Abstract
BackgroundHealthy 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.MethodsWe 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.ResultsWe 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.ConclusionThis 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.
Highlights
Healthy children achieve better educational outcomes which, in turn, are associated with improved health later in life
Twenty-nine studies were conducted in North America (27 USA [22,23,25,26,27,29,35,37,39,40,45,48,50,51,52,57,58,59,60,61,62,63,65, 66,70,75,83], 2 in Canada [71,82]), 19 in Europe [19,20,21,24,30, 32,33,36,41,42,44,47,53,74,76,77,78,85], 11 in Australasia [28,31,34,46,54,64,68,69,72,73,81] and eight in middleor low-income countries (China [56,79,84], India [55], Mexico [38,49], Egypt [80] and Tanzania [67])
Thirtyfour studies focused on physical activity and/or nutrition
Summary
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. As noted by Sawyer [11:1631] in a special issue of The Lancet on adolescent health, ‘many opportunities for prevention of noncommunicable diseases, mental disorders, and injuries in adults arise from a focus on risk processes that begin in or before adolescence’. Promoting health during this early period of life is key to many public health agendas [11]
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