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Seeing the smoke from the wheeze

Kirkby in Merseyside has the UK's highest death rate from smoking-related diseases. A project in a local primary is helping pupils resist the lure of nicotine. Carey Newson reports.

Sue Occleston is big and huggable. When her car pulls up at St Laurence's RC Primary School in Kirkby, Merseyside, children hang through the railings to greet her. Once we're inside, others walk up and throw their arms round her. Manchester-born of Irish stock, she has the same down to earth charisma you meet in Irish missionaries working in far-flung places. But Sue's personal mission is in Merseyside and it's a curious one. She has taken an idea which grew up in the developing world and adapted it to Britain.

Child-to-Child is a form of health education in which children are entrusted with vital information that will benefit their families and communities. At its core is a recognition that they can participate and make a difference. In India, for example, "health scouts" visit families to teach them about anaemia and diarrhoea, while in Bangladesh schoolchildren are taught to weigh and measure babies and spot the first signs of malnutrition. The idea has proved tremendously successful, mushrooming across the developing world in the last 17 years until today there are schemes in more than 70 countries.

Sue first came across Child-to-Child 10 years ago in Madras while working as a volunteer in a mission hospital and saw a UK potential. As advisory teachers in health education, initially employed by Knowsley Education Authority, she and Pat King have pioneered the approach with nine to 14-year-olds in 40 Merseyside schools over the past three years. It is the first major Child-to-Child initiative in Britain.

But whereas Third World children learn about hygiene and waterborne disease, the UK schemes tackle the health problems of urban life in industrialised countries - including crime, drugs, bullying, environmental pollution and smoking.

Smoking and its hazards are issues that directly affect everyone at St Laurence's. The school's immediate area of Kirkby has the UK's highest death rate from smoking-related diseases and two-and-a-half times the national death rate from lung cancer. Teenage smoking is rife and 10 to 11-year-olds are already anticipating the pressure they'll face to conform when they move into secondary school. But Child-to-Child may give them an extra chance of resisting the nicotine trap.

In adapting the idea to the UK, Sue and Pat have brought in parents to act as facilitators and begin with co-operative games before splitting classes into mixed-ability groups. Children are then asked to draw and write about what makes them feel good or bad. Invariably, says Pat, someone will say they feel bad when they're ignored and good when they're listened to.

Both teachers and parents attend a training day. Class teacher Sheila Edwards admits to envisaging noise and chaos in the classes which were to follow. "At the end of the session I sat there quite cynically and thought this won't work. But five parents worked alongside me and I'm absolutely overwhelmed at the success."

To investigate the dangers of smoking, each class group chose a different issue, and a name to suit. While "The Defenders" found out about passive smoking, "The Flames" explored fire risks. With the support of parent facilitators they were encouraged, as far as possible, to direct their own work. Some of the children with poor language and reading skills shone in a new light, winning respect from their more able classmates.

Children came up with songs, raps and sketches which they performed at school and in the local town centre where they received a more mixed reception. While some shoppers shed tears, others lit up. The class handed out leaflets, made posters for local surgeries and persuaded many of their families to keep at least one room as a smoke-free zone.

Thirty-six adult smokers signed the children's cut-down pledge cards, some planned a stopping smoking group and three quit.

The school sent a bouquet to one mother who gave up because her son became upset after learning about the risks. What made it different, the children say, is that teachers weren't telling them what to do - they were deciding for themselves.

Of course, the real test is yet to come. Many teachers have watched health conscious 10-year-olds turn into teenage smokers. To maintain the solidarity engendered by Child-to-Child, Sheila is offering to meet her class every year, on the anniversary of their presentation, until they are 16.

Sue believes the real strength of the approach is not the information children take on board but the self-esteem they gain by participating and being listened to. She points out that children as young as eight are often well aware of the effects of cigarettes. Warnings about health are not enough: "You have to look at how people deal with situations and take control of their lives." She aims to give children the confidence to choose for themselves.

Recognition of the strength of the project came last month when St Laurence's won first prize in a regional "health challenge" award for improving health. The Pounds 10,000 prize will be spent on furthering health promotion.

The Merseyside projects have been financed from several sources including the Knowsley Education Department and Health Authority, and the Lung Cancer Fund.

While funding sometimes dictates the topic, some projects have been more open-ended. At Mosscroft Primary in Huyton, children identified dog fouling as the environmental problem which affected them most. They kept watch over their school field and leafleted offending dog owners, put on puppet shows to tell younger children about health dangers, designed pooper-scoopers from recyclable materials and contacted the council to ask why legislation wasn't being enforced.

Teachers don't know exactly where projects will lead, says Sue, but find a good deal of what is covered falls within national curriculum science and English.

At St Laurence's, Year 6 say they'd like to do another Child-to-Child project. Asked what topic they'd go for next time, they volunteer a catalogue of gritty issues. Drugs, crime, abuse, attacks, alcohol, glue sniffing, vandalism, pollution and steroids, trip off their tongues as readily as the names of breakfast cereals. It's a sore reminder that outside their calm and orderly classroom they've plenty to contend with, and need all the support that Child-to-Child can offer.

The Child-to-Child Trust is a charity providing materials, expertise and training, with an international advisory centre at London University's Institute of Education, 20 Bedford Way, London WC1H 0AL. Tel: 0171-612 6647

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