An ounce of prevention

The knowledge, attitudes and behaviours established in childhood and youth have significant implications, beneficial or otherwise, for behaviours and circumstances in later adult life. Individuals, communities and the society at large, experience these outcomes. Habits of living, exercise patterns and nutrition also become established during these early years, producing either beneficial or harmful impacts in later life. There is a growing body of evidence that links healthy infant and child development to the health status in later life. Early life experiences can ‘imprint’ both physiologically and psychologically in a way that affects the expression of disease throughout life (1). Costly cardiovascular and cancer disease groups as well as musculoskeletal conditions, are intimately intertwined with health practices and health environments that begin early in life and are experienced throughout the school years. Unintentional injuries, the leading cause of mortality in children, youth and young adults, are far too frequently related to health practices such as alcohol and drug misuse. It is clear from the global experience that opportunities exist within the school setting, from kindergarten to grade 12, to significantly and positively influence many domains of youth health (2,3). There is also a broad consensus on the types, frequency and dosage of interventions that will work to positively influence youth health. Conversely, there is also an array of interventions that have been shown to be ineffective (4–9). It is abundantly clear that, given that risk behaviours increase in frequency and prevalence with age, health interventions that stop at grade 10 (as do most in Canada) will be suboptimal in their impact and effectiveness (10). Many jurisdictions, including British Columbia, have failed in the past to take universal advantage of this body of knowledge, and the opportunities that a ‘captive’ school-age population presents. However, federal and provincial health ministers are currently supporting the development of a Pan-Canadian Healthy Living Strategy aimed at promoting healthy nutrition and physical activity among Canadian citizens. At the same time, education ministers have indicated their willingness to work with their health colleagues to focus this strategy in school settings during its initial stages. This provides an unprecedented opportunity to take action by addressing the health status of children and youth. Three key themes provide the foundation on which to build interventions that leverage this relationship to achieve a positive impact on health status. These themes are the healthy schools concept, comprehensive school health promotion, and the application of the school as a crucible for development through a focus on resilience. The adoption of a healthy schools concept as a framework for planning and delivering education programs is critical to the healthy development of children and youth. It emphasizes that the school itself operates within a broader community context. For school health programs to achieve their potential, they need environmental and community support and connectivity. The importance of this is clear when one examines some of the external influences that impact daily on a child, eg, most food advertising during children's television programming focuses on fast food, soft drinks, candy and presweetened cereals, and promote larger portions. These unhealthy, countervailing influences need to be acknowledged and addressed in any community discussion on health promotion in schools. Recognizing that the school itself is a community, schools should work in partnership with communities to achieve a healthier community and school environment. Comprehensive health education in schools is a key strategy in disease prevention and health improvement through childhood, adolescence, and into adulthood. Comprehensive school health promotion embraces a number of core elements: health instruction should be provided to students in all grades from kindergarten to grade 12; preventive health services should be provided, including personal guidance and counseling services, as well as the early identification and referral of children and their families to health services; resources must be made available at colleges of education and to teachers to support the development and implementation of this comprehensive curriculum; social supports such as role modelling, peer counselling and health promotion policies for school staff and students must be in place; and education must be provided within a healthy physical environment. Such an environment is free of significant risk of injury and is one in which children feel physically and emotionally secure. Schools must be a safe place to work and learn. The school, in its nature and purpose, plays an unavoidable and vital role in human development, including the strengthening of protective factors associated with resilience. The resilience concept brings health and human development together into an overarching goal of building resilience in children and youth as a universal health enhancing quality (11). It holds promise, not only from a public health view, but also in terms of overall educational and social outcomes (12). Social and academic success, positive peer engagement, and supportive, positive peer dynamics are all school-centred protective factors associated with resilience and the capacity to succeed when dealing with life's challenges (13). Fostering resilience in children and youth offers a positive approach to reducing the risk for health-related problems while helping them reach what we all hope for them – a responsible, caring and competent adulthood (14). The school social environment, in particular, plays a key role in shaping the social development of children and youth. In its 2002 report, Accenting the Positive (15), the British Columbia-based McCreary Centre Society provides a useful framework for building social environments that enhance protective factors between students and their environments. Preventative interventions for children and youth take on exceptional importance in reducing economic costs (16), and in improving the future health and functioning of children and youth. Schools, because of their access to children and youth, their central role in child and youth development and their responsibility to teach, must figure prominently as partners in local community, provincial and national health promotion efforts. School health promotion is a critically important strategy in improving the health of all Canadians. As risk increases with age, school health promotion must be targeted at all students and not just the lower grades. From a public health viewpoint, the school is an active player in promoting and assuring the future health of Canadians. School health is accomplished through direct instruction, school services and an environment that reinforces and actively fosters positive development and strong social support. Improving the health of students and promoting their future health into adulthood demands that the entire school health process be viewed as a responsibility borne mutually by government, school boards, communities, parents, the private sector, public health and other health care professionals, and the general public. The potential of our schools to act as catalysts to promote the healthy development of our young people, is tremendous. The human and economic benefits of promoting and improving the health status of our children and youth are self-evident. An ounce of prevention is indeed worth a pound of cure.

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