The National Center for Spinal Disorders, an affiliate of the Buda Health Center, is the only hospital in Hungary covering virtually the entire diagnostic and treatment spectrum of all disorders of the spine.

Magyar

Holistic health promotion (HHP) in Hungarian schools

Dr. med. Annamária Somhegyi Ph.D.

Director for prevention, National Center for Spinal Disorders, Budapest, Hungary
National coordinator for WHO Schools for Health in Europe (SHE) Network, nominated by the Ministry of Human Capacities, Budapest, Hungary

According to the Hungarian Constitution „Everybody has the right to physical and mental health.“ The „Strategy for Healthy Hungary 2014-2020“ defined the main public health goals and interventions, between them holistic health promotion (HHP) in educational institutions.

Short story of HHP:

The plan of HHP in schools was born in 2003: corresponding to the Parliamentary decision No. 46/2003. (IV.16.), and to the Public Health Interministerial Board’s  decisions the Ministry of Health in consensus with other competent departments (Ministry of Education, Ministry of Children, Youth and Sport, Ministry of Finance) created the plan of holistic health promotion (HHP) in schools, which – mainly because of lacking political commitment from the side of education – was not implemented until 2010.

In 2010 the Program of Government, in 2011 the Act Nr. 190 on National Education, and in 2012 the Decree  No. 20/2012 of the Minister for Education prescribed the institutionalized implementation of holistic health promotion (HHP) in Hungarian educational institutions. Since 2013 more projects from the health and the sports sector gave significant professional assistance and motivation to schools to further their daily work in health promotion.

For all these results an efficient intersectoral cooperation was needed, which worked on the basis of the “giga-ministry”, the Ministry of Human Capacities containing 8 human sectors (health, education, sport, higher education, youth and family, social integration, culture, church and civil society).

We had several facilitating factors from the international professional sites:

- The lessons learnt from the European Network for Health Promoting Schools, now Schools for Health in Europe (1,2,3,4,5).
- The supporting works of WHO European Region in several fields: healthy eating, physical activity, mental health, health literacy, “whole school, whole child, whole society” approach in Health 2020 (6,7,8,9,10,11,12,13,14).

Essence of HHP:

Holistic health promotion means a holistic, whole school approach where health promotion has to be part of the every day life of the school. There are four main health promoting tasks for schools to do in their daily work - with participation of the whole school, of parents and the public environment:

I.) Healthy eating - potentially based on local food products; 
II.) Daily physical education fulfilling health promotion criteria (15,16,17) and other    forms of physical activity;
III.) Appropriate pedagogic methods (including also the use of arts) to enhance mental health; 
IV.) Improving health literacy and health competencies of the children (see enclosure). 

Follow up of HHP:

We follow up the effects of HHP with some regular measurements:
- for healthy eating we have the results of National Institute of Pharmacy and Nutrition, and the results of HBSC;
- for daily physical education we have the new national measuring tool “NETFIT” (18,19);
- for mental health we have HBSC and ESPAD
- for health literacy we have no significant measurement till now, but in a new project we want to produce it.

Whole society gains of HHP:

The key strategic goal of HHP is to reach for all school-children a better physical, mental and spiritual health; better academic achievement; better social inclusion; better social well-being; and primary prevention of NCDS. All participating sectors (health, education, sport, higher education, youth and family, social integration, culture, church and civil society) co-benefit from an efficient implementation of HHP, the gains for each are obvious:
- Health: primary prevention of most NCD-s, better physical, mental, spiritual and social well-being and health for all children.
- Education: better health for all children = better academic achievements, more effective pedagogic work of teachers, better social inclusion, less drop-out, less agressivity.
- Sport: better basis for later sportsmen.
- Higher education: better health, better academic achievements.
- Youth and family: better health of children needs much cooperation from parents and families - this means shared tasks.
- Social integration: children from poor social background can be reached mostly in the schools; better health=better social integration.
- Culture: mental health promotion of the children is served by the application of arts in the school-days.
- Church and civil society: churches have schools, where health promotion is also prescribed; better health=better academic achievements.

Continous cooperation of health and education sector at the Government’s level:

Effective implementation of HHP having so many beneficial consequences it is considered a „whole society” target by the public health and the education administration as well. Therefore, in a joint effort the Department of Education and the Department of Health (Ministry of Human Capacities) issued in March 2016 a Recommendation for every-day HHP activites of the pedagogues, listing all those websites where help would be available for them. The HHP Recommendation was mailed on April 19th 2016 to the directors of each and every schooling institution, it was put on the www.kormany.hu (the Hungarian Government’s website), it was mailed to the directors of the Education District Centres (together 60 Centres), and since April 2018 it is also available on the official website www.egeszseg.hu.

