The scope of health education realised in up- per

The scope of health education realised in up- per

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The scope of health education realised in upper-secondary schools in Poland
(Zakres edukacji zdrowotnej realizowany w szkołach ponadgimnazjalnych w Polsce)
M Pietrzak A,D, H Cieślak E, Z Sienkiewicz B,F, E Kobos B, B Knoff C, A Leńczuk-Gruba B,
G Wójcik B, A Idzik B
Abstract – It is the school, according to the habitat approach,
which is responsible for health education. Education, which is
the pillar of all actions connected with promoting health, prevention and disease therapy. The research unequivocally indicates that many diseases manifesting in adults should be prevented during childhood. In Poland, the discussion whether the
content of health education should be integrated with other
subjects or extracted as a separate subject has been pending for
many years. The school can be supported in realizing health
education by the basic health care, local governments, government administration and non-governmental organisations
(NGOs). The variations in the range of health education
throughout different regions of Poland seem to be an important
issue.
This paper was developed based on an analysis of legal acts
and documents.
Słowa kluczowe - szkoła, edukacja zdrowotna, młodzież.
Author Affiliations:
Medical University of Warsaw, Faculty of Health Sciences,
Nursing Division
Authors’ contributions to the article:
A. The idea and the planning of the study
B. Gathering and listing data
C. The data analysis and interpretation
D. Writing the article
E. Critical review of the article
F. Final approval of the article
Correspondence to:
Key words - school, health education, young adults
Streszczenie – Na szkole, zgodnie z podejściem siedliskowym
spoczywa odpowiedzialność za prowadzenie edukacji zdrowotnej. Edukacji, która jest filarem wszelkich działań dotyczących promocji zdrowia, zapobiegania oraz terapii chorób. Wyniki badań jednoznacznie wskazują, że wielu chorobom ujawniających się w życiu dorosłym należy zapobiegać w dzieciństwie. W Polsce od wielu lat toczy się dyskusja nad zintegrowaniem treści edukacji zdrowotnej z innymi przedmiotami czy
wyodrębnieniem jej jako samodzielnego przedmiotu. W realizacji edukacji zdrowotnej szkoła może być wspierana przez
podstawową opiekę zdrowotną, samorządy, administrację rządową oraz organizację pozarządowe. Istotnym zagadnieniem
wydaje się występowanie zróżnicowania zakresu edukacji
zdrowotnej w różnych rejonach Polski. Celem pracy jest przedstawienie nierówności w dostępie uczniów do edukacji zdrowotnej realizowanej w szkole. Praca została przygotowana w
oparciu o analizę aktów prawnych oraz piśmiennictwa.
Mariola Pietrzak, Medical University of Warsaw, Faculty of
Health Sciences, Nursing Division Ciołka 27 Str., PL-01-445
Warszawa, tel. 0-22 877-35-97.
Accepted for publication: March 6, 2015.
I.
INTRODUCTION
chool is a place, which, besides family, is responsible
for the process and the effects of health education of
children and young adults. As an organisation,
through the process of education, it influences the healthrelated behaviour of children and young adults, and indirectly also of their parents [1]. Health education is closely related to the activities in the area of health promotion
and disease prevention. In the process of education real-
S
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ised at school, every child has the right to health education, as it is where a systematic health education - an
important element of the country's health policy - is enabled. One should notice that health education constitutes
a significant support in the realisation of school's tasks
[2]. The goal of health education realised at school is
developing the students' attitude of self-healthcare and
care of other people's health, as well as the ability to create a health-friendly environment [3]. The conditions
influencing the effectiveness of health education include:
 the use of various methods and activating techniques in conducting the classes
 cooperation with parents at the stage of planning
and realizing the classes
 conducting the evaluation of the classes with participation of students and their parents and, basing
on it, introducing modifications of the content and
organisation of the classes [4]
The aim of this work is to present inequalities in the
students' access of to health education realised at schools.
The paper has been written based on legal acts and literature.
II.
