The World Health Organization’s Health Promoting Schools Framework: A Cochrane Systematic Review and Meta Analysis

Abstract

Background: Healthy children achieve better educational outcomes which, in turn, are associated with improved health later in life. The World Health Organization's Health Promoting Schools (HPS) framework is a holistic approach to promoting health and educational attainment in school. The effectiveness of this approach has not yet been rigorously reviewed.Methods: We searched 20 health, education and social science databases, and trials registries and relevant websites in 2011 and 2013. We included cluster randomised controlled trials. Participants were children and young people aged four to 18 years attending schools/colleges. HPS interventions had to include the following three elements: input into the curriculum; changes to the school's ethos or environment; and engagement with families and/or local communities. Two reviewers identified relevant trials, extracted data and assessed risk of bias. We grouped studies according to the health topic(s) targeted. Where data permitted, we performed random-effects meta-analyses. Results:We identified 67 eligible trials tackling a range of health issues. Few studies included any academic/ attendance outcomes. We found positive average intervention effects for: body mass index (BMI), physical activity, physical fitness, fruit and vegetable intake, tobacco use, and being bullied. Intervention effects were generally small. On average across studies, we found little evidence of effectiveness for zBMI (BMI, standardized for age and gender), and no evidence for fat intake, alcohol use, drug use, mental health, violence and bullying others. It was not possible to meta-analyse data on other health outcomes due to lack of data. Methodological limitations were identified including reliance on self-reported data, lack of long-term follow-up, and high attrition rates. Conclusion:This Cochrane review has found the WHO HPS framework is effective at improving some aspects of student health. The effects are small but potentially important at a population level.

Health and nutrition in public and private schools in the city of Recife

“…10,20 The involvement of the school community represents a main role in social support to children and adolescents. This support is made available by friends, teachers and family, and can improve the school environment 13 as well as influence in the practice of physical activity and health eating behavior. [21][22][23][24][25] Silva et al, 10 which also evaluated the participation of parents and teachers, indicate a low execution of these initiatives for the group of adolescents, which demonstrates the necessity of a higher guidance for this age group.…”

“…8,13,27 In this context, the building of policies and environments which stimulate the choice of healthy food and restrict the selling of non-healthy food is a necessary measure for the promotion of health in schools.…”

“…22,28,29 Studies in this area have been verifying that interventions of physical activities in school environment reduce the body mass index (BMI), and is regular practice represents an important change in the nutritional state of this group. 13,29 However, in about a half of the public schools from the municipality, the managers realized the structure of physical activity support as being inappropriate. In both of the school networks there were a reduced number of regular practical classes.…”

“…11,12 The promotion of health in school constitutes a world-class initiative which makes possible a greater interaction between teachers and health professionals for inter-sectorial and collaborative actions which deal with the situations of vulnerability of adolescent's health, including parental support and cooperation and stimulating policies in this community. [13][14] In Brazil, such objectives are endorsed in the National Policy of Health Promotion and the Health Program at School (PSE -Programa de Saúde da Escola), which has intersecto-riality as one of its main guidelines. 15 These initiatives can be evaluated based on three interrelated components:1) integral health education, 2) creation and maintenance of physical and psychosocial healthy environments, 3) and the offer of health services, healthy eating and active life.…”

“…14 The presence of these components in schools may promote healthy eating behaviors and the practice of physical activity, which are fundamental measures for a healthy life and for the prevention of chronic non-communicable diseases in adult life. 13,16,17 Consideringscarce the information on state of implementation of health promoting measures in schools in Recife city, and considering obesity, sedentary behavior and adoption of inappropriate eating habits as some of the main factors of morbidity in adolescents, the present study aims to evaluate the implementation of initiatives and health promoting environments, focused in healthy eating and the practice of physical activity aimed to adolescents in public and private schools in Recife.…”