Kathleen J.

MSPH Department of Health Education and Recreation Southern Illinois University, Carbondale, IL

It is a great pleasure to be working with you in Samara for the fifth summer. I see some familiar faces and some new ones, as well. Listening to your reports on your programs, the challenges you have faced and the successes you have had, I am very impressed by the progress you have made in the past five years. Five years ago, the schools and practitioners in the community were working almost independently of each other, and there seemed to many obstacles to working together. Today you've described programs in which schools, health care providers, and other community agencies have joined together to serve the needs of children.

The physical health, the emotional well-being, and the spiritual development of our children are important to all of us. In fact, I think we'd agree that our mutual concern for the children is a force that drives our professional lives and unites us here today, whatever our other differences. This is your conference, to share your ideas and strategies. I am here simply to review a few things we've learned about "programs that work". All of the things I'll mention are things you are doing here in Samara oblast. So, maybe you can take a little rest now as I speak, and reflect on your accomplishments, rather than on the things still left to do.

We've talked this morning about the physical and psychological problems of the youth in Samara. Some of you have described school programs to identify these problems early, or prevent them before they start. We also know that the problems of adults begin with the lifestyles of children. This is true of problems with the spine and nervous system, which you have talked about today. This is also true of other diseases that will become more prominent in Russia as you adopt "western ways". Diabetes, lung disease, cancer, and heart disease begin with the lifestyles people adopt in youth. These include a poor diet, a lack of physical activity, and cigarette smoking. In the U.S. we see signs of heart disease starting in some children before their teen years, and these lifestyle factors are to blame. Cigarette smoking isn't often talked about as a problem in Russia yet, but your country imports more tobacco products than any other country. As more and more young people smoke, tobacco-related health problems will increase rapidly in Russia, as they have elsewhere. And of course you are aware of the health and social problems caused by alcohol and drug abuse, including the epidemic ofHIV-AIDS.

These health problems are largely avoidable, if people learn to live healthy lifestyles when they are young. Someone spoke earlier about "working with children with bad habits". I think we'd all agree that it is more effective and less costly to work with children before they develop those bad habits. And we must insist to those who make health and educational policy, and those who budget the dollars that what we call "primary prevention" must have more attention... That is, preventing our children's health problems before they ever start. Furthermore, the best strategy for doing this involves working with schools, families, and the whole community.

Doctors are an important part of our prevention team, of course. They can diagnose problems early and, in many cases, keep them from getting worse. And doctors can advise their patients about how to take better care of their health. But doctors cannot protect the public's health all by themselves. It takes a team effort to help our youth develop healthy lifestyles.

I was asked to talk a little about what we Americans like to call "best practices", or "programs that work". There is noone "best" solution, however. A program must fit the needs, the social conditions, and the culture. Some of the things you do here would not be successful in the US, because they are not consistent with US cultural traditions. The same is true of some American approaches. As you have demonstrated here today, the secret to success is to look carefully at your own situation and find creative solutions that fit your circumstance.

In the U.S., as in most of the world, what we call "health education", and what you often call "healthy lifestyles" education takes place primarily at school. Evaluations of school programs in the U.S., northern Europe, and Africa show that programs that make a lasting change in the lifestyles of youth share several characteristics. By lasting change, we mean changes that continue past the end of the school year, and past the end of the educational experience.

The first characteristic of successful school programs is a strong commitment to health education in the curriculum. As all of us here know, it is often difficult to get school officials to commit to health education. School officials in Russia and the U.S. say "academic subjects come first; that's what we're here for". Parents often agree with them. Plus, parents and church leaders ask, "What are you teaching our children? Are these things we want our children to know?" We do find, though, that if we communicate well with school officials, parents, and the community, we can get their support to educate our children in matters that affect their physical and psychological health.

The second pattern associated with successful school programs is that they teach three kinds of things. First, they teach information and health skills: they teach our young children how to brush their teeth and wash their hands. They teach older children about things like diet, physical activity, sexuality, drug, alcohol, and tobacco use. Second, good health education programs motivate children to want to live a healthy lifestyle. This is what you call "valuology", and we call "values clarification". It is important for young people to consider how health fits into their goals for their lives. They must understand that bad health and unhealthy behaviors will make it difficult for them to reach those goals. Third, good health education programs teach children the life skills they need to make good choices, and to handle difficult situations where their friends or other people challenge their healthy choices. The ability to communicate well; to say "no" and mean it; and to make good decisions in a dangerous or unhealthy situation are important skills for our children.

In the U.S. we believe that the best way to teach health education is through a special course each year throughout a child's education. In this class, students leam the information, develop physical skills, explore their values, and practice life skills. However, in the U.S., as in Russia, this is not what usually happens. Students get pieces of what they need in different courses; in different grades; and not always at the age where they need something most. In both our countries, it takes dedicated professionals who have a vision of what is needed, to keep coordinating and expanding health education opportunities as best they can.

It has been said that children need a clear and consistent message about what is healthy and what is not healthy; and they need to understand why their good health is important. Schools cannot do this alone, of course. Children spend only part of their day at school. Their families, their friends, their neighborhoods and their society also influence their values and their behavior.
Several of you here have talked about the role of parents in your programs. Parents are the child's first educators, the child's supervisors, and the child's "role models". Often, parents do not understand how much they influence their child. Experts in Samara recognize this problem. We see many social workers, psychologists, and educators here talking about teaching parents more "parenting skills". Our American experience suggests something in addition to general parenting skills. Some of our programs have the parent and child work together to clarify their health-related values. And, parent and child plan healthy changes in the family's lifestyle (such as healthy ways to prepare food, or exercising or doing yoga together). Children in these programs experience more lasting change because their parents are encouraging them, and often making changes themselves. Parents in these programs are also less resistant to the teaching of values, because they are the ones doing most of the teaching, with guidance from the curriculum.

Studies of programs that work also tell us that healthy children need "healthy communities". In a healthy community, society's standards support a healthy lifestyle. Children do not have easy access to alcohol, drugs or cigarettes, and if they are found using these things, the adults intervene. Further, children are not exposed to alcohol abuse and drug use, and abuse is taken seriously. In a healthy community, children are not exposed to violence or inappropriate sex in their own lives or through the media. In a healthy community, people care for each other and look out for each other.. .in a positive way, not a punitive way. People feel part of something larger than themselves, and feel cared about and important. I suspect that, as I describe "healthy community", some of you are thinking that your communities were healthier in Soviet times, and that may be true. Now, professionals in your country and mine must constantly struggle to give all our children communities that will help them grow into healthy, happy, productive adults.
A new direction here in Samara is for professionals to become advocates for healthier communities. Some of you are working to influence social policy, laws, and law enforcement in ways that will protect the children and give them the best possible lives. This is not easy for people with our training and temperaments. We often do not want to "make a fuss". But in the U.S. as in Samara, we have found that we must move beyond the classroom. We must advocate for children's health, and promote children's healthy lifestyle education.

The unfortunate fact of life is that the needs of children are often overlooked. This is true around the world. It is also true that, with the many pressures of our daily lives, we often neglect to live a healthy lifestyle... even when we know it is important and how to achieve it. But those of you in this room are the leaders. You the people with a vision of how things might be for the children. You have shared exciting and important ideas here today. I am sure that you will continue to develop creative new strategies for the problems of your young people. And I look forward to more opportunities to share ideas and plan strategies with you in the coming years.