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PART SPORTS AND HEALTH

PART B ENRICHMENT OF HEALTH EDUCATION

At schools, health education is mainly promoted through overall educational activities centering around "physical education" and "health and physical education" classes and special activities. These classes and activities aim to provide an understanding of health related information, and at the same time foster the skills and attitudes necessary for leading a healthy existence. Furthermore, based on the School Health Law, measures have been taken to promote health care such as school health planning, medical checkups, health counseling and maintenance and sanitation improvements.

The 1989 revised Courses of Study, enriched the educational content of primary and secondary schools placing emphasis on providing an understanding of basic and fundamental knowledge regarding health and safety and fostering attitudes and skills that enable school children to autonomously practice good health habits in accordance with their developmental stages. This emphasis cultivates the foundation for respect of self and others and for leading a safe and healthy existence throughout one's lifetime. This revision was made from the fundamental viewpoint that in a society that stresses learning throughout the lifetime, emphasis should be placed on the independent study of health and safe practices throughout the individual's entire life span.

In the revised Courses of Study, directions for health care maintenance and promotion were as follows. Time should naturally be set aside for the key classes in health education. "physical education" and "physical and health education," and adequate effort should be made towards providing health education through "special activities" and other activities as well. These "special activities" include class and home room activities with the following themes: "formation of healthy and safe attitudes toward life" for elementary schools, "formation of healthy and safe attitudes and living habits, and adjustments in sexual development," for lower secondary schools and "establishment of habits and attitudes for a healthy and safe life" for upper secondary schools. Also, examples of school events related to health and safety or physical education are provided, and each school can carry out such events during set class hours, according to their locate and conditions.

In recent years AIDS has dramatically increased all over the world, becoming a severe social problem.

The number of AIDS patients and carriers in Japan has risen. It has been pointed out, that the principal transmission route of the disease is through heterosexual contact and that the number of cases is increasing, particularly among people in their twenties. Stressing prevention measures for halting the rapid spread of the disease has become an urgent issue. At schools, AIDS prevention instruction is being taught throughout the entire range of school educational activities, including "health and physical education" classes, "special activities," and "moral education." Skills and attitudes necessary for AIDS prevention are being cultivated through imparting correct information about the concept of AIDS, the route of transmission, methods of prevention, etc. Moreover, attempts are being made to correct misinformation and reduce prejudice about AIDS through cultivating a spirit of respect for human rights. Also, since AIDS is closely linked to sexual behavior, it is important to consider the greater effectiveness of carrying out AIDS education as a part of sexual guidance.

In furthering AIDS prevention instruction, upgrading teaching materials, improving training for teaching and other staff, and reforms in teaching methods are all important. More specifically the Ministry is promoting policies furthering (l) drawing up and distributing an "AIDS Guidance Handbook" as material for primary and secondary school teachers (2) carrying out training for AIDS prevention instruction through training seminars for school health related personnel and (3) carrying out practical study projects on teaching methods with the cooperation of primary and secondary schools, communities and families such as the "Projects for Promoting Sexual Guidance Including the AIDS Problem" and others.

Also in consideration of the recent AIDS situation, in 1992 the "AIDS Guidance Handbook" was thoroughly revised and distributed as a means towards improving guidance materials. Additionally, new materials are to be created and distributed to upper secondary school students.

Sexual guidance in schools is wide ranging, including the teaching of scientific information, (according to the developmental stage of students) and providing the opportunity for students to autonomously develop a way of life based on a spirit of respect and sexual equality. The Ministry has been providing direction for this kind of sexual guidance throughout the range of school education activities centering on "health and physical education," "homemaking", "moral education" and "special activities."

In the revised Courses of Study, course content has been further updated regarding mental and physical development during puberty, adolescent lifestyles, and marriage. More specifically: in elementary school "physical education" classes, children are taught about bodily changes during puberty. In lower secondary school, "health and physical education" classes discuss secondary sexual characteristics, and "moral education" classes discuss mutual respect between men and women. Also, during "special activities" the topic of "adjustment during sexual development" is covered. In upper secondary schools, "health and physical education" classes deal with puberty, marriage and health. "Homemaking" classes discuss health during motherhood and giving birth. "Special activities" take up the topic of cooperation and mutual understanding between men and women.

