Network News. In this issue: 2006 Tenth Issue The European Network of Health Promoting Schools. A new phase for the ENHPS

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1 2006 Tenth Issue The European Network of Health Promoting Schools In this issue: A new phase for the ENHPS Cyprus today Reports from three schools 15 years of school health promotion in Germany Achievements and challenges in Scotland Evaluating the project in Greece Taking stock of developments in Slovakia and Slovenia EUROPEAN COMMISSION

2 The 13th Business Meeting for National Coordinators of the European Network of Health Promoting Schools took place in Copenhagen, Denmark, October 2006 International Planning Committee (IPC) 2006 All rights in this document are reserved by the IPC of the European Network of Health Promoting Schools, a tripartite partnership involving the WHO Regional Office for Europe, the European Commission and the Council of Europe. The IPC welcomes requests for permission to reproduce or translate its publications, in part or in full. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the IPC or its participating members concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Where the designation country or area appears in the headings of tables, it covers countries, territories, cities, or areas. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers products does not imply that they are endorsed or recommended by the IPC in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. The IPC does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use. The views expressed by authors or editors do not necessarily represent the decisions or the stated policy of the IPC. Layout and print by Kailow Graphic 2

3 Editorial Vivian Barnekow This is the 10th issue of Network News. The first issue was published in It was the first attempt to share good practices in health-promoting school approaches and policy developments throughout Europe. From the start in 1992, seven countries joined the European Network of Health Promoting Schools (ENHPS). In 1995, the ENHPS had 28 countries as members. Today 43 countries are members. During the years we have published case studies from schools and countries focusing on policy development, dissemination of health-promoting schools, evaluation and issues such as diet and nutrition and physical activity. The ENHPS will undergo major changes over the next couple of years. The Technical Secretariat will move from the WHO Regional Office for Europe to the Netherlands Institute of Health Promotion and Disease Prevention. We have prepared a new structure including the participation of the Council of Europe, European Commission and the WHO Regional Office for Europe as members of the Advisory Board, the involvement of centres of excellence and representation of national coordinators in the Executive Board. This will move the ENHPS into the future. Many successful events have been launched in recent years. The first conference of the ENHPS in 1997 produced a resolution focusing on democracy, equity, empowerment and action competence, the school environment, curriculum, teacher training, measuring success, collaboration, community involvement and sustainability. All of these are still valid as key areas for developing health-promoting schools. The Education and Health in Partnership Conference in Egmond-aan- Zee in 2002 focused on strengthening the evidence base for developing health-promoting schools. The Conference adopted the Egmond Agenda, a tool to help establish and develop health promotion in schools and related sectors across Europe. The main areas of the Agenda were conditions, with a focus on situation analysis, evidence, partnership and advocacy, programme content and objectives, long-term planning, teacher training and professional development and evaluation. The Fifth Workshop on Practice of Evaluation of the Health Promoting School Concept, Indicators and Evidence, kindly hosted by the Swiss Federal Office of Public Health in June 2006, focused on models, experiences and perspectives. The Workshops have not only benefited the participants; they also contributed to build the evidence base for developing health-promoting schools. At the First Workshop in 1998, the concept of indicators of health-promoting schools was launched. Indicators should be chosen to reflect the most important issues and the main actions that can be taken, be consistent with the values of the ENHPS and reflect the aims of those working within the ENHPS. Indicators help to recognize strengths, identify areas where good practice needs to be maintained or where improvement is needed and to build an action plan. At the Fifth Workshop, we finished the circle by examining the use of indicators in different contexts. We have published capacitybuilding manuals and examples of good models of practice. In between the many national events, we have launched new initiatives, built capacity, disseminated healthpromoting schools programmes and developed policies. The annual ENHPS Business Meeting held in Copenhagen on October 2006 presented and discussed the health-promoting schools resource book to be published soon and the Tool for Schools, which is being prepared. The resource book will provide an overview of the history and concepts of health-promoting schools and the development of indicators and will be a useful tool for various audiences, including decisionmakers and practitioners. The Tool for Schools will provide inspiration for any school wanting to develop and implement health-promoting schools approaches. These two publications will support the further development of health-promoting schools in the European Region. We have come a long way since the early 1990s. Health-promoting schools is recognized throughout the European Region as a useful investment in both health and education. There is, however, still a long way to go before all countries have created conditions that will enable schools to continue to create a physical, social and mental environment conducive to strengthening both health and learning. The Secretariat in Copenhagen wishes the best of luck and a very successful future for the ENHPS. Vivian Barnekow 3

