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HEALTHY AND
SAFE
SCHOOLS
By
Afshan Huma
Naila Sadaf
Afaque Durrez
Daastan Publishing 2023
First Published in Pakistan by Daastan PVT LTD
House # A-41, Madni Street, Lala Rukh, Wah Cantt, Punjab 47040
Text copyrights © Afshan Huma, Naila Sadaf, Afaque Durrez
Book Design copyright © Zeeshan Akram
Edited by: Nayyab Mushtaq
The moral rights of the writer, illustrator and editor have been asserted.
All rights reserved
This book or any portion thereof may not be reproduced or distributed in any manner whatsoever without the express written permission of the publisher, except for the use of brief quotations in a book review.
ISBN 978-969-696-872-6
Ebook ISBN 978-969-696-873-3
This book is dedicated to all the children who got viral diseases that were neither diagnosed nor treated in time and to those who were bullied or abused at school or killed in an attack on school.
Contents
Major diseases reported among school children.
Oral and Dental Health Problems.
Psychological Issues and Special needs.
Health issues due to Technological Interventions.
New diseases reported during COVID-19.
MODELS OF SCHOOL HEALTH PROGRAM.
SCHOOL HEALTH PROGRAMS IN COMPARATIVE PERSPECTIVE.
School Health Program in Oman.
School Health Program in Germany.
School Health Program in Nigeria.
School Health Program in Barbados.
Health education programs after COVID-19.
School Health Program in Pakistan.
POLICY EFFORTS OF SCHOOL HEALTH PROGRAMS IN PAKISTAN.
HEALTH AND HYGIENE CONDITIONS IN PAKISTAN.
Collaboration of Education and Health Department.
Forms of school violence and attacks.
Importance of Security Infrastructure in Schools.
History of School Safety Policy.
Case of Schools’ Security Violation in Pakistan.
APS Peshawar Attack 16 December 2014.
Internal Security Situation in Pakistan.
War on Terrorism with Particular Reference to Pakistan.
Impact of Terrorism on Secondary School Students in Khyber Pakhtunkhwa.
Enhancement of School Security.
Financing for School Security.
Budgeting for School Security.
An Analysis of Public Expenditure on Education in Pakistan.
Financing Education in Pakistan – Opportunities for Action.
School Security Practices: Investigating the Consequences.
Homeland Security Planning for Urban Area Schools.
School Security Systems in Pakistan.
Allocation of all types of budgets to schools.
Criteria for Allocation of NSB.
Criteria and Allocation of FTF.
Special Security Supplementary Grants.
Procurement of Security Equipment.
Policy and Budgetary Document Analysis.
Needed Actions by School Heads and Management.
Financial Allocations and Issues.
Effects of Area on School Security.
Effects of Surroundings on School Security.
Joining Roofs with Neighbourhood.
Emergency Exit from Classrooms.
Helping Items along Boundary Wall
Display of Emergency Contacts.
Priority in Provision of Security Equipment/Facilities.
Budgetary Plan in View of Assigned Priorities.
OTHER ELEMENTS OF SCHOOL VIOLENCE.
Ensuring physical safety and security.
Fundraising for school security.
Training for school security and safety.
PREFACE
It has been a journey of 25 years in the profession of teaching and teachers training plus a journey of additional 25 years in learning through different institutions that include my home, school, college and universities in Pakistan and abroad. After my home, I remember my school as one of the best places in my life. I enjoyed studying there and was never bored or burdened. It was a small private school, in the city of Rawalpindi. I remember most of my teachers and many of my class fellows even today by names and by their faces. We had a rich learning experience in that school where none of the classrooms had more than 25 students. I think the school environment and culture was in accordance with my home environment and culture. I can now recall that most of the teachings at home were strengthened at school and vice versa. For instance, my mother had taught that if a stranger or a known person is teasing you then you must question in a louder voice so that the people around may listen and protect you. Same was being practiced at school during recess and games period, where we were told not to remain silent if anyone is harassing or trying to bully us.
I remember how the teachers were not only concerned about our learning but also about our well-being. During the early years of schooling, I had health issues and my teachers always remained in close contact with my parents. They never ignored a sign of sickness or weakness; they never labeled me or made me feel embarrassed of my health issues. I used to have severe sweating in my palms and my teachers were always helpful in making things easier for me by using multiple strategies to overcome my problem. I remember once during exam I felt very sick and they promptly called my mother. They let my mother sit with me in the examination hall and I completed my paper while leaning on to my mother. It was the extraordinary help and support of my teachers that I was able to keep my achievement graph going higher. These experiences for me and my fellow students inculcated the value of care. Even today if I see someone feeling sick, I offer help and I try to make things easier for anyone with any special need.
