the SDGs.

Chapter 1

1

The SDGs consist of 17 goals and 169 targets under these goals. The 17 goals are as follows:
Goal 1: End poverty in all its forms everywhere
Goal 2: End hunger, achieve food security and improved nutrition and promote sustainable

Healthagriculture
Goal 3: Ensure healthy lives and promote well-being for all at all ages
Goal 4: Ensure inclusive and equitable quality education and promote lifelong learning
opportunities for all

Learning objectives
You will be able to gain proper understanding and explain:

Goal 5: Achieve gender equality and empower all women and girls- The deﬁnition and aspects of health.

Goal 6: Ensure availability and sustainable management of water and sanitation for all- The importance and beneﬁts of health education programs in schools.

Goal 7: Ensure access to affordable, reliable, sustainable, and modern energy for all- The signiﬁcance of implementing school health activities.

Goal 8: Promote sustained, inclusive, and sustainable economic growth, full and productive- School health policies and initiatives adopted in Cambodia.

employment, and decent work for all
Goal 9: Build resilient infrastructure, promote inclusive and sustainable industrialization, andfoster innovation

This chapter provides basic knowledge necessary to understand human health and school healthinitiatives. First, we introduce basic health concepts and a few new ideas, and underscore that health isGoal 10: Reduce inequality within and among countries

a basic human right. Next, we explain the concept of child health based on the characteristics of child

Goal 11: Make cities and human settlements inclusive, safe, resilient, and sustainable

development. We also outline the global trend towards health promotion and building healthy societies,

Goal 12: Ensure sustainable consumption and production patterns

and describe the importance of school health initiatives, their four pillars, and school health policy in

Goal 13: Take urgent action to combat climate change and its impacts

Cambodia.

Goal 14: Conserve and sustainably use the oceans, seas, and marine resources for sustainable
development
Goal 15: Protect, restore and promote sustainable use of terrestrial ecosystems, sustainably manage

1. Aspects of healthforests, combat desertification, and halt and reverse land degradation and halt
biodiversity loss
Goal 16: Promote peaceful and inclusive societies for sustainable development, provide access tojustice for all, and build effective, accountable and inclusive institutions at all levels
Goal 17: Strengthen the means of implementation and revitalize the global partnership forsustainable development“Health” is a term that encompasses the physical, mental, psychological, and social state of humanbeings in a single word.
The constitution of the World Health Organization (WHO), signed by representatives of 61 nationsin 1946, describes the most desirable and ideal conditions for health with the following statement:“Health is a state of complete physical, mental and social well-being and not merely the absence of

The terms in bold in the list of 17 goals are those that are discussed in this textbook in relation todisease or inﬁrmity.”1 The WHO Constitution also declares that “enjoyment of the highest attainable

health and well-being, safety, and hygiene. They show that school health is not just about health education

standard of health is one of the fundamental rights of every human being.”1 This right must be guaranteedin schools, but that it plays a vital role in working towards the SDGs and can make a significant

regardless of race, ethnicity, religion, political belief, or socioeconomic status.1

contribution to Cambodian society. Furthermore, as stated in the Cambodian School Health Policy
2,3

The WHO Constitution warns that inequalities exist in the areas of health promotion and infectious(2016, 2019) , university students, pupils, and teachers who have studied school health are expected todisease control, depending on respective levels of socioeconomic development among nations. Suchbecome human resources who can contribute to a Cambodian society that grows sustainably and isconditions are described as a threat shared worldwide, not just among developing nations.1

peaceful and healthy.

More recently, global climate change as well as the spread of lifestyle-related diseases accompanying
changes in people’s ways of life and the rise in average human life expectancy have had a conspicuous
impact, prompting new ideas about health. One such example is to seek lifestyles that are in harmony

References

20

1

Cambodia Sustainable Development Goals. https://www.csdgs.org/km/

2

Ministry of Education, Youth and Sport. SCHOOL HEALTH POLICY. 2006.