THE MODEL OF HEALTH EDUCATION IN
UPPER-SECONDARY SCHOOLS
The actual introduction of health education to Polish
schools took place at the turn of the 20th and 21st century, as an effect of the reform of educational system and
of the developing movement of health-promoting
schools. In 1997, health education was included in the
core curriculum of general education for all types of
schools. The reform of educational system in 1999 introduced the educational path 'pro-health education'. In
2002, after another core curriculum modification, health
education was added to the core curriculum of general
education for all schools, obliging the schools to prepare
preventive healthcare programs [4]. The dissolution of
the educational path 'pro-health education' took place in
2008 with the introduction of the new core curriculum of
general education but its content are still present in almost all subjects, also physical education, which in the
stages 2, 3 and 4 of education1 plays a leading role in
health education [2,5].
The core curriculum of the stages 3 and 4 of education
set the physical education as having a leading role in
health education at school. A new and important change
1
The stage 2 of education includes the students of 4th-6th class of
primary schools, the stage 3 includes the students of secondary schools
and the stage 4 is realised for the students of upper-secondary schools
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was the individualisation of the bloc 'health education'. It
was established that the classes in health education as a
part of physical education should be adjusted to the
needs of the students, which would be assessed on the
basis of a conducted diagnosis. The contents of teaching
should also be correlated with the scope of topics realised within the subjects such as: biology, personal health
and social education, civic education, education for safety, entrepreneurship education, religion and ethics. Such
a solution requires the cooperation of teachers of different subjects and the nurse of teaching and education environment. It is also important to coordinate the classes
with the educational programs as offered by different
subjects [3]. It has been accepted that the content of
health education should take a holistic attitude to health,
resulting in the expansion of the content with the aspects
of psychosocial health and life skills [6]. The scope of
content of health education realised in upper-secondary
schools is presented in Table 1.
The classes in health education are obligatory and they
are realised from the pool of facultative hours, during
any semester chosen by a school in the whole stage of
education. Woynarowska B. distinguishes three variants
of health education organisation: an optimal, alternative,
and an incorrect variant. The optimal variant assumes
realisation of a bloc of minimum 30 hours during 3 years
of education in secondary and upper-secondary schools
as a continuous program (1 semester) and the time of
realisation of individual classes of 1 or 2 lessons. In the
alternative variant, the realisation of the program of lectures in a period shorter than one semester is proposed.
The incorrect solution points to the possibility of realisation of the lectures in the time period longer than 1 semester, with long gaps between individual lessons and
realisation of the content of the bloc during part of the
time planned for physical exercise. All the classes in
physical education, including the health education bloc,
should have the character of classes requiring physical
activity. It may be realised through: modification of
plays, giving additional tasks during the classes in physical education and conducting theoretical classes in the
form of a workshop [7].
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Table 1. The goals and content of teaching within the
scope of health education as included in the core curriculum for physical education in upper-secondary schools
Educational
goals - general
requirements
Preparation for
physical activity
throughout the
whole life, selfhealth and other
people's health
prevention and
improvement,
especially:
1. recognizing
the need for
physical activity
throughout
the whole life
2. using the rules
of pro-health
life style in
everyday life
3. acting as a
critical consumer (recipient) of
sports;
4. skills favouring the prevention of
diseases and
improving
psychological
and social
health.
Contents of teaching - detailed requirements
Student:
1. explains why health is a value for humans and a resource for society and
what the health care in the period of
puberty and early maturity consists
in;
2. explains what responsibility for one's
own and other people's health means;
3. discusses constructive, optimistic ways
of explaining difficult events and reformulating negative thoughts as
positive;
4. explains what is meant by working to
raise self-confidence, self-esteem and
the ability to take decisions;
5. explains what is meant by constructive
transmitting and receiving of positive
and negative information about
health and knows how to deal with
critique;
6. talks about the rules of rational time
managing;
7. explains how self-examination and
self- health control works and why
preventive medical examinations
should be conducted throughout the
whole life;
8. explains what it means to be an active
patient and what are the basic rights
of a patient;
9. explains the causes and effects of stereotypes and stigmatisation of mentally ill and discriminated people
(e.g. living with HIV/AIDS);
10. plans a project concerning selected
issues from the area of health and
points to the ways of winning allies
and co-participants of the project at
school, at home or local community;
11. discusses what co-participation and
cooperation of people, organisations
and institutions in pro-health activities consist in;
12. explains what is the relation between
health and environment and what
one can do to create a health-friendly
environment
III. PREVENTIVE HEALTH CARE OF SCHOOL
CHILDREN
Children and young adults require health care focused
on prevention and promotion of health. Presently, the
school system gives a possibility of conducting an extensive preventive health care of students and, indirectly,
also of parents. The preventive health care realised for
children and young adults of school age is an element of
the country's health policy and is realised as a part of
primary health care. The current conception of preventive health care is based on the assumption that the health
of an individual, as well as of the population, is conditioned by many non-medical factors, including the physical and social environment at school.
