准备学习并茁壮成长：世界各地的学校健康和营养

Schoolhealthandnutrition aroundtheworldlishedinbytheUnitedNationsEducationalScientificandCulturalOrganizationUNESCOeAttributionShareAlikeIGOCCBYSAIGOlicensehttpcreativecommonspublicationtheusersaccepttobeboundbythetermsofuseoftheUNESCOositoryhttpwwwunescoorgopenaccesstermsuseccbysaenerialieimagesillustrationschartsnotclearlyidentifiedasbelongingtoUNESCOorasbeinginthepublicdomain,priorpermissionshallberequestedfromUNESCOlicationcopyrightunescoorgUNICEFphotographsarecopyrightedandarenottobereproducedinanymediumwithoutobtainingpriorwrittenpermission.rmissiontoreproduceUNICEFphotographsshouldbeaddressedtoUNICEFDivisionofCommunicationUnitedNationsThedesignationsemployedandthepresentationofmaterialthroughoutthispublicationdonotimplytheexpressionofanyopinionelimitationofitsfrontiersorboundariesenotnecessarilythoseofUNESCOUNICEFandWFPanddonotcommittheOrganizations.ThementionofspecificcompaniesorofcertainmanufacturersproductsdoesnotimplythattheyareendorsedorrecommendedbyttersndWFPtoverifytheinformationcontainedinthispublicationtedwithoutwarrantyofanykindeitherexpressedorimpliedTheresponsibilitysarisingThispublicationincludescontributionsfromtheWorldHealthOrganizationWHO),theFoodandAgricultureOrganizationoflPartnershipforEducationGPEiewsexpressedinthispublicationandtheydonotnecessarilyrepresenttheviewsdecisionseWorldHealthOrganizationftheauthorsanddonotnecessarilyreflecttheviewsorpoliciesoftheFoodandAgricultureOrganizationoftheUnitedNations.theauthorsanddonotnecessarilyreflecttheviewsorpoliciesoftheGlobalorEducationInsideicons:originalbyAnnaJankovskaiaDesignedandprintedbyUNESCOimplementschoolhealthandnutritionammesSSHORTSUMMARYNearlyeverycountryaroundtheworldisinvestingintheirchildrenandadolescentsthroughschoolhealthandnutritionprogrammes.Governmentsrecognisethattheseprogrammesareasmartinvestment:theyimprovestudents’health,nutritionandlearningoutcomes,anddeliverbigdevelopmentgainstotheircommunitiesandcountries.Thisground-breakingreportbringstogether,forthefirsttime,multipledatasourcestoprovideaglobaloverviewofschoolhealthandnutritionpoliciesandprogrammes,showingthattheseareapracticalandaffordablewaytosupportlearners’well-beinganddevelopment.Forexample,morethan100countrieshaveschoolvaccinationprogrammes,oneintwoprimaryschoolchildrenreceivesschoolmeals,andalmosteverycountryincludeseducationforhealthandwell-beinginitscurriculum.Yet,manychildrenaremissingout,especiallyaglobalfoodcrisisandstrugglingwiththedevastatingeffectsoftheCOVID-19pandemic,thisreporturgesgovernmentsandwell-beingatthecoreoftheeducationagendaandtoimprovethequalityandreachoftheseprogrammes,sothatallchildrenandadolescentscanlearnandthrive.Thisrequiresimplementingcomprehensiveprogrammesthatarecoordinatedacrosssectorsandsustainedbyincreasedpolicyandfinancialcommitments. Schoolhealthandnutrition aroundtheworldReadytolearnandthrive:Schoolhealthandnutritionaroundtheworld4ForewForewordEverychildhastherighttoqualityeducation,health,foodandadequatenutrition.Everychildhastherighttothriveandrealizetheirfullpotential.Further,theeducation,healthandnutritionofyoungpeoplearenotonlyrightsandendsinthemselves;theyareaninvestmentinacountry’sfutureandinthecapacityofitspeopletoleadproductiveandfulfillinglives.Theserightsareinterconnected.Manyboysandgirlssimplycannotgotoschoolortakefulladvantageofeducationalopportunitiesduetoillhealth,hunger,povertyandmarginalization.Theseareseriousroadblocksineffortstofulfilthefundamentalrighttoeducationforall.Althoughsubstantialprogresshasbeenachievedinrecentyears,thechallengeisbiggertodaythanever.SchoolclosuresinresponsetotheCOVID-19pandemic,whichaffectedmorethan1.6billionstudentsinalmosteverycountry,intensifiedthelearningcrisis,withthegreatestconsequencesforthemostvulnerable.Withschoolclosures,studentsalsolostaccesstocriticalhealthandnutritionsupport,includingschoolmeals—asharpreminderthatschoolsprovidemuchmorethaneducation.Dropouthasincreased,alongwithearlymarriage,earlypregnancyandmentalhealthissues.Andnow,theunfoldingglobalfuelandfoodpricecrisesarepushingmillionsofchildrenintohungerandpovertyaroundtheworld.Thisreportshowsthatschoolhealthandnutritionprogrammesareafeasible,affordableandeffectiveresponsetotheseunprecedentedchallenges.Theyareoneofthesmartestinvestmentsgovernmentscanmakeintheeducation,healthandwell-beingoftheirchildrenandinthefutureoftheirnations.Thereportbringstogetherdatafrommorethan44sourcestogiveanoverviewofschoolhealthandnutritionpoliciesandprogrammesglobally.Thefindingsclearlyshowapositivetrajectoryoverthepasttwentyyears.Governmentsaroundtheworld,fromhigh-tolow-incomecountries,arealreadyinvestingintheirchildrenandyoungpeoplethroughschoolhealthandnutrition—oneofthemostwidelyimplementedpublicpolicies.Thedataandcountryexamplesshowthattherearemanywaysinwhichschools,asasystem,cansupportlearners’healthandwell-being.Theseincludetheprovisionofschoolmealsandotherhealthandnutritionservices,suchasvaccinations,dewormingandpsychosocialsupport;healtheducationthatprovidestheknowledge,attitudesandskillstoenablelearnerstoleadhealthylives;andsafeandinclusivelearningenvironmentsthatpromotehealthandwell-being.Thisreporttellsusthatalltheseelementsneedtobecombined.However,clearlythereisalongwaytogo.Oneofthereport’skeymessagesisthatcountriesandpartnersneedtourgentlystep-upinvestmentsinschoolhealthandnutritionsothateveryschoolconstantlybuildsitscapacitytoprotectandpromotethehealthandwell-beingofitsstudents.Programmesmustbecomprehensive,implementedatscaleandsustainedbypoliticalandfinancialcommitments.Theyalsoneedtoaddressequity,genderequalityandinclusionandprioritizethosemostatriskofbeingleftbehind.AsaconclusiontotheTransformingEducationSummitinSeptember2022,theUNSecretaryGeneral’sVisionstatementontransformingeducationhighlightedhowcriticalitistodevelopstudents’abilitytoleadahealthylifeandtosupportlearners’nutrition,physicalandmentalhealth,includingthroughtheexpansionofschoolcounsellingandschoolmeals.CountriesandpartnersattheSummitcommittedtosupportingthehealth,nutritionandpsychosocialwell-beingofeveryteacherandchildtoensurerecoveryandacceleratelearning.We,atUNESCO,arealsoconvincedthatlearners’healthandwell-beingareacornerstoneoftherenewedvisionfortheeducationthatweneedandmusthave.Readytolearnandthrive:SchoolhealthandnutritionaroundtheworldTheeducationsectorcannotachievethisvisionalone.Addressinglearners’needsholisticallyrequiresstrongpartnershipsandactiveengagementfromdifferentsectorsatallgovernmentlevels,aswellasfromstudents,parentsandcommunities.Onlybyaligningandincreasingourefforts,throughsharedleadership,willwebeabletoensureallchildrenandadolescentsareinschoolandhaveaccesstothecomprehensiveprogrammestheyneed.Thismeansincreasingfundingandsupportforhealthandnutritionalongwithmuchneededfundingforeducation.Futurelearningandwell-being,anddecadesofeconomicandsocialgainareatstake.UNESCOandthepartnersbehindthisreportarecommittedtosupportinggovernmentstostepupschoolhealthandnutrition,together,tounlockthepotentialoflearners—inalltheirdiversity—tothrive.StefaniaGianniniAssistantDirector-GeneralforEducation,UNESCOReadytolearnandthrive:Schoolhealthandnutritionaroundtheworld6CatherineRussellExecutiveDirector,UnitedNationsChildren’sFundSchoolhealthandnutritionprogrammescanmakeanenormousdifferenceinchildren’slivesandhelptotransformeducationbyincreasingschoolenrolmentandattendance,promotinginclusionandequity,and,mostimportantly,supportinglearning.ButmillionsofchildrenmissedoutonthesecriticalprogrammesduringCOVID-19schoolclosures—andmillionsarestillmissingout.Thisreporthighlightstheurgentneedtoimprove,scaleupandsustainschoolhealthandnutritionpoliciesandprogrammes.Theseprogrammesareeffective,cost-effective,andcanbeadaptedinallsettingstoreacheverychild.UNICEFisworkingwithourpartnersatUNESCOandothersaroundtheworldtosupportgovernmentstoexpandaccesstothesecriticalprogrammes,and,indoingso,ensurethateverychildishealthy,protected,nourishedandreadytolearn.DavidBeasleyExecutiveDirector,WorldFoodProgrammeThisinter-agencyreportonschoolhealthandnutritionprovidescriticalinformationastheworldgrappleswiththehugedamagethatCOVID-19andtheglobalfoodcrisiscontinuetoinflictonourchildrenandtheireducation.Thepandemicclosedschoolsworldwideanddeprivedmillionsofthemostvulnerablechildrenofaccesstotheonlynutritiousmealtheyreceiveeachday.Nowthatschoolshavereopened,manyareunderfunded,overstretchedandstruggletosupportchildrenfromhomesthatarepoorerandmorefoodinsecurethanever.Asthisreporthighlights,schoolhealthandnutritionprogrammes—includingschoolmeals—areaninvaluablesafetynetforthemostvulnerablefamilies.Theyurgentlyneedtobescaleduptohelpprotectanentiregenerationofchildrenandkeepthemineducation.DrQuDongyuDirector-General,FoodandAgricultureOrganizationTheFoodandAgricultureOrganizationispleasedtocontributetothefirstcomprehensivereportonthestatusofschoolhealthandnutritionaroundtheworld.Linkingeducationandagrifoodsystemsthroughintegratedschoolhealthandnutritionprogrammescanadvancenutrition,educationandhealthsimultaneously.Thecurrentevidencegapsandimplementationchallengeshighlightedinthisreportpresentanopportunityforourorganizationtobettertargetitscountrysupportandstrengthenournormativeguidance,inlinewithourmandateoffoodsecurityandhealthydietsforallschoolchildren,farmersandadolescents.CharlesNorthActingChiefExecutiveOfficer,GlobalPartnershipforEducationGoodhealthandnutritionareessentialforchildren’slearning,aswellastheirbroaderwell-being.Schoolfeedingcanhelpovercomebarriersthatkeepmarginalizedchildrenoutofschool.Thatiswhyensuringschoolsaresafe,healthyandinclusiveisapriorityfortheGlobalPartnershipforEducation.Manyofourpartnercountrieshaveschoolhealthandnutritionpoliciesandprogrammesinplace,andthisreportshowshowimportantandeffectivetheycanbe.Thesepolicieswillbeofgreatusetogovernmentswhenconsideringhowtheycandomoretopromotehealthandnutritioninandthroughschools.DrTedrosAdhanomGhebreyesusDirector-General,WorldHealthOrganizationThescienceisclear:investmentsinhealthandeducationdelivermutuallyreinforcingbenefits.Thisreportshowstheprogresswe,asaglobalcommunity,haveachievedinpromotingschoolhealth.Itisourhopethatitwillfacilitateamultisectoral,