health education in schools essay

Essay on Health Education for Students and Children

500 words essay on health education.

We all know that health education has become very important nowadays. It refers to a career where people are taught about healthcare . Professionals teach people how to maintain and restore their health. In other words, health does not merely refer to physical but also mental, social and sexual health. Health education aims to enhance health literacy and develop skills in people which will help them maintain good health.

Importance of Health Education

Health education is very essential for enhancing the condition of the overall health of different communities and people. It will also help in improving the health of the whole nation. You can also say that the economy of a country is directly proportional to health education. In other words, it means that the higher the life expectancy the better will be the standard of living.

Health education is given to people by professionals in the field known as health educators. They are qualified and certified enough to talk about these issues. Furthermore, they undergo training related to health and hygiene for educating people.

Similarly, health education is very important as it improves the health conditions of the people. It does so by teaching them ways on how to remain healthy and prevent diseases. Moreover, it also makes them responsible enough as a whole community.

The developing nations especially are in dire need of health education. It not only conveys basic knowledge about health but also shapes their habits and way of living. Most importantly, it not only focuses on physical health but also addresses other issues like mental illnesses, sexual well-being and more.

Methods to Improve Health Education

Although health education is very important, we often see how it is not given the importance it deserves. The poor condition of the prevalent health education in many countries is proof of this statement. We need to improve the state of public health education in the world, especially in developing countries.

As the developing countries have many remote areas, the necessary help does not reach there. We must emphasis more on conveying this education to such people. The villagers especially must be made aware of health education and what role it plays in our lives. We can organize these programs which will attract more audience like fares or markets, which already has a gathering.

Moreover, as most of the audience will be illiterate we can make use of visuals like plays, folk shows and more to convey the message in a clear manner. Subsequently, we must also make the most of the opportunity we get at hospitals. The patients coming in to get checked must be made conscious of their health conditions and also be properly educated on these matters.

Similarly, we must target schools and inculcate healthy habits amongst children from an early age. This way, students can spread this knowledge better to their homes and amongst their friends. Therefore, we must enhance the state of health education in the world to help people become healthier and maintain their vitality and dynamism.

FAQs on Health Education

Q.1 Why is Health Education important?

A.1 Health education is very important as it improves the health standards of the country. It further helps in preventing diseases and making people more aware of their health conditions. Most importantly, it not only focuses on physical health but also mental health and others.

Q.2 How can we improve health education?

A.2 We can improve health education by making the people of remote areas more aware. One can organize programs, camps, plays, folk shows and more plus teach it properly at schools too.

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• v.10(4); 2020

School as ideal setting to promote health and wellbeing among young people

Manuela pulimeno.

1 UNESCO Chair on Health Education and Sustainable Development, Naples, Italy

2 Doctorate in Human Relations Sciences, University of Bari “Aldo Moro”, Bari, Italy

Prisco Piscitelli

3 Euro Mediterranean Scientific Biomedical Institute, ISBEM, Bruxelles, Italy

Salvatore Colazzo

4 Department of History, Society and Human Studies, University of Salento, Lecce, Italy

Annamaria Colao

5 Department of Clinical Medicine and Surgery, Federico II University School of Medicine, Naples, Italy

Alessandro Miani

6 Department of Environmental Science and Policy, University of Milan, Milan, Italy

7 Italian Society of Environmental Medicine, SIMA, Milan, Italy

Background: Nowadays, young people face several health challenges. As children and teenagers spend most of their time in the classroom, schools may have the opportunity to positively influence students’ quality of life, playing a crucial role in fostering their health. The aim of this review was to analyze evidence that demonstrated why school is the ideal setting for thepromotion of young generations’ wellbeing.

Methods: We have reviewed the available literature about health promotion in school setting, searching for articles and books published from 1977 to 2020. A total of 74 articles and 17books were selected and assessed.

Results: The promotion of students’ wellbeing could reduce the prevalence of measurable unhealthy outcomes and improve their academic achievements. At least 80% of all cases of heart diseases, strokes, type 2 diabetes and one third of all cancers can be prevented through health education. In this perspective, primary prevention and health promotion should start as early as possible, finding in the school the ideal setting of action. Effective school-based preventive approaches should raise students’ motivation towards a personal interiorization of health knowledge and develop in young people a critical thinking about harmful consequences of the most common risky behaviours. Educators should receive adequate training concerning health topics and become expert in the most innovative approaches to effectively engage students in adopting healthy lifestyles.

Conclusion: As primary educational institution, school should integrate students’ health promotion in its ordinary teaching and learning practices in the perspective of "better health through better schools".

Introduction

In the 21st century, young people face several health challenges. On one hand, a high intake of total fat, free sugars, and salt, along with the lack of physical activity, have contributed to increase chidren’s obesity at alarming rates; on the other hand, adolescents’ lives are threatened by addictive and risky behaviours (e.g. tobacco smoking, alcohol, substance abuse, unprotected sex, inter-personal violence, intentional self-harm, extreme “deadly selfies”). 1

In this context, the United Nations (UN) recognize education as essential for children’s global growth and key factor for improving young people health. The UN agency UNESCO is focused on turning into actions the educational commitments set by the United Nations “2030 Agenda for Sustainable Development”, 2 while our Unesco Chair on Educational Health and Sustainable Development is specifically aimed at addressing the Sustainable Development Goals (SDGs), paying particular attention to the SDG3 concerning the promotion of “good health and wellbeing” and SDG4 to “ensure inclusive and equitable quality education and promote lifelong learning opportunities for all” ( Figure 1 ). The school-based activities of our Unesco Chair are targeted to the prevention of harmful habits and promotion of wellbeing among schoolchildren living in Southern Italy, an area characterized by a widespread presence of vulnerable social groups at higher risk of developing unhealthy behaviours, due to socio-economic disadvantages. 3

School System: education and wellbeing promotion in the frame of Sustainable Development Goals (SDGs) set by the United Nations

In the view of the holistic individual development, the primary commitment of school systems – along with students’ academic achievements – should be the improvement of children’s physical, mental and social wellbeing. 4 In our vision, school may represent the optimal setting to display educational health-related interventions, 5 - 8 as educators can have the opportunity to positively influence – day by day – students’ life-long learning and work to reduce health inequalities among young people. 3 Our first systematic review examined a number of studies concerning the effectiveness of multicomponent narrative-based strategies to improve healthy eating habits and decrease risk factors for overweight and obesity in schoolchildren. 9 More broadly, beyond the specific topic of healthy nutrition, children’s global wellbeing might be systematically promoted at school by adopting innovative active approaches, where young people are not considered passive or simple audience, but are engaged in practical actions about healthy lifestyles (i.e. balanced nutrition and physical exercise, no smoking, no alcohol, no drugs etc). 10 , 11

The World Health Organization (WHO) suggests that health literacy should be incorporated in the core curriculum as children enter school, supported by a health-promoting school environment. 12 - 14 A comprehensive school commitment towards students’ global wellbeing is expected to positively impact both children’s behaviours and their families. 15 For that reason, we question why scholastic institutions are not widely and systematically engaged in a proper path – according to specific keypoints set by WHO – to become “health-promoting schools” ( Table 1 ), able to prevent students’ risky behaviours. 16 , 17 This review is specifically aimed at providing evidence-based justification to consider school as ideal setting for the promotion of young generations’ wellbeing.

