September 1948 — Vol. 29, No. 9 —
School Children's
Health
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Because it is generally recognized that
ill—health is largely the result of mistakes which could
have been avoided had there been fuller knowledge and greater
care, this article is designed to look into the place of health
education and practice in the school. It is at the school
that for the first time every child's health can be assessed,
and deficiencies corrected. There, if anywhere, is our golden
opportunity for constructive work in building a healthy Canada.
The only limitations on health progress in any age are the
bounds set by the growth of scientific knowledge, the willingness
of those in authority to introduce advanced ideas, and the
readiness of people to pay the cost - a price which is low
relative to the resulting good.
Persons with vision will aim at much more than the prevention
of this or that disorder of childhood. It is no longer satisfactory
merely to detect measles, chickenpox, mumps and other "children's
diseases" and isolate the victims. The new idea implies the
promotion of bodily and mental vigour, strength and alertness,
a target worthy of our best attention.
We Have New Standards
Children born around the beginning of this century had prospect
of an average length of life of only 49¼ years; babies born
in 1947 may look for an average life of 66½ years.
Life has become safer for children, but it is hardly correct
to refer to the death rate in this and that disease as having
"dropped" or "declined." It was pushed down under the feet
of advancing science, the outstanding victories achieved by
medical research men, and the active co—operation of
parents and schools.
Our improved standards of living, too, have taken as their
chief beneficiary the infant and the child. This year's baby
will have more baths in his first twelve months than Frederick
the Great had in all his life. If the baby grows up into an
admirer of Chippendale furniture he will be horrified, equipped
as he is with a three—piece bathroom, to learn that the
great Master seldom was called upon to design a wash—stand.
Today, we have abandoned the 19th Century's mystical absorption
with "Survival of the fittest," and we are trying to do something
about the unfitness of some survivors.
There are, of course, fussbudgets who make this a point
of argument. They suggest that the saving in infant life has
preserved the unfit, and somehow suggest that this is a bad
thing. But they are not right. In addition to the reduction
in mortality there has been a great advance in protective
measures which save children from diseases likely to prove
injurious in later years.
Progress has been made, but our achievements and practice
fall far short of our ideals and knowledge. Dr. Griffith Binning,
Medical Director of Schools in Saskatoon, wrote an article
in the Canadian Journal of Public Health, reporting
on a comparison of Saskatoon children with army volunteers
on the basis of the Pulhems test. Whereas only 41.8 per cent
of the army candidates graded "A", there were 82.5 per cent
of Saskatoon children in this class. Dr. Binning makes this
striking statement: "A physical standard for children should
be evolved, since in their case the present Army standard
is too low an objective to be satisfactory."
What we need today is a gripping sense of the possibilities
of healthful living, and to get away from dependence for satisfaction
upon the reduction of death rates. Lowness of mortality, and
even absence of disease, are not satisfactory standards for
this age.
The C. E. A. Survey
As part of the constructive activity of the Canadian Education
Association and the Canadian Public Health Association, there
was set up in the summer of 1945 a National Committee for
School Health Research provided with financial assistance
by the Canadian Life Insurance Officers Association.
Data have been gathered from 26,101 elementary schools,
about 90 per cent of all in Canada, and 8,000 secondary school
classrooms, about 70 per cent of the total. The conditions
covered in the two reports already published show an average
across the country. and there are wide differences between
provinces, Most of the material in this article, applying
to Canadian schools, is drawn from the committee's reports,
but the comment and interpretation are our own.
Teaching Health in School
Health instruction is a positive duty of the teacher. It
cannot be left to occasional talks by the school physician
or advice from a physical training instructor.
The aims of health education should be practical: (1) to
bring about correct bodily development through physical activities
such as games, corrective exercises and dances; (2) to make
the physical constitution stronger through development of
sanitary and health habits; (3) to detect, and thus take the
first steps toward preventing or stopping physical upsets
such as are caused by dental defects, eye, heart and stomach
disturbances.
Explanations for health habits should be given. It is no
longer sufficient to say "Do this" and "Don't do that." Even
children in elementary classes look for the why and wherefore.
The child should be led to believe that his best health habits
are his normal health habits, and anything less is unworthy.
