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The Health-Promoting School Movement


The World Health Organization (WHO) describes the health promoting school as "a school that is constantly strengthening its capacity as a healthy setting for living, learning and working". Furthermore, a Health-Promoting School:

* Fosters health and learning with all the measures at its disposal.

* Engages health and education officials, teachers, teachers' unions, students, parents, health providers and community leaders in efforts to make the school a healthy place.

* Strives to provide a healthy environment, school health education, and school health services along with school/community projects and outreach

* Implements policies and practices that respect an individual's well-being and dignity, provides multiple opportunities for success, and acknowledges good efforts and intentions as well as personal achievements.

* Strives to improve the health of school personnel, families and community members as well as pupils; and works with community leaders to help them understand how the community contributes to, or undermines, health and education.


The following "Guiding Principles" for health promoting schools were put forward by the European Network of Health Promotion Schools (1997) (

1. Democracy. The health promoting school is founded on democratic principles conducive to the promotion of learning, personal and social development and health.

2. Equity. Healthy schools ensure that the principle of equity is enshrined within the educational experience. This guarantees that schools are free from oppression, fear and ridicule. Healthy schools provide equal access for all to the full range of educational opportunities. The aim of healthy schools is to foster the emotional and social development of every individual, enabling each to attain his or her full potential free from discrimination.

3. Empowerment and Action Competence. Health promoting schools improve young people's abilities to take action, cope and generate change. It provides a setting within which they, working with their teachers and others, can gain a sense of achievement. Young people's empowerment, linked to their visions and ideas, enables them to influence their lives and living conditions. This is achieved through quality educational policies and practices, which provide opportunities for participation and critical decision making.

4. School environment. Health promoting schools place emphasis on the school environment, both physical and social, as a crucial factor in promoting and sustaining health. The environment becomes an invaluable resource for effective health promotion, through the nurturing of policies and practices which promote well-being. This includes the formulation and monitoring of health and safety measures and the introduction of appropriate management structures.

5. Curriculum. A healthy schools curriculum provides opportunities for young people to gain knowledge and insight and to acquire essential life skills. The curriculum must be relevant to the needs of young people, both now and in the future, as well as stimulting their creativity, encouraging them to learn and providing them with necessary learning skills. The curriculum of a healthy school also is an inspiration to teachers and others working in the school. It also acts as a stimulus for their own personal and professional develoment.

6. Teachers' training. Teacher education (pre-service and in-service) is an investment in health as well as education. Legislation together with appropriate incentives, must guide the structures of teacher learning using the conceptual framework of the health promoting school.

7. Measuring success. Health promoting schools assess the effectiveness of their actions upon the school and the community. Measuring success is viewed as a means of support and empowerment, and a process through which health promoting school principles can be applied to their most effective ends. In other words, assessment and evaluation are an integral part of instruction and planning.

8. Collaboration. Shared responsibility and close collaboration between schools, parents and communities is a central requirement in the strategic planning of healthy schools. Roles, responsibilites and lines of accountability must be established and clarified for all parties.

9. Communities. Parents and the school community have a vital role to play in leading, supporting and re-enforcing the concept of school health promotion. Working in partnership, schools, parents, NGO's and athe local community, represent a powerful force for positive change. Similarly, young people themselves are more likely to become active citizens in their local communities. Jointly, the school and the community will have a positive impact in creating a social and physical environment conducive to better health.

10. Sustainability. All levels of government must commit resources both financial and human to health promotion. This commitment will contribute to the long-term sustainable development of the wider community. (

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The Health Promoting School movement has its roots in the international fields of Health Promotion and in Healthy Communities/Cities. Countries across Europe and North America have adopted the Health Promoting School approach, but details of implementation have varied. By 1997 over 5000 schools in 37 countries were involved.


the movement has been in some ways a top-down process. Countries wishing to join the network are required to have support from both their Ministers of Education and of Health and ten designated pilot schools willing and able to collaborate. Later, other schools in the country are able to join and learn from the practices of the model pioneering schools. Expectations of participating schools and countries are to:

develop a three-year project plan;

form a school project team and prioritize project initiatives;

implement projects to tackle issues of both local and European relevance, which can then be used as models of good practice;

implement activities that promote the health of young people, and foster a spirit of collective responsibility for personal and community health; and

maximize the project's visibility and credibility, and facilitate the evaluation and dissemination of results.