4 Fifth Workshop on Practice of Evaluation of the Health Promoting School Concepts, Indicators and Evidence Sigriswil, Switzerland, 8 11 June 2006 Sigriswil revisited The beautiful Swiss Alps once again became the meeting-place for a group of hard-working researchers involved in health-promoting schools initiatives across Europe. The Fifth Workshop on Practice of Evaluation of the Health Promoting School brought together delegates from 29 countries in the European Region to focus on issues related to evaluation of the health-promoting school programme. Specifically, participants were invited to contribute to the completion of the indicator section of the new health-promoting schools resource book by sharing information and finalizing case studies. In addition to plenary sessions exploring indicator issues relevant to ENHPS work, the Workshop gave participants the opportunity to discuss in groups their ideas on how the health-promoting schools resource book should evolve and to work under expert guidance with fellow authors on developing their case studies. The finalized case studies will appear in full in the health-promoting schools resource book. Four groups of participants presented progress so far in the development of their case studies to the wider group, and several more took the opportunity to display their progress through poster presentations. After long working days, participants enjoyed the social programme of the evenings, offering opportunities to get to know the Swiss landscape, farming and singing. 4

5 Three quick questions about the ENHPS 1. Is there an experience related to the ENHPS that you will never forget? 2.What is the funniest experience you can remember related to the ENHPS? 3. In your opinion, what difference has the ENHPS made? Henry Scicluna, former member of the International Planning Committee of the ENHPS representing the Council of Europe. 1 It is difficult for me to single out an unforgettable experience all the ENHPS events Greece, Italy and Edinburgh as well as all the little meetings we had in Copenhagen are still vivid in my memory. But what is most unforgettable is the WHO team that ran the show Vivian, David, Erio and Bente people who strongly believed in what they were doing and did it with great skill and inimitable charm. 2 I do not recall anything funny, except myself, of course but I do remember great joy in building up together the ENHPS and making it work successfully for so many years. 3 The most important achievement of the ENHPS is to show young people, teachers and parents that health education is not a series of interdictions and condemnations, that healthy living is not boring and that education should be directed towards inculcating individual responsibility. I do not know whether young people smoke less, drink less or indulge less in risky behaviour, but I am sure that thanks to the ENHPS they are more aware of the positive and negative aspects of their actions and more conscious of their potential to change their lifestyle if they want to. Aldona Jociute, Coordinator, Lithuanian Network of Health Promoting Schools 1Growing in experience from team work, which is rich in its multidisciplinary approach, diversities of culture, experiences, openness and tolerance, and at the same time working in this field, which is challenging and evolving over time. 2Spending more than half a day reading one page of a letter in English and trying to understand language that was incomprehensible to me then, in 1993 (when we joined the ENHPS). Now it is funny, but it was not funny at all 13 years ago. 3In my opinion, starting as an innovation system, the ENHPS is now realizing new efforts in building the health-promoting schools system, offering new ways to cooperate across boundaries of schools, organizations and countries applying the health-promoting schools concept and, very importantly, it successfully transfers the healthpromoting schools results to schools day-to-day work. Erio Ziglio, Head,WHO European Office for Investment for Health and Development and former member of the International Planning Committee of the ENHPS representing WHO 1Surely, this is the negotiation we had in with the European Commission and the Council of Europe to agree to manage the ENHPS as a joint initiative. The process leading up to the final agreement gave me a great opportunity to understand the diversity (institutional, mission, etc.) of these major European 5

6 Three quick questions about the ENHPS players and the opportunity to work in synergy. 2There have been numerous funny experiences. Too many to list here, I afraid. 3The impact of the ENHPS in countries has been diversified. In some countries it stayed at the project level, while in others health-promoting schools has been mainstreamed in education and health policies. Interestingly, at the Expert Conference on Health in All Policies, organized under the Finnish Presidency of the European Union in Kuopio in September 2006, five health ministers were asked for specific examples of health in all policies, and four mentioned health-promoting schools. one school, and I met many teachers, school doctors and nurses and principals. My overwhelming memory is the dedication and commitment of the professionals to developing the students in their charge. People made many sacrifices in implementing health-promoting schools, in terms of time and the freely given extras contributed by professionals proud of their work. I learned so much, and it changed my thinking and attitudes on many things: education, health, culture and life. I am very grateful to everyone with whom I met and worked for unforgettable experiences and great times together. 2My second visit to Romania was in the mid-1990s, and I still needed a visa to enter the country. I remembered that, on my first visit, the queue at the immigration desk was extremely long and chaotic, so although my papers were in order, I knew I still had a long and tedious wait ahead of me. I descended from the aircraft and walked to the bus that would take the passengers to the terminal. Then a young man came up to me and asked me my name, and I told him. He replied that he had been sent to meet me and he would arrange for my speedy passage through immigration and the collection of my luggage. Great!!! I thought. I had always envied the VIP passengers who are met at the aircraft and whisked off in fast black cars with blacked out windows. We got to the terminal and the young man began forcing a gap through a teeming crowd of passengers all trying to get themselves into place in the numerous queues: obtain your visa here, get your customs declaration form here, citizens of Romania, foreigners. My guide worked hard to find a way through all these to the small and well-guarded VIP queue, cordoned off with red rope and being observed by everyone else from the wrong side of the ropes. My guide looked proudly around as he waited beside me for my turn at the David Rivett, Technical Officer for Adolescent Health,WHO Country Office for Ukraine 1I began and continued my work with the ENHPS in the countries in transition from the socialist political and economic system to the globalized market. Life changed for everyone in these countries. In many countries the process is continuing and it is painful. I visited most of these ENHPS countries, most several times. I always tried to visit at least 6

