[A new organization of school health services: its twilight or renaissance?]

Starting from the beginning of January 1998, school health service in Croatia became exclusively a preventive activity. This change provoked a lot of controversial discussions among general public and medical profession. This paper gives an outline of the historic course, the aims and content of school health in different countries. From its very beginning in the middle of the 19th century, school health started to develop as a preventive activity directed primarily towards organic etiology dominant in the morbidity of school children at that time (infectious diseases, tuberculosis, malnutrition). The morbidity has changed over time. Nowadays, the problems of psychosocial etiology have emerged into the first plane. Moreover, schooling has been prolonged. It covers a great part of childhood and almost the entire adolescence. The problems of adolescents are different and complex. Health care of school children and adolescents is functionally bound to the school as their natural environment. The most efficient health care is provided in close cooperation between medical personnel and teachers. Besides, the classical model of school health offers, particularly with respect to current problems, large possibilities for health promotion of children and adolescents, and in the long run, of the whole population. Health care of school children is not equally organized in different countries. The main difference depends on whether the school health team is directed only towards preventive and specific activities or towards comprehensive primary health care. In Croatia, traditionally, the integrated health care has developed. Beside preventive health care, the school doctors provided curative care for students in their schools. Within the reorganization of health care a new situation has arisen. Compulsory integration of preventive and curative activities at the school level is completely incompatible with the right to a free choice of primary care physician. However, by the strict interpretation of the principle of indivisibility of preventive and curative care, one school should cooperate with numerous personal doctors for its students. The essential principle of school health would be lost. The school represents a community which is exposed to the same health risks but keeps a great potential for health promotion. So, if this advantage is to be utilized, preventive care must be organized at the school level. This is the very nature of the reorganization in school health service which is performed in Croatia under the auspices of the Ministry of Health. Providing the preventive and specific health care for all school children and adolescents is the responsibility of school doctors who have become the employees of the Institutes of Public Health, while the curative care is provided by the personal physician of a student's or his parents' choice.