multisystemapproachtoimprovechildren’slearningoutcomesthroughinvestmentsinhealthandwell-being.Thereportprovidesstrongevidencethatanenablingenvironmentforchildrenandadolescentscanbesustainedthrougheducationsystemsthatpromotehealth.Wearehopefulthatgovernmentswilldemonstratetheircommitmenttothehealthandwell-beingofchildrenandadolescentsbymakingeveryschoolahealth-promotingschool.ProfessorDonaldBundyDirectoroftheResearchConsortiumforSchoolHealthandNutritionrtisanoutstandingexampleofUNESCOsisthemostavailableofthecurrentstatusofschoolhealthandnutritionprogrammesworldwide.dicatesthatnationalprogrammestoaddresshealthandwell-beingthroughschoolplatformsremainandinadequateandevenmoresoasaresultnearlyeverycountryintheworldhasadoptedaformalpolicyonschoolhealthandnutrition,perhapsdemonstratingthatgovernmentsnowrecognizethevitalimportanceofinvestingvidencethatlookingafterthewellbeingofschoolchildrenandadolescents—especiallyofthepoorestandmostvulnerable—isamongthemoststmentstoimprovelearningoutcomes,strengthenhumancapital,andbuildteconomiesReadytolearnandthrive:SchoolhealthandnutritionaroundtheworldAAcknowledgementsThedevelopmentofthisreportwasledbyEmilieSidaner,secondedfromtheWorldFoodProgramme(WFP)totheUnitedNationsEducational,ScientificandCulturalOrganization(UNESCO)SectionofHealthandEducation,DivisionofPeaceandSustainableDevelopment(PSD),EducationSector.ItwasdraftedbyKathyAttawell,Consultant,withoverallstrategicandtechnicalguidancefromChrisCastle,DirectorofPSDandformerChiefoftheSectionofHealthandEducation,andinputsfromChristopheCornuandYongfengLiu,SectionofHealthandEducation.ParvizAbduvahobov,intheSectionofHealthandEducation,ledthedataanalysiswithsupportfromOscarDiazBotia,Consultant.Thisreportistheresultofcollaborationwithmanyinstitutionsandindividuals.Thereportteamwouldliketoacknowledgetheirsupportandthankallwhogavesowillinglyoftheirtimeandexpertise,inparticular:MembersoftheTechnicalAdvisoryGroupestablishedtoguidethedevelopmentofthisreportprovidedinvaluablestrategicguidance:ValentinaBaltag,DepartmentofMaternal,Newborn,Child,AdolescentHealthandAgeing,WorldHealthOrganization(WHO);ProfessorDonaldBundy,ResearchConsortiumforSchoolHealthandNutrition;LuisaCruz,FoodandAgricultureOrganizationoftheUnitedNations(FAO);NicolaGray,UNESCOChair/WHOCollaboratingCentre-GlobalHealthandEducation;ShanenGanapathee,InternationalYouthAllianceforFamilyPlanning,Mauritius;DidierJourdan,UNESCOChair/WHOCollaboratingCentre-GlobalHealthandEducation;EdwardLloyd-Evans,School-basedProgrammesDivision,WFP;JeanneL.Long,SavetheChildren;KathrynOgden,UN-NutritionSecretariat;DoctorRonaldOlum,MakerereUniversityandSt.FrancisHospitalNsambya,Uganda;LindaSchultz,ResearchConsortiumforSchoolHealthandNutrition.Thisreportisaninitiativeoftheinter-agencygrouponschoolhealthandnutrition(SHN).Membersofthegroupprovidedtheinputs,guidanceandqualityassurancethatmadethisreportpossible:MelissaVargas,FAO;StuartCameronandJingxinBao,GlobalPartnershipforEducation(GPE);JoannaLai,KennethRussellandDeepikaSharma,withsupportfromFatimaGohar,PatriciaLandinez,FumiakiSagisakaandFionaWatson,UnitedNationsChildren’sFund(UNICEF);StinekeOenemaandKathrynOgden,UN-NutritionSecretariat;CarmenBurbano,MicheleDoura,EdwardLloyd-EvansandMaria-JoseRojas,WFP;ValentinaBaltag,FatenBenAbdelaziz,KatrinEngelhardt,andKaiaEngesveen,WHO;FatimaBarry,EvaBrocardandMustaphaLo,WorldBank;andProfessorDonaldBundy,ResearchConsortiumforSchoolHealthandNutrition.WeacknowledgesupportfromtheUN-NutritionSecretariatintheirconveningrolearoundschoolfoodandnutrition,andtheguidancefromtheResearchConsortiumforSchoolHealthandNutritionindraftingthereport’skeymessages.ThereportdrawsextensivelyonreviewandanalysisofexistingdataandevidenceonSHNcommissionedbyUNESCOandconductedin2021bythePartnershipforChildDevelopment,ImperialCollege,London.ThestudyteamcomprisedHeikeRolker,QuantitativeAnalyst;SaraNourozi,PolicyAnalyst;PetyaAtanasova,QuantitativeAnalyst;LucindaMiddleton,ResearchAnalyst;MamtaGurung,KeyInformantInterviewLead;SamratSingh,ResearchManager;andLesleyDrake,PrincipalInvestigator.Wewouldparticularlyliketothankthosewhoprovidedinputsforspecificsectionsandcontributedtoboxesandcasestudies:ElizabethSmith,EYElliance;LuisaCruzandMelissaVargas,FAO;RichardClarke,FIAFoundation;StuartCameronandHeatherSaunders,GPE;ProfessorYinghuaMaandProfessorBinDong,InstituteofChildandAdolescentHealth,PekingUniversity;DoctorRonaldOlum,MakerereUniversityandSt.FrancisHospitalNsambya,Uganda;ProfessorKonstantinG.Gurevich,MoscowStateUniversityofMedicineandDentistry;SonjaCaffee,PanAmericanHealthOrganization(PAHO);SophieKosteleckyandAnshuMohan,PartnershipforMaternal,NewbornandChildHealth;ProfessorDonaldBundyandLindaSchultz,ResearchConsortiumforSchoolHealthandNutrition;JeanneL.Long,SavetheChildren;AnetteSchulz,SchoolsforHealthinEuropeNetworkFoundation;SallyBeadle,JenelleBabb,DanielBerlinguettePoulinandTigranYepoyan,UNESCO;JoannaLai,UNICEF;ProfessorUwePühseandDoctorIvanMüller,UniversityofBasel,SwitzerlandandUNESCOChairon‘PhysicalActivityandHealthinEducationalSettings’;KathrynOgden,UN-NutritionSecretariat;MicheleDouraandSophieJenter,WFP;SandraHittmeyer,WFP/SecretariatoftheSchoolMealsCoalition;ValentinaBaltag,PaulBloem,KaiaEngesveen,KatrinEngelhardt,SuvajeeGood,AntonioMontresorandHaydeePadilla,WHO.AspecialthanksgoestoReginaGuthold,WHO,whoprovidedtheanalysisandgraphsonmaindriversofmortalityandmorbidityamongchildren5to19years.Readytolearnandthrive:Schoolhealthandnutritionaroundtheworld8Thisreportwasindependentlypeer-reviewedbyagroupofexperts:ArleneMitchellandAyalaWineman,GlobalChildNutritionFoundation;ProfessorUwePühse,PatriciaArnaiz,JanDegenandDoctorIvanMüller,UniversityofBasel,Switzerland;ProfessorCherylWalterandDanielleDolley,NelsonMandelaUniversity,Gqeberha,SouthAfrica;NandiJoubert,SwissTropicalandPublicHealthInstitute,Allschwil,Switzerland;BradfordStrickland,BureauforAfrica,dreyKettanehConsultantinSHNWeexpressourgratitudefortheircomments,whichenhancedthequalityofthereport.WealsothankUNESCOcolleagueswhopeer-reviewedthereportandprovidedvaluablecommentsandinputs:JenelleBabb,MaryGuinnDelaney,XavierHospital,PatriciaMachawiraandTigranYepoyan,RegionalHealthandEducationAdvisers;SallyBeadle,JoannaHerat,LisaMuszynski,SylvainSeguy,ArushiSingh,ArianaStahmer,LeonieWernerandChipoZulu,SectionofHealthandEducation;MatthiasEckandJustineSass,SectionofEducationforInclusionandGenderEquality;NancyMcLennan,SocialandHumanSciencesSector;AlisonKennedy,SectionofEducationforSustainableDevelopment;andCamilaLimaDeMoraes,GlobalEducationMonitoringReport.Wewishtoacknowledgethosewhoworkedontheproductionofthereport,whichwascoordinatedbyCaraDelmas.ThereportwaseditedbyJaneCoombesanddesignedbyAnnaJankovskaia.ThisreportwasmadepossiblebygenerousfinancialsupportfromtheGovernmentsofSwedenandNorwayandfromWFP.Readytolearnandthrive:SchoolhealthandnutritionaroundtheworldTableTableofcontentsForeword4Acknowledgements7Acronyms12Glossary14Keymessages16Executivesummary18 