[Global HR Forum 2014] Global Aspect of School Health Promotion and Experience of Korea

transcript

Seoul National University College of Medicine

LEE, JONG-KOO

Global Aspect of School Health Promotion and Experience of Korea

Contents

Global Aspect of School and Youth Health 1

Experience of Korea 2

National Programs in Korea 3

Future Direction and Strategies 4

Global Aspect of School and Youth Health

WHO Report - 2014 World Health Assembly

• Analysis on the full spectrum of

health issues of adolescents

• Evidence-based guidelines

• Recommendations to

governments

• Raising awareness of health

issues for young people

Today’s Leading Causes of Death, Disease, and Disability

• Cardiovascular disease, cancer, chronic lung diseases

• Depression, violence, substance abuse, injuries

• Nutritional deficiencies

• HIV and helminth infections

All of these health problems have their roots in adolescence

• Tobacco use

• Alcohol and substance use

• Poor dietary pattern

• Sedentary lifestyle and obesity

• Sexual behavior and poor hygiene

Importance of Youth Health

Epidemiology : Youth Health

Mortality rates are low in adolescents compared with other age groups.

But, nearly 35% of the global burden of disease has roots in

adolescence.

HIV-related deaths have more than tripled since 2000, making it the

number 2 cause of death among adolescents worldwide.

5% of all deaths of young people between the ages of 15 and 29 are

attributable to alcohol use.

One out of two youth who start and continue to smoke will be killed by

tobacco-related illness.

In low-income countries, worm infections, vitamin A and iodine

deficiencies are the leading causes of disease and disability.

Top 10 causes of death among adolescents

- 2014 WHO -

Top 10 causes of DALYs lost among adolescents

DALYs = disability-adjusted live years lost

- 2014 WHO -

Causes of Death and Disability in Youth - 2014 WHO -

• Top causes of deaths

1. Road traffic injuries

2. HIV/AIDS

3. Suicide

4. Lower respiratory infections

5. Violence

• Top causes of illness & disability

1. Depression

2. Road traffic injuries

3. Anemia

4. HIV/AIDS

5. Self-harm

Most of the causes are preventable or treatable!!

More similarities than differences between high and low/middle income countries

Most of important current health problems can be significantly

reduced by preventing unhealthy behaviors.

Health behaviors are initiated or established during youth and

fostered by social and political policies and conditions.

Thus, an effective School and Youth Health Program can be one of

the most cost effective investments a nation can make to

simultaneously improve education and health.

Effectiveness of Youth Health Program

Health Promoting School and University

Background principle : WHO’s Ottawa Charter (1986)

• Settings-based approach to health promotion

• Paradigm shift in WHO’s public health policy

FROM Focus on Individual Behavior

TO Recognition of the wider social, political, environmental influences

on health

Determinants of Adolescent Health & Development: Ecological Model - 2014 WHO -

Health Promoting School and University

Health Promoting School (HPS, 1997)

Health Promoting University (HPU, 1994)

• Holistic, settings-based approach through the whole school environment

• Goal

To prevent important health risks among youth

To engage the education sector in efforts to change the educational,

social, economic and political conditions

Core Actions for Youth Health

Core Areas for Health Sector Action

• Providing health services

• Collecting and using the health data needed to plan and

monitor health sector interventions

• Developing and implementing health-promoting and

health-protecting policies

• Mobilizing and supporting other sectors

- 2014 WHO -

Health Services and Interventions for Youth - 2014 WHO guidelines -

Experience of Korea

Increase in Life Expectancy

Greatest gain in life expectancy among OECD countries

• In 1960 : 52.4 years

16 years below the OECD average

• In 2011 : 81.1 years (women : 85 yrs, men : 78 yrs)

1 year above the OECD average of 80 years

• Overall increase in longevity : 29 years between 1960 and 2011

Major contributors to Korean health improvement

• Rapid economic growth since 1960s

• Subsequent improvements in living standards, nutrition, and health care

Years Gained since 1960 - OECD Health Data

Life Expectancy at birth in 2009

Infant Mortality Rates, OECD Countries 2013

Perinatal Mortality Rates, OECD Countries 2013

Changes in Health Issues in Korea

Korea has experienced dramatic epidemiological changes in major

disease patterns.

Major Changes in causes of death

Infections (pneumonia, tuberculosis,

gastroenteritis, etc.)

