Healthy Schools: Healthy Living and Social Harmony 校園 健康 生活 : 健康 生活 、 和諧 人際

1. Healthy Schools: Healthy Living and Social Harmony 校園健康生活: 健康生活、和諧人際 Seminar for Schools organised by Education Bureau, Hong Kong SAR Professor Albert Lee Director of Centre for Health Education and Health Promotion Professor(Head of Family Medicine Unit) Department of Community and Family Medicine The Chinese University of Hong Kong Member of Curriculum Development Council, HKSAR and Chairman of Health Management and Social Care Panel 李大拔教授 香港中文大學醫學院健康教育及促進健康中心主任 香港中文大學醫學院社區及家庭醫學系教授 香港特別行政區課程發展議會委員及健康管理及社會關懷課程委員會主席

2. 健康素養與社區健康Health- Literacy and healthy community • 提昇社區人士的健康素養，有助集體式地增加他們對影響健康的社會、環境、架構及政策方面的因素之瞭解。 Higher level of health literacy within communities are likely to lead to a collective deeper understanding of social, environmental, organizational and political factors that impact on health. • 從而賦權予他們，多關注地區性的健康問題，並與其他社區人士協作，共同推動社區及政府改善問題。 Community members are likely to be more empowered to engage in debates around local health issues, and more enabled to collaborate with others in advocating for change at community and government level.

3. Mandala of Health: a model of the human ecosystem 人類生態系統模型 文化 Culture 社區 Community 生活習慣 Lifestyle 家庭 Family Psycho-socio-economic environment Personal behaviour 心理社交經濟環境 個人行為 精神 Spirit  Sick-care system 病患照顧系統 工作 Work 思維 Body Mind 身體 Human biology Physical environment 人類生物 物質環境 Human-made environment 人造環境 Source: Hancock and Perkins Health Education, Summer 1985, pps-10 生物圈 Biosphere

4. What are the learning goals? 課程改革有哪七個學習宗旨？ • Healthy lifestyle • 健康生活方式 • Responsibility • 責任感

5. 核心能力Core Competencies • 核心能力所涵蓋的層面不單是態度和知識 Competencies include more than attitudes and knowledge • 學生通過自省，建立有效和長遠的態度與價值觀，從而發展一套有效、具基礎及合乎道德的行為。 Students need to be empowered to think for themselves and develop sound and lasting attitudes and values, which direct their behaviours in consistent, fundamental and ethically sound ways. • 除了可以從校本社交及情緒工作坊中學會核心能力之外，輔導、治療、個人發展和社區為本的工作坊也可發展核心能力。 The competencies can be drawn from school based work on social and emotional learning, but also from counselling, therapy, personal development and community based work.

6. 核心能力 Core Competencies • 自尊來自從別人身上感受到自己的價值、在達成抱負時經歷的成功感以及受重視和具備才能的感覺。自尊可以幫助抵抗威脅及焦慮。 • The antecedents of self-esteem are the extent to which we feel valued by others, experiences success in achieving our own aspirations, and feel significant and competent. A sense of self-esteem can help to defend against threats and anxiety. • 要提升自尊，信任和安全感十分重要。 • A sense of trust and safety is essential building blocks for self-esteem.

7. 核心能力 Core Competencies 一般人認為社會及情感教育與傳統教學理念有衝突實為謬誤。其實，正面及健康的學校環境可幫助學童學習。It has always been an incorrect argument that social and affective education is in conflict with traditional academic goals. In fact positive and healthy school environment will enhance learning.

8. 核心能力 Core Competencies 這不單是有關健康的題目，這同樣與年輕一代能否有效處理社交及情緒能力有關，如終身學習、人際關係、解決問題的技巧、適應複雜的外在環境等等。 It is not simply a health issue but it is about the social and emotional competency of young generation to enable them successful management of life tasks such as life long learning, inter-personal relationship, problem solving skills and adaptation to complex external environment.

9. Social Impact of School Health Promotion健康學校的社會影響 • Health Promotion actions can change the attitudes and behaviour of students towards positive, life enhancing activities are important to improve health and well beings and would contribute to the social inclusion and social justice 健康促進行動能使學生的態度及行為變得正面，具生活意義的活動亦有助改善學生的身心靈健康，於維持社會接納及社會公義有利 (Education and Health in Partnership: European Conference, 2002)

10. Social Impact of School Health Promotion健康學校的社會影響 • Social justice enables young people to develop life skills to be effective citizens, builds strong and inclusive linkage in society and helps eliminate poverty in the long run 社會公義使青少年能夠發展生活技能以承擔公民責任、亦在社會上建立接納及包容的人際網絡、長遠來說有利解決地區貧困 (Scottish Executive, 2002)

