Youth Support: Healthy School

Professor Albert Lee MB BS (Lond) MD(CUHK) MPH FRCGP(Aus) FFPH(UK) FRCP(Irel) DCH

Professor (Clinical), School of Public Health and Primary Care, Director of Centre for Health Education and Health Promotion,

The Chinese University of Hong Kong.Chairman of Steering Committee of QEF Thematic Network of

Healthy Schools

QEF Seminar 13 October 2010

Pubertal transition in Health青春期的健康

• Puberty is initiated through cascade of endocrine changes leading to sexual maturation and reproductive capability.

青春期是由於一連串的內分泌轉變所致，促使性徵成熟和具生殖能力。

• It is accompanied by major physical growth and substantial brain maturation changes.

這還包括身體成長的重大轉變，以及腦部發展漸趨成熟。• Puberty also triggers emotional, cognitive, and behaviour

al changes 青春期會引發情緒、認知和行為上的轉變。

• Aristotle commented that “Youth are heated by nature as drunken men by wine”.

亞里士多德指出：「年青人被自然力量催化，尤如醉酒者被酒醉倒一樣。」

• These changes are observed by increased mortality and morbidity from accidental and intentional injuries, suicide, emotional disorders, substance abuse, and eating disorders in young people.

年青人出現意外性和意圖性的傷害、自殺、情緒、濫用藥物和飲食失調等問題，這些問題的發病率和死亡率上升均與青春期的轉變有關。

• This would be due to mismatch between biological and social maturation, and emergence of more dominant culture not always with adequate support and mentorship.

這可能因為生理上和社交上的成熟度不一致，以及圈子內的獨有文化並不得到足夠的支持和指導。

• Puberty begins with activation of complex neuro-endocrine network.

複雜的神經內分泌網絡啟動後，青春期即告開始。• The usual few years variation of puberty in healthy youth

reflects a strong genetic component, with nutritional, psychological status and socio-economic conditions.

健康青少年在青春期間的數年變化，反映了基因的元素，再加上營養、心理狀況和社會經濟條件等。

• The physiological processes of puberty interact with the social context to affect an individual’s emotional and social development.

青春期的生理發展和社交因素互為影響，因而影響到青少年人的情緒和社交發展。

• Gonadal hormones affect a wide range of neuronal processes including sensitivity of neurotransmitter receptors which would affect cognitive abilities, aggression, regulation of affect, learning and memory.

男性荷爾蒙影響多個神經處理過程，包括神經傳導受體，可影響青少年的認知能力、侵略性行為，還有對情感、學習和記憶的控制。

• Other physiological and psychological factors such as nutrition, genetics and sensory input would also affect development and the vulnerability to psychopathogies of different types Cameron JL. Annal NY Acad Sci 2004; 1021:110-23.

其他生理和心理因素如營養、基因和感官接收等，均影響個人的發展，以及可能較易受各種心理病理問題的影響。

• There is also evidence of greater neural plasticity around puberty and persistent changes in neural function as result of external stimuli would have major implication on health promotion. (Stroud LR et al. Biol Psychiatry 2002; 52: 318-27.

證據顯示，在青春期間，神經可塑性是較高的。但神經功能因外界刺激而經常轉變，則可能對健康有重大的影響。

• Behavioural problems would arise as result of mismatch between emotional reactions and cognitive capacities of young people.

如青少年的情緒反應和認知能力存在差異，就會產生行為問題。

•Adolescent Brains Show Lower Activity in Areas That Control Risky Choices 青少年腦部對作出風險選擇方面的活動量較低

•A new NIMH study could help explain why adolescents are so prone to make risky choices. When contemplating risky decisions, they show less activity in regions of the brain that regulate processes involved in decision-making, compared with adults. 一項全新的 NIMH 研究可解釋為何青少年會作出較高風險的決定。在遇到風險問題時，青少年腦部負責決策等問題的部份，在活動方面比成年人較少。

•The areas are among the last to develop and are involved in control of “thinking” functions, including decision-making, and in processing reward-related input and behavior (the orbitofrontal/ventrolateral prefrontal cortex and dorsal anterior cingulate cortex). 這些部位幾乎是最後發展成熟的，並多控制「思考」的功能，包括作決定，及處理奬勵有關的行為 ( 視覺額葉皮質區／腹側前額葉皮質區，以及前扣帶皮質區 )

Results of the study were reported in the March 9 issue of Neuropsychologia by Monique Ernst et al from the NIMH Emotional Development and Affective Neuroscience Branch.

