Lawrence St Leger

Can Health Promoting Schools contribute to the better health and wellbeing of young people? The Hong Kong experience

Background: The Health Promoting School (HPS) is a WHO sponsored framework, compiled to enable education and health sectors to be more effective in school based initiatives. Aims: This study attempted to test the hypothesis that students from schools that had comprehensively embraced the HPS concept as indicated by the Healthy School Award, were better, in terms of health risk behaviour, self reported health status, and academic results, than students from schools that did not reach the standard of the award. Methods and Results: The results presented came from nine schools (four primary and five secondary) applying for accreditation of the Healthy Schools Award after adopting the HPS framework for two years. Regular consultancy support and training were available to all schools. Students had completed before and after surveys to assess their health behaviours, self reported health status, and academic standing before the two year intervention, and at its end. Data from the before and after surveys of the students attending schools that reached certain level of HPS standard as indicated by the award, were compared with students whose schools did not receive the award, and the results showed differences. Some differences were found to be more significant among the primary school students than secondary schools students. This illustrated early intervention for lifestyle changes to be more effective. Students’ satisfaction with life also improved if their schools adopted the concept of HPS comprehensively. Conclusions: The results suggest that comprehensive implementation of HPS would contribute to differences in certain behaviours and self reported health and academic status.

Creating the document 'Promoting health in schools: from evidence to action'.

Schools across the world have been involved in health promotion and health education for nearly a century. Do school based initiatives make any difference to the education and health outcomes of young people? This article describes the process in developing the document Promoting health in schools: from evidence to action. The document was produced primarily for the Education sector. It develops an argument about why schools should be undertaking health related initiatives. It also highlights major findings from the literature about what is possible to achieve in school health and the circumstances under which the gains will occur. Attention is focused both on the evidence from the education sector, e.g. effective schools, learning and teaching approaches, and from the health sector, e.g. a whole of school or Health Promoting School (HPS) approach, as well as identifying outcomes from topic areas such as mental and emotional health, healthy eating and nutrition, physical activity, hygiene, sexual health and relationships, substance use and misuse. (Global Health Promotion, 2009; 16(4): pp. 69-71)

Evaluating health promotion in schools: a case study of design, implementation and results from the Hong Kong Healthy Schools Award Scheme.

Health promoting schools (HPS) and Healthy Schools Award Schemes from a number of countries have demonstrated positive changes in childrens health behaviours and the culture and organisation of the school. The Hong Kong Healthy Schools Award Scheme (HKHSA) aims to promote staff development, parental education, involvement of the whole school community, and linkage with different stakeholders to improve the health and well-being of the pupils, parents and staff, and the broader community, supported by a system to monitor the achievement. This concept is very much in line with the research literature on school effectiveness and improvement. The indicators examined to evaluate the success of the HKHSA reflect outcomes related to both health and education and are not limited to changes in population health status. The early results demonstrated significant improvements in various aspects of student health and also improvement in school culture and organisation. The evaluation framework described in this paper and data collected to assess how schools perform in the HKHSA scheme, provides insight into how HPSs could lead to better outcomes for both education and health.

A settings-based theoretical framework for obesity prevention community interventions and research

Childhood obesity presents one of the greatest challenges to the public health community because the drivers of obesity can be located at the level of individual, community, social and justice systems. The depth of complexity often gives rise to opportunities for trivial, competing, opaque, ‘homeopathic’ and indeed, potentially harmful and ineffective solutions. One of the unresolved issues in the polarity of these debates is the level at which prevention efforts should be targeted. Articulation of the most appropriate theoretical frameworks to guide prevention efforts is urgently called for. It is often argued that theoretical frameworks can provide an important structure for researching and understanding a public health problem or intervention. Well-developed theories can be used in problem-driven research to provide a conceptual framework for a study. They can contribute to an understanding and interpretation of the problem or issue being studied and can inform the selection of models or frameworks to guide action. Theoretical frameworks are, however, often under-utilised and implicit rather than clearly articulated, and rarely evaluated for their value and appropriateness. We argue that selecting, using, articulating and testing the choice of theoretical framework is an important component of rigorous population health intervention research; and aim to illustrate this point from the perspective of experience in developing, implementing and evaluating more than 14 system and community-based intervention studies in the field of childhood obesity prevention. The role of theory in research and intervention design There is no single, correct or universal theoretical framework for a particular area of study. In a complex endeavour such as obesity prevention, it is likely that several theoretical frameworks will need to be used to guide the interventions and the understanding of the results. The more important consideration is that the choice of theory or theories is driven by the research question or problem. In intervention or program-oriented research, there will be several theories that could make up a framework, so researchers have some flexibility in selecting the ‘best fit’ with the context and the outcomes sought. Careful consideration of alternative frameworks strengthens intervention thinking and design by highlighting the areas of consensus (i.e. where program design would be similar under any theoretical framework) and the areas of disagreement. The rigour of this approach enables and strengthens opportunities for reflective analysis of the attribution of measured success or failure to the success or failure of intervention and/or of theory.

