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Promotion of Health Education in Primary Schools

BÉATRICE DESCAMPS-LATSCHA

La main à la pâte


Evidence has accumulated that health education is not the province of only physicians, nurses, and other health professionals; rather, it has to be integrated with science education. Indeed, both health teaching content (how our body functions, how diseases appear and propagate, and how we can prevent them) and methodology (to observe, to propose hypotheses, to verify them, to deduce a behavior, and to evaluate its results) are scientific. Also, health problems are strikingly different between northern and southern parts of the world and strongly depend on environmental and socioeconomic conditions.

In industrialized countries, health education of children has become an important task for the Ministries of Health and the Ministries of Education. This theme has recently been introduced in school programs. Indeed, it is conceivable that health education of children may improve public health, notably in the prevention of risks and the protection against aggressions and addictions. Likewise, the sensitization of school-age children toward diseases and disabilities—avoiding stigmatization—could be of great importance for solidarity, respect, and tolerance toward “others,” not only within but also beyond the school.

In developing countries, a large part of disease prevention already relies on health education of children through nongovernmental organization initiatives such as health-promoting schools and the Child-to-Child Program initiated by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF), respectively. Interestingly, these programs are based on the principle of making children both actors and messengers of health for themselves, other children, their families, and the community.



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Promotion of Health Education in Primary Schools BéATRICE DESCAMPS-LATSCHA La main à la pâte E vidence has accumulated that health education is not the province of only physicians, nurses, and other health professionals; rather, it has to be inte- grated with science education. Indeed, both health teaching content (how our body functions, how diseases appear and propagate, and how we can prevent them) and methodology (to observe, to propose hypotheses, to verify them, to deduce a behavior, and to evaluate its results) are scientific. Also, health problems are strikingly different between northern and southern parts of the world and strongly depend on environmental and socioeconomic conditions. In industrialized countries, health education of children has become an important task for the Ministries of Health and the Ministries of Education. This theme has recently been introduced in school programs. Indeed, it is conceivable that health education of children may improve public health, notably in the pre- vention of risks and the protection against aggressions and addictions. Likewise, the sensitization of school-age children toward diseases and disabilities—avoid- ing stigmatization—could be of great importance for solidarity, respect, and tolerance toward “others,” not only within but also beyond the school. In developing countries, a large part of disease prevention already relies on health education of children through nongovernmental organization initiatives such as health-promoting schools and the Child-to-Child Program initiated by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF), respectively. Interestingly, these programs are based on the principle of making children both actors and messengers of health for themselves, other children, their families, and the community. 

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 PROMOTION OF HEALTH EDUCATION IN PRIMARY SCHOOLS MUCH TO LEARN FROM DEVELOPING COUNTRIES During the past 15 years, organizations such as WHO, the United Nations Educational, Scientific and Cultural Organization (UNESCO), UNICEF, and the World Bank have joined their efforts for developing health promotion strate- gies through health-promoting schools. Several world summit forums have been held, leading to declarations for improving the health, education, and develop- ment of children, and, through them, families and community members. The discussions have been mainly devoted to developing countries and aimed at preventing diseases related to poor environmental conditions (lack of drinkable water, malnutrition, defective personal and community hygiene) and to those pathogens responsible for pandemic infections (malaria, schistosomiasis, and HIV). Although most of these health problems are not encountered with a high prevalence and acuity in industrialized countries, most declarations were cast on a worldwide basis as indicated by the three following extracts: • The World Declaration on the Survival, Protection and Development of Children1 concluded that “Together, our nations have the means and the knowl- edge to protect the lives and to diminish enormously the suffering of children, to promote the full development of their human potential and to make them aware of their needs, rights and opportunities.” Of course, this is dependent on a new opportunity to make respect for children’s rights and welfare truly universal. • The declaration at the World Education Forum advocated, “All children must be given the chance to find their identity and realize their worth in a safe and supportive environment, through families and other care-givers. They must be prepared for responsible life in a free society. They should, from their early years, be encouraged to participate in the cultural life of their societies.” 2 • This same forum stated that girls must be given equal treatment and opportunities from the very beginning. This is noticeable not only for avoiding gender discrimination but also in its support of public health. Indeed, as recently revisited by the Women Health Education Programme,3 women’s illiteracy is still the major factor involved in the abnormally high perinatal maternal and child mortality in the developing world. 1Agreed to at the World Summit for Children, UNICEF 1990. See http://www.unicef.org/wsc/ declare.htm. Accessed September 13, 2007. 2 See http://www.unesco.org/education/efa/ed_for_all/dakfram_eng.shtml. Accessed September 13, 2007. 3 Developed by André Capron at the French Academy of Sciences through the Interacademy Panel (IAP). See http://www.whep.info/. Accessed September 13, 2007.