Preventive health care of students means health services
realised for the students, with the aim of supporting the
development and education of children and young adults
and of the cooperation for prevention and promotion of
health [8]. The preventive health care is realised by a
family doctor on the basis of declaration of choice of a
primary health care practitioner, a dentist and a nurse,
who accomplished a specialisation training in the area of
nursing in the school and teaching environment or is being trained in the specialisation of nursing in the school
and teaching environment or has a master degree in nursing and at least three years of experience in working in
primary health care or as a school nurse.
A nurse of the teaching and education environments is
one of the medical employees of the school who realizes
the preventive health care of the students. The number of
students under the preventive health care of one nurse is
conditioned by the type of school, the number of disabled
students, and their level of disability. The working time
of the nurse of the teaching and education environments
is proportional to the number of students under health
care and the timetable. The number of students for one
full working time of a nurse of the teaching and education environment is presented in Table 2. In case the
number of students is lower, the nurse provides the services in more than one school [9].
The school nurse realizes preventive health care of students, which includes activities preventing the diseases
and limiting disease factors, directed on students with
their families and on the school environment. Health services in the school environment are realised according to
the standards and methodology of work created by the
Institute of Mother and Child in Warsaw. [8, 10, 11]
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The health services realised for students by a nurse of the
teaching and education environment include:
 conducting and interpreting of screening tests;
 managing the screening test procedure and taking
care of the students with positive test results;
 active advisory services for students with health
problems;
 active health care (adequately to the type of school)
of students with chronic diseases and disabilities
and conducting medical procedures necessary for
students during their stay at school, only on written instruction by a medical doctor and in agreement with a primary health care practitioner to
whom the student is ascribed as a recipient of
medical services;
 providing first aid in the situations of sudden injuries, diseases or intoxications;
 advisory services for the headmaster in the area of
the safety conditions for students, sanitary conditions and organisation of meals;
 education about oral cavity health;
 taking part in planning, realisation and evaluation of
school education [9].
In the working standards for a nurse, as well as in the
guaranteed services, the educational tasks realised by
nurses for children and young adults of school age are
enumerated. Woynarowska B. distinguishes different
educational tasks of a nurse:
 student-oriented - every contact with a student creates an educational situation: collecting interviews, screening tests, giving ambulatory advises,
active advisory services;
 oriented on the group of students with health problems - education oriented on the group of students
with health problems, such as obesity, chronic
diseases, visual impairment, with the aim of helping to teach the students about self-care. What is
important is engaging parents in the realised educational tasks;
 connected with the activities of school - nurse can
provide advisory services for teachers, realize her
own programs or programs offered by other institutions, e.g. sanitary-epidemiological stations, local governments [1,2].