3

Royal Government of Cambodia. National Policy on School Health. 2019.

with the environment and ecosystem. For instance, the Ecohealth concept is rooted in awareness thathuman beings are also part of the ecosystem (Figure 1.1). This approach to human health stresses theimportance of maintaining a balance among the environment, the ecosystem, socioeconomic development,
peoples’ livelihoods, production activities, and lifestyles.2
Chapter 1
Health21

Therefore, health is a multidimensional concept including at least five aspects (Figure 1.2), which

nomic develop
eco
me
cio
nt
o
S

are often interdependent.

man health
Hu

LivelihoomandHuColumn: What is the WHO?

ECOHEALTH

The WHO was established as the directing and coordinating authority on international health within
the United Nations system in 1948. The WHO mission is to promote health, keep the world safe, andserve the vulnerable. Now more than 7,000 people from over 150 countries work in 150 national

E cosyst e moffices, 6 regional offices, and at our headquarters in Geneva.

Figure 1.1 Ecohealth is a health concept that says socioeconomic development influences

the ecosystem and human livelihood, and thus human healthWith the advancing age of populations in many nations, the world is moving into an era in whichmost people will have to deal with lifestyle-related diseases and physical, cognitive, psychological, and(Cited from: https://www.who.int/about/who-we-are/our-values, and https://www.who.int/about/
who-we-are )2. Health is a human rightsocial dysfunction. Such trends have encouraged people to accept and deal with health challenges.
Rather than eliminating disease and impairment, for example, greater emphasis is being placed on the

Health is considered a basic right for all people, regardless of their race, ethnicity, religion, politicalability to achieve decent living conditions despite illness or impairment, which involves controlling thebeliefs, or socioeconomic status.1 True to this principle, it is vital for the nation of Cambodia to ensure

lifestyle impact of such negative conditions while receiving the social support necessary to cope withthat all of its citizens enjoy access to the highest attainable standard of health.

such circumstances.

3

Healthy development, particularly for children, is a fundamental right in all nations. With that goal

In 1998, the WHO Executive Board approved a proposal to add “spiritual health” to the categories

in mind, the WHO Constitution emphasizes the importance of nurturing children who can liveof physical health (e.g., physiology, morphology, and body structure and function), mental healthharmoniously in a changing total environment.1 In this regard, school health initiatives play a vital role(e.g., intellectual and cognitive function), psychological health (e.g., emotional, behavioral, andin efforts to ensure that children attain sound development within the changing environment.

psychological development), and social health (e.g., participation, engagement in activities, and socialrole).4 While that proposition has yet to be officially adopted, spirituality is a vital dimension in thehealth and happiness of the people in the Buddhist nation of Cambodia. Spirituality has no ties to

3. Health during the developmental period

specific religions. Rather, it describes the universal spiritual nature surrounding our origins as humanbeings. It is the state of mind in which we experience sensations, such as harmony, goodness, beauty,

Human growth and development commence from encounters between sperm from a male and an ovum

sacred tranquility, and eternity beyond life and death. That inner state is brought about by feeling a(egg) in the female, with the fertilized egg(s) growing in the woman’s womb. The growth and development

connection with entities that transcend human beings through our mental activity, such as praying or

cycle follow a process of maturation that continues after a child is born, with various capacities andexpanding our minds to connect with nature and the universe.

characteristics peaking during adulthood. After attaining this peak, human beings experience the natural
phenomenon of aging. This phase is characterized by gradual decline and loss of capacities, eventually
Biological
Mentalresulting in death.
Within the course of human life, kindergarten, elementary, junior high, and high school students—
the targets of school health education—are in an age bracket defined by steady growth and development.
As they mature into adults, their minds, bodies, and social relationships evolve and change daily. The

Health

Psychological
SocialSpiritual

Figure 1.2 Multidimensionality of health22

term “developmental health” is used to express the changing reactions of such children during thisperiod to various experiences, the surrounding environment, and other factors.5“Developmental health” is thus a term used to express the process leading toward maturity that
schoolchildren follow. They experience various things (e.g., friendship, commitment to learning, leisureactivities, support from others, and mutual help) within social environments (e.g., school, family, andcommunity) and acquire numerous qualities (e.g., indulgence, honesty, trust, collaboration, curiosity,
Chapter 1
Health23

sense of justice, and aspiration) through interactions with their environment that steadily increase their

4.

food

intellectual, physical, and emotional capacities to their full potential.

