Re-creating health promoting schools will improve population health and help to reduce inequalities.
Dear Editor
We fully agree with Oliver simply renaming government agencies will not improve population health and tackle health inequalities.(1) However what is needed is an industrial shift in the scale of our activity in this area. In addition, instead of putting the responsibility for health solely on individuals, we need to create environments that help to maintain and improve health.
The idea of health promoting environments is not new and throughout the world, examples of a wide range of settings can now be found including health promoting schools; health promoting workplaces; and health promoting hospitals.(2-4) For some of these, for example health promoting schools, a considerable amount of academic literature has been produced, including theoretical papers, descriptive studies, evaluations and reviews.(2,5-16)
Five elements of a health promoting school are:
1) Health topics are promoted through the formal school curriculum;
2) Health and well-being of pupils are promoted through the ‘hidden’ or ‘informal’ curriculum e.g. school meals;
3) Health and well-being of all staff are promoted;
4) School health services actively support the curriculum;
5) Links are made with families, outside agencies and the wider community.
An outcome of this is essentially that children and young people become health literate; that is to strengthen their ability into adulthood to take control of their lives and reduce susceptibility to harmful influences.(17)
Good quality education is an investment for health and within schools, teachers, school nurses and catering staff could have key roles to play. The PSHE Association is ideally placed to provide support and training for teachers to be both competent and confident in delivering health education.(18) Externally, primary care teams could be facilitated by health promotion specialists to have positive and coordinated inputs and bring about healthy changes in schools.(19)
We recommend that the new Office for Health Promotion revisits the National Healthy School Scheme and reintroduces targets for schools to achieve the award of ‘Healthy School.’(20) Supported again by local authorities and health promotion specialists, health promoting schools have enormous potential. However, public health departments would need increased resources for them to undertake this work.(21,22)
Schools have been identified as a key settings with the potential of improving population health and contributing to health inequality reduction.(2,23) They can act as a ladder out of poverty. But we do need national government commitment to realise this potential.
The potential offered by schools for influencing young people in their formative period has long been recognised.(2) We now need a meaningful long-term commitment from the government. Sufficient public health resources are needed at regional and local authority levels.
4) Thompson S R, Watson M C, and Tilford S. The Ottawa Charter 30 years on: still an important standard for health promotion. International Journal of Health Promotion and Education. 2018,56(2), 73-84. https://www.tandfonline.com/doi/abs/10.1080/14635240.2017.1415765
5) Baric L. Health Promotion and Health Education in Practice. Module 2. The organisational model. Altrincham: Barns Publications, 1994.
6) Poland B, Green L and Rootman I (eds) Settings for Health Promotion. London: Sage Publications, 2000.
9) Langford R, Bonell CP, Jones HE, Pouliou T, Murphy SM, Waters E, Komro KA, Gibbs LF, Magnus D, Campbell R. The WHO Health Promoting School framework for improving the health and well-being of students and their academic achievement. Cochrane Database of Systematic Reviews 2014, Issue 4. Art. No.: CD008958. DOI: 10.1002/14651858.CD008958.pub2. https://www.cochrane.org/CD008958/BEHAV_the-who-health-promoting-school-...
11) Turunen H, Sormunen M, Jourdan D, von Seelen J, Buijs G. Health Promoting Schools—a complex approach and a major means to health improvement, Health Promotion International 2017, 32(2), 177–184. https://doi.org/10.1093/heapro/dax001
14) World Health Organization and the United Nations Educational, Scientific and Cultural Organization. Report of the first Virtual Meeting of the External Advisory Group (EAG) for the development of Global Standards for Health Promoting Schools and their implementation guidance. Geneva: World Health Organization and the United Nations Educational, Scientific and Cultural Organization, 2020. https://apps.who.int/iris/handle/10665/339614
16) Gugglberger L. A brief overview of a wide framework—Health promoting schools: a curated collection, Health Promotion International. 2021, 36 (2), 297–302. https://doi.org/10.1093/heapro/daab037
17) Lloyd J. Improving health outcomes and health literacy for children and young people through Personal, Social and Health Education in schools. Paper presented at the 17th EUSUHM Congress. 27th June 2013. Royal College of General Practitioners. London.
19) Campbell G. New Directions in Health Education. Lewes: Falmer Press 1985.
20) Department for Children, Schools and Families. The Children’s Plan. Building brighter futures, 2007. London: Department for Children, Schools and Families.
Rapid Response:
Re-creating health promoting schools will improve population health and help to reduce inequalities.
Dear Editor
We fully agree with Oliver simply renaming government agencies will not improve population health and tackle health inequalities.(1) However what is needed is an industrial shift in the scale of our activity in this area. In addition, instead of putting the responsibility for health solely on individuals, we need to create environments that help to maintain and improve health.
The idea of health promoting environments is not new and throughout the world, examples of a wide range of settings can now be found including health promoting schools; health promoting workplaces; and health promoting hospitals.(2-4) For some of these, for example health promoting schools, a considerable amount of academic literature has been produced, including theoretical papers, descriptive studies, evaluations and reviews.(2,5-16)
Five elements of a health promoting school are:
1) Health topics are promoted through the formal school curriculum;
2) Health and well-being of pupils are promoted through the ‘hidden’ or ‘informal’ curriculum e.g. school meals;
3) Health and well-being of all staff are promoted;
4) School health services actively support the curriculum;
5) Links are made with families, outside agencies and the wider community.