A "Handbook on Prevention of Smoking, Drinking and Drug Abuse" (for use in primary and secondary schools) was compiled and distributed between 1985 and 1987. This handbook provides a correct understanding of the influence of these substances on both the user and on others. The handbook emphasizes the fostering of proper attitudes and decision-making abilities regarding the problems of smoking, drinking and drug abuse. Furthermore, the handbook promotes guidance regarding ways of cultivating the necessary skills and attitudes for leading a long and healthy life, while developing a sensitivity towards the protection of other people's health as well as one's own.

From the viewpoint of the relationship between health and everyday behavior, the revised Courses of Study endeavor to improve understanding of the links between smoking, drinking and drugs and health through "health and physical education" classes.

Because the transition between baby teeth and permanent teeth (from 6 to 13 years of age) is a very important period for dental health, it is important to carry out greater improvements in school dental guidance, help children to acquire the proper dental habits, and provide early treatment. Thus, the Ministry has implemented the following projects and activities. Since 1978, "Designated Cavity Prevention Schools" (elementary) were set up to promote prevention of tooth decay and conduct practical research. Since 1983 activities such as the "Project for Promoting Cavity Prevention" have been carried out cooperatively among family, schools and the community. In 1991, with consideration of the rise of gingivitis cases, the "Handbook for Dental Care Guidance at Elementary Schools" (first published in 1978) was revised adding the following items: explanations of the factors underlying tooth and gum disease and its prevention and pictorial explanations of proper brushing methods for different sections of teeth, replacing the previous descriptions of brushing methods and positioning of the toothbrush.

In light of the recent progress in techniques for group examinations and changes in school children's health problems, a "study committee on medical examinations" was set up within the Japan School Health Association and has been operating since 1987. This committee investigates new methods for carrying out school medical checkups and the items included in such checkups. The committee reported on a number of pressing items that it judged appropriate for inclusion, and after a consideration of the opinions of the Subcommittee for School Health within the Health and Physical Education Council, the following amendments were made in the enforcement regulations of the School Health Law (Feb. 26, 1992): (l) carrying out of urinalysis; (2) optionalization of the required X-ray checkup for heart disease and irregularities (first year elementary school); and (3) simplifying eye examinations and revising the content of hearing and chest exams.

Recently pediatricians and other physicians have pointed out the occurrence of new health problems among school children such as certain allergies and symptoms of adult health problems. In order to grasp the nationwide situation, a longitudinal study entitled "Project for surveillance of the health condition of school children," has been carried out since 1991, under which fixed point observations have been made at sample schools as a means of gathering data and analyzing the health condition of schoolchildren.

In recent years there has been a growing number of school children who visit health clinics with complaints of psychosomatic-based headaches, stomachaches, general discomfort and various other problems. It has thus become necessary to provide appropriate mental health related counseling, instruction and guidance. For this reason, the following programs to enrich the in-service training of nursing teachers have been created. Since 1980 there has been a "Nursing Teacher Skills Seminar;" since 1985 a "Health Counseling Specialists Training Course" has been held, and since 1989 a "Training Seminar for Newly Appointed Nursing Teachers" has been carried out in an effort to raise the quality of nursing teachers.

In related developments, results from the "Survey on Visits to Health Clinics," (a part of the "Survey Research Project on Counseling Activities at School Health Clinics") showed that there were a significant number of school children who made visits to the school health clinic with psychologically related complaints. It has become clear that the importance of the role of nursing teacher in handling mental problems is increasing. Taking these matters into consideration, as part of the previously mentioned project, a practical handbook is being compiled for promoting counseling activities at school health clinics.

The School Health Law stipulates that schools must endeavor to maintain sanitation through measures such as providing adequate ventilation, sunlight, indoor lighting and temperature control as well as maintaining 'cleanliness and making necessary improvements.

Also, the standards for school sanitation (drinking and swimming pool water quality, classroom lighting, etc.) nut together by the Health and Physical Education Council in 1964 have been in use as a guide for the methods, items and follow-up measures etc. for school sanitation inspections (conducted on the basis of the School Health Law). However, in consideration of the progress in scientific technology and changes in the environment surrounding schools, revisions were made in June 1992 after deliberations by the Health and Physical Education Council. Among the major points of reform were: (l) raising the degree of illumination for classrooms and other facilities from 150+ luces to 200+ luces; when computers are in use, desktop illumination should be between 500 and 1000 luces. (2) The standard level of carbon dioxide was reduced from less than 100 ppm to less than 10 ppm. (3) Quality control inspections for drinking water (especially when well water is used) were increased from once a year to two times per year. (4) Limits for keepable foodstuffs were increased from 48+ hours to 72+ hours. (5) Pool inspections should reveal no colon bacilli, and mandatory regulation of the establishment and use of waist-deep washing/disinfecting pools was dropped. (6) New regulations were set for waste water control. (7) Environmental considerations including recycling trash materials.