Cardiovascular disease (CVD)

Cancer

Diabetes

Cancer CVD

Diabetes

Non-communicable diseases

Suicide

1960s 1980s 2000s

Causes of Death in Korea

Suicide Rates, OECD Countries 2012

Trend in Suicide Rates in Korea, 2002-2012

Health Behaviors of Korean Youth

Middle & High School Students » Korean Youth Risk Behaviors Web-based Survey 2013 (Korea CDC)

• Current smoking : 10%

• Alcohol use : 16%

• Students practicing vigorous physical activities : 36%

• Enough fruits or vegetable consumption : < 20%

• Obesity : male 15.1%, female 11.1%

• Experience of injury at school : 50%

• Safety education at school : 34%

• Depressive mood : 30%

• Suicidal attempt : 4%

▶ Health behaviors start in middle school and tend to increase in high school

Trends in Current Smoking

Korean Youth Risk Behaviors Web-based Survey 2013

Trends in Current Alcohol Use

Trends in Dietary Habits

KNHANES 2012

Trends in Physical Activity (Vigorous)

Prevalence of Obesity

Obesity : body mass index ≥95 percentile of 2007 Child-Adolescent Growth Chart or body mass index ≥25 kg/m2

KNHANES 2010-2012

School Injury | Injury Prevention Education

Emotional Stress | Depressive Mood

Toothbrushing after Lunch

Sexual Activity

University Students’ Health

University Students

• Over 70% of high school graduates are enrolled in universities

• Undergo life transition to independent adulthood

• Face and explore many health challenges, and establish lifestyles

University Students’ Health Assessment

• No available national health survey

• Need of comprehensive research into university students' health

for effective health policy and program development

National Programs in Korea

Tuberculosis screening (1955)

Legislation and National Health Programs

Major National Programs

Infections

(pneumonia, tuberculosis, gastroenteritis, etc.)

Cardiovascular disease (CVD)

Cancer

CVD, diabetes, NCDs

1960s 1980s 2000s

▲ 1956

Health Center Act

▲ 1967

School Health Act

▲ 2007

Health Screening Act

Maternal and Child Health Program (1956)

Dental health (1979)

Health Promoting School (2009)

▲ 1995

Health Promotion Act

Student health examination (1955)

Helminth intervention (1957)

Immunization program (1962)

Sanitation project (1975)

School Health Program }

National Health Programs

1. Maternal and Child Health

Maternal and Child Health (MCH) Programs

Launched in 1956

Customized health program meeting the requirements of communities

Key strategies

• Home visits for health management of pregnant women

• Health checkup for pregnant women and infants

• Immunization for infants and children

• Cultivation of human resources for maternal and child health

• Establishment of maternal and child health center

2. School Health Programs

School Health Programs

School Health Act (1967)

Revision since 2007 : towards strengthening of health promotion of

student and staff

Key strategies

• Health examination (1955)

• Tuberculosis screening (1955)

• Helminth intervention (1957)

• Immunization (1962)

• Sanitation project (1975)

• Dental health (1979)

School Health Act

Establishes criteria and conditions on

• School health facility standards

• Environmental sanitation and food hygiene

• Health screening

• Development and implementation of student health policy

• Health care

• Health education

• Immunizations

• Physical and mental health problem care and prevention

• Safety management and education

3. Health-Promoting School (HPS)

Adoption as a national program

• In 2009, Korean Ministry of Education

Pilot program of HPS

• From 2009 to 2014, primary and secondary schools nationwide

• Number of participating schools has increased from 16 to 98

Implications

• Evidence of effect

Improvement in student behavior in the classroom

• Obstacles

Low participation rates of middle and high schools

Disparities in ability implementing the program across schools

4. Smoking Prevention Program

Smoking Prevention Education and Cessation Program

• Budget expend

24 hundred million Won (2014) 519 hundred million Won (2015)

Source : 89.3% of increased cigarette tax (from 2015)

• In-School : elementary, middle and high schools

Expend of school education : 1,236 schools (2014) 11, 627 schools (2015)

Support from Ministry of Health : education material supply, training of teachers

• Out-of-School

Local children center, adolescent shelter, adolescent counseling center

Supply of nicotine patch, smoking secession program

• Development of age-specific and individualized smoking prevention programs

Pre-school age

School age

College students

- Korea Ministry of Health

Military men

Future Direction and Strategies

Policy Adoption at the National Level

Holistic and Consistent System

Building

Strengthening of School Health Organization

Sustainable and Qualified Program

Development

National Guidelines and Evaluation System

1. Policy Adoption at the National Level

< Change in public awareness and social climate >

Student health promotion Scholastic achievement

Policy adoption

at the national level

2. Holistic and Consistent System Building

A holistic and consistent system

• All levels of school

(from elementary to university)

+ Home

+ Wider community

3. Strengthening of School Health Organization

For an effective implementation of HPS,

each school health organizations in

should take roles in leading and

coordinating actions

• School members

• Parents

• Community

• Professional groups

• Regional or local authority agencies

Creating and strengthening of

school health organization

Needs of guide and support

from government

4. Sustainable and Qualified Program

Focus on building infrastructure and human resources for

sustainable program development in the long term

• rather than funding over a short-project base that do not take a

whole school approach.

Qualification of programs through rigorous scientific evaluation

of the effectiveness in health outcomes is essential

• rather than rapid quantitative expansion of program.

5. National Guidelines and Evaluation System

Development of a national HPS guideline and evaluation system

• To guide school policies and programs

• To develop a practical action plan

• To serves an indicator of contribution to a healthy society

ex) US school health index (CDC)

Healthy Society

Healthy School

고객의 건강을

챙기는 기업 Healthy Student

직원이

건강한 기업