Source: https://www.who.int/school_youth_health/gshi/hps/en/ .

Materials and Methods

Information sources, search strategies and study selection.

In this short narrative review, we have explored the available literature concerning the rationale for promoting children’s wellbeing in school setting. The review has been carried out by PhD candidates and academic experts in Human Sciences together with Medical Doctors according to the main items reported in the PRISMA checklist 2009. 18 We searched on Web of Science and Google Scholar for original articles and books published from 1977 to 2020 by using a search strategy based on the following keywords: “health promotion” OR “primary prevention” OR “wellbeing” AND “students” OR “school”. Data extraction was performed by a PhD candidate and separately confirmed by a medical doctor. Additionally, we used citation tracking to detect other papers concerning health promotion in school setting. Exploration of heterogeneity of the studies was performed by assessing their quality (i.e. level of evidence). Interpretation of the findings has been conducted in the frame of current knowledge. 19

Exclusion criteria

We have excluded studies concerning psychopathology, psychiatric disorders, drug/alcohol addiction or eating disorders, and therapeutical applications. We have also left out articles regarding clinical topics such as autism spectrum conditions, specific learning difficulties, cognitive or sensory/physical deficits. Moreover, we removed all the articles presented in language other than English and Italian.

Synthesis of search results and summary measures

A total of 74 articles and 17 books’ chapters were selected for the review. We have briefly summarized definitions of health, healthy lifestyles, health promotion, primary prevention, protective and risk factors, considering wellbeing (in its three dimensions of physical, emotional/mental and social health) as the main goal of every educational practice, and school system as the ideal setting to perform educational health-related interventions.

Students’ wellbeing promotion and academic achievements: a virtuous circle

Since education and wellbeing are intertwined dimensions, an important “mission” of any educational system is to ensure that students are healthy and able to learn. 1 Children spend most of their lifetime in classroom and that’s why school can be the natural setting for promoting their health. By working everyday with pupils, teachers have a crucial role in positively influencing their global development and equipping them with the knowledge, attitudes, and skills needed to protect and maintain their healthy habits for the entire life. 20 , 21

In the socio-cognitive perspective, school should educate young people to take responsibility for their own health since the early childhood. 22 A correct approach towards health in daily life encourages the development of children’s self-efficacy, which represents the ability to maintain healthy lifestyles during the life and enjoy the benefits of behavioural changes acquired. This emerging interest towards students’ positive dimensions (such as self-esteem, happiness and resilience) should represent a new priority for school staff and families, to be addressed in a synergic effort. 23 , 24

It is clear that school system is a strategic social environment that can impact children’s wellbeing, although in the last decades school has mainly focused on cognitive and academic achievements rather than adopting a comprehensive children’s care model. 4 However, as documented in various studies, the wellbeing of the students has also an undoubtable impact on their learning outcomes and should be considered by teachers as a crucial dimension to work on. 25 Therefore, health promotion can’t remain a marginal aspect of teacher work, as it has the potential to create a ‘virtuous circle’ that makes students able to reach better academic attainments and to improve health outcomes ( Figure 2 ). 26 Children with social and emotional problems usually show negative results at school, but at the same time those pupils who are experiencing academic difficulties might present increased social and emotional complications. 27 , 28 On the other hand, children who perform well at school seem to enjoy better health and have access to more opportunities during their lives. 29

Educational system goals

WHO has started in 2014 a specific “Health Promoting Schools framework” (HPS) to integrate health educational goals in a holistic perspective at school. This programme has shown to positively influence students’ behaviours at least for those interventions having the following endpoints: body mass index, physical activity, fruit and vegetables consumption, prevention of tobacco use and being bullied. 30 Despite this evidence regarding the potential benefits of school-based health interventions, nationwide structured and well planned health promotion strategies are still lacking. To achieve this goal, health-related contents may be embedded in the school curricula as core discipline, or could be integrated in a health-carrier discipline such as science, or even delivered as extracurricular programme. 14

The complexity of nowadays requires a deep change in teaching and learning practices, shifting the focus from the mere transmission of notions to active and motivational approaches, able to equip students with a fruitful knowledge and a wide range of life skills. This aspect is also relevant in the field of health education: teachers need to master an array of participatory activities such as class discussions, debates, case analysis, brainstorming, small working groups, peer teaching, co-writing, co-creating projects, educational games and simulations, storytelling, audio and visual laboratories (e.g. arts, music, theatre, dance etc.), in order to enhance students’ health learning outcomes. 31 , 32

Moreover, the accomplishment of multifaceted and authentic tasks over a long period of time, along with providing opportunities to reflect on the health-based learning experiences from different points of view, allow students to acquire those transversal skills they need in the real life. These innovative approaches are helpful in involving pupils in the control of the learning environment 33 , 34 and can be also useful to generate a respectful climate in the classroom, where pupils can freely practice social skills and lower anxiety due to competition or pressure of success. 35 Furthermore, researches on anti-bullying programmes have proved that structures, conditions, and learning settings (school environment) are at least as significant as individual factors. 36 , 37 Finally, school-based health promotion is more successful if a “whole-school approach” (based on comprehensive school policies) is adopted, paying also attention to school physical environment (appeal and sustainability of buildings, grounds and surroundings). Community links are an additional relevant dimension, because working together with families or communities (in collaboration with available health professionals) help schools in more effectively spreading a “culture of prevention”. 38

Primary prevention and education: a scientific justification for school-based interventions

According to the World Health Organization, health is a human right defined as “a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity” 39 and itis influenced by culture, which plays an important role in shaping quality of life perception, both for individuals and communities. Thus, health can be considered as a universal dimension of human culture, reflecting socio-cultural values, traditions, and beliefs shared by a community of people. 40 - 43 In light of this wide-ranging concepts of health, also healthy lifestyles could be regarded as complex cultural schemes, involving different aspects such as nutrition, physical activity, work/leisure time, and environmental protection. 44 , 45 The efficacy of health education at school can only be evaluated if taking into account multidimensional factors within a comprehensive view of health.