5.

income6.

a stable eco-system

7.

sustainable resources8.

social justice and equity

4. Health promotion
1) Background to the concept of health promotion

To inspire good health, it is vital for society to fulfill each of these conditions.
Six areas are identified as pillars of the health promotion movement.8 The key points of these pillars

Research in the 1970s and 1980s made it increasingly clear that certain aspects of personal lifestyles andare summarized below.

daily habits—including diet, exercise, rest, sleep, smoking, alcohol consumption, and work styles—are
primary factors in causing disease. The first work to bring about this change was A New Perspective on
the Health of Canadians by Marc Lalonde, published in 1974 and often referred to as the “Lalonde
6,7report”.

Lalonde also emphasized the role of physical and social environments as determinants ofhealth that are out of individuals’ control. However, this evidence strengthened the trend towards viewing
disease as a matter of personal responsibility, and efforts to both prevent disease and improve health1.

Build Health-focused Public Policy
Health promotion puts health on the agenda of policymakers in all sectors and at all levels,
directing them to be aware of the health consequences of their decisions and to accept their
responsibilities for the people’s health.

2. Create Supportive Environments

have focused on individuals, with little attention paid to social elements or social environments that

Health promotion creates living and working conditions that are safe, stimulating, satisfying,influence people’s daily habits.

and enjoyable.

Naturally, not everyone can freely determine their own daily habits, lifestyle choices, and other

3. Strengthen Community Actions

aspects of life. Key factors in this context include the quality of education received, work performed and

Health promotion works through concrete and effective community action in setting priorities,

level of income earned, quality of housing and co-habitants, foods consumed, and how leisure time ismaking decisions, planning strategies, and implementing them to achieve better health.

spent. Such factors are heavily affected by circumstances such as the communities in which people live,

4. Develop Personal Skills

their workplaces, cultural and economic conditions at provincial, district, and national levels, and social

Health promotion supports personal and social development through providing information,

stability and policies. Thus it is essential for communities and nations to collectively support the healthhealth education, and enhancing life skills.

of their citizens.8 The concept of health promotion evolves from this background.

5. Reorient Health Services
The role of the health sector must move in a health promotion direction, beyond its responsibility
for providing clinical and curative services.

2) The Ottawa Charter for Health Promotion

6. Moving into the Future
Caring, holism, and ecology are essential issues in developing strategies for health promotion.

The First International Conference on Health Promotion took place in Ottawa, Canada, on November

Holism is the idea that every part of a whole is intimately intercorrelated.

21, 1986. The conference featured the declaration of the Ottawa Charter for Health Promotion. This
charter contained the following definition: “Health promotion is the process of enabling people toincrease control over, and to improve, their health.”8 Health, meanwhile, was defined as follows: “Health3) The Bangkok Charter for Health Promotion in a globalized world8

is a positive concept emphasizing social and personal resources, as well as physical capacities.” Asstated, health was clearly perceived as a resource and capacity for pursuing everyday life, rather than

The Bangkok Charter for Health Promotion emerged from a meeting of WHO member states

being defined as an objective.

convened in Bangkok, Thailand, in August 2005. The meeting was held as globalization advanced

The charter also mentions the following eight areas as prerequisites serving as a foundation forrealizing good health:8

around the world, and reflected the growing impact of that trend on human health.9 The following
declaration was issued at that time: “Health promotion is based on this critical human right and offers apositive and inclusive concept of health as a determinant of the quality of life and encompassing mental

24

1.

peace

and spiritual well-being.”9 This charter emphasizes that health promotion must be the focus of2.

shelterdevelopment planning worldwide, with health also to incorporate spiritual aspects.

3.

education
Chapter 1
Health25

5. School health initiative2) Significance and importance of health education in schools

According to the WHO, approximately 2.3 billion school-age children worldwide spend about a third of

There are various interpretations of the significance of school health education. Dr. Didier Jourdan

their time each day at school. Schools are environments unique in their ability to foster a positive(Professor, Dean of the Faculty of Education at the University Blaise Pascal of Clermont-Ferrand,

outlook on life and establish healthy lifestyles.