11. Mission of a Health Promoting School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 students, staff and parents to actively influencetheir 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, Minister of Education and Young People, Scotland)

12. Social社會 Educational教育 Personal 個人

13. Education and Manpower Bureau, HKSAR 香港特別行政區政府 教育統籌局 WHO Western Pacific Region 世界衞生組織西太平洋區 Hong KongHealthy Schools Award Scheme Healthy Schools (Pre-school) Award Scheme Education and Manpower Bureau, HKSAR 香港特別行政區政府 教育統籌局 WHO Western Pacific Region 世界衞生組織西太平洋區

14. Physical & Social Environment • Safe environment安全環境 • Provide proper sanitary facilities and water 提供適當的衛生設備和水 • Suitable physical environment to enhance learning 提供合適的環境以幫助學習 • Encourage students to take care school facilities 鼓勵學生照顧學校設施 • Implement activities to promote healthy environment 實施促進健康環境的活動 • Smoke free school Quality School: Safe and healthy conditions for the life and work of the whole school community can promote better teaching and learning, and also better interpersonal relationship 安全和健康的生活及工作環境能提升教學及學習質素，同時增進人際關 • The school should promote self-esteem of students and staff through positive reinforcements and addressing the needs of students and staff 建立支持學生及教職員心理健康及社會需求的校風 • Creates an environment of friendliness, care and trust in school創造互相關心、信任及友好的環境 • Greater concerns and emphasis on parental education, and understand its importance to the whole person development of school children關注家長的教育需求，並注意這些需求對學生身心狀況 的影響 • Assistance for students with special needs給予那些處於相對弱勢地位的學生(如新移民、肢體殘障等)適當的支持和幫助 • Promote a sense of responsibility and sense of achievement and self worth 鼓勵學校成員對自己的行動、健康行為及生活模式負責

15. Establishing the Culture of Friendliness, Care and Trust Examples: • Mentoring projects • Main themes activities for different grades • Use of display board, exhibitions, leaflets • Seminars • Visits • Volunteer work and social services • Experiential learning/team building

16. Prevent Violence and Bullying Examples: • Real case and enlightening stories sharing • Visit police station, higher court, correctional services, prison, etc. • Provide outward bound or army training • Volunteer work • Home visit

17. 和諧校園的重要性Importance of Harmonious School • 兒童受其身處之社會的標準及價值觀影響，而養成他們的親社會還是反社會的行為模式。 Children learn their patterns of behaviours either prosocial or antisocial from the norms and values held by the social environment which they are bonded. (Catalano et al, 2004) • 11-12歲的兒童，他們的行為都受到朋輩壓力的影響 。 Durkin (1995) argues that at the age 11-12, children tend to conform to some kind of pro-social pressures from the peer group. (Durkin, 1995)

18. 和諧校園的重要性Importance of Harmonious School 校園和諧 Harmonious School 學校與學生之間的聯繫 Bridge Between School and Students 學生的責任感，對學校的歸屬感 Student’s Responsibility, Sense of Belonging to School

19. 和諧校園的重要性Importance of Harmonious School • 當學生意識到他們受老師和朋輩所關懷，同樣可以減少欺凌的行為。 If students perceive themselves as receiving care from teachers and peers, it will also discourage bullying behaviours. 減少有欺凌的行為 Decrease in bullying behaviors 感受被老師及同學關懷 To feel teachers and classmates’ caring

20. Effectiveness on Health Promoting School健康促進學校的成效Lee A., Kiyu A., Milman HM., Jara J. Improving Health and Building Human Capital through an effective primary care system. Journal of Urban Health 2007; 84(supp1): 75-85Lee A., Cheng F., Fung Y., St Leger L. Can Health Promoting Schools contribute to the better health and well being of young people: Hong Kong experience? Journal of Epidemiology and Community 2006; 60:530-536 Lee A., St Leger L., Moon AS. 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* 2005; XII (3-4): 123-130.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.Lee A., Wong M., Cheng F., Yuen H., Keung V., Fung Y. Impact of healthy schools award scheme and Health Promoting Schools teacher training programme on health behaviours of students. 5th Nordic Health Promotion Research Conference, University of Southern Denmark, Esbjerg, Denmark,15-17 June, 2006.