As pointed out by positive psychology, it is fundamental to foster physical, mental/emotional and social wellbeing of individuals since the early childhood, shifting from being focused on diseases prevention to wellbeing promotion, namely from risk factors to protective factors. 46 Both primary prevention and health promotion approaches are focused on proactively maintaining people healthy, ensuring this change of views. 47

According to the medical paradigm, three levels of preventive interventions are possible. Primary prevention (universal provision of information about healthy lifestyles) corresponds to health promotion and can be managed at school or community level, while secondary (early diagnosis of risky behaviours in selected population), and tertiary prevention (rehabilitative/dedicated interventions) concern medical field and require professional operators. 48

The knowledge about protective and risk factors (that belongs to the domain of primary prevention) is useful to plan psycho-socio-pedagogical interventions in school setting that might increase the benefits of protective factors (i.e. resilience, empathy and other soft skills, useful as personal resources or coping strategies to deal more effectively with stressful events). 49 - 51 On the other hand, risk factors are described as individual or environmental characteristics that predispose to the early onset of problems (including school dropouts, substance abuse, delinquency, violence, and early pregnancies), usually overlapping in vulnerable social groups. 52

At the present time, the prevention of emotional problems among young people, leading to possible social deviations, has become one of the most urgent educational emergencies so that primary prevention represents an important educational commitment. 53 Educational institutions face also the challenge of reducing health inequalities among students and their exsposure to risk factors associated to a higher probability of future problematic behaviours. 54 , 55 In particular, school system and teachers are asked to reinforce the points of strength (emotional and social skills) of the students, spreading “a warm blanket of prevention”, instead of adopting a regulatory and stigmatizing style towards already marginalized children or teenagers. 56 This means encouraging young people to make healthy choices, in order to reduce the risk of developing emotional/social difficulties and future chronic diseases.

Indeed, the World Health Organization has demonstrated that many early deaths are avoidable: at least 80% of all cases of heart diseases, strokes, type 2 diabetes and one third of all cancers can be prevented through health education. 3 In this perspective, as children’s health is a valuable resource for communities, primary prevention represents a necessary investment for our present and future. 57 A society that wants to live better should ask each stakeholder to take a piece of responsibility and invest in promoting healthy lifestyles since childhood ( Figure 3 ). Going beyond the mere academic achievements that students are expected to acquire, every educational practice should provide children with the basis for personal self-realization, helping them to grow up as confident learners and responsible citizens for individual and collective health. 58 , 59

Stakeholders involved in Health and Wellbeing Promotion

The attention to students’ wellbeing (physical, social and mental condition) should become part of any pedagogical design that wants to be effective in preventing socio-emotional difficulties and risky behaviours (i.e. addictions to alcohol, tobacco, and drugs). Educators must encourage the adoption of healthy lifestyles and foster the development of critical thinking towards unhealthy behaviours and their physical, psychological and social consequences. 60

From a pedagogical point of view, the principle of prevention is one of the fundamental concepts of education, in the perspective of life-long learning and people empowerment. Empowered students can be able to trigger processes of social progress in their communities, moving from a passive state to an agency asset and expressing a transformative potential on their communities. 61

The promotion of children’s health is not only a matter of preventive medicine, but it involves educational and ethical dimensions of social responsibility aimed at increasing young people consciousness and responsibility for their own and other people’s health. Therefore, while working on students’ motivation towards healthy lifestyles, school can raise their awareness about sustainable development topics, as health and environment are strictly interconnected.The adoption of healthy lifestyles – which turns into responsible consumers’ choices (ethical consumption) – is linked to the concepts of ecological, social and economic sustainability, as well as to those of solidarity, peace, equity and legality. 62 , 63

Finally, promoting students’ health at school has been found to engage in healthy habits also families and communities (a kind of multiplier effect): children can become health trainers of their parents, relatives and friends, impacting positively the entire society. 15 Due to its social commitment, school needs the support of all the private and public social actors, in order to overcome the obstacles that arise in the educational path, and build up a comprehensive “preventive system”, able to foster healthy protagonism of the “youngest part of the society”. 64

Everybody has the right to reach a state of wellbeing in which his or her own talents are fully accomplished, providing a personal contribution to the society. 65 Since education and health are interrelated, educational system can be considered among the most committed institutions for the promotion of young people’s wellbeing, together with families and communities. 66 , 67 However, the changes in social relationships occurred in the last decades (increase in the number of divorces, births outside marriage and family mobility), along with the difficulties due to recent economical crises, make even more crucial the comprehensive educational role of the school. 68 - 70

Working for prevention and bringing health information to students represents an intrinsic ethical duty for any scholastic institution, so that teachers – who are already recognized as “promoters of culture” – should become also “health promoters” and “emotional trainers” of their students. 71 Health education should inform the ordinary teaching activities, becoming part of the daily work of school staff, who have the responsibility to guide students towards the adoption of healthy lifestyles, developing all their cognitive, affective, spiritual and social aspects, especially in a context characterized by an increasing absence of parental support at home. 72 - 74

Indeed, effective school-based preventive approaches are those that raise students’ motivation towards healthy habits and foster their critical thinking about harmful consequences of the most common risky behaviours. In this perspective, teachers should boost students’ problem solving and judgment attitudes necessary for protecting their health, working on skills such as communication, assertiveness, self-management, rejection of influences, conflict resolution and negotiation with peers and adults. 75 The adoption of meaningful contents, methods and tools can ensure a deep and “transformative” learning process, and generates a personal interiorization of knowledge in young people. 76 Furthermore, a classroom climate of mutual trust and support – where each pupil is an equal participant – encourage students to find by themselves own life projects, following their personal interests and inclinations. 77 , 78

The modern educational challenges call for reviewing and updating teaching/learning practices, in order to implement promotional and motivating strategies – with a long-wide-deep learning perspective – thus addressing the limitations of traditional education that does not always satisfy the needs of the new generations. 79 , 80 At the same time, invasive or regulatory style should be avoided to reduce the risk of stigmatizing already vulnerable children. 81 It is possible to overcome the vertical transmission of knowledge based on passive acquisition of information by adopting experiential and participatory approaches such as role playing, debates, tasks of reality, artistic laboratories, 31 that help students’ to develop transversal competences and personal re-construction of knowledge, stimulating their agency. Active, motivational and participatory teaching/learning methodologies are also useful to set a healthy supportive school environment, where positive values are shared by the students, growing up as socially skilled citizens, able to select and build up their own learning, manage properly their time and apply in real life the knowledge acquired. 82