10

To achieve these objectives, schools work to

independently formulate various types of health services (e.g., health education, health check-ups, firstFrance) offers two distinctive perspectives.13 The first has to do with security, and the second with thewell-being of the individual and society.

aid, mental health counseling, and school lunches). It is also their mission to collaborate with social

In the first perspective, “security” signifies concern when increasing numbers of young people

resources available in their communities to contribute to the health not only of children, but also of

engage in unhealthy lifestyles and risky behavior due to inadequate knowledge about health. Such aschool personnel, children’s guardians, and local residents. The types of health services that schools

trend could result in damage to one’s own health, injuries to others, and behaviors that raise the economic

furnish and the approaches they use to supply those services—as well as the laws, policies, and ideas

burden on society. Public order could also deteriorate, leading to societal instability. In the interest of

regulating them—differ from country to country.

maintaining the security of society and avoiding such risks, providing young people with health education
at their schools is therefore believed essential.  

1) School health objectives and initiatives

Dr. Jourdan’s second perspective on the significance of school health education, “well-being,”
reflects the moral and ethical obligations of modern nation-states.13 This refers to expectations anddemands for a heightened sense of well-being by the individual and society. In other words, because theLet us look at the examples of the United States and Japan. Below is a summary of the seven school

health of individuals and society in general amounts to well-being, it is vital to make concerted efforts

health approaches and services supplied in the US, as presented by the American School Healthto maintain and improve the health of both individuals and society through school-based health education

11

Association.

School health support in the United States consists of three pillars: the environment,

and health promotion.

services, and teacher training.
• Environment:

3) The link between education and health

A healthy and safe environment, including the physical, psychosocial, and learning environments• Services:

According to Dr. Fiona Brooks (Professor, the Faculty of Health, University of Technology Sydney,

Services and opportunities, including meals, physical activities, and health education as well asAustralia), “research evidence shows that education and health are closely linked. So promoting thecounseling, social work, and nursing

health and wellbeing of pupils and students within schools and colleges has the potential to improve• Teacher training:
Knowledgeable teachers and competent staff for health education and health services

their educational outcomes and their health and wellbeing outcomes.”14
In the “Annual Report of the Chief Medical Officer 2012” issued by the Department of Health, UK,
Dr. Brooks also mentioned that promoting physical and mental health in schools creates a virtuous

In Japan, the Ministry of Education, Culture, Sports, Science and Technology defines the objectivesof school health activities as follows: ensuring that schools strive to maintain and improve the health ofcircle, reinforcing children’s attainment and achievement, which in turn improves their wellbeing,enabling children to thrive and achieve their full potential.15

students and other parties (e.g., teachers and school office staff); giving careful consideration to thehealth and safety requirements for school education activities as a form of group learning; and cultivating
abilities needed to maintain and improve the health of oneself and others.12 To achieve these goals,
schools provide on-site health administration and health education.

6. Cambodian initiatives Focusing Resources on
Effective School Health

Health administration comprises health initiatives such as conducting health checkups and improving
school environments based on the School Health and Safety Act. Health education aims to instill

The Cambodian government has set four goals in its quest for school health: 1) improve the health of all

knowledge and capabilities necessary for healthy living through all school education activities, including

people; 2) improve the capacities and skills needed to prevent sickness and avoid the dangers of accidents

subjects such as physical education and special activities.

in everyday life; 3) supply and encourage opportunities for school health promotion; and 4) ensure equal
access to health education services. These goals cannot be achieved through the efforts of the health andeducation sectors alone; they also require the cooperation of numerous related organizations (e.g., theprivate sector, community organizations and women’s groups, and non-government organizations).

26

Chapter 1
Health27

Based on that understanding, the program has been advanced through the Focusing Resources on

physical health, while promoting sanitation, cleanliness, and comfort in the interests of greater

16

Effective School Health (FRESH) framework.

safety and peace of mind in schools, communities, and public spaces- Participation, collaboration, and coordination of wide-ranging groups, organizations, and

FRESH was first proposed in 2000 as a framework for addressing comprehensive school health. The
program was based on the results of deliberations by the WHO; the United Nations Educational,

agencies

Scientific and Cultural Organization (UNESCO); the United Nations International Children’s

Participation and collaboration by all concerned parties (e.g., schools, local governments, health

Emergency Fund (UNICEF); and the World Bank. Those discussions addressed how best to integrate

workers, community groups, religious groups, and NGOs) to advance school health promotion

the effects of human, financial, and other resources in activities that would have positive effects on

programs

school health.17
In 2019, the Cambodian government introduced a new policy setting out future vision based on the

Under FRESH, the following four areas are considered core components for integrating such

School Health Policy 2006.18 Achieving effective school health in Cambodia based on the new policy

activities:

requires all students, teachers, guardians, and other concerned parties to actively participate and1.
2.