7 glass box, within which a steely-eyed immigration official scrutinized the paperwork. My turn came, my guide spoke a few words in Romanian and I was through in five minutes! My guide looked very pleased with himself on a job well done. He then said he would collect my luggage and asked me for my luggage label. I gave it to him and, as he walked away, he glanced at it and then froze. He looked at me, looked at the label, looked at me again and then said But, you re not Mr Rivonete!!!!. No, I guess I am not. 3Thousands of schools in the European Region are now using health-promoting school ideas and methods. Many other agencies and organizations are now using the language of health-promoting schools. Many thousands of teachers have attended training programmes on health-promoting schools. Most school health curricula are based on health-promoting school concepts and principles. I believe these are the differences the ENHPS has made. A new phase for the European Network of Health Promoting Schools In 2007 a new phase of the ENHPS will begin. The Technical Secretariat of the ENHPS will be transferred from the WHO Regional Office for Europe in Copenhagen, Denmark to the Netherlands Institute of Health Promotion and Disease Prevention (NIGZ) in Woerden, the Netherlands. Both WHO and the NIGZ will take responsibility for preparing a transition period during The transfer of the Technical Secretariat means that as of 1 January 2007, the NIGZ is in charge of dayto-day management, and the Council of Europe, the European Commission and WHO serve as a board of trustees for the ENHPS. The year 2007 is a transition period for the ENHPS, with the introduction of a new structure including an executive board with participation from the membership and representation from the centres of excellence that have been already appointed in WHO and the Netherlands Ministry of Health, Welfare and Sport have found funding for this transfer. The NIGZ and WHO are seeking additional funding to be able to carry out the 2007 work plan completely. The new contact address for the Technical Secretariat of the ENHPS from 1 January 2007: ENHPS Technical Secretariat Netherlands Institute of Health Promotion and Disease Prevention P.O. Box 500 NL-3440 AM Woerden The Netherlands Tel.: Fax:

8 Austrian Network of Health Promoting Schools Austria has been a Member of the European Network of Health Promoting Schools since The Austrian Network of Health Promoting Schools started with a three-year pilot phase, initially involving 11 schools, and has been continually expanded. Working with the of Austrian Network of Health Promoting Schools has given schools a chance, through health-promoting projects, to test new forms of cooperation, gain social support through teamwork and exert influence on the work situation. Today, the term health-promoting schools has become a quality feature. The Ministry of Education has supported Austria s schools in their efforts to review, control and further develop quality. It is envisaged that, henceforth, all school partners will jointly and systematically work and tackle issues of quality as a permanent part of school culture. Aiming at promoting health, health-promoting schools are working towards embodying into the school programme aspects of quality of education; class and school environment; school management; external relations; and staff development. Consequently, it has been possible to combine the concept of health-promoting schools with school development in general. At the beginning of any school development process, the following questions have to be asked. What is the meaning of health promotion in our given situation? What are our demands, perspectives and visions? What does today s school look like? And what do we know about it? All these are very difficult questions that each school has to answer. Quality should become the focal point of interest as well as the question of what contribution health promotion could make with one concrete result: the establishment of development targets and practical measures for their implementation. A first step in further developing high-quality work in health promotion in schools is joint data collection and analysis of the current status. National and international evaluation results have shown that students in health-promoting schools drink less alcohol, smoke fewer cigarettes and cannabis and take less medicine; hence, in the long term, the school environment may be improved and, in turn, students performance may be enhanced. The Ministry of Education has, therefore, made a first step towards establishing a Platform for Health Promotion (PGF 2010) in July 2007 and presented a strategy paper on health promotion in Austrian schools. This Platform is meant to form part of the development of health-promoting measures by assuming the following five roles: to act as a health conscience by defending the principle that health is a fundamental human right and to enhance public awareness of continued or newly emerging problems in connection with the health of the school community; to act as an authoritative information centre for questions of health promotion and health development; 8

