Health Promoting Schools: a healthy child is a learning child

TWENTY-five years after its inception, and 3 years after the World Health Organization and UNESCO launched an initiative to make every school in the world a “Health Promoting School” (HPS), Australian researchers have produced a set of global standards and indicators designed to make it happen.

Launched on Tuesday 22 June 2021, the HPS standards are “expected to serve over 2.3 billion school-aged children and adolescents and will contribute to the WHO’s 13th General Program of Work target of ‘1 billion lives made healthier’ by 2023 and the UNESCO strategy on Education for Health and Well-being contributing to ending AIDS as a public health threat by 2030”.

• Making every school a Health Promoting School: Global Standards and Indicators
• Making every school a Health Promoting School: Implementation Guidance
• Making every school a Health Promoting School: Country Case Studies

Professor Susan Sawyer, Director of the Centre for Adolescent Health at the Royal Children’s Hospital in Melbourne, and a lead author on the standards, told InSight+ that an HPS school was one “that is constantly strengthening its capacity as a healthy setting for living, learning and working”.

“Most of us from the health sector tend to think of schools as a platform to deliver programs or specific actions for health, but at its heart, HPS is really about saying schools are a community, out of which learning, health and well-being can each emerge.”

The eight standards are collectively intended to comprise a health promoting system, with an emphasis on governance:

1. Government policies and resources: There is whole-of-government commitment to and investment in making every school an HPS.
2. School policies and resources: There is commitment to and investment in a whole-school approach to being an HPS.
3. School governance and leadership: There is a whole-school model of school governance and leadership to support being an HPS.
4. School and community partnerships: There is engagement and collaboration within the school community including with students and between the school and local communities for HPS.
5. School curriculum support health and wellbeing: The school curriculum supports physical, social-emotional, and psychological aspects of student health and wellbeing.
6. School social-emotional environment: The school has a safe and supportive social-emotional environment.
7. School physical environment: The school has a healthy, safe, secure, and inclusive physical environment.
8. School health services: All students have access to comprehensive school-based or school-linked health services that address their physical, emotional, psychosocial, and educational health care needs.

In high income countries like Australia, many schools are already successfully implementing parts, if not all, of the HPS system.

Dr Monika Raniti, the lead author of the Global Standards report and a Senior Research Officer at the Centre for Adolescent Health at the Murdoch Children’s Research Institute, said in an exclusive podcast, that a key question was “what does successful implementation look like”.

“It’s important to recognise that HPS is not a discrete program, or a discrete curriculum with a start a middle and an end.

“It’s the way the school operates. It’s the atmosphere. It’s a school that is continually responsive to the needs of its students in the school community. There is no endpoint, because we’re talking about a complex system.”

Educators were part of the working party on the Global Standards. Researcher Dr Ruth Aston, a lecturer at the Centre for Program Evaluation at the Graduate School of Education at the University of Melbourne leading the work on the accompanying Implementation Guidance report. She told InSight+ that Australian teachers and schools were already implementing many elements of the HPS system.

“They are doing some of it already. Supporting student health and wellbeing is already part of the requirements for what it means to be a high-quality teacher and school leader here in Australia. However, we need to ensure that teachers and school leaders are adequately supported to do so and offer targeted professional learning and development where it is needed,” she said.

“Some of the recent commitments that have been made, such as funding mental health practitioners in schools, making sure that there is investment going into capital works that focus on building teaching and learning environments that promote social and emotional wellbeing, as well as providing a physical environment in which students can learn – that work is already happening. However, monitoring and evaluating the effects of these efforts and sharing this evidence to inform policy-decision making across Australia is crucial.”

As part of the research that informed the Global Standards, Dr Aston led eight case studies across low and middle-income countries – Bhutan, Indonesia, Paraguay, Philippines, South Africa, Senegal, Tunisia and Ukraine.

“We conducted documentary reviews of policy documents from ministries of education and health, and interviewed key informants in each country who had a role associated with health promoting schools, and were based in Ministries of Education or Health,” said Dr Aston.

“Our focus was to truly understand what was going on in those governments. What was fascinating was the power of written policy support from the Ministry of Education, as this then enabled the Health Ministry to come on board and say, here’s how we can support you to achieve this aim.

“Having the education ministry take ownership of the concept and express it in a policy document that was also endorsed by the Ministry of Health was particularly useful as it provided a framework from which collaboration and resourcing could flow.”

Professor Sawyer agreed that commitment at the ministerial level was crucial.

“In an ideal world, one way of achieving genuine collaboration would be if ministers of education had student health outcomes as part of their KPIs, just as I would want ministers of health to have educational outcomes as part of their KPIs,” she said.

“Within the Sustainable Development Goals, there is much talk about multi-sectoral collaboration. Two of the most essential sectors for children and young people are health and education. The organising framework of Health Promoting Schools is a prime example of how they might work more effectively together.

“While this type of collaboration often occurs on the ground within schools, until we live and breathe this at the highest level, it is much harder for the resources to flow to accompany these efforts.”

Professor Sawyer, Dr Raniti and Dr Aston have also written a comment article for The Lancet Child and Adolescent Health, to accompany the Global Standards.