School Health

1
School Health
2
Health Issues of School Aged Children

• Communicable disease
• Injuries
• Chronic Illness
• Psychological Issues
• Sexuality and contraception

3
Communicable Disease

• Skin infections
• Vaccine preventable diseases
• Sexually transmitted infections

4
Vaccine Preventable Diseases

• Routine childhood immunization begins at 2 mo. of
  age ends at 14-16 yr.
• Monitoring immunization rates in school aged
  populations important preventive strategy

5
Manitoba Childhood Immunizations Complete for Age
() 2003
6

• Immunization rates of 90 or higher are required
  to prevent outbreaks of disease
• 1979, Britain 100,00 cases of pertussis 36
  deaths after drop in immunization rates

7

• Ireland, 2000 1,200 cases of measles after
  immunization rates fell to 76 only 148 cases in
  1999

8
Sexually Transmitted Infections

• Major burden of infection borne by 5 groups
• Youth
• Those with more the 6 sex partners
• Poor homeless
• Women
• Those with limited access to health care services

9
Chlamydia Rates(/100,000) by Sex
10
Chlamydia Rates (/100,000) by Age and Sex
11
Gonorrhea Rates (100,000) by Sex
12
Gonorrhea Rates (/100,000) by Age Male Female
13
Injuries

• Leading cause of death in first ½ of life
• 2nd to cancer as leading cause of PPYL in Canada
• Types frequency of injuries vary at different
  stages of the lifespan

14
Injury Related Deaths Ages 0-19
15

• Males have increased risk of death from injury
  across the lifespan

16
Childhood Injury Related Deaths by Sex (/100,000)
17
Regional Disparities

• For children aged 0 19, regional differences
  in
• Mortality
• Injury-related hospitalizations

18
Regional Patterns in Childhood Injury Related
Death Rates
19
Income Disparities

• Correlation between family income risk of
  injury to children youth
• Lowest income quintile had
• 40 greater risk for death
• 25 greater risk for hopsitalization

20
First Nations Peoples

• Injury related mortality for status children
  three times the national average
• Widest gap is in the 1 4 age group

21
Injury Deaths Status Indians All Canadians
(/100,000)
22
Manitoba Data

• Nearly 50 of all deaths in children 29 days to
  14 years due to injures
• Over 75 of deaths in teens aged 15-17 due to
  injuries
• Injury rates for First Nations children over 5
  times higher than for all other children

23
Chronic Illness

• Obesity, related to
• Dietary patterns
• Activity patterns
• Environmental exposures

24
1. Obesity

• Recent study published in JAMA indicates that
  poor diet physical inactivity may soon overtake
  tobacco as leading cause of death in US

25
Physical Activity Levels (hr/wk) of Canadian
Children
26

• In 2000 2001, 4 out of 5 Canadian youth aged 12
  19 years were not active enough to meet
  guidelines for optimum growth development

27
Factors associated with decreased physical
activity

• Cars
• Suburbs
• Television
• Computers

28

• Poverty
• Lower income Canadians less physically active
  than those with higher incomes
• School curricula
• Only 16 of Canadian schools offer phys ed
  programs daily
• Hours of phys ed/wk decreases for students in
  higher grades

29
Dietary Patterns

• Evidence that Canadians consume lower fat diets
  than previously
• Implication that decreased activity levels may
  play the larger role in the increasing prevalence
  of overweight obese children

30

• Ongoing problems with dietary patterns
• Successful marketing of energy dense food
• Schools/universities
• Workplaces
• Television
• More meals eaten outside of home
• Cost of nutritious food

31

• Link between inactive activities (e.g. TV) and
  eating
• Increased consumption of soft drinks

32
Annual Per Capita Consumption Litres/Person
33

• Obesity rates have nearly tripled amongst
  Canadian children in past 2 decades
• Prevalence of obesity higher among Aboriginal
  children

34
Overweight Obesity Among Canadian Children 7-13
Years
35
2. Environmental Exposures

• Mounting evidence that environmental
  contamination is creating adverse health outcomes
• Cancer
• Asthma