An outcome of this is essentially that children and young people become health literate; that is to strengthen their ability into adulthood to take control of their lives and reduce susceptibility to harmful influences.(17)
Good quality education is an investment for health and within schools, teachers, school nurses and catering staff could have key roles to play. The PSHE Association is ideally placed to provide support and training for teachers to be both competent and confident in delivering health education.(18) Externally, primary care teams could be facilitated by health promotion specialists to have positive and coordinated inputs and bring about healthy changes in schools.(19)
We recommend that the new Office for Health Promotion revisits the National Healthy School Scheme and reintroduces targets for schools to achieve the award of ‘Healthy School.’(20) Supported again by local authorities and health promotion specialists, health promoting schools have enormous potential. However, public health departments would need increased resources for them to undertake this work.(21,22)
Schools have been identified as a key settings with the potential of improving population health and contributing to health inequality reduction.(2,23) They can act as a ladder out of poverty. But we do need national government commitment to realise this potential.
The potential offered by schools for influencing young people in their formative period has long been recognised.(2) We now need a meaningful long-term commitment from the government. Sufficient public health resources are needed at regional and local authority levels.
References
1) Oliver D. David Oliver: Renaming government agencies won’t improve population health. BMJ 2021;373:n1004
https://www.bmj.com/content/373/bmj.n1004
2) Tones K and Tilford S. Health promotion: effectiveness, efficiency and equity. Cheltenham: Nelson Thornes, 2001.
3) Watson, M. Going for gold: the health promoting general practice. Quality in Primary Care. 2008; 16:177-185. https://pdfs.semanticscholar.org/c1b6/3555f6b033effdc0062235adb7bab3de43...
4) Thompson S R, Watson M C, and Tilford S. The Ottawa Charter 30 years on: still an important standard for health promotion. International Journal of Health Promotion and Education. 2018,56(2), 73-84.
https://www.tandfonline.com/doi/abs/10.1080/14635240.2017.1415765
5) Baric L. Health Promotion and Health Education in Practice. Module 2. The organisational model. Altrincham: Barns Publications, 1994.
6) Poland B, Green L and Rootman I (eds) Settings for Health Promotion. London: Sage Publications, 2000.
7) Young, I. Health promotion in schools – a historical perspective. Promotion & Education, 2005. 12 (3-4): 112-117.
https://journals.sagepub.com/doi/10.1177/10253823050120030103
8)St Leger L, Young IM. Creating the document ‘Promoting health in schools: from evidence to action’. Glob Health Promot. 2009;16(4):69–71.
https://journals.sagepub.com/doi/10.1177/1757975909348138
9) Langford R, Bonell CP, Jones HE, Pouliou T, Murphy SM, Waters E, Komro KA, Gibbs LF, Magnus D, Campbell R. The WHO Health Promoting School framework for improving the health and well-being of students and their academic achievement. Cochrane Database of Systematic Reviews 2014, Issue 4. Art. No.: CD008958. DOI: 10.1002/14651858.CD008958.pub2.
https://www.cochrane.org/CD008958/BEHAV_the-who-health-promoting-school-...
10) World Health Organisation. Health Promoting Schools. An Effective Approach to Early Action on Noncommunicable Disease Risk Factors. WHO/NMH/PND/17.3. 2017.
http://apps.who.int/iris/bitstream/handle/10665/255625/WHO-NMH-PND-17.3-...
11) Turunen H, Sormunen M, Jourdan D, von Seelen J, Buijs G. Health Promoting Schools—a complex approach and a major means to health improvement, Health Promotion International 2017, 32(2), 177–184.
https://doi.org/10.1093/heapro/dax001
12) Lloyd J and Watson M C. IHPE Position Statement: PSHE. Lichfield, Institute of Health Promotion and Education, 2019.
https://ihpe.org.uk/wp-content/uploads/2020/02/PSHE-Position-Paper-Octob...
13) Cheater S. Health promoting schools – back to the future! International Journal of Health Promotion and Education, 2019, 57:6, 355-357.
DOI: 10.1080/14635240.2019.1665926
https://www.tandfonline.com/doi/full/10.1080/14635240.2019.1665926
14) World Health Organization and the United Nations Educational, Scientific and Cultural Organization. Report of the first Virtual Meeting of the External Advisory Group (EAG) for the development of Global Standards for Health Promoting Schools and their implementation guidance. Geneva: World Health Organization and the United Nations Educational, Scientific and Cultural Organization, 2020.
https://apps.who.int/iris/handle/10665/339614
15) Cheater S. Personal, social and health education in schools – a welcome improvement. International Journal of Health Promotion and Education, 2020, 58:2, 104-105.
DOI: 10.1080/14635240.2020.1716136
https://www.tandfonline.com/doi/full/10.1080/14635240.2020.1716136?scrol...
16) Gugglberger L. A brief overview of a wide framework—Health promoting schools: a curated collection, Health Promotion International. 2021, 36 (2), 297–302.
https://doi.org/10.1093/heapro/daab037
17) Lloyd J. Improving health outcomes and health literacy for children and young people through Personal, Social and Health Education in schools. Paper presented at the 17th EUSUHM Congress. 27th June 2013. Royal College of General Practitioners. London.
18) PSHE Association. [Accessed 25th April 2021]
https://www.pshe-association.org.uk/
19) Campbell G. New Directions in Health Education. Lewes: Falmer Press 1985.
20) Department for Children, Schools and Families. The Children’s Plan. Building brighter futures, 2007. London: Department for Children, Schools and Families.
21) Watson M C and Lloyd J, 2016. Need for increased investment in public health BMJ 2016;352:i761.
https://www.bmj.com/content/352/bmj.i761
22) Watson M C and Thompson S, 2018. Government must get serious about prevention. BMJ 2018;360:k1279.
https://www.bmj.com/content/360/bmj.k1279
23) Marmot M, Allen J, Boyce T, Goldblatt P, Morrison J. Health equity in England: the Marmot review 10 years on. Feb 2020.
https://www.health.org.uk/sites/default/files/upload/publications/2020/H...
Competing interests: No competing interests