Health education should be spread through the whole curriculum,
instead of being tacked on as an appendix to a course in physiology
and hygiene. One of the dullest books we know is one on hygiene,
which teaches about physiology instead of telling how the
functioning of the human organism enters into providing the
abundant energy we need if we are to do the things we want
to do.
Physical Examinations
It is said by qualified authorities that school health service
should place its main emphasis on positive action rather than
upon the construction of charts and tabulations. At the same
time, the tabulation arising out of regular medical examination
is needed to find out what defects are threatened. These records
frequently reveal changes in health factors which enable problems
to be tackled in time to prevent lasting trouble.
One of the latest devices is the Wetzel Grid, referred to
in the Annual Report of the Child and Maternal Health
Division of the Department of National Health and Welfare.
This chart, which helps to evaluate the physical status and
growth of children from birth to the age of eighteen years,
was distributed to authorities throughout Canada. It was being
used, according to the 1947 report, in the study of some 6,000
children in British Columbia, and Saskatoon was co—operating
in a study of emotional factors which may influence growth,
a preliminary report on which appeared in this spring's issue
of Health.
It is pointed out, very properly, that neither the Wetzel
Grid nor any other contrivance is designed to try to fit every
child into a preconceived "ideal" weight, height and degree
of development. There are many differences between children,
due to race, family habits, and conditions of living. The
test is: does the child progress? If records of physical examinations
show a halted or stumbling progress, then the child cannot
be looked upon as a satisfactory example of good health.
It will appear very sensible to the business man, accustomed
as he is to the use of flow charts and other devices to keep
business moving smoothly, that there should be a continuous
record kept of every child s health progress. This might start
in pre—natal days, and continue with the family doctor
until school age, then be handed over to the school health
authorities. At graduation, the record should be available
for the employer's physician, and should then follow the subject
to whatever doctor he chooses as his personal adviser.
Prevention of Disease
It is a good thing to cure illness, and great skill is shown
in treatment of those smitten by disease, but it is better
and shows more wisdom to prevent illness.
The policy of tuberculin tests for school children is steadily
gaining favour, and travelling clinics bring the campaign
for early detection of tuberculosis within reach of a substantial
proportion of the school population and the young adult group.
Means of protection against diphtheria and whooping cough,
available to the public free of charge, have done marvellous
things in prevention of these diseases. Smallpox has ceased
to be a serious menace in communities where vaccination is
required. The incidence of goitre among Prairie children was
radically reduced by the administration of iodine in various
forms.
Typical of the work being done in this field is that of
the National Immunization Division of the Health League of
Canada, whose Sixth National Immunization Week was scheduled
this year from September 12 to 18. A truly remarkable reduction
in both number of cases and deaths is recorded by the Division.
Dental Health
The condition of the teeth of our children is still shockingly
bad, said an article in the Statistical Bulletin of
the Metropolitan Life Insurance Company, a publication which
reports monthly on health matters in the United States and
Canada. "Surveys show that more than 95 per cent of the children
reaching 15 have already experienced some decay in their permanent
teeth." An inspection in Montreal in 1946 showed that some
73 per cent of the children examined had dental defects.
Dental decay is largely the result of defective nutrition.
Dr. Alan Brown of the Hospital for Sick Children, Toronto,
said in a radio address: " If children are fed meals that
contain sufficient milk, fruit, vegetables, eggs and meat,
and if they are given a daily dose of fish liver oil during
the eight colder months of the year, they will have much less
dental decay." From the age of three onward, he warned, children
should have their teeth checked every six months. Cleaning
is important, too. It is surely less significant that children
should be taught at school how many teeth they have, and their
names, than that they should learn to brush them daily and
eat the proper foods to build and preserve them.
Nutrition
At the beginning of this century much was made of the theory
that the prevalence of undernutrition was primarily, if not
wholly, an evidence of insufficient food due to widespread
poverty. It is now known that malnutrition may be prevalent
in the homes of the wealthy as well as among the poor, as
a result of faulty selection of food, insufficient rest, and
the aftermath of general infections or other causes.
The truth is that even when a community has advanced to
the point where it has a wide choice of foods, there
is nothing to prevent its people from eating the wrong kind
of food.