Section1Introduction26 Section2Globalcontextandevolutionofschoolhealthandnutrition322.1Whyschoolhealthandnutritionisasmartinvestment362.2Thehealthandnutritionneedsofschool-agechildrenandadolescents392.3ImpactofCOVID-19andtheeducationsectorresponse452.4Theevolutionofschoolhealthandnutrition462.5Globalandregionalinitiativesandpartnerships492.6Monitoringofschoolhealthandnutritionprogrammes53 Section3Statusofschoolhealthandnutritionpolicies563.1Nationalpoliciesandstandards593.2Themesincludedinschoolhealthandnutritionpolicies60 Section4Statusofschoolhealthandnutritioninpractice644.1Overviewofimplementationofschoolhealthandnutritionprogrammes664.2Educationforhealthandwell-being714.3Schoolphysicalenvironment854.4Schoolsocioemotionalenvironment964.5Schoolhealthservicesandschoolfeedingprogrammes103 Section5Conclusionsandthewayforward120References124Annex1Quantitativedatasources—dashboardsandsurveys140Annex2Tableofselectedcountryindicators146Readytolearnandthrive:Schoolhealthandnutritionaroundtheworld FiguressnpuponaloupspupsBBoxesReadytolearnandthrive:Schoolhealthandnutritionaroundtheworlda CasestudiesicaaantyReadytolearnandthrive:SchoolhealthandnutritionaroundtheworldAAcronymsASFEAnnualSurveyofFormalEducationAUAfricanUnionAUCAfricanUnionCommissionAUDA-NEPADAfricanUnionDevelopmentAgencyCSEComprehensivesexualityeducationEMISEducationManagementInformationSystemESPADEuropeanSchoolSurveyProjectonAlcoholandOtherDrugsFAOFoodandAgricultureOrganizationoftheUnitedNationsFRESHFocusingResourcesonEffectiveSchoolHealthGAMAGlobalActionforMeasurementofAdolescentHealthGCNFGlobalChildNutritionFoundationGINAGlobalDatabaseontheImplementationofNutritionActionGNPRGlobalNutritionPolicyReviewGPEGlobalPartnershipforEducationGSHSGlobalSchool-basedStudentHealthSurveyG-SHPPSGlobalSchoolHealthPoliciesandPracticesSurveyGYTSGlobalYouthTobaccoSurveyHBSCHealthBehaviourinSchool-ageChildrenSurveyHCCHealthyCaribbeanCoalitionHGSFHome-grownschoolfeedingHIVHumanimmunodeficiencyvirusHPSHealth-promotingschoolsHPVHumanpapillomavirusJRFJointReportingFormonimmunizationJMPJointMonitoringProgrammeLaoPDRLaoPeople’sDemocraticRepublicLGBTILesbian,gay,bi-sexual,transgenderorintersexLSHTMLondonSchoolofHygieneandTropicalMedicineLTKmentKitMenstrualhealthmanagementMICSMultipleIndicatorClusterSurveyNCPINationalCommitmentsandPolicyInstrumentNCDNon-communicablediseaseNGONon-governmentalorganizationReadytolearnandthrive:SchoolhealthandnutritionaroundtheworldNHCNationalHealthCommissionOECDOrganisationforEconomicCooperationandDevelopmentOREALCRegionalBureauforEducationinLatinAmericaandtheCaribbeanPAHOPanAmericanHealthOrganizationPCPreventivechemotherapyPCDPartnershipforChildDevelopmentPIASCYPresidentialInitiativeonAIDSStrategyforCommunicationtoYouthPIRLSProgressinInternationalReadingLiteracyStudyPISAProgrammeforInternationalStudentAssessmentQPEQualityPhysicalEducationSABERSystemsApproachforBetterEducationResultsSBHCSchool-BasedHealthCentreSDGSustainableDevelopmentGoalSELSocialandemotionallearningSHESchoolsforHealthinEuropeSHNSchoolhealthandnutritionSRHSexualandreproductivehealthSRMNCAHSexual,reproductive,maternal,newborn,childandadolescenthealthSR4SStarRatingsforSchoolsSTISexuallytransmi