Evaluating the WHO's Health Promoting Schools framework - what works and where are the gaps?
Dr. Beki Langford (DECIPHer)
10.00, Tuesday 9 July. Millennium Lounge, level 5
Background
There is a strong reciprocal relationship between health and education: healthy children achieve better educational outcomes which, in turn, are associated with improved health outcomes later in life. This relationship underpins the WHO’s Health Promoting Schools (HPS) framework, which takes a holistic, settings-based approach to promoting health in schools. HPS interventions require action in the following three areas: curriculum, ethos/environment and links with families/communities. We undertook a Cochrane systematic review to assess the effectiveness of the HPS framework in improving students’ health, well-being and academic achievement.
Methods
Our review focused on cluster randomised controlled trials of the HPS framework that targeted children and young people aged between 4-18 years. We searched a wide range of health, social science and educational databases and identified 54 studies eligible for inclusion.
Results
Almost half (27 studies) of the studies were from North America, with 13 studies from Europe, eight from Australia, three from China and one each from Mexico, India and Tanzania. Interventions focused on a wide range of health topics. The most common topics were physical activity/nutrition (25 studies), multiple risk behaviours (seven studies), smoking (five studies) and bullying (four studies). Very few studies focused on mental or sexual health (two studies each) and few presented any academic or school-related outcomes (five studies). There were positive intervention effects observed for physical activity, nutrition, alcohol, smoking and violence outcomes. Results for substance use and bullying outcomes were more equivocal but also showed a trend towards intervention effectiveness. The data for obesity outcomes (BMI/zBMI) were complex and equivocal. There was no effect seen for depression outcomes. It was not possible to combine the two sexual health interventions in a meta-analysis.
Conclusion
The HPS framework appears to be effective in improving certain health outcomes within schools, although we lack evidence of the long-term sustainability of such impacts. More research is needed to establish the effectiveness of this approach for mental health, sexual health and academic achievement.
There is a strong reciprocal relationship between health and education: healthy children achieve better educational outcomes which, in turn, are associated with improved health outcomes later in life. This relationship underpins the WHO’s Health Promoting Schools (HPS) framework, which takes a holistic, settings-based approach to promoting health in schools. HPS interventions require action in the following three areas: curriculum, ethos/environment and links with families/communities. We undertook a Cochrane systematic review to assess the effectiveness of the HPS framework in improving students’ health, well-being and academic achievement.
Methods
Our review focused on cluster randomised controlled trials of the HPS framework that targeted children and young people aged between 4-18 years. We searched a wide range of health, social science and educational databases and identified 54 studies eligible for inclusion.
Results
Almost half (27 studies) of the studies were from North America, with 13 studies from Europe, eight from Australia, three from China and one each from Mexico, India and Tanzania. Interventions focused on a wide range of health topics. The most common topics were physical activity/nutrition (25 studies), multiple risk behaviours (seven studies), smoking (five studies) and bullying (four studies). Very few studies focused on mental or sexual health (two studies each) and few presented any academic or school-related outcomes (five studies). There were positive intervention effects observed for physical activity, nutrition, alcohol, smoking and violence outcomes. Results for substance use and bullying outcomes were more equivocal but also showed a trend towards intervention effectiveness. The data for obesity outcomes (BMI/zBMI) were complex and equivocal. There was no effect seen for depression outcomes. It was not possible to combine the two sexual health interventions in a meta-analysis.
Conclusion
The HPS framework appears to be effective in improving certain health outcomes within schools, although we lack evidence of the long-term sustainability of such impacts. More research is needed to establish the effectiveness of this approach for mental health, sexual health and academic achievement.