The European Schoolnet can be visited at

a) IN ENGLAND, the Department of Health and The Department for Education and Employment have recently given a boost to the healthy school movement by launching a healthy school pilot in each of eight regions in September, 1998. Each pilot school has received 150,000 L in funding. Marilyn Toft, national healthy schools coordinator says the new initiative represents a significant change in approach to developing healthy schools -- "We are looking at education outcomes as well as health outcomes," she says. The idea is that by driving up educational standards, the aim of reducing health inequalities will also be achieved -- "In a healthy school that has a 'supportive but challenging learning environment,' that values positive relationships, makes learning a priority, and encourages pupils to have higher self-esteem and confidence, pupils will achieve more -- not just academically, but personally and socially." (Moore, p.14) More information on healthy school activities in the U.K. can be found at


the term "Comprehensive School Health" is used more commonly than the term "Health Promoting School".

a) IN THE U.S.

the Institute of Medicine carried out an extensive study of comprehensive school health programs starting in 1994 and culminating in the publication of the book, Schools & Health: Our Nation's Investment in 1997. It presents a strong theoretical base to the field and documents an extensive amount of work in this area in the U.S. The appendices on the initiatives of various states are particularly useful for examining models of charter documents, etc.

The largest network of schools striving for positive change in the U.S. is led by an organization called Communities in Schools (formerly known as Cities in Schools - http/ in conjunction with an organization called America's Promise supported through the leadership of Colin Powell ( America's Promise has identified five resources that every child must have for health, success, and well-being:

An ongoing relationship with a caring adult.

Safe places and structured activities during nonschool hours.

A healthy start with a potential for a healthy future.

Marketable skills through effective education.

The opportunity to give back through community service.


basic information on Comprehensive School Health has been posted on Health Canada's website. ( This site is set up to post information on school health lesson prototypes, the workplace health system student model, health behaviors in school-aged children (from an international survey), health promoting school environments, health promoting school policies, related services and contacts.


a healthy school initiative was launched in the early nineties through the combined Ministry of Health and Ministry Responsible for Seniors. By 1994, 300 schools in 42 school districts were involved. Many resources were produced and circulated on schools and health and diverse projects were initiated by students involving such issues as nutrition, recycling, parent-student and teacher-student relationships etc. As with other initiatives in North America and Europe, students, teachers and communities have been inspired to undertake much positive health enhancing activity that is widely supported and highly visible, but research and evaluation on the impact on the health status of students and communities is in its infancy.


a Coalition of Agencies for School Health (COASH), was established to further the awareness and application of a comprehensive approach to school health education. One of its latest projects is a "Youth Empowerment Study: A Purposeful Sampling of Youth-Led Groups in Ontario -- Nothing About Us, Without Us!" prepared by Cindy Andrew (June, 1998)

A new website on "Improving Student Health and Learning through Comprehensive School Health" has been prepared through the leadership of Andy Anderson at OISE/UT with Hospital for Sick Children's Foundation and OISE/UT funding. It provides in a vibrant, interactive format, basic information on the meaning of health, health literacy and Comprehensive School Health as well as case stories. Through this website, educators are familiarized with health promotion in action and enabled to create more effective partnerships for school health. It is an indispensable resource for school leaders and health educators who aim to improve school and student health. (


has an active School Health Interest Group consisting of lay members, professionals and academics in health and education. It was established more than a year ago to look at issues of joint interest such as curriculum and inservice training. One of its projects has been to examine the potential of incorporating organizational development and "systems thinking" concepts into the healthy school curriculum, especially for preservice teachers and inservice courses for additional qualifications. The group is developing capacity for collaborative projects in the area of school health. Members include representatives from Public Health, the Centre for Addictions and Mental Health, OISE/UT, and the Toronto Board of Education. It is chaired by Dr. Irving Rootman, Director of the Centre for Health Promotion, Suite 207, Banting Institute, 100 College St. Toronto, tel. 416-978-1809.