Health-related school policies

collaborate in healthcare services, health education, and environmental enhancement, and to join in

Strategic positioning of health in school administrative policies

efforts to help schools serve as health promotion hubs.

Safe water and sanitation—the essential first steps toward a healthy physical and learning
environment
The true foundation of safe and healthy school environments lies in safe water and sanitation

3.
4.

Column: National School Health Policy 2019 is promulgated

Skills-based health education

Under School Health Policy 2019, by improving the quality of education, the government will engage

Health education positioned to cultivate the attainment of specific skillsin the following challenges; providing health knowledge based on scientific knowledge of mental

Access to health and nutrition services

and physical development, providing basic health services, encouraging the learning of skills for

Supply of outstanding health and nutrition services

preventing infectious and non-infectious diseases, fostering values and behaviors for attaining full
health (mind, body, and spirituality), and enhancing a sense of responsibility for behaviors.

As described above, FRESH serves as a framework for effectively achieving Cambodia’s drive torealize better, more child-friendly schools by prioritizing the aspects of school health expected to produce

Furthermore, the new school health policy has the goal of creating an inclusive learning environment
and fostering a culture of care in school personnel, family, and community.

positive effects.
The new policy has the following eight pillars, of which we list some examples.

7. The future of school health in Cambodia

1

Improve fundamental health of learners and educational personnel- equipping health rooms- providing health examinations and physical measurements, first aid, and vaccination

Since 2006, the School Health Policy has enabled fundamental understanding of Cambodia’s pillars of
17

school health. It consists of the four pillars listed below, which are shared with school health schemes--preventing infectious diseases, food poisoning, and mental health insufficiency
2

Promote nutrition provision

adopted in the US and Japan. Pursuing better school health initiatives in keeping with these schemes is- implementing a school vegetable garden

therefore likely to lead to a brighter future for school health in Cambodia.

- setting environmental hygiene standards- monitoring food sales in educational facilities- Basic healthcare services- setting food safety and hygiene standards

Supplying basic healthcare services that children need to equitably attain physical, mental, spiritual,and social development- providing nutrition education for parents
3- Health education- setting the guidelines of the minimum requirements for water, hygiene, and cleanliness

Promoting behavioral changes in children to achieve well-being and safety (via information supply,- enhancing facility cleanliness and hygiene, and sanitary behavior

knowledge, skills, and changes in attitude to this end)

- strengthening the concept of cleanliness, safety, and hygiene behavior- Environment
Pursuing initiatives to improve facilities and equipment that support learning environments and28

Improve supply of clean water, sanitation, and hygiene

4

Improve safe, inclusive, comfortable and friendly learning environment- creating an environment to support health, happiness, and comfort of children and personnel,
Chapter 1
Health29

including exhibiting educational materials and works- equipping garbage disposal- holding school events- providing education to prevent tobacco, alcohol, and illegal drug use- as accident prevention, setting up signs to inform of danger, traffic signs, and teaching traffic
safety rules
5

Promote security and order in educational institutions- setting “One School, One Harmonious zone” principle- prohibited bring in dangerous materials and weapons- strengthening traffic safety education- installing school fence to ensure safety- teaching accident prevention (drowning accident)- appointing a vice-principal in charge of school health- implementing extracurricular activities for children and teachers in collaboration with healthorganizations and communities

6

Promote health education- making a health education curriculum to introduce health education into teacher training andordinary education- training health education specialists at teacher training institutions- providing in-service training to school teachers and training to teacher training institutions

References
1

World Health Organization Constitution. https://www.who.int/about/who-we-are/constitution

2

Asakura T, Mallee H, Tomokawa S, Moji K, and Kobayashi J. The ecosystem approach to health is a promising strategy ininternational development: lessons from Japan and Laos. Global Health. 2015; 11: 3. doi: 10.1186/s12992-015-0093-0.

