Health-Promoting Schools: Evidence for a Holistic Approach to Promoting Health and Improving Health Literacy

By Lee, Albert | Applied Health Economics and Health Policy, March 2009 | Go to article overview
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Health-Promoting Schools: Evidence for a Holistic Approach to Promoting Health and Improving Health Literacy


Lee, Albert, Applied Health Economics and Health Policy


Chronic diseases are now the major causes of death and disability worldwide, with 35 million deaths (of a total 58 million deaths) due to chronic or non-communicable diseases (NCD) in 2005.[1] A number of risk factors, including high cholesterol, hypertension, obesity, and cigarette and alcohol use, are responsible for the majority of the chronic-disease burden. One study[2] has concluded that high lipid levels, smoking, hypertension, diabetes mellitus, abdominal obesity, psychosocial factors, insufficient consumption of fruits and vegetables, excess alcohol use and lack of regular physical activity accounted for most of the risks of myocardial infarction worldwide in both sexes, at all ages, and in all regions. Evidence has suggested that disease prevention is possible by minimizing exposure to potential risk factors with sustained actions directed at both individuals and families, as well as at the broader social, economic and cultural determinants of NCD.[3] In many urbanized areas, health-risking behaviours that contribute to the leading causes of mortality and morbidity later on in life (e.g. cardiovascular disease, cerebrovascular disease and malignant neoplasm) are often established during youth and extend to adulthood. Public health interventions to modify these risk behaviours have the potential to reduce premature death by 47% and increase global life-expectancy by 9.3 years.[1,4]

In Australia, the health of young people continues to deteriorate: youth depression has tripled in the past 30 years, and about 30% of teenagers experience mental health issues before the age of 18 years.[5,6] Thirty percent of Australian teenagers drink alcohol regularly, 16% smoke regularly, and 50% of those aged <18 years have tried cannabis.[5,6] In the US, surveillance of youth risk-taking behaviour has also shown an increase in youth health-risking behaviours.[7] Surveys in Hong Kong in 1999 and 2003 revealed that a substantially high proportion of young people did not have healthy eating habits, did not partake in regular exercise and were emotionally disturbed.[8,9]

Most of the health-risking behaviours adopted by children and adolescents will have greatest impact on their health later in life, but this impact has been underestimated by society. A 'life-course' approach to promoting healthy behaviours should begin early in life. One way to target health improvement in young people is through the 'health-promoting school' (HPS) framework. This article discusses the impact of HPS on the improvement of youth health.

1. Health Improvement for Young People: the Health-Promoting School (HPS)

Effective health-improvement education gives individuals or groups easier access to health information and facilitates their understanding of health-improvement concepts.[10] Different settings offer good opportunities to gain access to individuals and groups. The WHO[11] defines a 'setting' as having physical boundaries, a range of people with defined roles, and an organization. Green et al.[12] expanded this definition to include the arenas of sustained interaction, with pre-existing structures, policies, characteristics, institutional values, and both formal and informal social sanctions on behaviours. 'Healthy-setting' approaches such as HPS can address the determinants of health, particularly the social, cultural and political aspects, and can assist organizations and institutions in creating a culture for health improvement.

A positive health culture would facilitate a higher level of health literacy, helping individuals to build the personal, cognitive and social skills that determine their ability to gain access to, understand and use information to promote and maintain good health.[10] School is an important setting in helping students to achieve health literacy.[13] Programme experiences and research findings worldwide suggest that adolescents need accurate information about their health and development; life skills in order to avoid risk-taking behaviours; counselling services; acceptable and affordable health services; and a safe and supportive environment.

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Health-Promoting Schools: Evidence for a Holistic Approach to Promoting Health and Improving Health Literacy
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