My school had a multistorey building which had two gates. One was used for the junior section students and one for senior section students. It had guards deputed on both gates and the duty teachers used to be there in the morning and at the end of school day. The teachers and guards, especially in the primary school, made sure that we were safely coming to school and leaving with someone known to them as a family member or reliable person nominated by the family. Teachers on duty used to take care of primary school students during the break time and games period. The safety and health of children was one of the major priorities on their minds. We were never left unobserved even out of the classrooms. Monitoring was also done with the help of senior school students during the co-curricular activities and special events. Studying in this environment made us learn how to stay safe and keep others safe around us.
The experiences of my own schooling and the scenarios I witnessed in the recent years during my ethnographic research studies at schools, helped me to select the topic of this book being published on health and safety aspects of schools. I strongly believe that primary schools need to have these two major elements if we look at the school environment with the lens of child’s well-being. Sometimes, I strongly felt that parents put a lot of trust on the school’s management for their children’s safety and security. Two major incidents in Pakistan made me think deeper and I became concerned of child safety and security more deeply - one was the attack on Army Public School in Peshawar in which terrorists killed around 150 school students and teachers; while the other was a report of extensive pedophile and pornography ring that abused round 300 children in Kasur. These two incidents pushed me to work closely with schools.
Two of my graduate students Naila Sadaf, and Afaque Durrez have worked on two detailed research studies related to school health and safety. They have coauthored the two sections of this book titled “Healthy and Safe Schools.” These students have conducted detailed research in their respective area and the content of the two sections comes mainly from their research and literature review. I am highly obliged that they worked on these topics and wrote these sections with me. After writing this book I realized that the lack of literature available in our local context has made it impossible for these topics to be part of the teachers’ preparation and school leadership programs as well.
I wish to inform the readers that we are publishing this book for helping the researchers, scholars and students of educational planning and management, for informing the planners and policy makers as well as for sensitizing the teacher educators, practicing teachers and school managers. The book brings together global and local set of information and knowledge on the basis of empirical evidence. I and my co-authors are always available to talk, discuss and elaborate on any part of this book and also to conduct live sessions and workshops related to school health and safety.
Afshan Huma
SECTION 1: SCHOOL HEALTH
Naila Sadaf and Afshan Huma
Health is a complex and multidimensional concept that refers to a state of complete physical, mental, and social well-being. It is often defined as a positive concept, emphasizing the absence of disease and infirmity, as well as the presence of physical and emotional wellness. It is important to note that in the early and late childhood, children spend maximum time either at homes or in schools. The school represents a formal education setup, as it aims to deliver education directly, thoroughly, and systematically. Within a school, on the part of the educators, there is a deliberate struggle to provide knowledge as well as instill certain values, skills, habits, and attitudes in the learners; which are presumably beneficial and important for them. Educational institution is like a big home or mini-society, which not only prepares young people for positive roles in their lives but also transfigures them into successful citizens. It makes them think broadly about the problems that challenge them and enables them to find out the most appropriate solutions. It is, therefore, vitally important that schools must have a healthy environment to make a healthy society. In school, a proper ambiance makes young children feel happy and ready to learn. Here they could easily be shaped to play their societal role in a prolific way. Thus, school is a social institution where children and adolescents undergo mental, emotional, physical, and social rearing. It is almost an incubator where the development of the natural competencies of a child takes place. Education itself is a process that boosts a child`s potential to the maximum so that he can play his effective role towards the improvement of the society and country, by becoming a productive citizen. During the education process, a balanced upbringing of both boys and girls is reliant on a number of factors, but it is their health that plays the most significant role. If a child is mentally and physically fit, it becomes more probable that he/she will succeed in all walks of life. “Good health and nutrition are foundations for learning and a crucial investment for more sustainable, inclusive and peaceful futures – they can improve education outcomes, empower learners to thrive and promote inclusion and equity in education and health” (UNESCO, 2023).