In every survey conducted in Canada it has been found that
one child in three could be expected to benefit by eating
a better diet.
The school lunch should be mentioned as one agency which
is operating as a health influence in many schools. The mere
provision of one suitable meal a day results in nutritional
betterment of many children, and when this is accompanied
by an educational programme the results are more outstanding.
Eating places in the school afford a wonderful opportunity
for instruction in good nutrition and development of good
eating habits. By relieving mothers of some of their work,
to the ultimate benefit of the children, school lunches may
prove to be a substantial contribution to better family life.
Physical Training
The purpose of physical training is to promote a strong
body in which all the muscles, because in daily use, perform
their functions properly, giving necessary support to the
vital organs.
More than exercise is involved. Knowledge must be given
of respiration, circulation, glandular action, rest and diet.
When the "why" is explained, the pupil will better understand
the demand made that athletes must be temperate in their way
of living as well as submissive to training.
In a report of the Quebec Protestant Education Survey over
the signature of W. A. F. Hepburn, physical education was
carried into even the one—room school, where the floor
is taken up with nailed—down desks and an immovable stove.
These features, plus the fact that pupils range in age from
five or six to fifteen, present obstacles which might seem
impossible to surmount. But this committee made suggestions,
and if it has found a way of providing indoor physical training
under such circumstances there is no excuse for any school
anywhere to fail.
The committee emphasized the undesirability of stressing
the kind of competition which results from inter—school
leagues. It is all right in its place, but the training of
a few selected athletes should never be done at the expense
of the majority of the pupils.
Mental Health
The subject of mental health merits treatment in a separate
article, but its mention here is necessary because in many
respects it is part and parcel of physical health. Many more
children relieve their emotional tensions by getting sick
than do so by becoming behaviour problems.
It is not sufficiently realized that mental achievement
tests will show a marked drop in the presence of emotional
stresses. The child's I. Q. may appear to be lower than it
really is. Because of worries, which may be of home origin,
he may stay a second year in the same grade, without teacher,
parent or child realizing that the cause is illness.
Ideally, the child would be properly diagnosed, even at
considerable expense. Among the treatments used should be
rest from mental and physical stress. Instead of this, unfortunately,
a child mentally sick because of his emotional problems is
likely to be loaded with pressures from home and school. In
an effort to push him ahead he may be given extra home work
and special lessons. Is it any wonder that the child so often
protests against the mental upset by developing body illness
or relapsing into the more comfortable dream world of mental
disease?
Our schools cannot disregard this emotional side of the
child's life in favour of concentration on his intellectual
development, any more than they can ignore the physical health
side. Intellectual fitness, physical well—being and mental
health are so interdependent that the wholeness of an individual
cannot be achieved if any one is neglected.
While the home is necessarily the most important factor
in mental hygiene, the school and the community have their
responsibilities, particularly in the early unbiased detection
of abnormalities which, if neglected in childhood, develop
into personality maladjustments of adult life.
Twenty years ago it was pointed out in an article in the
Annals of the American Academy of Political and Social
Science: "If the youngster was fairly born, with a good prospect,
and if now, at the age of seven he is developing tantrums,
or if at 16 he has become delinquent, or if at 19 he has developed
a neurosis, or if at 25 he has developed a psychosis not of
an accidental type, or an organic type, then, not having been
born with these defects, where did he get them? If it were
the measles we would ask, 'whom has he been with?' It is a
good question to ask here; and the answer is - mostly with
his parents and teachers."
The National Committee tackles this problem head—on,
and presents this report: "Mental health problems will be
reduced to a secondary position if we strive for: (a) smaller
classes with teachers better trained in at least the elementary
principles and techniques of mental health; (b) a release
from the 'lock—step' system of education in which we
attempt to have forty—odd children of widely varying
abilities all learn the same things at the same rate of progress;
(c) the satisfying of the basic psychological needs of the
child; (d) better liaison between school and home; (e) education
of the parents in the rearing of children."
Training for Teachers
While the school has accepted the duty of education in health
as one of its responsibilities, there remains some degree
of confusion both as to objective and means. This should be
resolved by consultation and agreement on the highest levels,
followed by proper and adequate training of those who will
administer the school health programme.
