School-based health initiatives: listening to teachers

Schools have long been used as a setting for public health improvement interventions, and over the years have been involved in everything from promoting healthy eating and physical activity to preventing multiple risk behaviours such as smoking, drugs and alcohol abuse. More recently, schools in Wales have taken on the responsibility of providing free breakfasts for pupils and even allocating time in the school day for teeth cleaning.

Recently there have been increased calls for mental health education to run alongside physical education during the school day, and just last week, the Attorney General requested that schools should now teach the risks of using social media as part of the curriculum. Acknowledging the issues that may arise through young people’s engagement with social media, he suggests that as secondary school is often where young people start using social media, “you could argue that something [to address this] could be shoved into the secondary school timetable somewhere”.

Photo of child cleaning teeth

Allocating time in the school day for cleaning teeth: great idea or a misuse of school time?

Whilst no-one can dispute the importance of educating pupils on these issues, it does raise a number of questions. Is it achievable or even desirable for all public health and wellbeing issues to be addressed through school? Does health promotion work get in the way of teaching things like literacy and numeracy? How much more can we realistically ask schools to be responsible for before jeopardising academic achievement?

Getting headteachers’ views

As part of my DECIPHer PhD research, I was involved in interviewing 19 primary school headteachers to look at their views on using their school as a setting for health improvement interventions. Most schools have now come to accept health initiatives as a part of school life and can see the importance of both health and education for a child’s wellbeing. Indeed, most headteachers that we interviewed didn’t see health and education as discrete entities and often described how each impacted on the other, rendering them both imperative.

  …I feel if you haven’t got the wellbeing and the health and the physical side, then sometimes children are not ready to learn. So we’ve got to get that aspect, that’s equally as important as getting the curriculum taught… (Participant F)

However, despite an appreciation of the importance of pupils’ health, there was a perception of an ever-growing expectation from the government and local councils for schools to take on additional health issues whilst simultaneously improving standards in literacy and numeracy. This conflict of agendas and the reliance on schools to address health as well as education led to headteachers feeling overburdened:

Everybody thinks that it’s reasonable to ask the schools to do something, you know, every year and something terrible happens in Wales, you know, maybe a drug issue, and somebody will want to say, ‘Well schools need to do more about that’…Nobody ever cares when you say, ‘Well what shall I not do then, so that we can do this? Just give me that, just give me that waiver, give me the piece of paper that I can give to the inspectors to say that we didn’t do probability and shape and space because we did this instead’. (Pilot 2, emphasis added)

You could argue that schools have allocated sessions within the curriculum for pastoral care or personal, social and health education. Given the wealth and complexity of the issues that schools are expected to cover, though, is one session a week really enough?

The interviews we carried out show that headteachers do appreciate their role in public health improvement and in helping pupils maintain a healthy lifestyle. However, the increasing expectation to cover more and more does bring challenges.

The expectation of schools to address health as well as the formal curriculum can leave teachers feeling overburdened.

Challenges and barriers

Whilst teachers are the experts in education in their school, they may not necessarily be equipped with the skills and experience of a health professional in dealing with matters relating to health. This suggests the need for health professionals to have a greater role within schools; however, this may require extra funding and an allowance within curriculum time.

With governments highlighting educational achievement as schools’ main priority, this can often restrict opportunities to bring in additional projects which may detract from curricular time. Therefore, unless health promotion interventions can demonstrate improvements in learning, or have elements of cross-curricular working, schools may be reluctant to displace curricular time to accommodate such interventions. Many of the headteachers interviewed felt that they are predominantly assessed on academic achievement meaning they have to see this as their first priority; it could be argued that unless they are given more recognition for improving health and wellbeing, this will always be a secondary priority for schools.

Parental engagement was also deemed important by headteachers, in order to minimise the risk of all the hard work done in schools being contradicted at home, and to encourage parents to reinforce the same health messages being taught at school. This may be a particular problem if parents engage in unhealthy behaviours or lifestyles themselves, potentially causing confusion for younger pupils.

Working together

Schools already do a great deal of work regarding public health and it is important that they gain recognition for this. Many schools have come to accept that health interventions are a part of school life and appreciate the need for these and their impact on education; however, schools are restricted by time, existing curriculum constraints, funding and expertise, and it is not merely as simple as ‘shoving’ something else into the timetable.

Those of us working to address health within the school environment have a duty to ensure we assist schools in delivering high quality health education and improving access to health services whilst still allowing schools to educate their pupils. These headteachers appreciate the synergy between health and education, so by following their lead and allowing greater collaboration between schools, health professionals and policy makers, there is no reason why public health cannot work successfully with schools for a healthier, well-educated future for all.


 About the author: Danielle Christian is a DECIPHer PhD student, researching physical activity interventions for children and adolescents.

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