9 Next step in Austria to foster the general concept of health promotion in schools and ensure its regular updating within the entire region; to offer topical, scientifically proven instruments that partners may use to transform programmes within the basic concept of health promotion in schools into concrete approaches for action; and to act as catalyst for measures to be taken. The Platform for Health Promotion will do this by: offering cooperation in order to ensure a mutually beneficial exchange of experiences between the steering institution and regional health-promoting institutions; playing a leading role within the regional efforts towards developing concepts and implementing them; and promoting measures centred on the networks in cooperation with numerous partners. Henry Scicluna, one of the earliest promoters of the ENHPS, once said that Health-promoting schools is starting not to be a little project any more; I can see a change into a movement. This is happening in Austria. We started with 11 schools and have gained a lot of experience. Building on this experience, we aim at expanding the concept of healthpromoting schools so that it may become a programme for all schools. For more information on Healthy School in Austria, see on mental health promotion, see and on the quality of schools, see Beatrix Haller National Coordinator (1993 to March 2006) Austrian Network of Health Promoting Schools Realigning the Austrian Network The Austrian Network of Health Promoting Schools is currently moving into a quality process. In 2005, the Federal Financial Controlling Department suggested restructuring the Network based on a cost-benefit perspective. The Federal Ministry of Education, Science and Culture, the Federal Ministry of Health and Women and some social partners decided to restructure the system of health-promoting schools. The partners are planning a roundtable platform for health-promoting schools: all stakeholders who are offering health-promoting school programmes will build a strong partnership and network. The objectives of the platform are: to build a strong structured Network, including an advisory board, executive board, centres of excellence, technical office and platform pool for all stakeholders; to establish a federal administrative office (technical office); to develop clear objectives and current evaluation; to develop information and assessments for policy-makers; to unify the health-promoting school programmes and initiatives; to develop quality criteria for health-promoting partners; to develop quality criteria for health-promoting schools; to develop a leadership academy for health-promoting teachers; to support and develop healthpromoting circles in various regions; to raise funds; and to develop a marketing and public relations strategy. The Austrian Network has 150 schools as members. The Network will be restructured in 2006/2007 and will change its name to Healthy School. Martain Gerhartl Federal Ministry of Education, Science and Culture Coordinator, Austrian Network of Health Promoting Schools Vienna Austria 9

10 What s new in Cyprus? Reports from three The role of alcohol in the lives of teenage students Our school joined the Cypriotic Network of Health Promoting Schools in 2005/2006. The subject chosen was the role of alcohol in the lives of teenage students. Aims The aims were: to study the extent of underage alcohol consumption in our school; to elucidate the reasons for underage drinking; to inform students that alcohol is an addictive substance with longterm effects; to describe how alcohol abuse may severely harm an individual s life in terms of family life, work life, social life and financial situation; to guide students in developing responsible attitudes towards alcohol consumption; and to explain why driving while under the influence of alcohol is irresponsible and dangerous. We used interactive approaches to achieve our objectives. This allowed our students to draw their own conclusions from individual research projects. It also enabled them to express and discuss openly, in a friendly, non-criticizing and trusting environment, their feelings, experi- ences and personal ideas on the subject. Programme set-up The programme was divided into modules. Module I was a research project on a sample of 405 students of all age groups and both sexes. The research was carried out using a questionnaire created by a committee of students (17 18 years old) and teachers. The questions focused on such topics as: the awareness of students about the legal age for drinking; their personal outlook on driving 10

11 schools under the influence of alcohol; and their personal habits and perceptions on alcohol use. Module II was a series of workshops divided into activities A, B and C. Activity A was for all first-year students (ages years). It comprised a set of educational and awareness workshops carried out by trained personnel from the Legal Drugs Detoxification Unit of the Ministry of Health. The workshops involved a brief, informative talk, followed by a question-and-answer session. Here the students had the opportunity to express and discuss their own experiences, ideas and beliefs on: the dangers of alcohol use and abuse by teenagers; the effect of alcohol on their health; the dangers of drinking and driving; and how friends, parents and family habits and attitudes influence their own drinking. Activity B was an interactive workshop for the 16- to 17-year-old students. The students were asked to visualize themselves being out with friends having a good time. They were then asked to write where they were and draw on a plain piece of paper what they what they were drinking. Within this activity, the students had the opportunity to discuss: their own drinking experiences and habits; their experiences compared with those of others; friends habits and attitudes toward drinking; and family habits and attitudes toward drinking. The students had to tackle such factors as what they drink, why they drink and when they consume alcoholic drinks. 11

