What's the place of schools in promoting health? Are we too optimistic?

405 Schools are viewed by the health sector and the community as playing a key role in solving society’s health problems. This is true in both developed and developing countries. The emerging obesity/overweight problems of the developed world, and poor sanitation and basic hygiene in many developing countries are just two of the many topics, which may find their way into a school’s curriculum. But can schools actually make a difference to the health status of young people? And what part, if any, do they play in reducing dental caries, poor nutritional behaviours, unwanted pregnancies, gastrointestinal diseases, tobacco use, etc., etc.? Perhaps we believe schools are better placed to address health issues than the reality suggests. We might even have an inappropriate model on which we have based most school health interventions. Compulsory schooling in many countries began in the latter half of the 19th century. This was a time when pioneers such as Chadwick, Howard and Simon had argued that addressing the settings in which people lived, by developing policies to change the social conditions and physical environments, produced significant improvements in the health status of communities. It was not surprising that the newly developed schools took on a role in building the health knowledge and skills of their students. Clement Dukes’ seminal work on school hygiene formed the basis of the health curriculum in many countries (Dukes, 1885). The emphasis was on proper hand washing, toileting and careful use of water from uncontaminated sites. There is no doubt that if students learn basic hygiene practices, then they reduce the risk of contracting certain diseases. The school curriculum in most developing countries still has a major component on hygiene. Schools gradually included more topics in their health programmes. Alcohol education or ‘temperance education’ as it was often called, was a prominent component for much of the first half of the 20th century. Physical fitness, especially for boys, was prominent and much of the health teaching was done by visiting doctors and nurses. Little teacher training was available and resources were limited to the occasional library book. Some of the visiting doctors actually saw health education, or hygiene instruction as it was often known, as an opportunity to make links with the community and other curriculum subjects. For example, nearly 100 years ago, the first school medical officers in Victoria, Australia, Doctors Harvey Sutton, Jane Greig and Mary Booth stated: