Social determinants of health

Stories of positive action from around the world

Story numbers correspond to those in the Report.

Ensuring Equity from the start

5.3: A comprehensive aproach to addressing early child development challenges in Jamaica

Young children in poor Jamaican communities face overwhelming disadvantages, among others of poverty. The Malnourished Children’s Programme addresses the nutritional and psychosocial needs of children admitted to the hospital for malnutrition. Hospital personnel observed that, before initiation of their outreach programme, many children who recovered and were sent home from the hospital had to be readmitted for the same condition shortly after. To address this, follow-up home visits were set up to monitor children discharged from hospital. During home visits, staff focus on stimulation, environmental factors potentially detrimental to the child’s health, the child’s nutritional status, and the possible need for food supplementation.

Parents participate in an ongoing weekly parenting education and social welfare programme. They are helped to develop income-generating skills, begin self-help projects, and find jobs or shelter.Unemployed parents are also provided with food packages, bedding, and clothing. In addition, there is an outreach programme in poor communities, including regular psychosocial stimulation of children aged 3 and under, supported by a mobile toy-lending library.

Adapted, with permission of the publisher, from Scott-McDonald (2002).

5.6: Universal child development services in Cuba

Cuba’s Educa a Tu Hijo (Growing-up with your child) programme is generally thought to be an important factor in Cuba’s educational achievements at the primary school level (UNICEF, 2001). The programme, introduced in 1985, is a non-formal, non-institutional, community-based, family-centred ECD service under the responsibility of the Ministry of Education (Preschool Education). The programme operates with the participation of the Ministries of Public Health, Culture, and Sports, the Federation of Cuban Women, the National Association of Small Farmers, the National Committee for the Defence of the Revolution, and student associations.

This extended network includes 52 000 Promotres (teachers, pedagogues, physicians, and other trained professionals), 116 000 Executors (teachers, physicians, nurses, retired professionals, students, and volunteers), and more than 800 000 families. During the 1990s the programme was extended, reaching 99.8% of children aged 0-5 years in 2000 – probably the highest enrolment rate in the world.

Source: CS, 2007

5.10: Country approaches to pre-primary education

In Chile, the expansion of pre-primary education for socially disadvantaged children began by extending provision first for ages 5-6, then ages 4-5, then ages 3-4. The programme focuses on integrating quality education, care, nutrition, and social attention for the child and his or her family care (JUNJI, nd). Expansion of preschool education in Sweden was achieved with a government commitment that preschool education should have an emphasis on play, children’s natural learning strategies, and their comprehensive development. It was a policy goal to integrate this comprehensive approach to education into the entire education system (Choi, 2002).

5.11: Child friendly schools

UNICEF has developed a framework for child friendly schools that takes a rights-based approach to education. Child friendly schools create a safe, healthy, gender-sensitive learning environment, with parent and community involvement, and provide quality education and life skills. This model or similar models are now developed or being developed in more than 90 countries, and adapted as national quality standard in 54 countries. Source: UNICEF, nd,d

5.12: Kenya – abolition of school fees

When Kenya abolished school fees in 2003, there was an immediate influx of 1.3 million children into the school system, overwhelming school infrastructure and teachers. School enrolments since 2002 increased by 28% while the total number of teachers increased by only 2.6% between 2002 and 2004; in some areas the ratio rose to one teacher for 100 pupils. Source: Chinyama,2006