12 What s new in Cyprus? Reports from three schools Activity C was an interactive workshop involving both parents and students. The question How do young people achieve a good night out? was given to both groups, who were asked to draw young people having fun. The students were able to express openly, in the company of parents, their feelings and expectations on going out and having fun. The discussion focused on the notion that alcohol helps them to relax and have fun by reducing their inhibitions. In parallel, the groups of parents expressed concern over the dangers their children face when they go out. Further, they strongly questioned the teenagers ability to act responsibly in consuming alcohol. The workshop concluded with a discussion on: how teenagers and the parents can develop a healthy relationship based on trust, thus eliminating conflict; and the dangers behind the use of alcohol as a means to escape stressful situations and to rebel against parental oppression. Module III comprised of a set of activities organized and coordinated by the journalism teacher. The students of the group took part in module II, activity B and were asked to choose and carry out related research projects. All the students were enthusiastic and produced excellent work. These included: live interviews on alcoholism from their schoolmates as well as from a random group of people from the local community; an interview with the head of the traffic police; minor research on the drinking habits of adults from the local community; and a presentation on the dangers of driving under the influence of alcohol. In module IV, students from the English-language section (ages years), under the guidance of their teacher, carried out an extensive Internet and library search and prepared presentations and leaflets focusing on the effect of alcohol on a person s health, the dangers of driving under the influence of alcohol and the role of alcoholic drinks in social life. In module V, students of the graphic arts section (ages years) were asked to create a poster on the subject of alcoholism and/or drinking and driving. Module VI: the first student conference in the school was entitled Alcohol: Widely Acceptable Potentially Damaging. The main speakers analysed: the psychology of teenagers; the effect of alcohol on health; the European approach to drug detoxification; the journey from alcohol use to alcohol abuse and alcoholism; and the dangers of drinking and driving. 12

13 In addition, the students presented the results of their own projects and other work carried out during the academic year within the framework of the programme. Most of the students attended the conference as well as groups of students from other schools. In addition, many parents, representatives of the Ministry of Education, Ministry of Health, the police department and the local council attended the conference. Results All activities indicated that underage drinking is a problem. Most teenagers who drink are largely unaware of the conse- quences this may have on their health and their life in general. Young people use alcohol in order to relax, forget about stressful situations and to lose their inhibitions so they may have fun. Non-drinkers feel left out and find it difficult to integrate into groups of drinkers. Nobody reported any difficulty in buying a drink from a kiosk, bar or club. Drinking students said that their parents knew that they drink when they go out and this causes conflict, as the parents appear distrustful. Students, parents and educators strongly requested a better educational policy on alcohol. All students stressed the importance, for all young people, of cultivating a responsible attitude towards drinking. The students pointed out the need for stricter law enforcement and criticized the police for being lenient in implementing the regulations on serving and selling alcoholic drinks to individuals younger than 18 years. Niki Mesariti Rose Biology Teacher Programme Coordinator Makarios III Lyceum Larnaca Cyprus 13

14 What s new in Cyprus? Reports from three schools European citizenship: an aspect of health promotion This year is the third that St. Athanasios (A) Primary School is participating in the Cypriotic Network of Health Promoting Schools. The school is one of the two primary schools of St. Athanasios, an area in the outskirts of Limassol that is very close to the town. The school has an average of 240 students and about 16 teachers. The topic developed in the school was learning about Europe, to get to know about European countries and their people and healthily fit into the whole and to become active and useful European citizens. This derived from Cyprus entry into the European Union in May 2004 and had two purposes. First, it was intended to help our children learn about other people, in this case Europeans, and accept being different, but also to apply a holistic healthy school policy that would actively involve the students in the process. It was a multicultural health-promoting action plan that enriched children s knowledge, developed their skills and attitudes towards European countries, their people and their culture, but also improved their self-image and self-esteem since the programme aimed at reinforcing Cyprus s culture. All these were considered necessary to eliminate prejudice and stereotyped ideas and contribute to the development of the children s European identity. In addition, different aspects of health were also developed such as loving and caring for the environment, learning to eat healthily and exercise regularly and learning to appreciate life without any dependence on smoking, alcohol and drugs, attitudes that children should develop for life. The approach was cross-curricular, and all teachers explored a topic related to the school s project in their subjects or areas of interest. For example, the following activities related to Europe took place in various subjects of the curriculum: First-grade students prepared an A3 booklet on the alphabet of Europe during language lessons. Each page represents a letter of the alphabet and presents a different European country. Drawings of sightseeing monuments of European countries were compiled to make a wall calendar for the school year 2005/2006. This was an art project of sixthgrade students. Drawing like Van Gogh, Monet, Kandinsky and other wellknown European artists was an activity that took place all three years in art lessons. Children of different age groups produced real masterpieces. In design and technology, children were involved in several projects during the three years. The first year they used various materials to make models of the famous monuments of European countries, such as the Eiffel Tower, Big Ben and London Bridge. The second year, they made small artefacts based on the cultural traditions of European countries, such as decorated boxes with shells and painted flowers of Norway and Christmas ornaments of Sweden. The third year, one project was designing and making a table toy with Europe as a theme. In home economics, throughout the three years children had the chance to familiarize themselves with European cuisines and their philosophy and cook dishes from them. They were also involved in projects about healthy eating, which again related to healthy and less-healthy eating patterns in Europe, and good or bad examples were compared and discussed. In geography lessons, Europe was the theme that not only older students (fifth-grade syllabus) but younger ones developed by exploring the countries and their capital towns, learning about European seas, mountains and rivers and carrying out projects. Children of different age groups carried out projects on myths of Europe, Europe in literature and European writers and poets during their Greek-language lessons. Third and fourth-grade students examined the euro and the European Union monetary system in general in mathematics. The European Union was also a theme children talked about on several occasions, and they took part in some children s contests. 14

