[Global HR Forum 2014] Global Aspect of School Health Promotion and Experience of Korea
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Transcript of [Global HR Forum 2014] Global Aspect of School Health Promotion and Experience of Korea
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
Korean Youth Risk Behaviors Web-based Survey 2013
Trends in Dietary Habits
KNHANES 2012
Trends in Physical Activity (Vigorous)
Korean Youth Risk Behaviors Web-based Survey 2012
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
Korean Youth Risk Behaviors Web-based Survey 2013
Emotional Stress | Depressive Mood
Korean Youth Risk Behaviors Web-based Survey 2013
Toothbrushing after Lunch
Korean Youth Risk Behaviors Web-based Survey 2013
Sexual Activity
Korean Youth Risk Behaviors Web-based Survey 2013
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
National Health Programs
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)
National Health Programs
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
National Health Programs
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
Women
Military men
Future Direction and Strategies
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