21. Changes observed in School Health Policies after Implementation of Health Promoting School發展健康促進學校後，學校健康政策的改變 (n=32 schools) • Healthy eating policy 健康飲食政策 • A smoke free school 無煙校園 • Policy on prevention of infectious disease 預防及控制傳染病政策 • First Aid and safety policy 急救及安全政策 • Violence and bullying policy 預防欺凌及暴力行為政策 • Occupational safety and health policy 職安健政策 %

22. School ethos and interpersonal relationship and Life Satisfaction校風/ 人際關係及對生活的滿意度 Life Satisfaction 對生活的滿意度 School ethos and interpersonal relationship校風/ 人際關係 ( *P value = 0.046 )

23. 學校鼓勵學生參與社區活動及社會服務Schools encouraging students to participate in community activities and services ( *P值 = 0.005 )

24. Improvement on Health and Well-being of Students學生健康行為的改善 • Bullying problem 欺凌問題 Primary schools (Schools = 7; No. of students: 820)小學（學校=7；學生數目=820） Secondary schools (Schools = 8; No. of students: 2661)中學（學校=8；學生數目=2667） *P value < 0.05

25. Distribution of schoolsof Primary 4Lee A. et al. Can Health Promoting Schools Contribute to the Better Health and Wellbeing of Young People?:The Hong Kong Experience. Journal Epidemiology and Community Health. 200660:530-536 Mental Health情緒健康 ** P<0.05

26. Distribution of schools of Secondary 3Lee A. et al. Can Health Promoting Schools Contribute to the Better Health and Wellbeing of Young People?:The Hong Kong Experience. Journal Epidemiology and Community Health. 2006; 60:530-536 Mental Health 情緒健康 ** P<0.05

27. Impact of healthy schools award scheme on school environment and health behaviours of students.健康學校獎勵計劃對學校環境及學童健康行為的影響5th Nordic Health Promotion Research Conference第五屆北歐健康促進研究大會University of Southern Denmark, Esbjerg, Denmark, 15-17 June, 2006南丹麥大學　丹麥艾斯堡　2006年6月15-17日Lee A., Wong M., Cheng F., Yuen H., Keung V., Fung Y. Another cross-sectional survey was conducted in two categories of schools in 2005 於2005年，為以下兩類學校進行橫斷面調查： 1. Schools in the HAS Scheme (hereafter called “HSA”) 　健康學校獎勵計劃之參與學校（以下簡稱為「HSA 」） 2. Schools that were not in the HSA Scheme and whose teachers did not attend any training in HPS or diplomas (hereafter called “controlled school”)學校沒有參與健康學校獎勵計劃及其學校之教職員亦從沒接受健康促進學校培訓或參與課程（以下簡稱為「對照學校」） Schools in category (3) will be used as controls. 組別(3)的學校所得之數據將作為比較之用。

28. Impact of healthy schools award scheme on school environment and health behaviours of students健康學校獎勵計劃對學校環境及學童健康行為的影響 Primary schools小學 (p=0.001) Secondary schools中學 (p=0.001)

29. Impact of healthy schools award scheme on school environment and health behaviours of students健康學校獎勵計劃對學校環境及學童健康行為的影響 Secondary schools中學

30. Impact of healthy schools award scheme on school environment and health behaviours of students健康學校獎勵計劃對學校環境及學童健康行為的影響 Secondary schools中學 (p=0.001)

31. Risk and Protective factors associated with suicidality among the Chinese adolescent in Hong Kong與香港青少年自殺問題相關的危機及預防因素 Lee A., Wong SYS, Tsang CKK., Ho G., Wong WCW Wong, Cheng F. Poster discussion paper. 36th Annual Scientific Meeting of The Society for Academic Primary Care: Primary Care Research for Better Health: Delivering International Excellence. Hosted by Royal Free and University College Medical School University College London on behalf of London Department of General Practice and Primary Care, 4-6 July, 2007

32. 企圖自殺Attempted suicide —estimated odds ratios (stepwise forward multiple logistic regression) Nagelkerke R-square=0.520

33. Community Relationship • Family involvement in school activities提倡家庭參與學校生活 • Community involvement in school activities提倡社區參與學校生活 • Proactive linkage with other schools and communities學校能積極地與當地學校社區連繫 Quality School: Link with the wider community in relation to cultural, social and work-oriented activities 就文化、社會及職業導向有關的活動策劃 及推廣聯繫社區伙伴

34. 您知道家庭（FAMILY）這個詞的意味著什麼嗎？ 家庭 FAMILY= 爸爸(F)ATHER 和 (A)ND 媽媽(M)OTHER 我(I)愛(L)OVE你們(Y)OU

35. Main effects of family on health: Nature and Nurture Apart from genetic Influences (every individual is a product of the interaction between his genotype and the environment), there is a large body of evidence supporting the relationship between family pathology and childhood disorders both physical and behavioural e.g. respiratory disease, bedwetting, failure to thrive.......

