NCD IN SCHOOL FROM POLICY TO ACTION

Saidatul Norbaya Buang

And

Don Ismail bin Mohamed

School Health Sector

Family Health Development Division

13th NATIONAL SYMPOSIUM ON ADOLESCENT HEALTH 5 th – 7 th April 2017, Grand Riverview Hotel, Kota Bharu, Kelantan

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Presentation Outline

• Defining Non Communicable Disease

• The Causation Pathway for NCD

• Important of Tackling NCD in School

• NCDs Trend Among School Children

• National Strategic Plan for NCD

• NCD Activities In School

• Challenges In Translating Policy Into Actions

• Conclusion

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Define Non-Communicable Disease

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• Non-Communicable Diseases (NCDs), also known as chronic diseases, are not passed from person to person.

4 main types of NCDs

• Cardiovascular diseases (like heart attacks and stroke),

• Cancers, • Chronic respiratory diseases (such as

chronic obstructive pulmonary disease and asthma)

• Diabetes.

Other NCDs • Chronic neurologic disorders (e.g.,

Alzheimer’s, dementias) • Arthritis/Musculoskeletal diseases • Unintentional injuries (e.g., from traffic

crashes) • Genetic diseases

Global Health Observatory Data, WHO http://www.who.int/gho/ncd/mortality_morbidity/en/index.htm 3

Source : Adapted from Preventing Chronic Diseases: A Vital Investment. Geneva, WHO 2005

Underlying

Determinants

• Globalisation • Urbanisation • Population Ageing

Common Risk

Factors • Unhealthy diet • Physical Inactivity • Tobacco & Alcohol

Use • Age (Non-

modifiable) • Hereditary (Non-

modifiable)

Intermediate

Risk Factors • Overweiught /

Obesity • Raised Blood Sugar • Raised Blood

Pressure • Abnormal Blood

Lipids

Main NCD • Heart Disease • Diabetes • Stroke • Cancer • Chronic Resp.

Diseases

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The Causation Pathway for NCD

Area we should tackle…

• NCD is a global issue – affecting all range of age

• Children are the frequent victims of pollution and behaviours such as

tobacco use, physical inactivity and unhealthy diet leading to NCDs

• The burden of NCD in Malaysia continues to increase

• Most of the drivers of NCDs and their risk factors lie outside the control

of the health sector

• Impact on the health, productivity i.e. student’s achievement

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Important of Tackling NCD in School

• Youth who are overweight or obese have substantially higher odds of remaining overweight or obese into adulthood

Ebbeling CB, Pawlak DB, Ludwig DS. Childhood obesity: public-health crisis, common sense cure. Lancet. 2002;360:473-82

.

• Increasing their risk of disease and disability later in life.

Singh AS, Mulder C, Twisk JW, van Mechelen W, Chinapaw MJ. Tracking of childhood overweight into adulthood: a systematic review of the literature. Obes Rev. 2008;9:474-88.

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Important of Tackling NCD in School

• School is a place where intervention can take place in changing knowledge, attitude and behaviour.

• WHO stresses that strategic directions are needed to move forward… tailored approaches to increase the access, coverage, and quality of child health services. (WHO,2016)

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Important of Tackling NCD in School

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National Strategic Plan for NCD 2010-2014 Seven Strategies for Malaysia

Prevention and

Promotion Clinical Management

Increasing Patient Compliance

Multi-sectoral Collaboration

Monitoring, Research & Surveillance

Capacity Building Policy & Regulatory

Interventions

Education Expectation • Academic excellence

• Functioning adult upon education completion

Health System Expectation • Reduction in Non-

Communicable Diseases in later life

Creation of future adult generation equipped

with

life , social , vocational skills to enable them

making HEALTHY LIFE CHOICES in later life

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Challenges Implementing NCD Intervention in School Setting

Partnership in Health in School Setting Long standing MOH and MOE relationship since 1967

• 1967

• 3 component model approach

• Alternative chairmanship

Rancangan Kesihatan Sekolah

• 1996

• Health Promoting School Concept

• Alternative chairmanship

Program Bersepadu

Sekolah Sihat • 2008 till present

• Clean, Healthy and Safe School Concept

• Deputy Minister of Education lead the committee

Program 3 K

Health policy in school approved

and monitored through 3x / year

meeting 11

Act, Regulation And Policy

• Education Act 1996, Chapter 12 (a) and (b) • school children must received periodic

medical and dental health assessment

• Convention Right of Child • Disease Control Act • Food Act • Tobacco regulation • National nutrition plan of action • Adolescent Health Policy • Health related Education circulars • 3K meetings decisions

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Governing Health In School Setting

Translating Policy

• Promote healthy living

• Monitor growth and development

• Screening school children at risk

• Diagnosis

• Intervention and referral

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Into Activities In School

Healthy Living In School

Health And Physical Activity

Curricular

Health Program In

Schools

PTA Special Programs

Extra Curricular Activities

• Health and physical activity curriculum

• Extra curricular

• Sport, Uniform body, School clubs

• PTA – parents SARANA

• Health programs in school

• Nutrition program

• Mental health screening

Health Policy In School

• Smoke free school

• School against bully

• Accident free zone in school

• Healthy food sale in school

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The vision for school health is the promotion of the optimal health and development of school going children and the communities in which they live and learn.