Health-promoting schools: working in partnership to address global needs, a collaboration leading to the production of practical tools for practitioners.

Modern schools do their best to motivate young people to live fulfilling, healthy and productive lives and the United Nations has put school education at the heart of the Millennium Development Goals. The context of education in schools is changing, but there is evidence from across the world that school health promotion can make a difference to health and education outcomes. The International Union for Health Promotion and Education (IUHPE) has recognized this potential in schools and, for the last five years in its work globally, has been actively engaged in strengthening efforts through successful partnerships. This commentary explores aspects of global partnerships in school health and the progress of the IUHPE’s leadership and partnership work in school health promotion. It also provides some reflections on what has been achieved to date and what might lie ahead in school health promotion globally.

Improving the quality of school health evaluations

Purpose – To highlight the challenges and identify options to improve school health evaluations.Design/methodology/approach – This editorial draws on recent international and national meta‐evaluations and the experiences of the author.Findings – A simple set of questions is needed for discussion between those commissioning evaluations and those conducting them to make school health evaluations more effective and relevant to stakeholders.Originality/value – The paper identifies important steps which need to be considered in undertaking evaluations of school health interventions.

The education and training framework for healthpromoting environments

EALTH-PROMOTING environments provide major challenges for the education and H training requirements of the workforce. We may need to rethink how we approach public health education and training in Australia. This commentary begins by identifjmg the knowledge and skills for personnel in the various healthpronioting environments that have emerged from the research articles in this issue of the Journal and that are necessary to implement the settings approach. A brief review of the dimensions and purpose of education and training follows, before exploration of the question ‘Education and training for whom?’ The paper then identifies how education about health-promoting environments may be optimised and suggestions are made about determining whether i t is working or not. Finally, hvo issues are described briefly-issues that need to be resolved before we invest in more or less, arid the same 01di€ferent, education and training strategies, products and services in this area of public health.

The Hong Kong Healthy Schools Award Scheme, school health and student health: An exploratory study

Objective: The Hong Kong Healthy Schools Award Scheme (HKHSA) developed an assessment and monitoring system to examine the status of Health Promoting Schools (HPS). This study made use of the HKHSA programme to investigate the school health ‘profile’ and student health status of four gold award schools following 3–4 years’ participation in the scheme. Design: Repeated cross-sectional student health surveys of the same year level (Secondary 3) were conducted over different time periods, and achievement of HKHSA was assessed by repeated assessments of the school health profile using HPS indicators. Setting: This study included four schools with the Healthy School gold award in Hong Kong, together with students from three of the four schools. Methods: School performance in the six HPS key areas were analysed using radial plot graphs, and students’ health behaviours were measured by means of repeated cross-sectional student health surveys. Results: The four gold award schools demonstrated various degrees of achievement in different HPS key areas with student health behaviours markedly improving in these schools. Further analyses revealed how certain HPS key area components were associated with sustained positive health behaviours among students. Conclusion: The ongoing implementation of HPS impacts on schools’ environment and students’ health behaviours. The HKHSA is designed for formative and summative assessment of school health promotion. Findings provide insight into an HPS assessment process, signalling future directions for the development of school health promotion.

Investing in Youth Health Assets

The policies and practices to build the health and wellbeing of youth occur largely outside the health sector. Yet there is a prevailing mistaken belief in society that youth need to be given messages about appropriate health behaviours such as healthy eating practices and responsible drinking, and that, as a consequence, they will become healthier and less vulnerable to disease. This paper asserts that this is not the case.

New horizons for social development

This commentary follows up on a field visit made by the authors to a community development programme in Cairo supported by a local non-governmental organization called New Horizon Association for Social Development (NHASD). The people who comprise NHASD are dedicated to improving the conditions and quality of life of the most marginalized and underdeveloped communities. The paper describes the overall approach that community members, social workers and leaders use to tackle the underlying causes of poverty and the skills, resources and services they build using a rights-based and participatory community development approach. It also addresses ideas for IUHPE concrete action, which came from discussions stimulated by the visit, to support such community initiatives out of isolation. It ranges from complimentary membership of the NHASD to the organization of a specific health promotion network of extremely socio-economically vulnerable communities in urban areas worldwide, connected to the IUHPE Group on Settings-based Health Promotion, as well as sessions at the forthcoming IUHPE 20th World Conference on Health Promotion on the theme “Health, Equity and Sustainable Development”. (Global Health Promotion, 2009; 16 (1): pp. 65—68)