Finnish School Health Care system & Health Education Elina Hermanson MD, Ph.D, pediatrician, Special competence in adolescent medicine Chief Physician / City of Helsinki, School and Student Health Care
Proud to be a Finn! Free school meals since 1948 Comprehensive schools grades 1-9 (7 to 15 years) >> high school / vocational school Top results in OECD Programme for International Student Assessment (Pisa) 2003-2012: Literacy 1.st in Europe, 6.th in the world. Nearly free university education Low drop-out numbers
School drop-outs in Finland 2014* Comprehensive school: 0,46% High schools: 3,4 % Vocational school: 7,6 % * www.stat.fi
Teenage abortion rates in Finland 2015: 8.4 per 1,000* England and Wales: 11.7 * National Institute for Health and Welfare, Finland & Office for National Statistics, Britain
Abortions in the Nordic countries in 2014 per 1000 35 30 25 20 15 10 Danmark Finland Iceland Norway Sweden 5 0 15-19 20-24 25-29 30-34 35-39 40-44 45-49 23.11.2016 VL-Medi
Age standardised abortion rate per 1000 women aged 15-49 in the Nordic countries 2014 20 18 16 17,9 14 12 10 8 6 12,3 8,3 11,7 11,8 Danmark Finland Iceland Norway Sweden 4 2 0 Age-standardised abortion rate per 1000 women aged 15-49 http://norden.diva-portal.org/smash/get/diva2:1034907/fulltext02.pdf 2016 Health Statistics for the Nordic Countries
Abortion rates by age groups in Finland, per 1,000 women in age-group
Daily smoking: 15-year-old Finns % 50 40 BOYS GIRLS 30 20 10 22 30 28 25 19 25 22 23 20 18 19 20 17 16 10 14 13 7 0 1984 1986 1990 1994 1998 2002 2006 2010 2014 WHO 1984-2014
Weekly alcohol 30 25 20 15 10 5 0 14-15 yrs, boys 14-15 yrs, girls 16-17 yrs, boys n high school 16-17 yrs girls in high school 16-17 yrs boys in vocational school 16-17 yrs girls in vocational school
In Finland, the health and well-being of adolescents are well monitored and guarded 1. Preventive health care at schools Nurses with 4.5 years of college training School health physicians (GPs) 2. Other school welfare personnel Psychologists Social workers, Special education teachers 3. Sexual health/ family planning clinics at health centres 4. Health care at health centres (GPs) 5. Secondary health care with specialists F. ex. Adolescent psychiatry 6. Since 2001, systematic, mandatory health education at schools (teachers)
Health education in the National Core Curriculum FINLAND Grades 10-12 Upper secondary School HE is an independent subject. 1 compulsory course, 2 optional courses Vocational School 1 compulsory HE course 7-9 5-6 1-4 HE is an independent subject. 3 courses, 38 lessons of each. Alltogether 114 lessons. HE integrated into biology and geography and into physics and chemistry HE integrated into environmental and natural science studies
NINE STEPS OF SEXUALITY Sexuality = inside process Through the emotions and love Understanding own developmental stage Permission not to hurry Self knowledge and self-esteem Respecting others Informed choises
2 of 3 U.S. Parents Want Schools to Expand Health education beyond sex ed and substance abuse* 2/3 wish education to cover stress and bullying 1/3 tell that those are covered 70% wish the kids to learn first aid 63% wish the kids to learn CPR we have them all, plus: Mental health, nutrition, benefits of physical activity, safety in traffic, most common health issues etc. *University of Michigan C.S. Mott Children's Hospital, news release, Sept. 19, 2016. https://consumer.healthday.com
School health services = Nurses and physicians at schools Preventive care Provided on school premises Part of the student welfare services
School health nurses 4.5 years of college training Vaccinations Individual health promotion 1. line screening: observation Recommendation: 1 nurse / 600 pupils 1 physician / 2100 pupils (reality: 3000-4000)
Preventive care includes: Health promotion, screening, counselling, referral, vaccination Health inspection performed by Comprehensive School Grades 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Public health nurse x x x x x x x x x x Doctor x x x Parent present x x x x
School health physicians The final part of the extensive health check-up 3 times during the 9-year primary school. broad view of the well-being of the pupil a parent and the pupil present screening for diseases, growth screening for psychosocial problems and mental health support for the health promotion (most work is done by nurses and teachers) 30 minutes /family Counselling for the nurse and school personnel Referrals for the secondary care
World Health Organization standards for health care services for adolescents* *M Nair et al. J Adol Health 2015:57;288-298 1. Adolescents health literacy 2. Community support 3. Appropriate package of services 4. Providers competencies 5. Facility characteristics 6. Equality and nondiscriminantion 7. Data and quality improvement 8. Adolescents participation
Current issues Nationwide health reform & the welfare personnel at schools Confidenciality vs collaboration Time allocation between the health checks, and the pupils in need for a physician - evidence for health checks?! Health education >< individual health promotion by nurses ADHD Education of school health doctors