NIMH 情緒發展和情感神經科學部的 Monique Ernst et al ，將研究結果刊登於 3月 9日的 Neuropsychologia 。

The results suggest that when it comes to making choices involving risk, adolescents do not engage the higher-thinking, decision-and-reward areas of the brain as much as adults do.

結果建議，在作風險性決定時，青少年較成年人少使用腦部涉及深度思維、決策及獎勵的部份。

Brain development continues throughout adolescence, and the reduced activity seen in specific areas in the healthy adolescents in this study appears to be normal.

青少年期的腦部發展持續，研究顯示青少年腦部某部位活動較少其實是正常的。

Youth health needs in Hong KongYouth health needs in Hong KongLee A., et al. Youth Risk Behaviour Surveillance in HK. Lee A., et al. Youth Risk Behaviour Surveillance in HK. Public HealthPublic Health 2004; 118(2): 88-95 2004; 118(2): 88-95

The youth health surveys in 1999, 2001and 20

03 both revealed that substantial high proportion

of our young people DID NOT have a healthy e

ating habit, not performing exercise regularl

y and also emotionally disturbed. The 2001 surv

ey found correlation of youth health compromisi

ng behaviors with emotional disturbance and life

satisfaction.

於 1999 年、 2001 年及 2003 年進行的調查，均反映出大部分青少年都沒有健康的飲食習慣、沒有定期運動，而且受情緒困擾。據 1999

年的調查顯示，少於一半的受訪者有進行定期的身體檢查。而 2001 年的調查又發現青少年的健康狀況與情緒困擾及對生活的滿意程度有關。

三個層面的全人健康(Total well-being)

人自己之生長發育 Healthy Personal Development

Healthy interaction with nature, making wise decision 人與自然、面對事物時如何作決定

人與人、社會、文化之互動 Healthy interpersonal relationship, healthy interaction with society and culture

Healthy Development Enjo

y Learning健康成長、愉

快學習

Personal 個人

Active body 充滿動力

Sound Mind 腦根清醒

Well nourished

營養均衡Regular life

pattern作息定時Away from drugs,

alcohol, cigarettes遠離毒品、煙酒

Prevent injury

預防意外

Good communication skills 善於

溝通

Good interpersonal relationship 良好人際

關係

Family 家庭Caring parents 父母關愛

Family harmony

和諧家庭

Role modeling

以身作則

Communicat-ion and sharin

g溝通及分享

Mutually support

互相支持及鼓勵Sense of belongi

ngs歸屬感

Family as a team

家庭團隊

Showing care and love

關愛表達

Open discussion

開放討論

Respect parents

尊敬父母

School 學校Supportive school environment

學校支援環境School ethos校風

Interpersonal relationship人際關係

School connectedness

學校歸屬感

Home-school Co-operation家校合作

Parent Education親職教育

Parenting skills

家長技巧Values and ethics道德倫理及價值觀

Alertness of students’ behaviour

s察覺學生行為

Concern the students’ learning ne

eds關注學生學習

需要

Life skills education

生命教育

School policies學校政策

Teaching attitude

教學取態

Community 社區Supportive environment社區支援

Hygiene Healthy and safe environment

健康衞生及安全社區

School-community partnership

學校社區伙伴關係

Professional support

專業支援

Holistic community development plan 全面社區發展計劃 © Professor Albert LEE 李大拔教授 2009

Social harmony和諧社區

• Recent evidence suggests that the way the school is led and managed, the experiences students have to participate and take responsibility for shaping policies, how teachers relate to and treat students and how school engages local community and parents, build many protective factors for health and reduces health risk behavior Stewart-Brown, 2006. Blum et al.2002, Patton et al 2006).