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Table 2. The suggested number of students for a full
working time of one school nurse
Type of school
Primary schools, secondary schools, uppersecondary schools, specialized secondary schools
(without workshop classes), artistic schools on the
secondary or upper-secondary school laws, postsecondary schools with the teaching schedule not
longer than 2.5 years
Primary schools, secondary schools, uppersecondary school, specialized secondary school
(without workshop classes) with integration and
sports classes
*coefficient 7 - for the students with a light mental
impairment, physically fit, with physical impairment, visually impaired and blind, hard of hearing
and deaf, with chronic diseases, requiring additional health services during the education at school
*coefficient 10 – for students with light mental
impairment and physically impaired and students
with mild or advanced mental impairment and
physically fit
*coefficient 30 - for students with mild or advanced mental impairment and physically impaired
*coefficient 2 for the students of sports classes
Schools with professional education including
workshops conducted at school, sports schools
Number
of students for
one school
nurse
880 -1100
students
Number of
students
calculated
on the
basis of the
coefficient
700 students
Special schools for children and young adults
Type A – students with mild mental impairment,
physically fit, visually impaired and blind, hard of
hearing and deaf, with chronic diseases (including
students in the schools for children and young
adults socially maladjusted)
Type B – students with mild mental impairment
and physically impaired, students with mild mental
impairment, physically fit
Type C – students with mild mental impairment
and with significant physical impairment
150 students
80 students
30 students
Legend:
* coefficient of the type of disability
Calculating the number of students for one nurse with the coefficient: to the general number of students the number of disabled
students should be added. The result is to be multiplied by the
coefficient of the type of disability and divided by 880-1100
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Within the scope of health education, a nurse can fulfil
the functions of a medical consultant for the headmaster
and the pedagogical council, an educator for children and
parents and an initiator of actions and events concerned
with the topic of health. Woynarowska B. points to the
fact that a school nurse should be constantly oriented
toward health education through the ability of communicating with students and creating pro-health schemes of
behaviour [12,13].
In spite of pointing to the education as a service realised
by a nurse of the teaching and education environment, no
detailed description concerning the scope of topics was
included in any of the legal acts. It should be noticed that
the National Health Foundation specified the number of
students for one nurse as between 880 and 1100, which is
connected to their non-everyday presence in some of the
educational institutions. Such a situation is unfavourable
for familiarizing with students and guaranteeing an appropriate care and effective education and prevention.
As a consequence, chronic diseases tend to be diagnosed
later. Especially students from small towns and villages
do not have access to preventive health care on an appropriate level [14]. Jodkowska M. et al. notice the inequalities in the access to preventive health care services
realised for children and young adults at school, with the
disadvantage of students from village schools, special
needs schools and Basic Vocational Schools. Inequalities
in the access to preventive health care is best seen in the
area of health education - the smallest percentage of students taking part in health education is observed in Basic
Vocational Schools of rural areas (64%) [15].
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IV.
THE PARTICIPATION OF LOCAL
GOVERNMENTS IN REALISATION OF
PREVENTIVE HEALTH CARE OF SCHOOL
STUDENTS
The reform of state administration in 1999 gave local
governments on every level the rights to realize the prohealth policy. The National Health Program 20072015 in the goal 8 points to supporting the development
of physical and psychosocial health, as well as preventing the most frequent health and social problems of children and young adults, whereas in the goal 12 it proposes
the activation of regional authorities and nongovernmental organisations in activities aimed at promoting social health. Therefore, it gives the communes and
districts the possibility to realize broadly defined social
health initiatives.
The tasks of regional authorities include:
1. the formulation and implementation of regional and
local programs providing health services, also the
realisation of prevention and health promotion;
2. improving the possibilities of absorbing financial
resources, including EU ones, for realisation of
projects concerned with health prevention;
3. supporting and creating local partnerships for
health;
4. establishing regional networks and local representatives for realisation of pro-health policy;
5. development of sports and leisure infrastructure
[16].
On the basis of diagnosis of social health problems taking into consideration financial conditions, local governments decide about implementing health programs,
including those addressed to children and young adults of
school age. The programs can be realised within the area
of school or outside it. Table 3 presents preventive programs addressed to school students, including the students of upper-secondary schools.
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Table 3. Preventive programs addressed to children and young adults of school age realised by local governments
City
Name of the program
The program of Health Promotion for the city of Bydgoszcz
Preventive program concerned with lowering the scale of occurrence of
faulty postures among children and young adults of school age. Promoting
rational nutrition habits and preventing overweight and obesity;
Recipients of the program
Primary school students, upper-secondary school
students
Bydgoszcz
Upper-secondary school students
Educational program aiming at preventing mental disorders;
Secondary and upper-secondary school students
up to the age of 19
Gdańsk
The program of early identification of glaucoma;
Educational program:
For girls: about the prevention of breast cancer
For boys: about the testicle cancer [17].
Students of the last classes of upper-secondary
schools
Health program in the area of prevention and early identification of
civilisation diseases among children and young adults [18]
Students of 6, 9 - 11 and 14 years old
Lublin
Kraków
Kielce
Katowice
The program of prevention and health promotion for the city of Katowice for the years 2014-2020
Preventive health care of students;
Early identification of diseases, abnormalities and health hazards for children of pre-adolescent age
The 3rd grade of primary schools
The program of prevention of Human Papiloma Virus (HPV) infections in
the city of Katowice for the period of 2014-2020;
The 1st grade of secondary schools
Educational program about first aid [19].
The 4th grade of primary schools
The Program of Health Promotion and Preventive Health Care for the
Province [20].
Healthy Kraków
Program of equalisation of the access to health care and education on the
area of the city of Kraków
The Program of preventing overweight and obesity through promoting
healthy life style and physical activities among children
Children of primary schools (classes 4 - 6)
The project of preventing social pathologies - educational program
Children and young in the age group of 10 - 19
The program of preventive health care of addictions to Internet and computer games for children and young adults in the age group of 10 - 19
Children and young adults in the age group of
10-19
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The program of preventive healthcare of HIV infections for girls aged 1112 and women aged 16-22 [22].
Łódź
The program of preventing depressive disorders for children and young
adults
Young adults of upper-secondary schools
4th and 5th class of primary schools
Students in the age group of 10 -17
The Preventive Health Care Program "Różowa wstążka - rak piersi to nie
wyrok... (A pink ribbon - breast cancer is not a sentence...)
High schools students
The FAS Campaign [25]
Students of secondary and upper-secondary
schools
The program of preventive healthcare of HPV infections [26].
Girls born in 2002
1) attending schools in Opole
2) registered as Opole citizens and attending
schools outside the city of Opole
The program "Prostuj się nie wystarczy" (It's not enough to say "stand
straight")
Program for children and young adults in the age
group 6 - 18 with acquired fault postures
Zielona
Góra
Warszawa
Olsztyn
The program of obesity reduction and promotion of healthy nutrition
for children and young adults from Olsztyn
Opole
The Program of the Health-Promotion and Prevention Activities for the
Poznań district
Lectures, workshops, competitions and other educational classes in the area
of preventive health care, health promotion and health education [24].
The strategy of social problems solving in the city of Olsztyn up to the
year 2015
The program of prevention and therapy of faulty postures of children and
young adults from Olsztyn
Children from the area of the Łódzkie province in
the age group of 6-12
Szczecin
Poznań
The program of screening hearing tests for children of school age [23]
Children aged 11 - 13 and 14-17
The Warsaw Program of Preventive Health Care and Health Promotion
The risk assessment of cardiovascular diseases occurrence among children
and young adults aged 18 - 19
The program of preventive health care in the area of improving oral cavity
health
The program of screening hearing tests for the students of 1st and 6th class
of primary schools in the city of Warsaw
Health program within the area of preventive healthcare and correction of
fault postures
Preventive health care program of early identification of vision defects and
strabismus for children of 2nd class of primary schools on the area of the
city of Warsaw
Students aged 18 - 19
Students of 2nd year of primary schools
Students of 1st and 4th grade of primary school
Students of 4th grade of primary schools
Students of 2nd grade of primary schools
The Health Promotion Program "Zdrowy Uczeń" (Healthy Student) [28]
Students of primary schools, secondary schools
and upper-secondary schools
Vaccinations against HPV virus [29]
Teenagers aged 11 - 12
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V. HEALTH EDUCATION REALISED AT
SCHOOLS BY INSTITUTIONS AND
ORGANISATIONS
Schools have been the place of introducing various
forms of health education by institutions and organisations since the 1960s. Presently, schools are offered numerous preventive health care programs prepared centrally or locally. Most often the programs are realised by
The State Sanitary Inspection and Polish Scouting and
Guarding Association.
