Nutrition Project in China Produces Key Results

Good nutrition is illustrated in a Chinese student's drawing.

A six-school nutrition pilot project in China offered to more than 8,000 school staff, students and their families has produced significant improvements in their knowledge, attitudes, and behaviors, promoting optimism that the approach could benefit schools throughout China and around the world. Carmen Aldinger of EDC’s Health and Human Development (HHD) Programs recently returned from a final evaluation visit to the schools, where she and EDC’s partners, the World Health Organization (WHO) and the Food and Agriculture Organization of the United Nations (FAO), analyzed evaluation surveys and observed the school programs in action. The schools are located in the cities of Hangzhou and Wenzhou in the Zhejiang Province in the southeastern region of China.

The two-year program featured training, planning, and team-building activities to help the schools build nutrition education and services. WHO funded the project as part of its Health-Promoting Schools (HPS) initiative, which encourages schools to promote the healthy development of students, school personnel, families and surrounding communities with all means at their disposal. Health and learning are inseparable, as many studies have demonstrated, said Aldinger. For the China project, nutrition education was a meaningful “entry point” into the broader goal of building a health-promoting school. HHD conducted this project in its role as a WHO Collaborating Center to Promote Health through Schools and Communities.

“Improvements were found in several key areas,” said Aldinger. “By the end of the project, more children were eating breakfast, enjoying the school lunches, and practicing better hygienic habits—drinking clean water and not eating expired foods.” Parents, for example, showed a dramatic increase in health knowledge. Their scores on a health survey rose from 45% before the program to 73% in the final survey. Significant improvement was also seen in student attitudes about such topics as the importance of nutrition and HIV education. Behavior improvements, such as the numbers of students washing hands before eating, were marked, she said. Among staff at the outset of the program, 24% of staff paid attention to nutrition when planning meals; by the final survey 38% did so.

“The program drew on the schools’ strengths to encourage creative nutrition instruction, special projects, parent involvement, and overall improvements to the school,” she added. Yu Sen-Hai, WHO consultant, noted, “The pilot schools showed high enthusiasm and commitment to nutrition education.” He noted that they all made such impressive improvements that they earned WHO’s “bronze medal” of HPS achievement.

The program involved six schools and six others were chosen as controls. In the initial training in April 2000, Aldinger drew on the publication, Healthy Nutrition: An Essential Element of a Health-Promoting School in the WHO Information Series on School Health, jointly produced by EDC, FAO, and WHO. Aldinger, the main author, together with colleagues from WHO and FAO, offered assistance in planning and team development. “Schools, with fairly limited external guidance and assistance were able to plan and implement an impressive array of activities at different levels, involving students, teachers, the entire school, families and the communities,” said Peter Glasauer, FAO nutrition officer, in his final report.

The schools made changes in many areas throughout the school program, building, and environment. As the Principal from Si Ji Qing Elementary School in Hangzhou said, “The project was a challenge and an opportunity.”

Jack Jones, of WHO’s Department of Noncommunicable Disease Prevention and Health Promotion said that the project demonstrated the variety of opportunities schools have to improve health of students. He cited a number of examples:

• Use of school health policy: In one school, the headmaster reported that school starting hours were delayed so that children could get more rest and eat a healthy breakfast before school.
• Improvements in the school environment and services: One school enhanced its cafeteria service by improving sterilization procedures. Student/parent involvement: Students brought home recipes and nutrition information from school.
• Teacher satisfaction: Teachers reported being impressed with students’ increasing knowledge about nutrition.
• Parental acceptance: Many parents expressed their gratitude for the information and practical tips on how to integrate it at home.
• Health promotion: Based on the excellent results with the nutrition project, many schools are ready to expand to other health issues and/or work with other schools that want to become Health-Promoting Schools.

For Aldinger and her partners, the next steps will be to find ways to help sustain these improvements; consider expanding into other areas such as early childhood education, skills-based health education, or surveillance; and spread the word of these successes to other schools in China and around the world.