• 學校領導及管理； 學生的投入；老師對學生態度；學生如何令社區及家長參與都可幫助建立保護學童健康的因素及減低高危因素。

Stewart-Brown, S. (2006). What is the evidence on school health promotion in improving school health or preventing disease and specifically what is the effectiveness of the

health promoting schools approach?. Copenhagen: World Health Organization.Patton, G. Bond, L., Carlin, J., Thomas, L. Butler, H., Glover, S., Catalano, R. & Bowes, G.

(2006). Promoting social inclusion in schools: A group-randomized trial on student health risk behaviour and well-being. American Journal of Public Health, 96, pp 9.

Blum, R. McNeely, C. & Rinehart, P. (2002). Improving the odds: The untapped power of schools to improve the health of teens. Center for Adolescent Health and Development,

University of Minnesota

• The effective school health promotion programmes in changing health behaviors were more likely to be complex, multi- factorial and innovative activity in many domain (curriculum, school environment and community). Interventions of long duration were shown to be more effective (Stewart. Brown, 2006.)

• 多元化﹑多層面持續性及透過不同校本活動 (課程﹑活動﹑環境﹑社區合作等 ) 是有效推行校本健康促進的主要元素。

Marshall, B., Sheehan, M., Northfield, J., Carlisle, R. and St. Leger, L. (2000) “School-based health promotion across Australia” Journal of School Health, 70:6 pp251 – 252.

Lee, A., St Leger, L., Moon, A.S. (2005). Evaluating Health Promotion in Schools meeting the needs for education and health professionals: A case study of developing appropriate

indictors and data collection methods in Hong Kong. Promotion and Education, 20(2): 177-186.

• Evidence has been gathered extensively about what schools actually do in health promotion using the HPS/CSH frame work. (Lee. St Leger & Moon, 2006; Marshall et al, 2001)

• 近期已有不少實証反映學校如何按健康促進學校 /全面性學校衛生模式推動校本健康促進活動。

Moon A.M., Mullee M.A., Rogers L., Thompson R.L., Speller V. and Roderick P. (1999) Helping schools to become health-promoting environments – an evaluation of the Wessex Healthy

Schools Award. Health Promotion International, 14:111-122.

Lee A., Cheng F., St Leger L (2005a). Evaluating Health Promoting Schools in Hong Kong: The Development of a Framework. Health Promotion International, 20(2): 177-186.

• Audit type of evidence has provided schools and health and education authorities with comprehensive maps about what is happening and how comprehensive it is. It can assist schools and authorities to concentrate on the gaps and affirm qualities work in schools through award upstream (Moon et al, 1999; Lec, Cheng & St Leger, 2005)

• 核証式的檢視亦提供不少實証給學校﹑教育及醫療機構一個全面性的藍圖去推動健康促進學校 , 亦可幫助學校及有關機構集中補救不足之處 , 透過獎勵計劃亦可以加強發展優質學校。

Health Promoting Setting approach as effective public health

intervention• There is a paradigm shift of pubic health intervention

from addressing the devastating effects of the living and working conditions on population health to modification of health risk behaviours by individuals;

• and improvement of health literacyhealth literacy can help individuals to build up the personal, cognitive and social skills which determine the ability of individuals to gain access to, understand and use information to promote and maintain good health.

• In many countries, there is a well structured health care system to address diseases ad illnesses but there is NONO system addressing health particularly on promotion of positive health.

• The setting approach to health promotion (also known as ‘Healthy Setting’ or ‘Health Promoting Setting) has emerged from Ottawa Charter for Health (WHO, 1986) asserting that, ‘health is created and lived by people within the setting of their every-day life; where they learn, work, play and love.’

Health Promoting Setting approach as Effective public health intervention

• It has a long history of being organised around settings such as schools, communities and workplaces which provides the ‘social structures’ to reach the defined population and delivery of health promotion activities in the context of their daily lives. (Green et al, 2000; Lee et al, 2003).

• A setting approach also argues for investment in social systems in which people spend their daily lives.

• The approach can be regarded as an ecological model of health promotion in which health is determined by a complex interaction of environmental, organisational, and personal factors.

.Green LW., Poland B., and Rootman I (2000). The Settings Approach to Health Promotion. In B Poland, LW

Green and I Rootman (eds). Setting for Health Promotion: Linking Theory and Practice. Thousands Oaks, CA: Sage.