Health educational interventions should start as early as possible, addressing all areas of children’s growth (physical, emotional, social and cognitive development) 83 and should be planned at different levels of operation (with a structured and continuous monitoring of the processes and outcomes): universal programmes for the whole school or targeted preventive actions focused on most vulnerable groups. Health promotion impacts on the whole school population, while preventive interventions are more effective in those groups at higher risk. Health-promoting interventions implemented for disadvantaged children since early stage of life have been proved to be effective in coping with several forms of social marginalization and inequalities. 84 For this reason, sub-populations of children suffering from socio-emotional problems should be identified in advance (paying special attention to those pupils belonging to socio-economically disadvantaged families), by detecting the presence of ‘warning signs”, such as disturbing behaviours, school refusal, or unusual deviations in their academic profile. 85

The urgency of putting more efforts on health literacy at school is also triggered by the COVID-19 pandemic and other possible challenges arising from the altered ecosystems balance due to human activities. 86 Indeed, health promotion is strictly related to education for sustainable development, and the entire school system should deal also with the unavoidable task of environmental protection throughout a systemic strategy. The goal is to stimulate students’ citizenship skills, in particular their sense of responsibility towards personal and collective health, thus empowering young people to take action for a more healthy and sustainable society and to claim – as informed citizens – for policies that positively impact their health and the environment. 87 , 88

However, even though there is a strong evidence for implementing health education in school setting, the effects of this kind of interventions are variable and there is no guarantee of success, unless a full commitment of teachers and school staff is displayed. It must be also considered that every organization, including school system, has to deal with the low propensity of teachers to make full use of all the new training opportunities and accept to modify their current educational practices. 89 , 90 Moreover, schools have to cope with the lack of financial resources and expert staff (e.g. PhD candidates, professional health services, pedagogical and psychological consultants potentially useful for specific targeted interventions), that could be possibly provided to the school system by a stable cooperation with private and public stakeholders. 91 , 92

Scientific evidence demonstrates that school can be the ideal setting to implement health-related interventions aimed at fostering young people global growth. 93 Health promotion at school could be effective in improving both students’ wellbeing and their academic achievements, thus generating a virtuos circle. As primary educational institution, school might integrate children’s health promotion in its ordinary teaching and learning practices through a specific revision of the curricula. Educators should be adequately trained on how to raise students’ motivation towards healthy/sustainable lifestyles and display the most innovative participatory methodologies, in order to effectively convey health knowledge to young people, fostering at the same time their critical thinking about harmful consequences of risky behaviours. As Unesco Chair, we highlight that primary prevention should start as early as possible by carrying out well-structured health educational interventions, finding in teachers the most committed social actors, in the perspective of “better health through better schools”. 94

Acknowledgments

The UNESCO Chair on Health Education and Sustainable Development and the Italian Society of Environmental Medicine are grateful to the UNESCO Assistant Director-General for Education Dr. Stefania Giannini and her staff.

This research has been carried out in the frame of institutional activities of the UNESCO Chair on Health Education and Sustainable Development, without receiving any external funding or economical support.

Competing interests

All the authors declare that they have no competing interests.

Ethical approval

Not applicable.

Authors’ contributions

MP, PP, AM, SC, and AC conceived, wrote and revised this review.

Critical perspectives on health and wellbeing education in schools

Health Education

ISSN : 0965-4283

Article publication date: 7 August 2017

Leahy, D. and Simovska, V. (2017), "Critical perspectives on health and wellbeing education in schools", Health Education , Vol. 117 No. 5, pp. 430-433. https://doi.org/10.1108/HE-06-2017-0034

Emerald Publishing Limited

Copyright © 2017, Emerald Publishing Limited

This special issue of Health Education is first in the series of special issues planned under the framework of collaboration between Emerald and European Educational Research Association (EERA) www.eera-ecer.de/ , part of which is Network 8, Research on Health Education. EERA consists of more than 30 member associations and is organised in topic-based research networks with members from all over the world, representing broad range of the interdisciplinary field of educational research. EERA’s annual conference ECER is attended by about 2,500 participants from across the globe.

The general objective of the network “Research on Health Education” is to provide an interdisciplinary forum to continuously explore and critically discuss dynamic relations between education and health, contribute to conceptual development as well as empirically based evidence for the schools for health approach across Europe, and play a part in enhancing the knowledge base within educational research in a broader sense ( EERA Research on Health Education, 2011 ). The main overall research field includes education, learning and health and well-being promotion in schools. Health is considered as a multidimensional concept, including mental, emotional and social aspects, in addition to the physical dimension. Health is also viewed as a positive concept, encompassing well-being and quality of life, rather than solely absence of disease in bio-medical terms. These perspectives are embedded in a critical socio-ecological approach to health and well-being promotion and education, which looks not only at the health of individuals, but at the complex interplay of socio-economic, historical, political and other determinants of health and well-being.

Why critical perspectives on health and well-being education in schools?

School-based health and well-being education has long been a part of schooling. In many countries, health and well-being education is part of mandatory state/national curriculum architectures (e.g. Australia, Denmark, Finland, New Zealand). In other countries, health education finds itself vying for a place in official curriculum structures whilst being relegated to the status of non-statutory ( Fitzpatrick and Tinning, 2014 ; Simovska and Mannix-McNamara, 2015 ; Leahy et al. , 2016 ).

The health education curriculum also serves as an integral component of the “health promoting school” approach providing a platform for explicit teaching and learning about health, in addition to such broader features as policy frameworks, the whole-school environment and the collaboration between school and community ( Fitzpatrick and Tinning, 2014 ; Simovska and Mannix-McNamara, 2015 ; Leahy et al. , 2016 ).

While there is without doubt a significant amount of scholarship that has, over time, sought to examine health education and its role in enhancing children and young people’s health and education outcomes, the field has overwhelmingly been dominated by research that has emerged from public health and health promotion. Whilst a good deal is known about the impacts of different specific interventions and programs, there is little research that sheds light on the complexities and challenges of the everyday practices connecting health and education in schools. The lack of scholarship on the everyday of schooling means that there are significant gaps in what we know about the international, national and local formations of the health education curriculum and the mix of teaching, learning and assessment strategies that feature in health education classrooms. For example, who decides what do students learn about health and well-being in the everyday of schooling and what broader effects does health work have on the school community? How are teachers prepared to tend to health education and how does this impact on how teachers negotiate multiple (public) health imperatives and education (curriculum) imperatives? What kinds of teaching and learning strategies emerge at the health/education interface? What are the intended and unintended effects of this work in schools? The aim of this special issue is to showcase research that engages with these kinds of questions.

In the call for papers, we placed a focus on research that adopts a “critical approach” to school health and well-being education and promotion. Critical health and well-being education in schools has emerged as a result of the “critical turn” which called into question the politics of health education via a focus on power relations and their effects ( Gottesman, 2016 ). In seeking out papers that explicitly embrace a critical approach we intend to showcase how scholars engage with questions of politics, values, relations of power and inequality in their work. In other words, critical research on health and well-being education asks questions about the often taken for granted assumptions and practices such as curriculum imperatives, content and teaching strategies, and about the values and ideologies underpinning different research methodologies. We suggest that critical studies of health education have much to offer to the advancement of theory, policy and practice of health and well-being education and promotion in schools.