The objectives of school health are to support educators and the entire school community in creating Health Promoting Schools, address barriers to learning and in so doing act as a safety net for children who did not have

Nutrition In School

• Guideline on healthy canteen • List of food that CAN be sold, NOT

ENCOURAGE to be sold, and CANNOT be sold

• Surat Siaran Kementerian Pelajaran Malaysia Bil.23, 2012 dated 27th June 2012

• Display of food calorie in school canteen

• School Milk Program

• Food supplement for students from low income group

• School Meal Program

• PTA program

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Obesity

• Monitoring of children BMI by School Health Teams

• Teachers should take students’ BMI twice a year and inform the parents during academic parent-teacher meeting

• School physical assessment (SEGAK) – monitor BMI twice a year

• Optimizing activities during PE

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Mental Health

• Screening of student mental health status by counsellors • Form 2 and Form 4

• Screened for • Depression

• Anxiety

• Stress

• Mild to moderate problems – intervention by counsellors

• Severe – direct referral by teacher to Family Medicine Specialist

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Tobacco

• Towards generation free of tobacco by 2048

• Introduction of I’m Free Program

• Disease Control Division is working with dental in screening school children for smoking status

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Cancer Prevention

AIM

HPV Infection

FREE immunisation at school

Form 1

GIRLS ONLY

Begin in

2010

Prevent Cervix

Cancer in 20 years

later

PERLIS KEDAH PULAU PINANG

PERAK WPKL SELANG

OR

NEGERI SEMBIL

AN MELAKA JOHOR

PAHANG

TERENGGANU

KELANTAN

WP LABUAN

SABAH Sawawa

k

Bilangan 14803 124425 81751 136316 78548 271618 63459 48931 199526 84365 74652 113740 4372 146563 140813

Peratus 97% 97% 97% 96% 95% 95% 97% 97% 98% 97% 97% 97% 97% 100% 96%

92%

93%

94%

95%

96%

97%

98%

99%

100%

101%

0

50000

100000

150000

200000

250000

300000

MURID PEREMPUAN YANG MENDAPAT PERLINDUNGAN DARI KANSER SERVIKS MENGIKUT NEGERI 2010 HINGGA 2016

• 1,600,827 Form 1 students

received at least 1 dose of HPV

• 1,356,057 Form 1 students recived

optimal protection from HPV

infection and cervical cancer

1 2

3 ACHIEVEMENT TILL NOW

HOW DOES IT WORKS?

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Genetic Disease

AIM

Thalassaemia carrier

screening among the

Form 4 students

Informed decision among the adolescent

Prevent carrier-carrier marriage

95% reduction of Thalassaemia birth by 2050 OUTCOME 2016

2

3 1

61 students are Thalassaemia patients

5,109 confirmed Thalassaemia Carrier

12,108 awaiting molecular test

22,832 are anaemia

199,174 screened

208,381 students consented for screening

Counselling –

both students

and parents

Treatment

Sumber data: 1. KSK/ST/101 pindaan 2016 2. HKL, 2016

HOW?

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Disability Detection

• Learning disability

• Partnership with MoE to detect school children with learning disability.

• Objective : education placement in alternative curricular

• Skeletal deformity

• Year 6 and Form 3

• Visual defect

• Year 1, Year 6 and Form 3

• In between yearly by teachers

• Colour defect

• Form 3 21

Challenges In Translating Policy Into Actions

• Striking balance between health and education requirement • How much is adequate or too much? • Child academic achievement vs child

• Nurturing healthy behaviour through integrated education in schools

• Meeting parents and community expectation of education system without acknowledging importance of health skills in shaping future adults health decision making

• Persuade parents to practice healthy behaviour in line with health activities in school

• Sustaining good practice beyond schooling age

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Conclusion

• The MOH and MOE close partnership will continue to shape the health of school children in Malaysia

• School base health activities to be extended beyond school setting eg. In community and school to allow children continuously practice healthy choices in live

• Coordinated efforts to build future block of healthy adults begin from childhood and school offer opportunity for children to learn health behaviour correctly.

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