Lee Albert
Centre for Health Education and Health Promotion, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.
Appl Health Econ Health Policy. 2009;7(1):11-7. doi: 10.2165/00148365-200907010-00002.
Chronic diseases are now the major causes of death and disability worldwide, and non-communicable diseases (NCD) account for the majority of the global health burden. About half of premature deaths are related to health-risking behaviours that are often established during youth and extend to adulthood. While these diseases might not be curable, they are preventable. Prevention is possible when sustained actions are directed at individuals and families, as well as at the broader social, economic and cultural determinants of NCD. A 'life-course' approach to promoting healthy behaviour should begin early in life. The aim of this article is to discuss the impact of the 'health-promoting school' (HPS) on improvements in youth health. HPS can be described as a holistic, whole-school approach in which a broad health education curriculum is supported by the environment and ethos of the school. HPS moves beyond individual behavioural change to consider organizational and policy change such as improving the physical and social environment of the school, as well as its curricula and teaching and learning methods. A positive culture for health would facilitate higher levels of health literacy by helping individuals tackle the determinants of health better as they build the personal, cognitive and social skills for maintaining good health. There is reasonable evidence to demonstrate that the whole-school approach using the HPS framework is effective in improving health, ranging from physical activities and healthy eating to emotional health. Schools adopting the HPS framework have demonstrated changes in culture and organizational practice to become more conducive to health improvement. These schools were reported to have better school health policies, higher degrees of community participation, and a more hygienic environment than non-HPS schools, and students in these schools had a more positive health behaviour profile. Health promotion and disease prevention is essential to reduce the healthcare burden of children and adolescents. HPS would help to combat the global burden of childhood obesity by promoting healthy eating behaviours and encouraging higher levels of physical activity. There are gaps in service provision for children and adolescents from both the health and education perspective; the HPS framework has the potential to develop a mechanism of closer integration with the primary healthcare system, making youth health services more school based and student centred. A new model of interconnection between HPS and different components of primary healthcare can be evolved to make services for disease prevention and health promotion more student friendly.
慢性病如今是全球范围内死亡和残疾的主要原因，非传染性疾病（NCD）占全球健康负担的大部分。约一半的过早死亡与往往在青少年时期形成并延续至成年期的健康风险行为有关。虽然这些疾病可能无法治愈，但却是可以预防的。当针对个人和家庭以及非传染性疾病更广泛的社会、经济和文化决定因素采取持续行动时，预防是可行的。一种促进健康行为的“生命历程”方法应在生命早期就开始。本文旨在探讨“健康促进学校”（HPS）对改善青少年健康的影响。HPS可被描述为一种整体的、全校性的方法，其中广泛的健康教育课程得到学校环境和风气的支持。HPS超越了个体行为改变，转而考虑组织和政策变革，例如改善学校的物质和社会环境以及课程设置、教学方法。一种积极的健康文化将通过帮助个人在培养维持良好健康的个人、认知和社交技能时更好地应对健康决定因素，促进更高水平的健康素养。有合理证据表明，采用HPS框架的全校性方法在改善健康方面是有效的，从体育活动、健康饮食到情绪健康。采用HPS框架的学校已展示出文化和组织实践方面的变化，变得更有利于健康改善。据报道，这些学校比非HPS学校有更好的学校健康政策、更高程度的社区参与和更卫生的环境，并且这些学校的学生有更积极的健康行为特征。健康促进和疾病预防对于减轻儿童和青少年的医疗负担至关重要。HPS将通过促进健康饮食行为和鼓励更高水平的体育活动，有助于应对儿童肥胖的全球负担。从健康和教育角度来看，儿童和青少年的服务提供存在差距；HPS框架有可能建立一种与初级医疗保健系统更紧密整合的机制，使青少年健康服务更以学校为基础、以学生为中心。可以发展出一种HPS与初级医疗保健不同组成部分之间相互联系的新模式，使疾病预防和健康促进服务对学生更友好。