Overview of the papers

There are six papers in this special issue. The papers utilise different approaches to critical scholarship and provide insights into school health and well-being education across a range of countries including Ireland, New Zealand, Australia and Slovakia.

The first paper by Barry, Clarke and Dowling entitled “Promoting social and emotional wellbeing in schools” provides a critical perspective on the international evidence on promoting young people’s social and emotional well-being in schools. In the article, Barry and colleagues argue that the integration and sustainability of evidence-based social and emotional skills programmes within the context of whole-school systems is far from clearly established. In light of this, the authors discuss the value of applying a “common elements approach” to the development of school interventions. The paper presents findings from a pilot study that utilised a common elements approach in the development and implementation of an intervention. Initial results from the study highlight the potential of this approach in providing a set of core strategies that can be used in practice to address a range of behaviours of young people. However, the authors argue for more rigorous research to identify the best strategies for moving forward in integrating promotion of social and emotional well-being in schools.

The second paper also has a focus on social and emotional health and well-being in schools. In her article entitled “Towards dynamic and interdisciplinary frameworks for school-based mental health promotion,” O’Toole interrogates traditional individualistic, “expert-driven” conceptualisations of children and young people’s mental health and how such conceptions shape school-based intervention approaches. O’Toole argues that the field needs to engage with other perspectives, in particular insights from critical pedagogy and dynamic, emergent understandings of children and young people’s mental health which treat mental health as situated within socio-historical and cultural contexts, while aiming to confront the social injustices that impact children’s lives. In forging interdisciplinary critical connections and methodological synergies, O’Toole suggests that in this way we might be better able to harness strengths from the different philosophical and theoretical perspectives and develop fruitful innovative platforms for future critical work with promotion of mental health and well-being in schools.

The third paper, “Democratic school health education in a post-communist country” by Boberova, Paakkari, Ropovik and Liba, discusses the findings of an intervention programme built on the concept of children’s health literacy, focusing particularly on its citizenship component. The intervention employed the “Investigation Vision Action Change (IVAC)” model for participatory, action-oriented teaching in which children are supported to investigate different health issues that affect them, create visions about desirable changes and act toward bringing about change. The paper gives an account of the political and social context in post-communist Slovakia where the majority of health education programs are behaviourally oriented, with little space afforded to children’s own perceptions and influence. The focus on student participation is therefore of crucial importance as it represents a significant move away from the taken for granted behaviour-regulation and from the teacher and curriculum-centred approaches that have so far characterised health education in Slovakia. The authors utilised a cluster randomized controlled trial design to study the impact of the IVAC model. The findings revealed that there were improvements in children’s well-being, their perception of school and in reduction of violent behaviour.

In the fourth article, “LGBTQ youth, activism, and school: challenging sexuality and gender norms,” McGlashan and Fitzpatrick examine lesbian, gay, bisexual, trans and queer youth activism in schools as a means to challenge existing gender and sexuality norms. Although the authors claim that previous research had found that schools are not inclusive spaces for LGBTQ young people, they are mindful to note that a continued focus on how LGBTQ young people are marginalised is itself a problem. In an attempt to counter the continual cycle of marginalisation, the authors adopted a “strengths-based approach” to examine the various activities of a group of LGBTQ young people attending a public high school in Auckland, New Zealand. The strengths-based approach offers a refreshing counter to the risk and deficit fuelled approaches that have characterised much of the literature on sexualities and schooling. By drawing on critical ethnographic approaches and poststructural theory, the authors explore how LGBTQ young people engage as leaders and participants in school health promotion efforts. The findings indicate that the hetero-norms within the school were challenged, however the work impacted on student visibility, which in turn created tensions as young people grappled with their identities and the public spaces of school.

Burrows’ conceptual paper “Children as change agents for family health” explores ways in which children and young people are being positioned as “change agents” for families through school health promotion initiatives in New Zealand. Burrows draws on poststructural theories to map policy discourses and initiatives that directly or indirectly regard children as conduits of healthy eating and exercise messages/practices for families. Burrows is interested in the politics of school health education and promotion and in what the different health education curriculum packages suggest in terms of how “healthy” families should live. Given the proliferation of family-focused health initiatives in New Zealand and elsewhere, Burrows suggests that critical perspectives may help in unpacking how children are expected to be engaged in these initiatives, a well-meaning effort with potentially harmful implications and outcomes.

The final paper in the special issue provides insights from health education teacher education in Australia. In their paper, “Working against ‘pedagogic work:’ challenges to engaging pre-service teachers in critical health education,” Fane and Schulz draw from Bourdieu’s concepts of “bodily hexis” and “implicit pedagogy” (how the personal combines with the social through the cultural imprints and bodily memory), to investigate the challenges of redressing the dominance of individualism that infuses pre-service teachers’ understanding of health. The authors discuss the findings from a study that involved analysing pre-service education students’ reflective writing based on student experiences of a course that sought to engage students in thinking about health in socially critical ways. The analysis of student reflections revealed however that this was not easy to sustain and that, while they attempted to engage with and demonstrate knowledge of a socially critical view of health, contradictions or places where students unknowingly slipped into traditional risk-focused ways of thinking emerged frequently across the data. The article highlights some of the difficulties encountered by pre-service teachers and students when trying to engage with critical perspectives of health and schooling.

This special issue portrays six different takes on critical health and well-being education in schools, highlighted through the discussions of a range of varied themes: social and emotional learning, mental health promotion, participatory pedagogies, LGBTQ student activism, positioning of children in family health and challenges of teacher professional development. With this portrayal, we hope to contribute to and advance the debate concerning the role, the position, the potentials and limitations of schools and schooling in the promotion of health and well-being, developing innovative approaches that aspire not only to improve students’ health status and related behaviours, but also to foster their critical competences and to engage with the contextual determinants of health and well-being.

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Health Education and Health Promotion: Key Concepts and Exemplary Evidence to Support Them

• First Online: 09 October 2018

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• Hein de Vries 8 ,
• Stef P. J. Kremers 8 &
• Sonia Lippke 9  

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Health is regarded as the result of an interaction between individual and environmental factors. While health education is the process of educating people about health and how they can influence their health, health promotion targets not only people but also their environments. Promoting health behavior can take place at the micro level (the personal level), the meso level (the organizational level, including e.g. families, schools and worksites) and at the macro level (the (inter)national level, including e.g. governments). Health education is one of the methods used in health promotion, with health promotion extending beyond just health education.