Nursing teachers are responsible for: (l) individual guidance of school children having mental and physical health problems, such as physical weakness, nutritional problems, illness or emotional handicaps, and precisely ascertaining the health and cleanliness of school children, (2) Providing health promoting guidance to healthy children, (3) Active cooperation with regular teachers in carrying out everyday teaching activities.

Presently nursing teachers are placed at almost all of the nation's schools; as of May 1, 1992 they numbered approximately 40,000.

In 1992, designated schools were set in order to carry out practical studies on the professional duties of nursing teachers at large scale schools, and measures were taken for additional allocation of nursing teachers at designated public primary and secondary schools.

School physicians, dentists and pharmacists play an important role in effectively carrying out health related activities. In addition to taking charge of medical checkups, medical counseling and sanitation inspections at schools, they participate in planning school health policy. Furthermore, so that school health policy can be appropriately carried out, they provide guidance and advice (according to their specialty) to principals, health coordinators, and nursing teachers on the daily skills required to prevent cavities, myopia and various diseases as well as measures to take when illness is detected, etc.

Since it is important to secure the placement of qualified individuals for these important duties, efforts have been made to raise the salaries of school physicians, dentists and pharmacists through local allocation taxes. In 1992 a substantial raise was instituted (school physicians and dentists from 151,000 to 210,000 yen and school pharmacists from 111,000 to 145,000 yen). As of 1991 there were approximately 85,000 school physicians, 41,000 school dentists and 34,000 school pharmacists at work.

In schools, it is important that school health related staff members work together in a planned, organized way to promote school health. Accordingly, most schools have established school health committees that promote study and discussion of health issues. Normally, these school health committees are made up of representatives from both the school and community. A typical committee is formed of representatives from the school such as principals, vice-principals, chief teachers in charge of academic matters, health coordinators, nursing teachers, teachers in charge of physical education, teachers in charge of safety, teachers in charge of school lunches, teachers in charge of health education, other teachers and school physicians, dentists and pharmacists. Representing the community there are members from local families, public health centers and other health related community centers, organizations, etc.

The importance of school health committees was pointed out in the 1972 Report from the Health and Physical Education Council. Hereafter, more of these committees should be formed as they are expected to implement productive school health activities. The Ministry has been giving direction for the effective use of school health committees for some time. Concrete methods to make use of such committees are taken up in the revised February 1992 version of the Handbook for Dental Care Guidance at Elementary Schools.

Within school health committees, the person playing the key role is the health coordinator. The post of health coordinator was to be established at all of the nation's schools other than kindergartens and universities with the exception of some cases due to unusual circumstances through a revision of the enforcement regulations of the School Education Law in 1955. Health coordinators are appointed from among the teaching staff. School health coordinators work under the supervision of the school principal. Their professional duties involve the responsibility for managing school health committees, playing the major role in drawing up the school health plan with the cooperation of other teaching staff members, and coordinating activities for implementing the plan in a smooth and systematic manner.

The following financial assistance programs are being carried out for promoting the health care of school children.

The Ministry is providing financial assistance to school establishing bodies to promote active efforts towards the greening of school grounds, i.e., planting trees and shrubbery, etc., at public compulsory-level schools located in designated areas for urbanization and areas with polluted air.

In accordance with the "Law for Promotion of Education in Isolated Areas", financial assistance is being provided to school establishing bodies for municipally dispatched school physicians, dentists and pharmacists to conduct medical checkups, medical counseling and sanitation inspections for elementary and lower secondary schools in isolated areas lacking proper treatment facilities.

Funds are given to school establishing bodies to ensure that electrocardiogram checkups are smoothly carried out at schools in isolated areas where electrocardiograms would be normally unavailable.

Necessary funding is provided to school establishing bodies for special medical checkups and swimming pool cleaning equipment in areas designated as high volcanic ash fallout zones.

According to the School Health Law, financial assistance is provided for prefectures or municipalities to cover medical treatment fees for needy children attending compulsory schools when they are directed by the school to undergo treatment for certain specified contagious diseases or diseases with a high risk of causing learning disabilities.