The new contributions of education and the hope of articulation with the valuable contributions of health

Since 1984, and as per Law no. 3/84 of 24 March, the implementation of sexual education has been legally established as an integrating part of the “fundamental right to education (…) in schools” (Law no. 3/84 of 24 March, page 981). Successive legal and normative framework has further reinforced this implementation of the law. It is believed that schools have taken the first formal steps in the education and promotion of health, with the setting up of the National Network of Health Promoting Schools (i.e. RNEPS).

This has occurred as from 1994 onwards, the year Portugal joined the European Network of Health Promoting Schools School – RNEPS- (Duarte, 2005). Whereas back in 1994 the number of schools (10) and health centres (4) that were part of the RNEPS was minimal, this number grew as a result of partnerships between Health and Education (Duarte, 2005).
These schools worked together with local health centres (through School Health Teams) and carried out health education and promotion projects, namely in the area of sexual education, which was a basic need.

Thanks to the combined field work between Health and Education (legally set up and enforced), the various players in health education and promotion, such as parents, health professionals, and students, were able to carry out initiatives, such as awareness-raising and information sessions, and deliver training at the Health Promoting Schools.
Accordingly, and despite the fact that schools benefited from the essential contribution of Health in the area of sexual education, and of the Health School National Programme (i.e. PNSE) being in force, the intervention of health professionals in this context was gradually withdrawn, and, nowadays, it is not done in the context of health education and promotion.

Perhaps due to shortage of human resources, combined with the social and economic conditions of the country and of the population, Health was forced to reduce or cut the number of technicians appointed to intervene in health education. In general terms and at a national level, Health has “again” taken more of a remedial role than that of health educator and promoter.

Nowadays, with Law no. 60/2009 of 6 August (framework for the enforcement of sexual education in schools) and Ministerial Edict no. 196-A/2010 of 9 April (regulating the Law and defining the appropriate syllabi to each level of education), schools have to face the challenge of sexual education. However, they are more “alone” in this process.
Once more, Health is requested to ensure that health and sexual education is “supported locally by the competent public health unit as part of school health activity”, as per Ministerial Edict no. 196-A/2010 of 9 April, p. 1170-(3).

This support had already been referred to in the Protocol signed on 7/02/2006 by the Ministries of Education (i.e. ME) and of Health (i.e. MH), represented by the corresponding ministers.

The purpose of this protocol, which strengthens the partnerships between the Health and Education sectors, is to carry out health education promotion activities in schools, based on the options of the ME, with particular emphasis on the clarification of sexual education policies, and the options of the MH, through the dissemination of health promotion in schools.
The same document refers that “promoting health education in schools is a permanently ongoing process carried out by the Education and Health sectors. This process contributes towards the acquisition of competences by children and adolescents, allowing to positively confronting themselves, build a life project, and be able to make individual choices with conscience and responsibility. The mission of health education promotion in schools is also to create environments that facilitate those choices and stimulate a critical attitude that enables them to pursue an active citizenship” (Protocol between the Ministry of Education and the Ministry of Health, 2006, p. 1).

In this document, the MH states it will “encourage the Health Services’ participation in order to carry out the School Health National Programme, with a view to promoting children’s health, as well as that of adolescents and the remaining educational community, and to obtaining health gains, namely by (…) encouraging local health structures to include health promotion in schools in their Activity Plans”(Protocol between the Ministry of Health and the Ministry of Health, 2006, p. 4-5).
This idea is stressed in the Programme of the 17th Constitutional Government. Chapter II states that “ The work of the National Network of Health Promoting Schools had, by the end of 2002, managed to have 3403 participant schools, supported by 366 health centres, and involving about 1/3 of the student population in public schools, ranging from pre-school education to the 12th year of education. The RNEPS programme promotes the health of children and of their families, placing schools within the community network backed by the corresponding local councils. By the end of 2005, our target is to attain again the levels achieved in 2002 and, gradually up to 2010, involve the total number of schools included in the education system, with the support of the Health system” (Programme of the 17th Constitutional Government, 2005, p.11).

Therefore, the challenge the compulsory involvement of Health in the educational project presented to Education means that schools are trying to find a timely and agreed solution led by exiting technicians with responsibility for that purpose (namely through health coordinating teachers and an health education and sexual education interdisciplinary team).
The challenge, with a similar response, was given to the Health sector, and still there are not appropriate resources or sufficient encouragement (namely by means of enforcing the PNSE and the appointment of someone to lead the school health team) to be able to offer an adequate solution. It must be stressed that this response is essential if one is to carry out the Health plan successfully.
Only then will it be possible for Health to be “created and lived by people within the settings of their everyday life: where they can learn, work, play and love”! (Ottawa Charter, 1986).

Ana Luísa Duarte
Clinical Psychologist working in educational environments
psic.ana@gmail.com

Bibliography
Ottawa Charter for Health Promotion – First International Conference on Health Promotion (1986). Acceeded on 9 October 2010, at the Public Health Web site: http://www.saudepublica.web.pt/05-PromocaoSaude/Dec_Ottawa.htm

Duarte, A.L.S. (2005). A influência das práticas da Saúde Escolar na construção das significações da Saúde nos jovens. Master Degree Dissertation in School Health. Faculty of Medicine – University of Lisbon, Lisbon. 111 pp.

Law no. 3/84 of 24 March. Diário da República n.º 71 – I Série. Assembleia da República. Lisbon.

Law no. 60/2009 of 6 August. Diário da República n.º 151 – I Série. Assembleia da República. Lisbon.

Ministerial Edict no. 196-A/2010 of 9 April. Diário da República n.º 69 – I Série. Ministries of Health and of Education. Lisbon.

Programme of the 17th Constitutional Government. Acceded on 9 October 2010, at the Portuguese Government’s website: http://www.portugal.gov.pt/pt/GC17/Governo/ProgramaGoverno/Pages/programa_p011.aspx

Protocol between the Ministry of Education and the Ministry of Health. Acceded on 9 October 2010 at: http://www.dgidc.min-edu.pt/saude/Documents/1_ProtocoloMEMS.pdf