Studies over many years have shown a significant relationship between education and health. Features of the school as a learning environment and improvements in education are linked with improvements in health, and improvements in health status contribute to improvements in learning and academic outcomes (Nutbeam & Kickbusch, 2000). Both in developed and developing countries, studies have repetitively shown that literate and educated people are likely to be healthier. On the other hand, limited access to education has been related to reduced health, fortune, and well-being (Whitman & Aldinger, 2009). Education and health are closely connected in a way that children and young people with poor vision or hearing often have learning difficulties; those who are malnourished or tired have lesser concentration skills; similarly students with poor resistance to infections, or whose chronic situations are not effectively managed, suffer a considerably high rate of school absences. They also bear mental health problems and substance use can deteriorate the capacity of students to learn and flourish. Good health and educational achievements are not ends in themselves, but somewhat means which provide the opportunity to the individuals to lead a dynamic, productive and satisfying life. (National Health and Medical Research Council).
Educational achievement is not only a predictor of young persons` accomplishments; it also intensely predicts their physical and mental health outcomes. More frequently, it is observed that children who do not graduate have much higher health risks as adults, as compared to their higher-achieving peers, generating an unnecessary and unfortunate cycle of poverty and poor physical & mental health outcomes. The less education a young person has, the more probable they are to smoke, have diabetes, be overweight, and even die prematurely due to specific chronic conditions. As students who are grown up in poverty benefit the most from being in school and one of the most effective strategies to get these students out of poverty and misfortune is to do the best possible to get these students to school every day (Henderson, Hill, & Norton, October 2014). Health and Welfare of Australia’s Aboriginal & Torres Strait Islander Peoples reported that the relationship between health and education might be partially explained by the fact that healthy individuals are better able to start education in the first place. As a child’s health usually have a powerful influence on whether or not they will attend school and on their capabilities to learn, groom and contribute to school activities. Therefore, children with chronic health conditions or disabilities might be at risk of not carrying out their school and completing their education (Alperstein, Egan, & Deewr, 2010).
Similarly, researchers have shown that oral health has a substantial impact on overall child`s school attendance, and it is also being confirmed that oral health has a great impact on the academic performance of children. However, at an individual level the substantial number of days a student remains absent from school to deal with dental problems might be insignificant. Subjective and objective measures have proposed that there is a great possibility that a student may remain many more days absent from school when he suffers from the pain of untreated dental disease, which results in poorer academic performance. Similarly, World Health Organization has recognized the social impact of oral diseases resulting in restricted school, home, and work undertakings and loss of millions of school, home, and work hours annually. Another study concluded that in primary dentition dental carries a noteworthy impact on children’s well-being and overall health in terms of sleeping habits and eating patterns (Seirawan, Faust, & Mulligan, 2012).
United States Department of Agriculture (USDA) School Breakfast Program (SBP) has proved that skipping breakfast is related to decreased cognitive performance (e.g., alertness, attention, memory, processing of complex visual display, problem-solving) among students. Lack of satisfactory consumption of specific foods, such as fruits, vegetables, or dairy products, is connected with lower grades among students. Insufficiencies of specific nutrients (i.e., vitamins A, B6, B12, C, folate, iron, zinc, and calcium) are associated with lower grades and higher rates of absenteeism and lethargy among students. Hunger due to deficient food intake is related to lower grades, higher rates of absenteeism, repeating a grade, and failure to focus among students. So, healthy students are better on all levels of academic achievement i.e. educational behavior, academic performance, cognitive attitude and skills, and thus better learners. Students who are physically active incline to have better classroom behaviors (e.g., on-task behavior) and better school attendance, grades, and thus cognitive performance (e.g., memory). Thus, greater physical fitness levels and physical activity are related to improved cognitive performance (e.g., memory, concentration) among students. Brief classroom physical activity breaks (i.e., 5-10 minutes) are connected with improved classroom behavior (e.g., on-task skilled behavior), improved cognitive performance (e.g., attention, concentration) as well as educational outcomes (e.g., standardized test scores, math fluency scores, reading literacy scores,) among students (Centre for Disease Control, 2014).
No matter how well teachers are equipped to teach, no matter what responsibilities are put in place, no matter what governing structures are set up for schools, educational progress will be intensely limited if students are not motivated and able to learn. Health-related problems play a key role in limiting the motivation and the capability of students to learn. Healthier students are better learners (Seirawan et al, 2012). Poor health and nutrition affect access to education, as some diseases have serious effects on children's growth and development and subsequently chances of their enrolment (Jukes, Drake, & Bundy, 2008).As per UNESCO recommendations delivery of health services to the young students and children in the following forms generally come under School Health Program,
- Regular health screening (medical checkup) of students.