Since April 2016 the network of the Education Office (together 15 Hungarian Pedagogic Centres) consented to include HHP Recommendation into their regular professional meetings. On authority by dr. med. Zoltán Ónodi-Szücs, State Secretary of Health Department I was present at the Round-Table Conferences of the Department of Education in 2016 and 2017, and I was pleased to see that the ongoing renewal in public education systems has greatly advanced so that HHP gets much support.

Our next tasks to improve the quality of every-day HHP activities:

We have still to work hardly to organize the official helping network from the public health side – as schools need our professional help continuously, not only during our projects (20,21,22). After the appropriate legislation in the education sector we have now a new challenge: theachers are highly loaded with their work, so building the “whole school approach” in their daily routine work is not easy. The new quality management in education and the ongoing whole renewal of the national education are important helping structures and factors for us.

Conclusion:

Commitment of several medical professionals was the starting point, which was followed by the highest political commitment. Since 2010 governmental cooperation has been working effectively through the Ministry of Human Capacities responsible for health, education, sport, youth, family, social integration, culture, church and civil society. Our next tasks are the organization of the continuous professional help from the public health institutions to the teachers; and the motivation of teachers to change their routine and accustomed pedagogic methods. 

Budapest, 03. January 2019.

ENCLOSURE I. - TOPICS OF HEALTH LITERACY:

- Common responsibility for the health of the individual and of the whole society
- The child’s awareness of his/her rights and duties
- Preserving good health
- Personal hygiene
- Sound psycho-sexual growth
- Sound environment
- Media awareness, link between health and media consumption
- How arts do promote mental and spiritual health, sound personal development and academic efficiency
- Consumers’ rights
- Timing as a health factor, sleeping, bio-rhythm, proper time planning
- Co-existence with the handicapped, help to be offered where needed
- The impact of food and nutrition on our health and illnesses
- Healthy eating, local produce, local consumption
- Nutritional disorders of psychic origin
- How to feed ill people
- How physical exercise affects health and illnesses
- How much of physical exercise is needed to be and stay healthy
- The  effect of physical exercise on growing and development
- How sports activities do improve mental, spiritual health, personal development and academic efficiency
- Primary prevention of violence and addictions (smoking drinking, drugs, games, internet and tv addiction, etc)
- Problem solving, coping with stress and conflicts, assertivity, skills of communication 
- Self-esteemation, respectful communication and its impact on the partner’s self-esteem
- Female roles, male roles
- Society, manners and ethics, morality
- Family, relations, activities, communication
- Prevention of communicable illnesses
- Prevention of non-communicable chronic illnesses
- Spine protection
- Prevention of accidents, first aid
- Pregnancy, mother’s experiences transmitted to the foetus as growth affecting stimuli 
- How to relate to the child at home, at school so as to promote healthy development
- How to use the medical services
- How to use the services of school medicine
- Home nursing

ENCLOSURE II. - LEGAL TOOLS TO FACILITATE IMPLEMENTATION OF HHP IN SCHOOLS:

- Act Nr. CXC (2011) on National Education puts health promotion in quite a central position (including rights and duties, adequate attitudes and treatment, good co-operation between staff and parents, ethics and patriotism, social skills needed in family life and workplaces and the protection of our environment).

- Decree of the minister of human capacities Nr. 20/2012 on the functioning of educational institutions prescribed the institutionalized implementation of holistic school health promotion in Hungarian schools. Chapter X deals with health promotion in details: the full HHP programme of  a given schooling institution has to be part of the local pedagogic programme, in a detailed, measurable and controllable way and is to be produced by the teaching staff, with active help from the school-medicine actors.

- Decree of the minister of human capacities Nr. 37/2014 (IV.30) on Food Services, effective since September 2015, has greatly helped the reform of attitudes and practices, even as regards favouring local produce.

- In 2011 a more rigorous amendment to Act Nr. XLII (1999) on the protection of non-smokers and on tobacco traders has also proved helpful to HHP.

- Act Nr. CLIV  (1997) on Health Services (§ 42/1), Act Nr. CXXIII (2015) on General Medical Services, NM Decree 26/1997 (IX.3) on Services by School Medicine, and NM Decree 51/1997 (XII.18) on early diagnosis and screening of  illnesses included in public health insurance do also contain much helpful information relative to HHP.

REFERENCES:

1. Education and health in partnership. A European conference on linking education with the promotion of health in schools. Egmont aan Zee, 2002. szeptember 22–27. Conference report. International Planning Committee (IPC) 2002. (ISBN: 90-72796-07-2.)