Models and theories that focus on understanding health and health behavior are of key importance for health education and health promotion. Different classes of models and theories can be distinguished, such as planning models, behavioral change models, and diffusion models. Within these models different topics and factors are relevant, ranging from health literacy, attitudes, social influences, self-efficacy, planning, and stages of change to evaluation, implementation, stakeholder involvement, and policy changes. Exemplary health promotion settings are schools, worksites, and healthcare, but also the domains that are involved with policy development. Main health promotion methods can involve a variety of different methods and approaches, such as counseling, brochures, eHealth, stakeholder involvement, consensus meetings, community ownership, panel discussions, and policy development. Because health education and health promotion should be theory- and evidence-based, personalized interventions are recommended to take empirical findings and proven theoretical assumptions into account.

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de Vries, H., Kremers, S.P.J., Lippke, S. (2018). Health Education and Health Promotion: Key Concepts and Exemplary Evidence to Support Them. In: Fisher, E., et al. Principles and Concepts of Behavioral Medicine. Springer, New York, NY. https://doi.org/10.1007/978-0-387-93826-4_17

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UNESCO and WHO urge countries to make every school a health-promoting school

UNESCO and the World Health Organization today launched the Global Standards for Health-promoting Schools, a resource package for schools to improve the health and well-being of 1.9 billion school-aged children and adolescents. The closure of many schools around the world during the COVID-19 pandemic has caused severe disruptions to education. An estimated 365 million primary school students went without school meals and significantly increased rates of stress, anxiety and other mental health issues.

“Schools play a vital role in the well-being of students, families and their communities, and the link between education and health has never been more evident,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “These newly launched global standards are designed to create schools that nurture education and health, and that equip students with the knowledge and skills for their future health and well-being, employability and life prospects.”

Based on a set of eight global standards, the resource package aims to ensure all schools promote life skills, cognitive and socioemotional skills and healthy lifestyles for all learners. These global standards will be piloted in Botswana, Egypt, Ethiopia, Kenya and Paraguay. The initiative contributes to WHO's 13th General Program of Work target of ‘1 billion lives made healthier’ by 2023 and the global Education 2030 Agenda coordinated by UNESCO. 

“Education and health are interdependent basic human rights for all, at the core of any human right, and essential to social and economic development,” said UNESCO Director General, Audrey Azouley. “A school that is not health-promoting is no longer justifiable and acceptable. I call for all of us to affirm our commitment and role, to make every school a health-promoting school”.

The global standards provide a resource for education systems to help foster health and well-being through stronger governance. UNESCO and WHO will work with governments to enable countries to adapt the package to their specific contexts. The evidence is clear. Comprehensive school health and nutrition programmes in schools have significant impacts among school-aged children. For example:

• School health and nutrition interventions for girls and boys in low-income areas where worms and anaemia are prevalent can lead to 2.5 years of additional schooling.
• Malaria prevention interventions can result in a 62% reduction in absenteeism.
• Nutritious school meals increase enrolment rates by 9% on average, and attendance by 8%; they can also reduce anaemia in adolescent girls by up to 20%.
• Hand-washing promotion reduces absenteeism due to gastrointestinal and respiratory illnesses by 21% -61% in low-income countries.
• Free screening and eyeglasses have led to a 5% higher probability of students passing standardized tests in reading and math.
• Comprehensive sexuality education encourages the adoption of healthier behaviours, promotes sexual and reproductive health and rights, and improves sexual and reproductive health outcomes such as the reduction of HIV infection and adolescent pregnancy rates.
• Improving water and sanitation (WASH) services and supplies in school, as well as knowledge on menstrual hygiene, equips girls to maintain their body hygiene and health with dignity, and may limit the number of school days missed during menstruation.

The Health Promoting Schools approach was first articulated by WHO, UNESCO and UNICEF in 1995 and adopted in over 90 countries and territories. However, few countries have implemented it at scale, and even fewer have effectively adapted their education systems to include health promotion. The new global standards will help countries to integrate health promotion into all schools and boost the health and well-being of their children. 

Join the virtual launch event : https://www.who.int/news-room/events/detail/2021/06/22/default-calendar/making-every-school-a-health-promoting-school

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The Importance of Mental Health Awareness in Schools

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by Nancy Barile, Award-Winning Teacher, M.A.Ed.

Mental health awareness is an important issue for all educators, who are often the first line of defense for their students. Education professionals have recognized the impact that a student's mental health has on learning and achievement, and they realize that there's a great deal that can be done to help students with mental health issues. As a high school teacher with more than 23 years of experience, I welcome the fact that mental health awareness is finally becoming an important part of a school's function and curriculum.

Seeing the Signs in My Student

A few years ago, a student in my senior class changed drastically in a short period of time. I noticed that Melina no longer did her homework, and she didn't even try on her essays. Previously meticulous in her appearance, Melina would come to school disheveled, wearing the same clothes. When I tried to speak to her, she was uncharacteristically distant and withdrawn. Because I had some training in mental health awareness, I knew Melina was in some sort of trouble.

Luckily, my school had social workers on staff who could speak to Melina and assess her issues. They discovered that Melina was depressed and suicidal, and she needed an immediate psychiatric intervention. Melina was hospitalized for a period of time, but she was able to return to my classroom a few months later. With the help of medication and therapy, she managed to graduate with her class.

Understanding the Impact

The National Alliance on Mental Illness  estimates that one in five people live with some sort of mental disorder or disease. Despite the fact that the average age of early signs of mental illness is 14, most individuals don't seek help until adulthood. Underlining the seriousness is the fact that 60 percent of high school students with mental illness don't graduate.

Further reading:  Ease Student Anxiety in the Classroom

New York mental health experts recognized that earlier intervention could result in more positive outcomes for these students. Beginning in July 2018, New York will be the first state in the nation to require mental health education for all students.  The overall mission of New York's School Mental Health (SMH) program  is to promote healthy social, emotional, and behavioral development of students, and "break down barriers to learning so the general well-being of students, families, and school staff can be enhanced in collaboration with other comprehensive student support and services."

The SMH program supports the emotional health and academic growth of all students with the following:

• Integrating comprehensive services and support throughout every grade level
• Assessing mental health needs through universal, selective, and targeted interventions
• Providing access to behavioral and mental health services and programs
• Leveraging higher-level personnel, such as those working with the Department of Education, for necessary support and services
• Building collaborative relationships between the school and students' families and communities

Spreading Awareness Across the Nation

Until mental health education is a mandatory aspect of all schools, teachers and administrators can work to promote awareness with their students. Key elements to shine a light on include the concept of self-care and responsibility for  one's own mental health and wellness , with an emphasis on the fact that mental health is an integral part of health, and the concept of recovery from mental illness.

