Gaining health : analysis of policy development in European ...

Chapter 4
90
intoxication, improves services for people at risk and organizes
training at local and national levels for health promotion
practitioners. The Association employs about 1200
physicians, social workers and training agents in specialized
teams within its 100 local committees, located throughout
France and the overseas territories.
2.9. Settings
2.9.1. Schools
Health promotion in schools is carried out by two types
of stakeholder. First, school physicians are responsible for
health checks on pupils, and an obligatory health check
takes place at the ages of 6, 12 and 15 years. School physicians
are employed by the Ministry of Education but the
service is managed jointly by the Ministry of Education and
the health ministry since data on health examinations is
forwarded directly to institutes of the latter. .
Second, teachers are requested to address health aspects
in all school subjects. In France, no course is specifically
devoted to health promotion and, in the absence of a clear
framework, teachers introduce aspects of health promotion
on an ad hoc basis. Nevertheless, in 2003 the Ministry of
Health and the Ministry of Education signed an agreement
on strengthening the methodological assistance for teachers
in this field. To this end, INPES issued methodological
guidelines for teachers and published brochures on healthy
nutrition and tobacco use in clear, understandable language
for children. In addition, INPES developed jointly with the
University Institute for Teacher Training specific training
modules on health promotion for trainee teachers. France
faces a lack of coordination and consistent practice of health
promotion in educational institutions. In response to the
need for improvement, a committee has been established
in every school to coordinate the presentation of health
promotion and to provide assistance and expertise to the
teachers. School physicians and teachers are volunteer
members of this committee.
The Public Health Act of 2004 ordered some changes to the
structures of health promotion in schools. The new public
health decision-making mechanism, the GRSP (see section
2.5), established by the Act, must have a so-called “rector”
as a permanent member, who is charged with ensuring an
appropriate representation of health promotion at schools in
the PRSP. The rector is appointed by the Ministry of Education
and represents all schools of the region in the GRSP. The
work of the rector is supported by a permanent team.
The report of the Commission on Prevention (see section
2.2), launched in 2006, devoted a chapter to health
promotion in schools and suggested introducing a regulated,
continuous presentation of health promotion in the school
curriculum. It was recommended that the School Committee
on Health organize suitable training for teachers. In
addition, it was proposed to take advantage of the current
system of “school projects”. Within the framework of this
system, schools are asked to highlight a certain issue or
topic every year and organize events and activities around
it. The Commission recommended adapting this project
annually to focus specifically on health under the leadership
of the School Committee on Heath (25).
2.9.2. The workplace
Occupational health care was systematically developed after
the Second World War, initiated and supported by NGOs.
Until recently, health policy at the workplace remained
restricted to health inspections and health examinations by
physicians and on safety at high-risk sites.
Government competence for workplaces and occupational
health lies with the Ministry of Employment, Social
Cohesion and Housing and the National Institute for the
Prevention of Accidents at Work and Professional Diseases
(INRS). INRS is the oldest institution in occupational health
(a governmental body since 1968) and works under the
supervision of the Ministry. Through its activities, INRS aims
Case studies: policy development in countries for tackling noncommunicable diseases