improve her self-esteem.

Also as part of the project, the Global School-Based Student Health Survey was conducted in May 2004 in all participating middle and secondary schools, as was the Psycho-social Environment Profile. According to teachers’ comments, the survey can prove what was done right and can offer new concepts for making changes.

“This project is significant because it expands Health-Promoting Schools systematically over the entire province,” Aldinger said. “The newly added schools will later serve as mentors to get on board more schools around them,” she added.