- Referral of students to medical centers, after identification of health problems, for rehabilitation or treatment.
- De-worming promotions.
Thus, a number of children can be saved from losing interest in their studies and dropping out of school when their maladies or learning problems are identified through health screening and addressed at early stages. For this component of School Health Program, association between education and health sectors is essential.
There are two related principles on which School Health Programs mainly base. Firstly, the connection between the health states of students and quality of learning, and secondly, state`s responsibility to facilitate smooth mental and physical growth of children so that they can be dynamic members of the society in future. A third aspect highlighted in certain situations is the prospective role of students in the circulation of health and hygiene education messages to their parents and community enormously. This phenomenon is also termed as child to child, and child to community transmission of information regarding health care and disease control. (UNESCO, 2010).
In Dakar, international agencies (in 2000 at the World Education Forum) agreed on a mutual agenda for school health that was called Focusing Resources on Effective School Health. FRESH supports not only accurate and effective but also, results-oriented implementation of School Health Programs so that schools could be made healthier i.e. where children learn to be healthy and where children could be enabled to learn with interest. Through School Health Programs, it was expected and ensured that children would enroll and stay in schools, would learn more while in school, and would develop knowledge, skills, and healthy behaviors that would definitely protect them and their future generation from serious diseases. School Health Programs also contribute to the Education for All (EFA) goals which includes improvement in the quality of education and learning outcomes. Similarly, School Health Programs also indirectly contribute to the major health and development goals by promoting healthy behaviors amongst schoolchildren and the larger community in which they live. School Health Programs and school health have great importance for the accomplishment of the Education Millennium Development Goals (UNESCO, 2023).
School Health Programs are effective to improve health status, increase access to health care, increase access to dental care, increased cognitive skills, improved maternal education, increased social skills, decreases in child abuse, higher income, and education levels during young adulthood, increases in IQ, decreased young criminal behavior, and an increased sense of well-being as young adults (Emel & Alkon, 2006). It is important to note that many childhood diseases can be prevented or treated through proper healthcare, vaccination, and lifestyle changes. Schools can play an important role in promoting health and preventing disease by providing health education and promoting healthy habits among students. By working together with families and healthcare providers, schools can help children stay healthy and achieve their full potential. However, before we look into the details of how a school can maintain healthy environment, it is important to understand some of the basic concepts such as health, disease and illness.
Health
World Health Organization defines health as “A state of complete physical, social and mental well-being, and not merely the absence of disease or infirmity” (WHO 1948, p. 100). At the same time, the Universal Declaration of Human Rights (1948) acknowledged that Health is a resource for everyday life, not a mean and purpose of living, and is a positive concept. It stresses social and personal resources as well as physical capabilities. Health is a basic human right. It is also a necessary component of development, important for a nation's economic growth and internal stability. It is now a proven fact that better health outcomes play a vital role in reducing poverty (WHO, 2015).
Berkman and Kawachi study, conducted in 2000, shows that the state of health in human beings is a function of several variables, or health factors. Health factors for individuals or populations include the physical environments in which people live and work; their behaviors; their biology (genetic makeup and the physical and mental health conditions attained during life); a multitude of social factors including economic circumstances, socioeconomic status in society, income disbursement, discernment based on factors such as race, ethnicity, gender, or sexual orientation, and the accessibility to social networks and social support; and the health facilities to which they have access (Beaufort & Longest, 2004).
These descriptions and definitions highlight the importance of considering all aspects of health, including physical, mental, and social well-being, and recognize that health is more than just the absence of disease. In summary, health can be defined as a state of complete physical, mental, and social well-being that enables individuals to lead fulfilling and productive lives. It is a dynamic and ongoing process that requires ongoing attention and effort to maintain and improve.
Disease
Disease is defined as a condition in which body health is adversely affected. The disease is not a static thing but a process that begins before man is actually affected by a living or non-living agent in the environment in which he lives, leading to a scuffle between the agent and man’s protective forces. The combat on the part of man’s defensive forces is an attempt to maintain positive stability against injurious forces that try to disturb his health equilibrium (PMU & PHSRP, 2009-10).