3

Huber M, Knottnerus J A, Green L, et al. How should we define health? BMJ 2011;343:d4163. doi: 10.1136/bmj.d4163.

4World Health Organization 101st Session Agenda item 7.3. Review of the Constitution of the World Health Organization: report of5

Australian Medical Association. Developmental Health and Wellbeing of Australia’s Children and Young People - revised 2010.

the Executive Board special group. EB101.R2, 1998. https://apps.who.int/gb/archive/pdf_files/EB101/pdfangl/angr2.pdf
https://ama.com.au/position-statement/developmental-health-and-wellbeing-australia%E2%80%99s-children-and-young-people-- disseminating information on disease/risk prevention- appointing health education managers- fostering a health education role model
7

Promote the implementation of health skills- changing behavior for health, environmental health, and social well-being- learning first aid skills- building a gymnasium- implementing systematic hygiene and cleanliness measures

8

Promote the participation of all stakeholders in improving school health- promoting engagement of relevant agencies, parents, communities, aid partners, monks, andcommunity leaders in school health(Source: Royal Government of Cambodia. National Policy on School Health. 2019)revised6

Lalonde M. A New Perspective on the Health of Canadians -a working document. Minister of Supply and Services Canada, 1981.
https://www.phac-aspc.gc.ca/ph-sp/pdf/perspect-eng.pdf

7

Lalonde report. https://en.wikipedia.org/wiki/Lalonde_report.

8

World Health Organization. Health Promotion: The Ottawa Charter for Health Promotion. https://www.who.int/healthpromotion/
conferences/previous/ottawa/en/

9World Health Organization.  Health Promotion: The Bangkok Charter for Health Promotion in a Globalized World (11 August 2005).
https://www.who.int/healthpromotion/conferences/6gchp/bangkok_charter/en/

10 World Health Organization. Maternal, newborn, child and adolescent health: School health services. https://www.who.int/maternal_
child_adolescent/adolescence/school-health-services/en/
11 American School Health Association. What is School Health? http://www.ashaweb.org/about/what-is-school-health/12 Ministry of Education, Culture, Sports, Science and Technology. Promotion of School Health. https://www.mext.go.jp/a_menu/
kenko/hoken/index.htm
13 Jourdan D. Health education in schools: The challenge of teacher training. Saint-Denis : Inpes, coll. Santé en action, 2011 : 144 p.
https://pdfs.semanticscholar.org/677b/09068a6de93acdc7cde3dce98881b78a667a.pdf
14 Brooks F. The link between pupil health and wellbeing and attainment: A briefing for head teachers, governors and staff in education
settings. Public Health England 2014. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/

Exercises for further thought and research[1-1] Think about what health and the conditions for being healthy mean to you.
[1-2] Consider why school programs need to teach children about health and diseases.
[1-3] Examine how Cambodian society views diseases.
[1-4] Conduct group discussions on what Cambodian schools can do to promote children’s health,reflecting on your own experiences.
30

file/370686/HT_briefing_layoutvFINALvii.pdf
15 Brooks F (2013). Chapter 7: Life stage: School Years, in Chief Medical Officer’s annual report 2012: Our Children Deserve Better:
Prevention Pays, ed. Professor Dame Sally C Davies. London: Department of Health, UK. https://assets.publishing.service.gov.uk/
government/uploads/system/uploads/attachment_data/file/252657/33571_2901304_CMO_Chapter_7.pdf
16 UNESCO, UNICEF, WHO, World Bank and Education International Inter-agency flagship programme in EFA. FRESH acomprehensive school health approach to achieve EFA. 2002. https://www.paho.org/hq/dmdocuments/2016/2002-FRESH-eng.pdf
17 Ministry of Education, Youth and Sport. School Health Policy. 2006. https://www.moeys.gov.kh/index.php/en/policies-andstrategies/1986.html
18 Royal Government of Cambodia. National Policy on School Health. 2019.
Chapter 1
Health31