36. Influence on the spread of disease • Infection • Neurotic illness- spouses and children of neurotic people are at risk of neurotic illness • It has been shown in one study that male with severe family problems are three time more likely to develop angina

37. The family as a system Anything affects one member of the family affects relationships within the family as a whole

38. Modes of Partners’ involvement in HPS Learning at home Parenting Education partners(Schools、families 、communities) Collaborating with the community Communicating Decision making Volunteering (Epstein, 1995)

39. Model of Family, School and Community Relations (external structure) • Student get older  • Spheres of influences pulled apart  • Shared area  Community School Family

40. Model of Family, School and Community Relations (external structure) • HPS  • Application of Community Relationship Strategies  • Shared area Community School Family

41. Growth Across Life Span Family Infant  Toddlers  Childhood  Teenage  Late  Young  Late  Elderly adolescents adults adults Nursery School School School Workplace Workplace Peers & Peers Peers Peers Friends Neighbourhood Pre-school Local Wider Local Society Professional community community & global Families of Affiliations community spouse or Families of Neighbourhood close partners spouse or Affiliations close partners (Clubs)

42. Protective factors that serve as a coat or armor and promote resiliency • Being reared in a loving, functional family • Being involved in school activities • Having positive self esteem • Having clear defined goals and plans • Feeling a sense of accomplishment at school • Positive, healthy and active living lifestyles

43. Protective factors that serve as a coat or armor and promote resiliency • Having close friends and adult role model who do not have addictive behaviours • Having a healthy attitude about competition and athletic performance • Being committed to following the rules of the community and respect social values • Having a plan and support in coping with life stressors

44. Healthy Schools(Pre-school) Award Scheme • Project launched in 2005. • Supported 100 local kindergartens developed along the concept of health promoting school.

45. Healthy Schools Mentorship Project新界西健康學校夥伴計劃 Strengthening Social Capital 強化社會資本 Enhancement of Social Harmony促進社區共融 Organic Farming Workshop Medical Room & First-aid Facilities Workshop

46. Healthy City Programme Mental Health 情緒健康 Healthy Workplace Health Promoting School Effective Health Promotion via Setting Seminar organized by Shatin Doctors’ Network Health Promotion in Primary Health Care Healthy Workplace

47. Kostarova L (2005). Empowering children for risk-taking-children’s participation as a health promotion strategy in the “Safe Schools in a Community Risk’ project. Promotion and Education, X11(3-4): 142-143.裝備兒童面對危機挑戰－推動兒童參與作為「於社會危機中建設安全學校」計劃之健康促進策略 Children in communities exposed to rapid changes such as a war or refugee crisis are forced to learn quickly and more quickly, than children in stable environments. They become more receptive and skilful in recognising and dealing with changes. However, the challenges in community at risk cannot persist in long run for children especially for children with lower social power. 生活於社會環境急速變化之兒童，例如正處於戰爭或難民潮湧現的社會，與生活在安穩社會之兒童相比，他們被迫以很快的速度不斷學習。這些兒童的接受能力較強，而且更容易洞悉及處理轉變。然而，兒童沒法長期處於一個充滿危機的社會，尤其是那些擁有較少社會力量的兒童之情況更甚。

48. Following a year of armed conflict, the project “A Safe Schools in a Community Risk” was initially designed to reduce a general feeling of insecurity in the children and their teachers, and to restore the lost trust of the multi-ethnic school and community faced with the crisis. The project was carried out in the northwest of Macedonia characterized by a rich multicultural tradition which is a key part of Macedonian concept of HPS. 經過一年武裝衝突過後，推出「於社會危機中建設安全學校」計劃，藉以減輕學童及老師之不安情緒，並且於面對危機的不同種族及社區之間重建互信基礎。此計劃於馬其頓之西北部推行，這地方擁有多種不同文化傳統，為乃於馬其頓實踐健康促進學校概念之重要部分。

49. The goals are 計劃目標： • raise the community awareness of continuous crisis, the needs and rights of children to restore the feeling of safety and belonging 提升社會關注兒童處身持續社會危機裏，重建他們的安全及歸屬感之需要及權利 • reduce the post-traumatic consequences of war so students and staff can involve actively in school and community life 減低戰後創傷之影響，鼓勵學生及教職員積極投入學校及社會生活 • build a sustainable networks of assistance and support under the adverse living conditions 建立具持續性的支援網絡，並於惡劣生活環境中提供支援

50. The project was a highly participatory, democratic and multi-level in its approach to the problem. The project started with networking and cooperation amongst teachers, school heads, and students. The subject of ‘violence’ was a taboo and was not discussed openly outside families. This issue was gradually introduced in a sensitive way into the schools’ activities. 計劃採取積極參與、民主及多層面的策略以處理有關問題。計劃之始由一群教師、校長及學生組織網絡及建立合作關係。「暴力」是一項禁忌，於家庭之外是不容談論的；而計劃逐步把這議題引進學校活動之中。