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 SCIENCE, SOCIETY, AND EDUCATION WHY FOCUS ON SCHOOLS? Ensuring that children are healthy and able to learn is, without a doubt, an essential component of an effective education. Likewise, school is a key setting. There, it is possible to improve and sustain the health, nutrition, and education of children previously beyond reach (e.g., girls). A large amount of research has shown that health and education are insepa- rable. Studies have indicated, for example, that cognitive performance is affected by a child’s nutritional status and that illness from parasite infection results in absenteeism, school failure, and dropouts. Likewise, for education systems to be effective, efforts to increase enrollment, build more schools, or train more teachers are not enough and come to naught if physical or mental health problems prevent children from attending school regularly and remaining in school for a sufficient number of years. In its final report, the World Education Forum also stressed, “Effective health education responds to a new need, increases the effi- cacy of other investments in child development, ensures better educational out- come, achieves greater social equity and is a highly cost effective strategy.” The report proposed the FRESH (Focusing Resources on Effective School Health) framework as a start for enhancing the quality and equity of education. 4 THE CHILD-TO-CHILD EDUCATIONAL APPROACH Introduced in the early 1970s, the Child-to-Child educational approach has now become a central core5 of a worldwide movement of health and education workers to protect and preserve the health of communities through the education of children. It mostly relies on the principle of encouraging and enabling school- age children to play an active and responsible role in the health and development of themselves, other children, and their families. A great number of activity sheets and reading resources have been produced that deal with the major health top- ics encountered in these countries, such as breastfeeding, children’s growth and development, nutrition, personal and community hygiene, diarrhea, vaccination, maternity without risks, and the prevention and cure of diseases such as malaria and AIDS. Boxes 1 and 2 retrace, as an example, the Child-to-Child framework set up for preventing HIV/AIDS pandemic and supporting children facing the impact of this new plague for our humanity. 4 Seehttp://www.unesco.org/education/wef/en-docs/findings/rapport%20final%20e.pdf. Accessed February 13, 2008. 5The Child to Child Trust is currently chaired by Dr. Patricia Pridmore at the Institutes of Education and Child Health, London University.

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 PROMOTION OF HEALTH EDUCATION IN PRIMARY SCHOOLS BOX 1 Steps in the Child-to-Child Approach for Preventing HIV/AIDS 1. Understanding the issue: What happens to children when parents are sick with AIDS or have died? 2. Finding out more: How does HIV/AIDS affect their community? 3. Discussing findings and planning action: Children prepare posters and compose poems, songs, and dramas. 4. Taking action: Children organize a special event for other children and adults aimed at tackling discrimination, ensuring that all children are included, and motivating families. 5. Doing better: Children use all opportunities individually and as a group to help each other and younger children to cope with the impact of HIV/AIDS. BOX 2 Support of Children Facing the Impact of HIV/AIDS in Their Families 1. Training for older children on issues of growth and development of themselves and of younger children. 2. Fostering relationships between older children and younger orphans and other vulnerable children living with HIV/AIDS and/or having been abandoned. 3. Counseling for children heading households on their psychological and emotional needs. 4. Working with parents and children to develop memory books to help them in the future to get a sense of their identity and know they have been loved. LA MAIN À LA PÂTE: A NOVEL APPROACH TO HEALTH EDUCATION The recent development of inquiry-based science teaching owes much to the efforts of the scientific community. In France, three physicists—Georges Charpak, Pierre Léna, and Yves Quéré—launched their own version of inquiry- based science teaching under the label La main à la pâte6 (translated as “Hands on” in English). It has now spread to more than 40 percent of French schools and to many schools in numerous other countries, including Afghanistan, Argentina, 6 Recently revisited in Charpak et al. (2005) and Quéré and Jasmin (2005).