Teachers and students should be provided with ways to recognize signs of developing mental health problems, and there should be opportunities around the awareness and management of mental health crises, including the risk of suicide or self-harm. Further, instruction should address the relationship between mental health, substance abuse, and other negative coping behaviors, as well as the negative impact of stigma and cultural attitudes toward mental illness.

Further reading:  Social-Emotional Learning

Because teens spend most of their day at school, it just makes sense to have mental health awareness and education become part of the curriculum. When we empower students with knowledge, and encourage dialogue, students will be able to get the help they need.

Ready to Start Your Journey?

HEALTH & NURSING

Recommended Articles

Take a look at other articles from WGU. Our articles feature information on a wide variety of subjects, written with the help of subject matter experts and researchers who are well-versed in their industries. This allows us to provide articles with interesting, relevant, and accurate information. 

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Teaching Health Education in School Many parents are keenly interested in the basic academic education of their youngsters—reading, writing, and arithmetic—but are not nearly as conscientious in finding out about the other learning that goes on in the classroom. A comprehensive health education pro­gram is an important part of the curriculum in most school districts. Starting in kindergarten and continuing through high school, it pro­vides an introduction to the human body and to factors that prevent illness and promote or damage health. The middle years of childhood are extremely sensitive times for a number of health issues, especially when it comes to adopting health behavior that can have lifelong consequences. Your youngster might be exposed to a variety of health themes in school: nutrition, disease prevention, physical growth and development, reproduction, mental health, drug and alcohol abuse prevention, consumer health, and safety (cross­ing streets, riding bikes, first aid, the Heimlich maneuver). The goal of this ed­ucation is not only to increase your child's health knowledge and to create positive attitudes toward his own well-being but also to promote healthy be­havior. By going beyond simply increasing knowledge, schools are asking for more involvement on the part of students than in many other subject areas. Children are being taught life skills, not merely academic skills. It is easy to underestimate the importance of this health education for your child. Before long he will be approaching puberty and adolescence and facing many choices about his behavior that, if he chooses inappropriately, could im­pair his health and even lead to his death. These choices revolve around alco­hol, tobacco, and other drug use; sexual behavior (abstinence, prevention of pregnancy and sexually transmitted diseases); driving; risk-taking behavior; and stress management. Most experts concur that education about issues like alcohol abuse is most effective if it begins at least two years before the behav­ior is likely to start. This means that children seven and eight years old are not too young to learn about the dangers of tobacco, alcohol, and other drugs, and that sexuality education also needs to be part of the experience of elementary-school-age children. At the same time, positive health behavior can also be learned during the middle years of childhood. Your child's well-being as an adult can be influenced by the lifelong exercise and nutrition habits that he adopts now. Health education programs are most effective if parents are involved. Par­ents can complement and reinforce what children are learning in school dur­ing conversations and activities at home. The schools can provide basic information about implementing healthy decisions—for instance, how and why to say no to alcohol use. But you should be a co-educator, particularly in those areas where family values are especially important—for example, sexu­ality, AIDS prevention, and tobacco, alcohol, and other drug use. Many parents feel ill-equipped to talk to their child about puberty, repro­duction, sex, and sexually transmitted diseases. But you need to recognize just how important your role is. With sexual topics—as well as with many other ar­eas of health—you can build on the general information taught at school and, in a dialogue with your youngster, put it into a moral context. Remember, you are the expert on your child, your family, and your family's values. Education seminars and education support groups for parents on issues of health and parenting may be part of the health promotion program at your school. If they are not offered, you should encourage their development. Many parents find it valuable to discuss mutual problems and share solutions with other parents. Although some parents have difficulty attending evening meet­ings, school districts are finding other ways to reach out to parents—for in­stance, through educational TV broadcasts with call-in capacities, Saturday morning breakfast meetings, and activities for parents and children together, or­ganized to promote good health (a walk/run, a dance, a heart-healthy luncheon). In addition to providing education at home on health matters, become an advocate in your school district for appropriate classroom education about puberty, reproduction, AIDS, alcohol and other substance abuse, and other relevant issues. The content of health education programs is often decided at the community level, so make your voice heard. As important as the content of a health curriculum may be, other factors are powerful in shaping your child's attitudes toward his well-being. Examine whether other aspects of the school day reinforce what your youngster is be­ing taught in the classroom. For example, is the school cafeteria serving low-fat meals that support the good nutritional decisions encouraged by you and the teachers? Is there a strong physical education program that emphasizes the value of fitness and offers each child thirty minutes of vigorous activity at least three times a week? Does the school district support staff-wellness programs so that teachers can be actively involved in maintaining their own health and thus be more excited about conveying health information to their students? In addition to school and home, your pediatrician is another health educator for you and your child. Since your child's doctor knows your family, he or she can provide clear, personalized health information and advice. For in­stance, the pediatrician can talk with your child about the child's personal growth patterns during puberty, relate them to the size and shape of other family members, and answer questions specific to your youngster's own de­velopmental sequence and rate. For most school-related health concerns, your pediatrician can provide you with specific advice and tailored guidance. You and your pediatrician may also consult with the school staff on how to deal most effectively with school time management of your child's health problem. Open access Published: 02 December 2022 School-based peer education interventions to improve health: a global systematic review of effectiveness Steven Dodd 1   na1 , Emily Widnall 2   na1 , Abigail Emma Russell 3 , Esther Louise Curtin 4 , Ruth Simmonds 5 , Mark Limmer 1 & Judi Kidger 2   BMC Public Health volume  22 , Article number:  2247 ( 2022 ) Cite this article 17k Accesses 41 Citations 18 Altmetric Metrics details Introduction Peer education, whereby peers (‘peer educators’) teach their other peers (‘peer learners’) about aspects of health is an approach growing in popularity across school contexts, possibly due to adolescents preferring to seek help for health-related concerns from their peers rather than adults or professionals. Peer education interventions cover a wide range of health areas but their overall effectiveness remains unclear. This review aims to summarise the effectiveness of existing peer-led health interventions implemented in schools worldwide. Five electronic databases were searched for eligible studies in October 2020. To be included, studies must have evaluated a school-based peer education intervention designed to address the health of students aged 11–18-years-old and include quantitative outcome data to examine effectiveness. The number of interventions were summarised and the impact on improved health knowledge and reductions in health problems or risk-taking behaviours were investigated for each health area separately, the Mixed Methods Appraisal Tool was used to assess quality. A total of 2125 studies were