See OHPE #96.2 for more School Health Resources

"A Comprehensive Approach to the Mental Health of Children and Youth" Comprehensive School Health Update, Vol. 2, No. 6, December, 1994.

Allensworth, D. 1993. "Health Education: State of the Art." Journal of School Health. Vol. 63, No. 1.

Allensworth, D., E. Lawson, L. Nicholson, and J. Wyche, eds. 1997. Schools & Health: Our Nation's Investment. Washington, D.C.: National Academy Press.

Andrew, C. 1998. "A Report on the COASH Youth Empowerment Study: A Purposeful Sampling of Youth-Led Groups in Ontario -- 'Nothing About Us, Without Us!'"

Bennet, Kathryn J, and D. R. Offord. 1998. "Schools, Mental Health and Life Quality" in Canada Health Action: Building on the Legacy Papers Commissioned by the National Forum on Health. Vol. 3. Determinants of Health: Settings and Issues. Sainte-Foy, Quebec: Editions MultiMondes.

Community action programme on Health Promotion, Information, Education and Training: Projects subsidized in 1997. Luxembourg: European Commission

Comprehensive School Health Education: Suggested Guidelines for Action. Geneva: WHO, 1992.

Hamilton, K and L. Saunders. 1997. The health promoting school: a summary of the ENHPS evaluation project in England. London Engalnd. Health Education Authority.

Hawkins, J.D. and R.F. Catalano "Broadening the Vision of Education: Schools as Health Promoting Environments. Journal of School Health, Vol. 60, No. 4.

Lavin, Alison T., G. R. Shapiro, K. S. Weill. 1992. "Creating an Agenda for School-Based Health Promotion: A Review of 25 Selected Reports. Journal of School Health. vol. 62, No. 6.

McCall, Douglas S. "Mental Health, Children, Youth and Schools: A Review of Selected Research and Resources." Canadian Association for School Health draft paper.

National Action Plan for Comprehensive School Health Education. 1992. Atlanta GA: American Cancer Society.

Network News: The European Network of Health Promoting Schools. Copenhagen, Denmark:WHO Regional Office for Europe, Health Promotion and Investment for Health Programme.

Palframan, David S. 1992. Comprehensive Health Education in Ontario: A View from the Medical Perspective. OMA Committee on Child Welfare

Parsons, C., D. Stears, C. Thomas, L. Thomas, and J. Holland. 1998. The Implementation of ENHPS in Different National Contexts. Centre for Health Education and Research. Daterbury Christ Church College.

Public Health in the European Community Health Promotion Programme: Information on European Networks Supported by the Programm of Community Action on Health Promotion, Information, Education and Training. WHO publication, June, 1998.

Public Health in the European Community Health Promotion Programmes (1996-2000). 1997. Luxembourg: European Commission.

Raphael, Dennis. Emerging Concepts of Health and Health Promotion. Journal of School Health, September, 1998.

Shain, M.S.J.D., M. Johlnston, T. Dalton, A. Gauvin-Fleurant. "Influences on the Health of Adolescents at School: In Search of the Modifiable". Centre for Health Promotion, University of Toronto. Issues in Health Promtion Series # 10.

"The Health Promoting School -- an investment in education, health and democracy" Conference Report (Greece, May 1-5, 1997). Copenhagen, Denmark: WHO Regional Office for Europe.

"The Economic, Educational and Cost Effectiveness of CSH" Comprehensive School Health Update, White Rock, B.C.: C.A.S.H., Vol. 2, No. 1, January, 1994

WHO's Global School Health Initiative. Health-Promoting Schools: A healthy setting for living, learning and working. Geneva, Switzerland. WHO Division of Health Promotion. 1998.

WHO Information Series on School Health.