The educational tasks of the State Sanitary Inspection
health promotion department are based on the assumptions of the National Health Program, the guidelines of
the World Health Organisation, as well as the epidemiological situation and the health needs of the citizens of a
given province. The department of health promotion of
the State Sanitary Inspection initiates, organizes, realizes, coordinates and supervises the educational-health
activities, which aim at shaping appropriate health attitudes and behaviours of the society and developing the
habits of self-health care. The programs are realised
within the national, regional, and local scopes. One of
the national programs is the program "Trzymaj Formę"
(Keep your shape), which is directed to 5th and 6th
grade students of primary schools and secondary school
pupils, as well as their parents or legal guardians. The
program aims at the shaping of permanent pro-health
habits among young adults. Some of the programs are
addressed to the students of upper-secondary schools,
e.g. "Wybierz życie - pierwszy krok" (Choose Life - the
first step). It is an educational program concerning the
prevention of cervical cancer. Another program is
"Zdrowe Piersi są OK!" (Healthy Breasts are OK!)
[2,4]. Schools are where the Scouting Association activities mainly take place. The Scout Law states that a scout
does not drink alcohol nor smoke cigarettes. Since 1996
,a Scout Life Saving School is active, organising first aid
trainings.
The list of organisations offering various educational
programs to schools is gradually growing. The police,
the fire service, academic institutions, various commercial companies using educational activities for product
placement, agencies, and non-governmental organisations dealing with the prevention of the use of psychoactive substances could be enumerated. Many programs
copy the same contents and we lack data about their
quality, the evaluation of results and empirical proofs of
their effectiveness. Schools are eager to use external
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educational programs instead of realizing an independent
health education.
VI. SUMMARY
The first two decades of human life are characterized by
dynamic development. The school period is not only
when various dysfunctions appear or are identified, but
also when health habits are shaped, which are later
brought into adult life, determining an individual's
health. Schools have a significant influence on the development of children and young adults and indirectly
also parents. They have the possibility to influence almost the whole population of students between 6 and 18
years old. This is why presently there is a need of extending the participation of schools in pro-health activities. Health education has been evaluated as the most
beneficial, long-term investment in the health of society,
with its costs being incomparably lower than the costs of
disease treatment. The effectiveness of health education
is dependent on the fulfilling of many conditions, such
as: taking into consideration all aspects of health, ensuring the continuity of the classes, as well as finding time
and place for it in the school timetable. What is also important is creating the opportunities to practice prohealth behaviours and the cooperation with families and
local communities.
The population in schooling age besides being guaranteed proper life conditions and education (including
health education) should also be entitled to preventive
health care. Preventive health care realised by a nurse of
the teaching and education environment should be based
not only on conducting screening tests but also on performing many other tasks listed in the legal regulations.
The authors of a report prepared by the Sector of Health
Care Supervision of the Department of Social Policy for
the Podkarpackie province in Rzeszów, concerning preventive health care of children and young adults at
school, point to the difficulties in the access to nurse
care at schools in rural areas, resulting from including a
number of schools in the scope of duties for one nurse.
Health education as well as health care of children with
health problems, chronic diseases, and disabilities are
usually not realised at schools which are not equipped
with a nurse's office. The authors of the report notice the
growing inequalities in preventive health care between
the students from the schools of rural and urban areas.
The conducting of screening tests among students is
mostly not dependent on the existence of a school nurse's
office. Inequalities in the access to preventive health care
are mostly noticed in the scope of preventive health care
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realisation to the disadvantage of students from rural
areas. To improve the situation, it seems to be necessary
for local governments, as governing authorities of the
schools, to show more engagement in the issue, as well
as for the school nurses to get more involved in the realisation of preventive health care programs.
To sum up, it is the medical staff as well as school, students and their parents that should be actively involved
in the students' health care and health promotion. However, the authorities play an important role in this matter,
as they are responsible for realising the pro-health policy. The issue of inequalities in the access to preventive
health care between different provinces and the place of
residence (rural and urban areas) should be also taken
into consideration.
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