Student teachers—in—training should acquire a
thorough understanding of what is meant by positive health
education and of its techniques. Teachers who are already
in positions should be given in—service training.
Dr. Binning urges establishment in universities of a Chair
of School Medicine as a means to assuring that school medical
work shall be in the best possible hands and shall be conscientiously
performed. In Great Britain the Central Advisory Council for
Education recommended in 1947 that all medical officers entering
the service should be required to hold special qualification
in children's medicine, and that the school health service
should be made to provide a satisfactory career for a medical
officer.
School Environment
As well as having fully qualified medical practitioners
and specially trained teachers, the schools need a certain
healthful environment. This includes attention to location,
construction, size, ventilation, heating, lighting, acoustics,
seating, adequacy of lavatories and handwashing facilities,
physical training space with lockers and showers, health service
rooms and health libraries. All these, said an article in
Canada's Health and Welfare, are necessary for adequate
health training.
Too often, in schools which emphasize health instruction,
health practices do not keep pace with the lessons. Pupils
cannot be expected to build and practise the health habits
which are taught when conditions are the opposite of the teaching.
"It would be ridiculous to think of functional health teaching
in many schools where sanitary conditions are actually a menace
to health," said the National Committee report.
In some provinces as high as 12 per cent of the secondary
schools do not provide even a hand basin for washing; in six
provinces at least 20 per cent have no soap and paper towels;
only 28.5 per cent have the water supply tested periodically;
only 43 per cent of secondary school classrooms have artificial
lighting giving the minimum required intensity; the proportion
of one—room schools with inadequate natural lighting
ranges up to 43.5 per cent; and in most provinces more than
80 per cent of these schools have no artificial illumination
of any kind; in one province all one—room schools have
only outdoor toilet facilities and over all provinces the
proportion is 71.4 per cent; in many schools drinking water
is in an open pail, with a dipper for drinking, and slops
go back into the pail.
In one province 100 per cent of the schools have first aid
kits, but only 15 per cent of them test their drinking water
supply annually.
These and hundreds of other facts regarding the environment
in schools are given in the National Committee report, published
in Canadian Education, Volume II, Number 2, 1947,
and Volume III, Number 2, 1948. There is, on this evidence,
more room for improvement than most people thought possible
in an enlightened age, and the Committee makes constructive
suggestions arising out of its findings.
A Combined Operation
It is evident that the health of children calls for a combined
operation in which school and home and community participate.
In a very real sense, the limits of school health are the
boundaries of the community, not the fence around the school
yard.
Health education begins with pre—natal education and
care, and continues with the sanitation of the community,
the home hygiene of the pre—school child, the training
of the adolescent in school, and the graduation of the student
with sound knowledge upon which to base his own treatment
of his own children. This is not a programme to be floated
upon sentimental propaganda in fits and starts, but one to
be laid out on a basis of facts found by trained investigators
and carried out by technically qualified personnel.
There is needed, obviously, a new effort to win close co—operation
between teachers, members of the school health service, and
parents. The best kind of youngsters cannot be raised by guess
and by hearsay. Good will and good intentions cannot be substituted
for expert skill and knowledge. Some of the required knowledge
can be had for the asking, either by talking with the school
medical authorities or by writing to the provincial board
of health for up—to—date booklets, which are freely
available.
The Penalty of Neglect
The penalty of neglect of health in childhood is very heavy.
As Horace Mann said: "All through the life of a feeble—bodied
man, his path is lined with memory's gravestones which mark
the spots where noble enterprises perished for lack of physical
vigour to embody them in deeds."
Those who take office on school boards have a special responsibility
to appreciate their opportunity to improve the health of coming
generations, and to that end to provide all practicable facilities
for teaching and practising health in the schools of today.
There are problems of personnel and equipment and funds,
but these should not be allowed to baffle people of good will
and good sense. The objective is well worth striving for.
A good start, but merely a start, has been made. Only unremitting
effort, intelligently directed by those responsible, supported
by the resources of the community, can adequately fulfil the
obligation.
Published by RBC Financial Group. All editions from the RBC
Letter collection are available on our web site at www.rbc.com/responsibility/letter.
Our e-mail address is: rbcletter@rbc.com.
Publié aussi en francais.
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