A disease is characterized by specific symptoms and signs that indicate that something is not functioning as it should. Diseases can be caused by various factors, such as infections, genetic predisposition, lifestyle factors, and environmental exposure. They can range from mild and temporary conditions, such as the common cold, to serious and chronic conditions, such as heart disease, cancer, and diabetes. Diseases can be classified into various categories, such as infectious diseases, chronic diseases, genetic disorders, and mental health disorders, among others. The type and severity of a disease can vary depending on various factors, such as the cause of the disease, the individual's age and overall health, and the presence of other underlying medical conditions.
Illness
Illness refers to a subjective feeling of being unwell. It is an individual's personal experience of physical, mental, or emotional discomfort or distress. Illness can be caused by a variety of factors, such as infection, injury, stress, or lifestyle factors, and can range from mild to severe. Eisenberg summarized the difference between illness and disease –“disease literally as dis-ease, meaning that deals with pathology, which is what doctors are trained to identify and manage, while illness is what patients are interested in, as the impact of disease occurs on their functioning, relationships and social interactions” (Ventriglio, Torales & Bhugra, 2017).
Thus, illness is a phenomenon in which one or more usual functions of the body are so disturbed that the affected individual cannot meet the ordinary requirements of everyday life. It is a condition in which the balance of the body and its functions are disturbed. On one hand, if the disturbance is severe and its duration is not long, the person is said to be intensely ill; if on the other hand, illness continues for a long period of time without disability, the affected person is said to be chronically ill (PMU & PHSRP, 2009-10).
Major Diseases Reported Among School Children
Number and kinds of diseases that affect education are extremely widespread and incredible. Health and nutritional challenges that children face change as they grow (Jukes, Drake, & Bundy, 2008). Especially children in poor countries face a large number of diseases and these poor countries are unable to either have the services to provide education or to deal properly with the poor health of their schoolchildren and consequent behavior and attitude problems of children with poor health (Jukes et al, 2008).
Viruses
The majority of viral diseases mainly respiratory tract virus, adenovirus, parainfluenza, rhinovirus, and corona-virus are reported to spread by the droplets in the process of sneezing, coughing and even through breathing and talking. Organisms can be transmitted through nasal secretions, eye secretions, or saliva (Robinson, 2001). The droplets remain in the air and on the surfaces from where another individual can breathe them in or naked hand can catch these viruses. Thus, in a school situation where children are in contact in group forms, such diseases can easily spread. School is a place where teachers and children share desks, books, toys with naked hands and children touch their faces frequently. Moreover, many viruses in children are asymptomatic until a longer time, thus leaving more chances of spreading unknowingly. Polio is initiated by a virus and is an extremely infectious disease. Poliovirus attacks the nervous system and causes permanent paralysis (usually of the legs) in around 1 in 200 cases. Polio could be possibly and successfully controlled by using an oral vaccine (Jukes et al, 2008).
Malaria
Malaria is a most communal infectious disease that causes mental disability in low-income countries. Normally, malaria produces headaches, fever, vomiting, and other flu-like symptoms. Malaria disease is so dangerous that if drugs are not available for treatment or the parasites are resistant to them, the infection can lead rapidly to life-threatening. Malaria disease kills either by infecting and destroying red blood cells (anemia) or by blocking the capillaries that transmit blood to the brain (cerebral malaria) or some other vital organs. A number of children who survive an episode of severe malaria suffer from brain damage or learning impairments. Illness due to malaria can cause children to miss school, once children are enrolled in school. Nevertheless, malaria remains a major cause of cognitive impairment and absenteeism in school-age children. (Jukes et al, 2008).
Under-nutrition
Under-nutrition (also called protein-energy malnutrition) is a common term applied to children with heights and weights below age-referenced criteria resulting from insufficient protein or calories in their diet. Under-nutrition is caused by the deficiency of macronutrients and is distinguished from the term 'malnutrition' that refers to diets that have adequate calories but lack essential elements, such as micronutrients. As compared to the rest of the body, brain growth is resistant to the effects of under-nutrition. Initially, the brain remains secured from the growth retardation resulting from a lack of nutrients but when nutritional deficits become sufficiently austere, growth processes in all areas of the brain are affected. This comprises those growth processes that are taking place at the time of the nutritional deficiency and some that take place afterward. It has often been theorized that nutritional deficiencies are more likely to have permanent effects on the brain if they occur during crucial periods of brain growth. Nevertheless, brain structure usually recovers after the nutritional disease is treated (e.g. by nutritional supplementation) (Jukes et al., 2008).
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