Lee A., Lee SH., Tsang KK., To CY. (2003). A comprehensive “Healthy Schools Programme” to promote school health: The Hong Kong experience in joining the efforts of Health and Education Sectors. Journal of Epidemiology and Community Health, 57, 174-177.

Mission of a Health Promoting SchMission of a Health Promoting Sch

oolool 健康學校的使命健康學校的使命• Every child deserves to be given every opportunity

to achieve their full potential

每個孩子都應該有機會發展個人潛能• Aims of Health Promoting Schools: to empower st

udents, staff and parents to actively influence their lives and their living conditions

健康學校的目標：增強學生、教職員、家長的能力去影響自己的生命及生活狀況

(Peter Peacock, Past Minister of Education and Young People, Scotland)

• Health Promotion (by WHO) 世界衛生組織將健康促進定義為

– The process of enabling people to increase control over, and to improve their health增強人們掌控及改善自己健康的能力

• To ensure sustained positive changes 確保能持續地作出正面的改善• To address the interwined social, educational, psychologi

cal, and health needs of school children 配合學童在社會、教育、心理和健康上的多種需要

Health Promoting SchoolsHealth Promoting Schools健康促進學校健康促進學校

WHO Western Pacific Regional Office: Health Promoting School Guidelines 2008WHO Western Pacific Regional Office: Health Promoting School Guidelines 2008

St Leger L., Kobe LJ., Lee A., McCall D., Young I. School Health: - Achievements, Challenges and Priorities. In McQueen D., Jones C. Global Perspective on Health Promotion Effectiveness. Springer, New York, USA., 2007.

WHO Stakeholders Consultation Meeting to update

Regional Guidelines for HPS 3-5 March 2008, Singapore

Hong Kong Healthy Schools Award SchemeHong Kong Healthy Schools Award Scheme香港健康學校獎勵計劃香港健康學校獎勵計劃

Healthy Schools (Pre-school) Award Scheme Healthy Schools (Pre-school) Award Scheme 健康幼稚園獎勵計劃健康幼稚園獎勵計劃

Education Bureau, HKSAR

香港特別行政區政府教育局

WHO Western Pacific Region

世界衞生組織西太平洋區

Education Bureau, HKSAR香港特別行政區政府

教育局

WHO Western Pacific Region

世界衞生組織西太平洋區

Healthy School Policies and Services for School Health Promotion

School Physical and Psycho-social Environment and Linkage to Family and Community

Competency on Health

Integrated Framework for Health Promoting School© Professor Albert LEE 李大拔教授 2009

On the whole, students from Healthy School award (HAS) group showed positive results in the health behaviours of students and actions taken by schools.總括而言，就讀 HSA之學童進行健康行為及 HSA 學校實踐健康促進方面都有顯著的成果。

Advantage of Healthy School

• Better learning achievement• Higher job satisfaction• Better care for pupils• Better school atmosphere• Leads to school improvement• Better schools, better lives

Buijs G. Better school, Better Lives. National Conference of Australian Health Promoting School Association. 6-8 October, 2010, Perth Australia

Unwritten role of school

• Teachers as role models• Creating a mini society• Establish social skills• Create confidence• Connectedness

Stacey Waters. Creating secure connections and securing existing ones. National Conference of Australian Health Promoting School Association. 6-8 October, 2010, Perth Australia

Stacey Waters. Create secure connections and securing existing ones

• Students are more likely to succeed when they feel connected. School connectedness is the belief by students that adults in the school care about their learning as well as about them as individuals

• Significant protective factor and less likely to be below average, poor physical health, sexual activity, mental health problems, reduced drop out, alcohol consumption, misuse of drugs,

Promoted by- Academic press (do their best)- Safe school environment- Caring and structured environment- Clear and fair disciplinesConnectedness is more ecological termJournal of School Health 2004; 74(7): 233-235

We strive to provide aWe strive to provide a

Life-enriching (Le) EducationLife-enriching (Le) Educationfor our studentsfor our students

which meanswhich meansadopting the Core Values ofadopting the Core Values of

1Q 3Cs 1Q 3Cs for / infor / in T & L T & L(Q-Quality, C-Caring, C-Community,(Q-Quality, C-Caring, C-Community,

