Principles for principals: diffusion of health promoting schools across Europe

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By Gillian Hewitt

Schools are a popular setting for programmes that seek to improve children and young people’s health and wellbeing. Nearly all children spend a substantial amount of their time at school, so there is a large, captive (if not always captivated!) audience.  Programme coverage or ‘reach’ is therefore very high, increasing the potential health impact of the programme.  Benefits beyond student health may also occur; young people’s health is linked to their capacity to learn so improvements in educational attainment may arise. There is also a potential ‘ripple effect’, whereby programmes produce positive impacts for school staff, students’ families or the wider community.

The potential of school-based health promotion has been encapsulated in the Healthy Schools movement.  Healthy Schools is a settings-based approach to health promotion and one of a number of ‘Healthy settings’ developed by the World Health Organization (WHO).  Regular readers of this blog will remember Healthy Universities, but did you know that the DECIPHer universities of Cardiff, Swansea and Bristol are all situated in Healthy Cities?  Such settings-based approaches follow the principles set out in the WHO’s Ottawa Charter for Health Promotion.  Rather than focusing on individual behaviours, the charter emphasises instead the social, political and environmental determinants of health.

                                                                                            The captivated audience.

What is a health promoting school?

Healthy schools seek to develop safe, supportive environments that are conducive to health.  Under the health promoting schools framework, health is defined broadly to include physical and mental health, emotional wellbeing and safety,  and is seen as the responsibility of the whole school community.  Healthy schools are expected to uphold principles of democracy, equity, sustainability, social justice, collaboration and empowerment and address the health of staff as well as students.  Healthy schools’ holistic approach focuses on three broad areas of school life:


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  • the formal curriculum;
  • the environment and ethos of school; and
  • the school’s links with the wider community.

This comprehensive approach aims to ensure that schools’ policies and their physical and social environments reinforce the formal health education curriculum.  So no vending machines brimming with crisps and soft drinks outside the classroom where the principles of a healthy diet are taught!

Healthy schools networks


Throughout the development of the healthy schools movement, networks to support local schemes and facilitate knowledge exchange have been vital. In Wales, national and local government have been so successful in establishing and supporting healthy schools (see this review by DECIPHer’s Heather Rothwell and Simon Murphy) that nearly every school in Wales is involved in a healthy school scheme. These are coordinated by local authorities and, since 1999, each local scheme is in turn supported by the national Welsh Network of Healthy School Schemes.

In 1992, the European Network of Health Promoting Schools (ENHPS) was launched, to support healthy schools across Europe.  The ENHPS advocated the healthy schools concept internationally and provided member countries with technical assistance, training and fora for sharing good practice and knowledge. 

The ENHPS was quick to recognise two key things that would contribute to local success.  

Firstly, that local flexibility was crucial and it was not specific activities, but the core values and principles of the healthy schools approach, that were key.  Its role, therefore, was not to be prescriptive about health promotion activities, but to support countries to embed the values and principles of health promoting schools in light of their own local cultural, organisational and political contexts.

Secondly, the ENHPS insisted from the outset that any country wishing to join the network had to have a signed agreement of collaboration between their ministers of health and education, thereby securing high level, cross-sectoral commitment within each country.

The Schools for Health in Europe network

The ENHPS no longer exists, but it has been succeeded by the Schools for Health in Europe (SHE) network.  Run by a small team in the Netherlands, the SHE network continues the advocacy, training, capacity building and dissemination work of the ENHPS, and encourages school-based health research.  Fully committed to the health promoting school approach, the SHE network’s core aim is to make schools in Europe better places for learning, health and living.

The SHE network has grown to 43 member countries across Europe and central Asia, and has built up a wealth of experience. This puts it in a strong position to help tackle the health challenges facing young people today, a role recognised by the WHO in their current strategy to control non-communicable diseases in Europe.
                                                                                                                                The A to Z (almost) of school health promotion:
                                                                                                            the SHE network has 43 members, from Armenia to Uzbekistan.

Building on a growing body of work on health promoting schools and school environments, DECIPHer will soon be conducting an evaluation of the SHE network’s recent activities.  This is an exciting opportunity to contribute to the ongoing development of the healthy schools movement in Europe, and further our understanding of the role of both school settings and structures for collaboration and support, such as the SHE network, in health promotion.



Dr. Gillian Hewitt is a Research Associate at DECIPHer.

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