Historical perspective
The concept that schools have a role in promoting the health of young people is not a new one. However, the modern view of health promotion in schools can only be fully understood in the context of wider health promotion developments.
The World Health Organization's (WHO) Ottawa Charter for Health Promotion (1985) clarified the nature of health promotion, defining it as 'the process of enabling people to increase control over, and to improve, their health'.
This definition gave added scope and purpose to health promotion and had the potential to reconcile different viewpoints on the relative roles of the individual and society in the process of promoting health.
Earlier writings on health promotion appeared to an extent to be rather dismissive of an educational approach and many people from an educational or pedagogical background felt that not only was the value of an educational approach in danger of being misrepresented but that health education could completely disappear.
It is worth recounting the history as it is important to realise that the health promoting school was born at a time when there was considerable scepticism about whether an educational approach in general or in schools in particular could have much impact on the health of the population.
School health education and the health promoting school
In 1985 the Scottish Health Education Group (SHEG), which was a collaborating centre for the WHO European Office, was given the task of organising a European symposium. Entitled 'The Health Promoting School', it took place in 1986 with 150 delegates from 28 member states. At this event the concept of the 'health promoting school' was developed and refined. In fact the name 'The Health Promoting School' was born in the planning for the event although the concept had been evolving for several years and the literature in Europe had talked of the school as 'a health promoting institution'.
This symposium was significant because it offered WHO an opportunity to apply its developing theoretical model of health promotion to the setting of the school. From this event a report entitled 'The Healthy School' was produced on behalf of WHO in 1989.
The report described health promotion in schools as a 'combination of health education and all the other actions which a school takes to protect and improve the health of those within it'.
The health promoting school was considered to have three main elements:
- time allocated to health-related issues in the formal curriculum through subjects including home economics, physical education, social education and health studies
- the hidden curriculum of the school including staff/pupil relationships, school/community relationships, the school environment and the quality of services such as school meals
- the health and caring services providing a health promotion role in the school through screening, prevention and child guidance.
More modern ideas of the breadth of the health promoting school concept have since developed and further refined ideas about the scope of health promoting schools in Europe and beyond.
USA and Canada
In the USA and Canada the terminology used to describe health promotion in schools is different and it is important to explore these terms and to reflect on whether they reveal a fundamentally different approach or if they are in fact closely related.
In the United States terms like the 'healthful school environment' have been used since the early 1950s, indicating that there has been an awareness of the importance of wider influences on health in schools beyond the 'health instruction' of the classroom. In the early 1980s in the USA the term 'comprehensive school health programme' became the common term to encompass a broader approach. At that time this concept was considered to comprise health instruction, the school health services and the school environment, which was remarkably close to the European model.
In the 1990s this broader concept of 'comprehensive school health programmes' was further developed to include:
- health education
- health services
- health environment
- physical education programme
- food service programme
- psychology and counselling programmes
- programmes to protect and improve the health of staff
- integrated efforts of school and community agencies to improve the health of school and students.
These closely parallel the European model set out by Young and Williams in 'The Healthy School' report of 1989, although the European model emphasised pupil participation more strongly than the USA approach.
The European model has further developed to emphasise equity and democracy at the core of its activities and this represents the egalitarian approach that had its origins in earlier European history.
However, I would conclude that these two models have much more in common than differences. This is interesting because to some extent they evolved independently of each other with only limited cross-fertilisation compared to the international contacts we enjoy today through electronic media. However, of greater interest are the similarities in the approaches and the fact that to some extent they represent convergent thinking on how schools can affect the health of young people and bring this together into all-encompassing coherent models.
~ Ian Young
NHS Health Scotland