15 Learning about health promotion can actually be fun! school took initiatives to improve children s self-esteem to enable them to ultimately become strong enough to resist dependence on such substances as tobacco, drugs and alcohol. Planned, systematic workshops for sixth-grade children, teachers and parents were organized for this purpose. The development of strong relationships between the school, the family at first and the wider community later on is an important and valuable element of the health-promoting school. Based on this, there has been an effort to promote the cooperation of all these parties, and the community organization of different activities has been planned during these three years, which has put the school in the centre of the community. In some cases teachers invited parents with a specialty to come at a lesson time and demonstrate their skills or even work with the children. In other cases, parents volunteered to help in events the schools organized. A big event resulting from this effort was the organization of a celebration devoted to Cyprus entering the European Union (May 2004), since all the games prepared either by the school or members of the community had Europe as a theme. All these activities took place in parallel with various efforts. For example, the school s physical environment was improved, school buildings renovated and schoolyards refurbished with the help of parents and children and murals painted on the walls with the art teacher and the children. Further, children s healthy eating habits were promoted. For example, a day was devoted to healthy breakfast where children of all ages in the schools talked with the school s health visitor and the home economics teacher about the importance of eating healthily in the morning and had breakfast prepared by the parents. Improving the food being sold at the school shop was another goal, which was tackled by selling fruit at break time. The school made efforts to improve children s physical health by taking part in physical education activities such as whole-day sports days with games with other schools and water sports at the sea. In addition, the It was a programme that seemed to be very demanding when we had been planning it at the beginning of the school year and I had my doubts about its success, a school staff member admitted when asked to evaluate it. However, she continued, it was a programme that worked out without pressure despite the short time we had and was very useful for all of us! St Athanasios (A) Primary School Limassol Cyprus 15

16 What s new in Cyprus? Reports from three schools Kornos Primary School: moving to a whole-school approach Kornos Primary School is a rural public school with about 180 students. The school joined the Cypriotic Network of Health Promoting Schools in September This report elaborates the development of the health programme from September 2003 until June The health programme began with two classes and gradually shifted to a wholeschool approach. This gradual movement to a whole-school approach was fruitful for the development of a health-promoting culture among all members of the school community. In the first two academic years, the programme was applied systematically in two classes (33 eight- to nine-year-old children). Two members of the staff were appointed as coordinators and three aims were set: a) to develop children s selfesteem, b) to enable students to recognize and control their own and others feelings and c) to improve children s relationships. Special time was reserved on the programme so that every week a lesson was delivered related to the three tasks. The two coordinators were the teachers of the classes, so they often organized relevant activities in other lessons (such as in art and music lessons). The other schoolteachers applied some of the activities produced by the coordinators in a less systematic way. The two coordinators worked on a weekly basis to evaluate children s needs and to develop accordingly the forthcoming activities. During the special lesson, the classroom setting was transformed into a more pleasant, relaxing environment: desks were moved and children could sit on pillows or move around freely. The lesson began with music and body movement. This relaxation moment was followed by creative activities in groups (such as to produce a dialogue or a scene or to discuss experiences and pictures) or by individual work (normally students filled in leaflets that asked them to think of their own strengths and weaknesses, to name feelings or write about their own experiences). At the end of each lesson, memory games and competitions among groups were organized in which children were asked to remember what their classmates said, to guess what feeling a child was presenting in a drama scene or which child was presented in each leaflet. Children particularly enjoyed this lesson and even changed its name from emotional health lesson into The game I teach myself and the others. Their own words are indicative: We learned how to behave, to speak politely, I made new friends and this game made me happy, I feel secure because I have taught myself and This game has changed my life I hope it is continued next year. In 2005/2006, the programme developed further and a whole-school approach was applied. The two coordinators (a new one was appointed since the previous one got a job in another school) presented sample activities to the teachers during the weekly staff meetings. The staff selected which activities to apply in their classrooms, and some teachers even produced their own activities that also promoted the school s tasks. The coordinators also delivered sample lessons in every classroom and applied some of the activities to the teachers so that methods were fully explained (such as the relaxing atmosphere and the games). Teachers enjoyed the chance they were given for their own self-reflection! Similarly, parents were invited to school to participate in an afternoon seminar. The coordinators informed them about the philosophy of the programme and applied some of the activities to them to give them an opportunity to talk to each other about their children and understand how the programme was to be developed in classes. The students made drawings of fruit and decorated the school 16