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 SCIENCE, SOCIETY, AND EDUCATION BOX 3 The Ten Principles of La main à la pâte The teaching approach: 1. Children observe an object or a phenomenon in the real, perceptible world around them and experiment with it. 2. During their investigations, pupils argue and reason, pooling and discussing their ideas and results and building on their knowledge, since manual activity alone is insufficient. 3. The activities suggested by the teacher are organized in sequence for learn- ing in stages. The activities are covered by the program and leave much to pupil self-reliance. 4. A minimum schedule of 2 hours per week is devoted to the same theme for several weeks. Continuity of activities and teaching methods is ensured throughout the entire period of schooling. 5. Each child keeps an experiment logbook, in which the children make notes in their own words. 6. The prime objective is the gradual acquisition by pupils of scientific con- cepts and operating techniques, with consolidation through written and oral expression. Partnership: 7. The family and community are solicited for work done in class. 8. At the local level, scientific partners (universities, etc.) support classwork by making their skills and knowledge available. 9. Teaching colleges in the vicinity give teachers the benefit of their experience. 10. Teachers are able to obtain teaching modules, ideas for activities, and replies to queries via the Internet. They can also take part in a dialogue with col- leagues, training officers, and scientists. and scientists. Brazil, Cambodia, Chile, China, Columbia, Egypt, Iran, Malaysia, Mexico, Senegal, and Togo. The general idea of La main à la pâte is to enable children to participate in the discovery of natural objects and phenomena, to bring them into contact with the phenomena in their reality (outside virtual reconstructions) directly through observation and experimentation, to stimulate their imagination, to broaden their minds and to improve their command of the language (see Box 3). A number of distinct resources, including an Internet Web site,7 are now available. The golden rule is that teachers should be trained as children will be taught. 7 www.inrp.fr/lamap.

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 PROMOTION OF HEALTH EDUCATION IN PRIMARY SCHOOLS The widespread development of La main à la pâte throughout the world, under distinct terms such as Hands-on in the United States, Learning by Doing in China, or Penser avec les mains in Switzerland, illustrates well how science education at an early age could serve as a bridge across cultures. Interestingly, an international portal has recently been added to the French Académie des Sciences site by the International Council for Science and the Interacademy Panel in direct link with La main à la pâte. The La main à la pâte team has recently set up a working group to develop teaching modules of health education on major themes of public health. Among these, the prevention of solar exposure was chosen first, because it is responsible for the high prevalence of cutaneous cancers and the increased frequency of cataracts. This theme has led the group9 to build a teaching module, Vivre avec le Soleil (“To Live with the Sun”; see Wilgenbus et al., 2005), aimed at the sensitization of children to the characteristics of sun exposure and of its poten- tial damaging effects as well as to the importance of simple protective measures against ultraviolet exposure. It is also hoped that, as is already happening with the Eratosthenes10 model, by joining children from several parts of the world to measure the Earth’s radius, To Live with the Sun might serve as an accurate chal- lenge for the idea of education as a bridge across cultures all over the world. In the past two years our group has focused on poor nutrition, a worldwide health problem that, depending on the part of the world and even on the region in some countries (e.g., Argentina), results in malnutrition or obesity. As in many other industrialized countries, obesity appears to follow an epidemic progression from very early in childhood. Recent statistics on overweight children in the United States indicating that it affects nearly 25 percent of children under the age of ten justifies the sensitization of children on the important roles of bal- anced diets and physical activity. In France, a threefold increase in overweight children—from five percent in 1980 to 16 percent in 2000, among which four percent are obese, has also been observed and has justified, in 2002, the initiation of a national program (Programme National Nutrition Santé) aimed at disseminat- ing overweight prevention messages to the general French population, based on eating well and regular physical exercise. In most industrialized countries, obesity has thus become a major public health problem, mainly through its associated complications, such as hyper- tension, cerebrovascular and cardiac incidents, and diabetes, which reduces the overall life expectancy of the obese by 10 years. Being overweight is a condi- 8 Contact: marc.jamous@inr.fr. 9With the contribution of the Association Sécurité Solaire. 10 In this project entitled “Following in the Footsteps of Eratosthenes,” more than 300 English- speaking pupils have measured the Earth’s circumference from their classroom, simply by observing the shadow of a vertical stick at noon local solar time. Again this time, schools of many countries will join together to reproduce the observations of the Greek scientist who, more than 2,000 years ago, was the first to propose a simple method to measure our planet’s size.

