Guest pen Children and young people need more effective services

School health care offered worldwide in more than a hundred countries. Although the ways of organizing vary greatly, the study provision in no other country is as diverse as in Finland. Curators, psychologists, nurses and doctors work alongside teachers in Finnish schools, and their co-operation in Finland will be further intensified. Another strength of Finland in promoting the health of school-age children is the provision of health education to all.

Finland’s weaknesses are the deteriorating mental health of young people and the large health inequalities between population groups. Unfortunately, despite free education and comprehensive schooling, socio-economic disparities in young people’s learning outcomes and health behaviors have only intensified in the 21st century.

Fresh in the light of research data, statutory health checks in school health care do not appear to remedy the situation. Therefore, in addition to administrative reforms, Finland should dare to invest in measuring and increasing the effectiveness of social and health services.

Fortunately for children and young people, this work does not have to start over. The World Health Organization (WHO) and the United Nations Educational Organization (UNESCO) last summer issued a joint recommendation, based on extensive research, on how best to organize school health care and promote health and well-being in schools.

In order for services to be effective, the most common causes of disease and nausea in children and young people should be identified and addressed. Children born in Finland are examined more than ten times before school age, so the most serious developmental problems are detected early and there is a huge amount of information about the child’s development and growing conditions. Up-to-date information can be collected from schoolchildren and parents through electronic surveys, of which the Welfare Map used in Espoo is an excellent example. If the survey alerts or does not respond, the student is quickly invited to a nurse appointment.

School children the most significant well-being threats are obesity, mental health problems and exclusion, which are often intertwined. According to Paula Häkkänen’s dissertation, obesity does not change in the monitoring of school health care. Instead of weight controls, completely new ways of working would be needed.

Depression is screened from high school students, but there are no resources to treat it, which makes the whole screening unethical. Addressing school absenteeism, which predicts exclusion, varies from municipality to municipality and school to school, and school health care is not used consistently, even when the reported reasons for absenteeism are healthy.

Ineffective measures must be abandoned. The most acute example of this is scoliosis screening, which has not been supported by extensive scientific reviews in the United States and England. Doing ineffective screening is an unethical waste. There is a lot of use for free resources in student care.

Student care effectiveness should be measured across disciplines. Rapid changes could be expected in absenteeism and dropout, behavioral problems and concentration, safety, suicide, anxiety, and sexual health. From the perspective of children and young people, the accessibility, reliability and communication skills of employees are also important indicators.

While prioritization is a daunting word for some politicians, it can increase effectiveness and ensure that the children and young people who need it most really get the help they need. In Finland, there is a lot of information produced by registry surveys on health and well-being risks and protective factors, but the utilization of this information is halfway. The growth of health and well-being inequalities between children and young people must be stopped, because Finland needs all its children.

Silja Kosola

The author is a specialist and docent in adolescent medicine at the Pediatric Research Center.

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