36

• Environmental contamination accelerated by
• Industrial revolution
• Production of synthetic chemicals
• Intensification of agricultural production
• Chemical warfare
• High costs to store or dispose of hazardous
  wastes
• Automobiles

37
Sources of Environmental Exposure

• Air
• Primarily result of incomplete combustion
• Associated issues
• -ozone layer depletion
• Increase atmospheric carbon dioxide
• Acid Rain

38

• Ionizing Radiation
• Ultraviolet
• Radon gas
• Electrical magnetic field radiation
• Nuclear radiation

39

• Endocrine Disrupters
• Mimic naturally occurring estrogen testosterone
• Lock on to estrogen receptors in reproductive
  organs

40

• Known or suspected disruptors include
• DDT
• PCBs
• Dioxins
• Furans
• Pesticides
• Organochlorines

41

• Persist in environment long after initial use
• Found as residue
• On food
• In bodies of animals consumed by other animals
• Bio-concentration
• In atmospheric pollution
• In soil

42

• Body burden
• Total sum of all exposures from all routes of
  entry
• Inhalation
• Ingestion
• Skin absorption

43

• For fat soluble persistent chemicals, body burden
  provides a measure of cumulative exposure
• 177 different organo-chlorine residues can be
  detected in the body of the average middle aged
  American male

44
Why are Children at Greater Risk?

• Fetal growth Development
• Rate of growth
• Vulnerability of specific tissues organs
• Brain
• Neural tissue
• Lungs
• Immune system
• genitalia

45

• Behavioural Differences
• Inability to control their environments
• Different sources of nutrition
• Different nutritive needs
• Play exploration
• Short stature

46

• Anatomical Biological Differences
• More total body water extra-cellular water
• 3X greater daily intake of water/kg body wt.
• Less mature hepatic renal function
• Greater gastric absorption
• Increased absorption from other routes

47

• Other Factors
• Risk of contamination before conception
• Contaminants are found in sperm ova
• Place of residence

48

• In children, leukemia accounts for largest number
  of cancer related new cases (26) and deaths
  (32)
• Other frequently diagnosed childhood cancers
• Brain and spinal cord
• Lymphomas

49

• Incidence of these cancers is increasing
• Etiology not well understood
• Often categorized as non-preventable
• Role of environment in etiology under increasing
  scrutiny

50

• Also evidence that respiratory illnesses such as
  asthma are increasing

51
3. Other Issues in the School Setting

• Mental Health
• Reproductive Health
• Family violence
• Tobacco use
• Bullying

52
Why Schools?

• A place to assess the health of children
• Communicable disease control
• Immunization
• Screening for physical and developmental problems
• Vision
• Hearing

53

• Healthy children learn better
• Counselling
• Health education
• Material support
• Breakfast/lunch/after school programs

54

• Schools are a natural site for community based
  health promotion
• Can integrate skills knowledge from many
  sectors in this setting

55
Healthy Schools Initiatives

• WHO definition
• . . . a place where all members of the school
  community work together to provide students with
  integrated and positive experiences and
  structures which promote and protect their
  health. This includes both the formal and
  informal curricula in health, the creation of a
  safe and healthy school environment, the
  provision of appropriate health services, and the
  involvement of family and wider community in
  efforts to promote health.

56

• Interest in schools as settings for health
  promotion increased after Ottawa Charter (1986)
• European coalition established in 1992

57

• Canada Comprehensive School Health
• United States Coordinated School Health
• Europe Australia Health Promoting Schools

58

• Need to move beyond health education
• Link between knowledge provision and behaviour
  change never well established
• Places significant burden on teachers

59

• Few resources
• Few professional development opportunities
• Specific health issue groups focus primarily on
  uptake of their materials

60

• Lets rethink school health away from kits and
  projects to solve problems and use the school as
  an ongoing setting where health is created,
  supportive environments are built, partnerships
  made and many skills learned.

61

• Example nutrition
• Policy development
• Physical environment
• Social environment
• Links with local community
• Personal skills
• Partnerships

62
Manitoba Health Schools Initiative

• Priority Issues
• Physical activity
• Nutrition Diet
• Safety
• Substance use addictions
• Sexual reproductive health
• Mental health