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0 SCIENCE, SOCIETY, AND EDUCATION tion involving many factors, including not only nutritional and physical factors but also psychological, socioeconomical, cultural, and genetic factors. Most of these are outside the scope of the health education of children. However, many countries have started to develop nutritional education programs directly within schools. The nutrition education module To Eat and to Move for My Health recently proposed by La main à la pâte (Bense et al., 2008) is devoted to 5- to 7-year-old primary school children. It stresses the importance for the child to have both a diversified and well-balanced diet and a regular physical activity program. Follow- ing closely the La main à la pâte principles (see Box 3), it proposes a series of pedagogical sequences11 in which each child has the opportunity to propose a hypothesis, to experiment (alone or in small groups), and to write observations and conclusions in an experiment notebook. However, special attention has to be drawn to two major aspects of nutri- tion that have been at the center of our reflections when preparing that module. The first is to avoid the stigmatization of the obese child, who is often present in the classroom and has led us to propose a sequence named: All Similar or All Different? Indeed, it has to be kept in mind—and teachers themselves do not always know—that the mental suffering of the obese child is intense and often hidden behind behavioral troubles. Moreover, the obese child is an easy target of mockery and injurious jokes from other children. Together, these lead to feelings of disgust toward their own bodies and to depression. The second deals with the absolute necessity of informing parents of the teaching procedure, obtaining their consent and, whenever possible, having them participate. Even if eating is a biological function, to eat and to gie to eat are also vehicles that touch the intimate, self-representation, and family life. Nutri- tion education allows the development of the capacities to judge and to make social and individual changes without putting into question important habits and familial traditions. Finally, the statement of Yves Quéré (2008) is important: “When I was a child, health education was already taught but often within The moral lesson and on a distinct day from The science lesson […]. Science and health were two worlds which at school ignored each other.” Indeed, this La main à la pâte pedagogical approach—that is, an investigation developed by the children under the direction of their teacher, initiated by their questioning, and relying on their own experimentation—herein proposed for health education in primary school contributes to demonstrating that this has to be considered as a part of science teaching. More globally, attempts made to promote health education at primary school 11 Four sequences (comprising three 1.5-hour pedagogical sessions) are entitled as follows: Se- quence 1, To Move, but for What?; Sequence 2, Hygiene, Is It Important?; Sequence 3, Eating Well, but How?; Sequence 4, Drinking, But not No Matter What?

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1 PROMOTION OF HEALTH EDUCATION IN PRIMARY SCHOOLS and aimed at enabling children to face present public health dangers should always incorporate the first ethical principle of Kant, “First do no harm,” and its corollary, “So act as to treat humanity, whether in thine own person or in that of any other, in every case as an end withal, never as a means only.” REFERENCES Bense, D., B. Descamps-Latscha, and D. Pol. 2008. Manger, bouger, pour ma santé. Paris: Hatier. Charpak, G., P. Léna, and Y. Quéré. 2005. L’enfant et la science. L’aenture de la main à la pâte. Paris: Odile Jacob. Quéré, Y. 2008. Foreword. In Manger, bouger, pour ma santé, D. Bense, B. Descamps-Latscha, and D. Pol. Paris: Hatier. Quéré, Y., and D. Jasmin. 2005. When learning science becomes child play. A World of Science 3(3). Wilgenbus, D., P. Cesarini, and D. Bense. 2005. Vire aec le soleil: actiités Cycle : guide de l’enseignant. Paris: Hatier.