School-based health and nutrition services are provided through the school system to improve the health and well-being of children and in some cases whole families and the broader community. These services have been developed in different ways around the globe, but the fundamentals are constant: the early detection, correction, prevention or amelioration of disease, disability and abuse from which school aged children can suffer. Background It was shown by statistics that many pupils were behind in their studies only because of lack of physical vitality. In 1920, it was shown that so many pupils in the schools of Brooklyn, New York, were compelled to pass through the same grades twice that, at the average cost of US$40 a term for each pupil, they cost the borough $2,000,000. On this basis various social organizations demanded an appropriation from the city of $100,000 for more effective medical aid to the school children, contending that more than half of the extra expense could thus be saved. Out of 252,000 school-children inspected in New York City in 1919, 74% were found defective physically, defective teeth and vision being the chief faults. Unesco Tools Unesco published a set of tools, to support the FRESH framework, to guide those wishing to set up school health services around the world. Designed primarily for developing nations, these tools can be of universal use. The main emphasis of these tools is on: HIV/AIDS Food and nutrition Helminths and hygiene Malaria Violence Drugs, tobacco and alcohol United States School health services are well developed in the United States. Central guidelines are provided by Making Health Academic but each state and within that each school board has adopted its own specific methods. Making Health Academic This is a five-year project funded by CDC's Division of Adolescent and School Health (DASH) designed to enable all schools to be part of a co-ordinated school health program. The project is built around the fact that six preventable behaviours, mainly learned in childhood and youth, account for most of the serious illnesses and premature deaths in the United States. Examples of existing services Massachusetts. An example from a maritime state is where a typical mission statement starts "School Health Services fosters the growth, development and educational achievement of Massachusetts' students by promoting their health and wellbeing ... " New Mexico. An example from a southern state is where an interesting "yucca model of coordinated school