17 Apart from classroom activities, whole-school competitions, shows and activities promoting healthy eating took place. Competitions aimed at creating health-promoting or correct models of behaviour to students. In three competitions one for each semester children were asked to vote and choose the classmate that they invited to become their new friend (a special lesson in class analysed what a good friend is), the child who made the biggest improvement in lessons or in the way he or she behaved and finally to select the child with the best sense of humour. The children who collected the most votes from classmates were awarded a special certificate and wore a budge for a whole day. Two talent shows were organized to give students the opportunity to show their talent, to enhance their self-esteem and to encourage physical activity and health-promoting hobbies. Children and parents stated in a talent box who they considered to be talented in the school. The two coordinators examined these statements and formed two groups of children. The students of each group presented their talents in two shows: they sang, danced, played musical instruments not usually found in a school orchestra, read the Fruit week at Kornos Primary School, Cyprus poems they wrote and presented karate moves. For the children who were talented in drawing, a special board was placed in the yard. Each week two students presented their drawings and personal information about their hobby. Healthy eating was also a matter of concern. The school s health service teacher gave a lecture on healthy eating habits, and the parents association offered a free healthy breakfast to all children. The programme coordinators organized a fruit week to encourage eating fruit. A health committee was created in which representatives from all classes participated. The children agreed on the activities of the fruit week. At first, the school was decorated with giant fruit drawings made by the artists of the school. Then, from Monday to Thursday, the fruit-consumption competition took place. Five minutes before the second break, each child was to be eating the fruit he or she had brought from home. The members of the health committee visited the classes to see how many students had managed to bring a fruit. Two of the teachers of the school took the initiative in organizing two surprises for the students: they organized students and parents in groups, brought fruit and offered free fruit salad and free fruit juice for every child on two different days. Finally, a fruit-creation competition was organized. Students were asked to use their imagination and decorate plates or baskets with fruit. The final day of the week was a day of celebration: fruit creations were exhibited and awards were given to classes and students that did well in all fruit competitions. The health-promoting programme in Kornos Primary School transformed the school ethos and the school environment. It created a pleasant workplace for both students and teachers that enhanced mental, physical and social health. The programme s effectiveness can be improved through such measures as establishing more links with the home and the community, promoting staff health and students engagement in decision-making. Nevertheless, the history of the programme development in our school allows us to be optimistic about its future. Andri Loizidou ( ), Anna Christou-Kaisi ( ) & Louisa Solou-Pittakara ( ) Programme Coordinators Kornos Primary School Kornos Cyprus Fruit art! 17

18 The development of school health boards in Estonia health promotion in Estonian schools. The project team collected best practices from schools, which had to meet the following criteria. Estonia s National Institute for Health Development has coordinated a project on the development of school health boards since early Initiated and funded by the Estonian Health Insurance Fund, the project s objective is to work with all 600 general education schools in Estonia and the established school health boards and: to build the community s capacity to work on children s healthy development; and to create and support a healthy environment. The school health boards consist of students, teachers, health care specialists, extracurricular teachers, members of the governing body, managing board and municipality (altogether 5200 people). Also local health promotion specialists, education advisers, students board members, health care institutions and other interested organizations and stakeholders are included (almost 1000 people). During the first year of the project, a 16-hour educational seminar was carried out with 220 school health Konguta School Health Board members: physical education teacher, local health promotion specialist, school principal and students boards. The boards were given advice on how to draw up and to implement their own health promotion action programmes; in all the duration of counselling was 1270 hours. Every general education school health board was sent a manual on health promotion in schools and a compilation of best practices in The aim of the activities is to improve students mental and/or physical health, raise and change their health awareness and behaviour. Target groups age and needs are considered while choosing the methods; students, parents, teachers and other stakeholders are always involved. The activities are healthy and do not harm anyone physically and/or mentally and help to enhance the emotional microclimate. The first year of the project was a success. A project evaluation survey showed that 98% of the people who participated in the educational seminars believe they can use this knowledge in their everyday work. The mean evaluation of the seminar on a five-point scale was 4.5. Another positive outcome shows that 75% of the students and also parents are satisfied with the health promotion activities that take place at school. Today about 150 school health boards in Estonia work according to Kehra School team on World No-Tobacco Day 18