C-Christian Values, T-Teaching, L-Learning)C-Christian Values, T-Teaching, L-Learning)in order to nurturein order to nurture

the qualities ofthe qualities of

  3 Haves 4 Cans 1 Purpose3 Haves 4 Cans 1 Purpose(Have Faith, Have Hope, Have Love;(Have Faith, Have Hope, Have Love;

Can Learn, Can Teach, Can Serve, Can Innovate;Can Learn, Can Teach, Can Serve, Can Innovate;Purpose – Honor God, Serve Man & Make a difference)Purpose – Honor God, Serve Man & Make a difference)

in every Tsung Tsin Collegianin every Tsung Tsin Collegian  Tsung Tsin College is thus to becomeTsung Tsin College is thus to become

a Healthy School which Nurtures and Enriches a Healthy School which Nurtures and Enriches LivesLives  

The Lord Jesus said, “I have come in order that you might have The Lord Jesus said, “I have come in order that you might have life - - life in all its fullness. (John 10:10) life - - life in all its fullness. (John 10:10)

  

SchoolSchoolVisionVision

Cheung MB. The Story of Our Journey to Health Promotion: through the Leadership Lens. National Conference of Australian Health Promoting School

Association. 6-8 Oct, 2010, P

erth Australia

Community Partnership• Home-school co-operation• School-community partnership concept of community school• Parent education• Student participation in community

Personal Health Skills• Comprehensive school health

education and inter-relationship between different components

• Integrated approach• Life long learning skills• Integration of health issues and

life education in co-curricular activities

Healthy School Policy• Comprehensive healthy youth

development including policies or drug, bullying, violence• Wide consultation with professionals, community leaders and stakeholders• Periodic review with latest

evidence• System of awarding students

in wider perspectives

Prevention of Substance

MisuseSocial Environment• Caring and harmonious atmosphere• Respect students’ diversity• Respond to special needs of

students• Develop atmosphere of mutual trust and sharing

Physical Environment• Safety• Healthy school environment

for physical and leisure activities• Green environment

School Services for Health Promotion• Primary prevention: avoid exposure to risk factors and build up protective factors• Secondary prevention: identification of at risk cases and appropriate counseling and/or specific individual health education• Tertiary prevention: rehabilitation

運用健康促進學校的概念預防青少年濫藥問題

What is School Health Policy?What is Healthy School Policy?

School Health Policy 學校衞生政策

• Statutory requirement for health protection, e.g., infection control, good hygienic practice

• Initiated by Health Authority

• Unique standard across all schools

• Based on guidelines and procedures

Healthy School Policy Healthy School Policy 健康學健康學校政策校政策

• Putting health on school agenda

• Promote better health and well being for students and staff

• School based initiatives based on needs of the school

• Comprehensive approach to promote healthy school environment making use of possible means and resources

QEF Thematic Network of Healthy Schools

優質教育基金健康校園網絡計劃Centre for Health Education and Health

Promotion, School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong

• Project leader: Professor Albert Lee • Co-project leader: Dr. Robin Man-biu Cheung

Establishment of Quality Circle of Health Promoting Schools for Quality Education and Student Well-being

促進全人健康　實踐優質教育　建設以健康促進學校為本的學校支援網

健康學校

健康社區

健康的新一代

建立健康的文化建立健康的文化創造健康的生活環境創造健康的生活環境

健康學校與優質教育• 共同的哲學、宗旨和展望共同的哲學、宗旨和展望

邁向十週年 健康資源贈閱及大優惠

共同推動健康 培育學童全人成長香港中文大學醫學院健康教育及促進健康中心香港中文大學醫學院健康教育及促進健康中心

http://www.cuhk.edu.hk/med/hephttp://www.cuhk.edu.hk/med/hep

謝謝各位謝謝各位 !!香港中文大學醫學院健康教育及促進健康香港中文大學醫學院健康教育及促進健康中心中心電話電話 ：： (852) 2693 3708(852) 2693 3708

傳真傳真 ：： (852) 2694 0004(852) 2694 0004

電郵電郵 ：： alee@cuhk.edu..hk網址網址 http://www.cuhk.edu.hk/med/hep

地址地址 ：香港新界沙田瀝源健康院：香港新界沙田瀝源健康院 44字樓字樓