‘Toward a School promoting health‘ is the document drafted by the ministries of Education and Health, approved on 17.1.19 by the State-Regions Conference. Health and proper lifestyles must come firmly into the educational proposal, from kindergarten to high school. Beautiful words but utterly lacking in concreteness, while rampant among others is the epidemic diabetes.
Health at school, the program
The program of the Ministry of Health and the Ministry of Education does not consider school teaching dedicated to healthy lifestyles. Rather, it aspires to promote them-with a cross-curricular and holistic approach-in the entire educational journey and relationships. With the (idealistic) commitment of all those who interact with the educational institution. Families, teachers, managers, pupils, organizations and other institutions that relate to schools, including health care providers.
‘Healthy girls and boys and who do well in school learn better. At the same time, boys and girls who attend school and are placed in a positive learning process have better health opportunities‘ (State-Regions Conference document, 17.1.19)
Health promotion and ‘health equity’ requires systematic interventions that benefit the individual, regardless of social background and across the life course. Following the ‘life course‘, verbalized by theWHO, school is the first place to learn, work, ‘live better’ and ‘gain health‘.
The areas of focus indicated by the program are diverse:
– educating on healthy lifestyles. That is, counteracting the primary risk factors of chronic noncommunicable diseases, NCDs (Non-Communicable Diseases). Poor diet, physical inactivity, smoking, harmful use of alcohol, etc.). It also promotes oral health, (1)
– counteracting malnutrition in all its forms, between excesses and deficiencies,
– prevent addiction to illegal substances and drugs (including doping), as well as behavioral ones,
– prevent communicable diseases and antibiotic resistance, spread awareness about vaccination,
– encourage mental and physical well-being, including through interventions on issues of affectivity and global relationship education,
– support initiatives aimed at fostering early detection of neurodevelopmental disorders (2) and specific learning disorders, health protection, improved living conditions and school inclusion of individuals with disabilities and other issues. (3)
All schools will be able to (may even have to, by when?) intervene in ways they deem most appropriate to address the real educational and training needs of individual pupils. In accordance with the guidelines attached to the document.
The guidelines on ‘school and health’
The guidelines on ‘integratedpolicies (or policies?) for schools’ include. Structuring a joint path between ‘School’ and ‘Health’ in a medium- and long-term perspective. To foster the synergy of welfare-related goals and programs that meet criteria of ‘effectiveness and appropriateness’ and ensure ‘continuity and sustainability. In particular:
– To include the promotion of health, wellness and the culture of safety and legality in the educational system of education and training, through the three-year plans of educational offerings (PON, Law 107/2015),
– Support the spread of the so-called comprehensive school approach, recommended by the WHO (World Health Organization) based on scientific evidence. With educational and health, sustainability and equity goals,
– Include health topics in the curriculaschool as a cross-curricular education pathway. With the goal of equipping each student with basic and life skills. Namely, decision-making skills, creativity and critical sense, effective communication, empathy, and management of emotions and stress. In the broader concept of exercising legality, civil coexistence and active citizenship, in line with WHO recommendations,
– Promote the dissemination of intervention programs that aim to build know-how in schools designed to transcend the spatial-temporal context of a school year. With an inclusive and proactive approach, to best express the educational and training potential of the school project,
– Develop, rationalize and disseminate educational models that are based on methods validated in the scientific literature. To promote the building of individual and collective ‘citizenship’ responsibilities as well as health and well-being. Overcoming gender, cultural and social differences,
– activate an action of governance integrated cross-system, national and regional level of health interventions proposed to schools by public and private entities. Under the banner of the so-called ‘whole school approach’ of the health-promoting school,
– share tools for document collection of activities implemented by schools, to monitor processes and help disseminate best practices, based on shared criteria.
From words to deeds, some critical notes
It is surprising to see a policy document of such breadth and ambition yet lacking any mention of how it will be implemented. Not an example nor a reference to studies-cited in ‘principle only’-and best practices that can concretely guide the ruling class, school and health care, to turn words into deeds.
The good examples there is no shortage. On this site, we have reported on the positive experiences of projects accrued in the public sector, such as ‘giocoAMO‘ of La Sapienza University in Rome, in its fourth year of experimentation. In addition to some initiatives developed in synergy with NGOs and the private sector, such as the ViviSmart project and ‘Once Upon aSupper‘.
However, we need to select specific models, which have already been tested in some Italian districts or abroad. Assess its feasibility, within the limits of the ubiquitous ‘financial invariance’ clauses. Consider its potential effectiveness in different school grades and territories, make appropriate adjustments, and develop both educational programs and educational materials for the various social actors involved.
The following must be defined responsibilities and competencies, at the state and regional levels, with appropriate guidelines to ensure the effectiveness of executive projects throughout the country. Training programs consistent with the goals set should be established, based on unambiguous information and recommendations. Criteria for monitoring the ‘status quo‘ and measuring the results obtained, with a view to program review and continuous improvement (in the organizational logic that inspires service quality management systems, e.g., ISO 9001). Not to mention the absence to date in Italy of a structured monitoring plan Of the health conditions of children and adolescents. (4)
The prevention of childhood obesity and overweight, unhealthy lifestyles, and related diseases then postulates the adoption of national policies necessary to address the Italian emergency in place, which is punctually denounced-so far in vain-by the scientific community and the pediatric society. Action should be taken on nutritional profiles Of foods, to distinguish good foods from junk food. On this basis, introduce a summary nutrition information scheme on the label (following the NutriScore model, already adopted in neighboring France and Spain). Introduce ‘soda tax‘ e ‘sugar tax‘, exclude HFSS foods (High Fats, Sugar and Sodium) from vending machines, bars and school cafeterias.
The #change by so many preached only in words must find concrete implementation and also be expressed through strict prohibitions on ‘marketing to kids‘, even on the ‘social media‘, still in vogue to promote sales of ‘junk food‘ (HFSS). But all this requires theindependence of politics and top administration from the lobbies of ‘Big Food‘, who persists in opposing WHO health policies with ‘fake news‘ on hypothetical attacks on the ‘Made in Italy‘.
Hope, it is known, is always the last to die. But from fine words to administrative acts and concrete deeds is a long way. As time flees and thediabetes emergency, to cite just one of the consequences of political inaction on child and youth health protection, is spreading like an epidemic in what was once one of the cradles of the Mediterranean diet.
Currently in Italy 3.5 million diabetic patients are diagnosed, 1 million are undiagnosed. The prevalence of diabetes in young people aged 20-30 has doubled in Italy in the past 10 years to 150,000. Type 2 diabetes accounts for 95 percent of cases ‘and is mainly related to negative lifestyle change. And if something is not done, the consequences will be severe‘, explained Dr. Francesco Purrello, president of the Italian Society of Diabetology, SID. Sigh!
#Égalité!
Dario Dongo and Giulia Baldelli
Notes
(1) The paper under review refers to ‘equity’ and oral health, neglecting the detail of the substantial inaccessibility of dental care by less affluent families. With significant asymmetries from region to region, and good for the LEAs (Essential Levels of Care)
(2) Refers specifically to communication and language disorders, ADHD(Attention Deficit Hyperactivity Disorder) and autism spectrum disorders
(3) It is only a pity that Law 9.1.1989 no. 13, on the subject of architectural barriers, is largely unimplemented to date. In and out of educational facilities at all levels, including universities (!). A real disgrace, for a country that dares to call itself civilized
(4) Where a systematic analysis of anthropometric data, disorders and diseases, lifestyle habits (diet, physical activity) could reveal data essential to program setting. As well as, in general terms, of health and prevention policies
(5) Data presented at the ‘Panorama Diabetes’ congress, in Riccione, Italy, on 8-13.3.19
Dario Dongo, lawyer and journalist, PhD in international food law, founder of WIISE (FARE - GIFT - Food Times) and Égalité.
Graduated in nutritional chemistry and pharmaceutical technologies, expert in quality management systems, social responsibility and supply chain