19 the suggested criteria. They meet 2 3 times a year and are motivated and efficient. As the project continues during 2006/2007, they set a good example for others. Three examples of best practices are given below. World No-Tobacco Day, 31 May 2006, Kehra High School The objective was: to raise awareness of the negative influence of tobacco smoke. The target group was students in grades The activities comprised a competition similar to Guinness World Records: which team could draw the longest poster on the subject of clearing the air. The winning poster was 40 metres long; an exhibition of all the posters was put up. Mõniste School Winter Olympics, 10 January 23 February 2006 The objective was to promote being physically active. The target group was schoolchildren, their parents and children from the kindergarten next door. The parents were partners. An Olympic committee was established, children were told about the history of the Olympics, meetings with famous athletes were organized and quizzes and competitions were A competition for a Guinness world record held. A big opening ceremony was organized with flags and fire, sports competitions sledging, skiing, ice hockey, running, snow sculptures etc. and a closing ceremony with speeches, awards and fireworks. Konguta School: 175 school days for everyone The objectives were to raise awareness of the advantages of a drug-free life and to increase students participation in classes, as only 6% of students had been at school all 175 school days last year. The target group was all 1500 students, and the partners were the municipality, parents and sponsors. The activities included educational seminars, competitions, health days, runs, creating and performing a play, a festival with youth bands, several organized activities during breaks, health week and swimming lessons for all students. The class who was the least absent won a class trip. The outcome was that students became more physically active and less sick. The percentage of students attending school all the days rose to 21%. Kädi Lepp National Institute for Health Development School Health Expert National Coordinator, Estonian Network of Health Promoting Schools Tallinn Estonia 5th Summer School for health boards social activity 19

20 Development in school health promotion in Germany Since 1990, Germany s regional education ministries and the highest authorities of the senates have carried out three pilot tests in schools throughout the country to develop a health-promoting ethos. The Bund- Länder Commission for Educational Planning and Research Promotion has supported these pilot projects: Gesundheitsförderung im schulischen Alltag (health promotion in daily school routines) in in Schleswig-Holstein; Netzwerk Gesundheitsfördernde Schulen (Network of Health Promoting Schools) in ; and OPUS Offenes Partizipationsnetz und Schulgesundheit: Gesundheitsförderung durch vernetztes Lernen (open network of participation and health in schools: health promotion by network-based learning) in Since 1993, Germany has participated in the European Network of Health Promoting Schools, and Germany endeavoured in the second and third projects to implement the innovative idea of a health-promoting school as it was conceptualized in the early 1990s. This new approach to health promotion in schools has brought about changes that may be summarized in eight important trends: from health education to health promotion; from the biomedical concept of health to a more holistic model; from schoolchildren to school community and school development; from a focus on the school to an open participatory network of schools and cooperation partners; from a risk orientation to a concept focused on salutogenesis; from individual health behaviour to healthy lifestyles in a sociocultural context; from individual health behaviour to a settings-related healthy lifestyle; and from a concept of norms and disciplines to an explicitly democratic emancipatory concept, participation and empowerment. However, I would like to highlight from the perspective of education in Germany some explicit and obvious deficits of the health-promoting school perspective to consider how the approach might be improved and to examine other perspectives that promise greater success for health promotion in schools on a long-term basis without renouncing the achievements of previous developments. Slow growth of health-promoting schools Although all federal states participated in the last two pilot tests of the Bund-Länder Commission (except for Bavaria), few schools have implemented the settings concept systematically other than the schools integrated in the OPUS network of North Rhine Westphalia. Even assuming that many schools would find difficulty in meeting the challenge of implementing the healthpromoting school concept in its entirety, it is remarkable that most did not attempt to embark on the first steps towards becoming a health-promoting school. In Germany, the concept of the health-promoting school has therefore not been widely adopted. The target expressed in the conference resolution of the first conference of the European Network of Health Promoting Schools in 1997 that every child in Europe has the right and should have the opportunity to be educated in a health-promoting school has certainly not been achieved. The lack of attention given to health promotion in current debates about educational policy and theory Current debates in Germany of educational policy and theory in reforming and improving schools are notably lacking in references to health promotion. These debates raise important questions of strategy in implementing more efficient, modern, innovative and exemplary schools and are already providing a basis for concrete programmes of implementation, but such initiatives are proceeding largely without reference to the experience gained in the development of health-promoting schools. This unfortunate development cannot be explained by blaming superficial phenomena, such as an inadequately developed approach to advo- 20

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