The news of masked children in Delhi being asked to stay away from school, or avoid outdoor activities even when school opens in smoggy November, is a depressing commentary on how the health of children is in jeopardy. While this makes headlines in the winter months due to air quality plummeting to ‘emergency’ levels, the pollution levels are much higher than the national standards even in other months in many parts of India. This cumulative exposure poses a serious threat to school-age children, and is a detriment to physical health and cognitive ability.
While our children do need to be rescued from the perils of air pollution, through urgent and effective multi-sectoral actions, there are many other health hazards that they are exposed to. Malnutrition manifests in many forms across the socioeconomic spectrum, from the still widely prevalent undernutrition of early childhood and anaemia of adolescence to the rising spectre of overweight and obesity. A recent survey from the Comprehensive National Nutrition Survey reveals that 27.4 per cent of children in the 10-14 year age group are too thin for their age (“severely or moderately thin”).
A recent UNICEF report states that over 80 per cent of adolescents in India suffer from “hidden hunger” of micronutrient deficiencies. While fruit intake is alarmingly low and vegetable intake is sparse and lacks diversity, increased intake of ultra-processed foods, sugar-sweetened beverages and unhealthy edible oils is putting young children on the road to early onset of diabetes, hypertension and heart disease.
Heightened stress erodes mental health, with high academic demands and negative social media interactions robbing the peace and pleasure of a happy childhood. Addictions, ranging from tobacco products to alcohol and drugs, entrap young persons with alarming frequency as unscrupulous suppliers prey on vulnerable adolescents. As young persons are hyperconnected in social media but remain emotionally disconnected in personal relations, the incidence of mental health disorders is rising in adolescence. Emotional fragility erodes mental fortitude and raises the risk of even minor adversity pushing an agitated or depressed child towards suicide.
While the multiple social, economic, environmental and commercial determinants of health and disease require multi-sectoral actions at many levels, the school setting too can provide remedial responses to several of these problems, by becoming an active promoter of health literacy and good practices. The value of personal hygiene, sanitation, appropriate nutrition, regular physical activity and eco-friendly living must become an essential part of assimilated learning in schools. Awareness of the physical, mental and social harm from consumption of addictive substances must be enhanced through interactive learning exercises.
Schools must not only provide health-related learning but also become active promoters of health through their own environment and services. A clean and green environment is a must — it can be created and maintained by the collective actions of the staff and students. Potable water must be available without recourse to plastic bottles. Hygienic toilets, separate for girls and boys, must be adequate in number to match student and staff strength. Schools must be tobacco-free, prohibiting and enforcing strict avoidance of tobacco in any form (smoking, vaping, chewing), by both students and staff.
Nutrition requires special attention. Students and parents must be made aware of the health benefits of a diverse diet which can be obtained through locally available and less expensive seasonal fruits and vegetables, pulses, millets and cereals. A simple message to students and parents: “The four legs of the dining table that serves a healthy diet are Variety, Balance, Regularity and Moderation”.
Schoolyard vegetable gardens will help, not only as a source of supply but also as a constant reminder of the nutritive value of different types of vegetables. Midday meals provide a pathway to introducing nutritionally rich and balanced diets with diverse food items. School canteens should not become profit-driven purveyors of unhealthy foods and beverages.
Regular physical activity is essential for good growth as well as physical and mental health. School time physical activity is increasingly sacrificed for crowding in more academic work. Forced sedentariness is an unnatural distortion of active adolescence and a perilous path to many diseases. It is essential that teachers and other school staff too participate in the regular physical activity sessions alongside students, to become fitness role models and personally reap health benefits. Physical activity also protects against the adverse effects of mental stress by building physiological cross-tolerance to high-demand situations.
Mental health must be zealously protected and promoted, especially in pressure cooker academic environments. A happy school environment must be fostered and teachers must be trained not to damage the self-esteem of a child through unkind words or actions. Schoolyard bullying must be strictly curbed. Teachers must also be trained to watch out for signs of depression, social withdrawal, severe anxiety, hostility, discrimination and violent behaviour. Wherever possible, teachers must act as trusted counsellors, calling for further parental and professional help when necessary. Peer-to-peer counselling and student support groups, with trusted senior students guiding junior students, can build a positive emotional environment. Building healthy gender relations is also an important function, which schools can perform by inculcating the values of gender equity and gender respect.
School students, sensitised to health issues and skilled in communication and advocacy, can also be effective change agents in school, home, neighbourhood and wider community environments. Many parents gave up their tobacco habit when passionately persuaded by their well-informed children. Young persons can also advocate effectively for health-friendly public policies, whether it is tobacco control or pollution control. While the example of the intrepid Greta Thunberg shines globally, Indian school students too have been effective health advocates and change agents (www.hriday_shan.org). Emphasis on school health can be transformational, not only for individual students but also for all of society.
K Srinath Reddy
President, Public Health Foundation of India, and author of Make Health in India: Reaching a Billion Plus.