2. STEWART-BROWN, S. 2006. What is the evidence on school health promotion in improving health or preventing disease and, specifically, what is the effectiveness of the health promoting schools appoach? Copenhagen, WHO Regional Office for Europe (Health Evidence Network report) 
(http://www.euro.who.int/document/e88185.pdf : 

3.Schools for Health (SHE) website: 
https://www.schoolsforhealth.org/

4.YOUNG, I., ST LEGER, L., BUIJS, G. 2013. School health promotion: evidence for effective action. Background paper SHE Factsheet 2. Available on
http://www.schools-for-health.eu/uploads/files/SHE%20Factsheet_2_Background%20paper_School%20health%20promotion_Evidence.pdf 

5. SULDO, S. M., GORMLEY, M. J., DUPAUL, G. J. et al. 2014. The impact of school mental health on student and school-level academic outcomes: current status of the research and future directions. School Mental Health; DOI: 10.1007/s12310-9116-2. Available on
www.researchgate.net/publication/262571894

6. WHO 2004. Global strategy on diet, physical activity and health. Available on http://www.who.int/dietphysicalactivity/goals/en/index.html 

7. WHO 2007. A Guide for population-based approaches to increasing levels of physical activity. Implementation of the Global Strategy on Diet, Physical Activitiy and Health. Available on
http://www.who.int/dietphysicalactivity/PA-promotionguide-2007.pdf

8. WHO 2008. School policy framework. Implementation of the WHO Global strategy on diet, physical activity and health. Available on
http://www.who.int/dietphysicalactivity/schools/en/index.html 

9. WHO 2008. Action plan for The Global Strategy for the Prevention and Control of Non-communicable Diseases 2008-2013. Available on http://www.who.int/nmh/publications/9789241597418/en/ 

10. European Commission 2008. EU Physical Activity Guidelines. Recommended policy actions in support of health-enhancing physical activity. Available on
http://www.eupea.com/nl/x/289/eu-physical-activity-guidelines

11. WHO 2010. Global recommendations on physical activity for health. Available on http://www.who.int/dietphysicalactivity/factsheet_recommendations/en/index.html 

12. European Commission 2013. Physical education and sport at school in Europe. Eurydice report. Available on http://eacea.ec.europa.eu/education/eurydice/documents/thematic_reports/150EN.pdf 

13. WHO 2015. Physical Activity Strategy for the WHO European Region 2016-2025. Available on
http://www.euro.who.int/__data/assets/pdf_file/0010/282961/65wd09e_PhysicalActivityStrategy_150474.pdf?ua=1

14. WHO Regional Office for Europe. 2014. Health 2020: education and early development. Synergy between sectors: Fostering better education and health outcomes. Available on
http://www.euro.who.int/__data/assets/pdf_file/0004/257881/H2020-SectoralBrief-Education_11-09-Eng.pdf 

15. Ministry of Health 2001. Healthy Nation Public Health Program 2001-2010. Budapest, 2001

16. SOMHEGYI, A. 2014. Health promoting criteria of daily physical education: present state of implementation. English abstract available. Népegészségügy; 92:4-10.

17. SOMHEGYI, A., LAZÁRY, Á., FESZTHAMMER, A. et al. 2014. Application of special exercises in physical education to develop, automatize and maintain the biomechanically correct posture. English abstract available.  Népegészségügy; 92:11-19.

18. Hungarian School Sport Federation (HSSF) website: 
http://www.mdsz.hu/en/netfit-2/about-netfit/

19. CSÁNYI, T., FINN K., WELK G. J. et al. 2015. Overview of the Hungarian National Youth Fitness Study. Research Quarterly for Exercise and Sport; 86 (Sup 1): S3-S12.

20. SOMHEGYI, A. 2017. Daily physical education (DPE) as part of holistic school health promotion (HHP) in Hungary. The 19th EUSUHM Congress Youth Health Care in Europe, Leuven. Abstract and presentation available:
https://kuleuvencongres.be/EUSUHM2017/

21. SOMHEGYI, A. Furthering role of public health experts and institutions in holistic school health promotion. English abstract available. Népegészségügy; 2018; 96:69-76

22. SOMHEGYI A: Daily physical education as part of holistic health promotion in Hungarian schools. In: Dlouhy, M. (Ed.) Proceedings of the 3rd V4 Conference on Public Health 2017. Prague, Professional Publishing, 2018. Available from: https://nb.vse.cz/~DLOUHY/v4_public_health_Prague_2017_proceedings.pdf