identified after the initial search and 73 articles were included in the review. The majority of papers evaluated interventions focused on sex education/HIV prevention ( n  = 23), promoting healthy lifestyles ( n  = 17) and alcohol, smoking and substance use ( n  = 16). Papers mainly reported peer learner outcomes (67/73, 91.8%), with only six papers (8.2%) focussing solely on peer educator outcomes and five papers (6.8%) examining both peer learner and peer educator outcomes. Of the 67 papers reporting peer learner outcomes, 35/67 (52.2%) showed evidence of effectiveness, 8/67 (11.9%) showed mixed findings and 24/67 (35.8%) found limited or no evidence of effectiveness. Of the 11 papers reporting peer educator outcomes, 4/11 (36.4%) showed evidence of effectiveness, 2/11 (18.2%) showed mixed findings and 5/11 (45.5%) showed limited or no evidence of effectiveness. Study quality varied greatly with many studies rated as poor quality, mainly due to unrepresentative samples and incomplete data. School-based peer education interventions are implemented worldwide and span a wide range of health areas. A number of interventions appear to demonstrate evidence for effectiveness, suggesting peer education may be a promising strategy for health improvement in schools. Improvement in health-related knowledge was most common with less evidence for positive health behaviour change. In order to quantitatively synthesise the evidence and make more confident conclusions, there is a need for more robust, high-quality evaluations of peer-led interventions using standardised health knowledge and behaviour measures. Peer Review reports Ensuring good health and wellbeing amongst school-aged children is a global public health priority and the contribution schools can make to this goal is increasingly recognised [ 1 ]. Worldwide, we have seen a rise in peer education interventions over recent decades [ 2 ]. For example, a survey in England revealed that 62% of primary and secondary schools had offered a peer-led intervention in 2009 [ 3 ]. Peer-led interventions within school settings are popular for many reasons, including the important role peers play within the lives of young people, a perception that this approach involves relatively few resources, and the more even balance of authority than in teacher-led lessons [ 4 ]. The use of peer educators for health improvement has also been linked with the importance of peer influence in adolescence [ 5 ]. This is a time of increased social development and peer attachments are central to young people’s development, particularly during adolescence [ 5 , 6 ]. Further, there is evidence that young people are more likely to seek help from informal sources of support such as friends in comparison to adults [ 7 ], and of older students being perceived as role models by their younger peers [ 8 ]. Benefits are also likely to exist for peer educators themselves, including opportunities to develop confidence and leadership skills, as well as many schools rewarding peer educators with a qualification or endorsement for their participation [ 9 ]. Existing peer education interventions cover a wide range of health areas, including mental health, physical health, sexual health, and a general promotion of healthy lifestyles including eating habits and smoking prevention [ 10 , 11 , 12 , 13 ]. There is also variation in the format or delivery of peer-led interventions including 1:1 peer mentoring, peer buddy initiatives, peer counselling, and peer education [ 14 , 15 , 16 , 17 ]. This review focuses specifically on peer education, which typically involves the selection and training of ‘peer educators’ or ‘leaders’, who subsequently relay health related information or skills to younger or similar aged students in their school, known as ‘peer learners’ or ‘recipients’. Summary of related reviews The current literature on peer education indicates a mixed evidence base regarding its effectiveness. Ten previous reviews were found concerning health-related peer education among young people [ 10 , 12 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. Of these, six concerned sexual health/HIV prevention, two concerned health promotion/education more broadly, one focused on substance abuse and one focused on mental health. Kim and Free’s review concerning sexual health [ 21 ] found no overall effect of peer education on condom use, mixed findings on sexually transmitted infection (STI) prevention, and positive findings regarding improvements in knowledge, attitudes and intentions. Siddiqui et al. [ 20 ] reviewed peer education programmes for promoting the sexual and reproductive health of young people in India, revealing large variations in the way peer education is implemented as well as mixed effectiveness findings and limited effects of behaviour relative to knowledge. Maticka-Tyndale and Barnet [ 22 ] compiled a review into peer-led interventions to reduce HIV risk among youth using a narrative synthesis, and found that peer interventions led to positive change in knowledge and condom use, and had some success in changing community attitudes and norms, but no significant findings for effects on other sexual behaviours and STI rates. By comparison, Tolli’s review [ 12 ] regarding the effectiveness of peer education interventions for HIV prevention found no clear evidence of peer education effectiveness for HIV prevention, adolescent pregnancy prevention or sexual health promotion in young people of member countries of the European Union. Mellanby et al. [ 23 ] reviewed the literature comparing peer-led and adult-led school health education and identified eleven studies. Seven of these studies found peer-led to be more effective for health behaviour change than adult-led and three of these studies found peer-led to me more effective for change in knowledge and attitudes. Harden et al. [ 24 ] identified 64 peer-delivered health interventions for young people aged 11 to 24 in any setting (i.e. not restricted to school settings), with only 12 evaluations judged to be methodologically sound. Of these 12, 7 studies (58%) showed a positive effect on at least one behavioural outcome. This review concluded an unclear evidence base for peer-delivered health promotion for young people. MacArthur et al’s [ 19 ] investigation of peer-led interventions to prevent tobacco, alcohol and/or drug use among young people aged 11–21, comprised a meta-analysis, pooling 10 studies on tobacco use, and found lower prevalence of smoking among those receiving the peer-led interventions compared with controls. The authors also found that peer-led interventions were associated with benefit in relation to alcohol use, and three studies suggested an association with lower odds of cannabis use. A recent systematic review by King and Fazel of 11 school-based peer-led mental health interventions studies revealed mixed effectiveness [ 10 ]. Some studies showed significant improvements in peer educator self-esteem and social stress [ 25 ], but one study showed an increase in guilt in peer educators [ 26 ]. Two studies also found improvements in self-confidence [ 27 ], and quality of life in peer learners [ 28 ], but one study found an increase in learning stress and decrease in overall mental health scores [ 26 ]. The review concluded there is better evidence if benefits for peer educators compared to peer learners. The summary above of previous systematic assessments of the peer education approach reveals a limited evidence base for school-based peer education interventions. Only two reviews were included regarding school-based peer education, one of which occurred over 20 years ago [ 23 ], while the other [ 10 ] was more narrowly concerned with mental health outcomes. Despite the widespread use of peer-led interventions, the evidence base across all health areas still remains limited and little is known regarding their overall effectiveness in terms of changing behaviours or increasing health-related knowledge and/or attitudes. Due to the limited evidence base of peer education interventions, this review is broad in scope and will cover global peer education interventions covering all health areas. Although some peer education interventions are targeted towards specific populations, this review focuses on universal interventions available to an entire cohort of students (for example whole class or whole year group). The review aims to summarise the effectiveness of existing peer-led health interventions in schools. This is a review of quantitative data; the qualitative peer education literature will be published in a separate review. We followed the PICO (Population, Intervention, Comparator and Outcome) format to develop our research question. We completed the systematic review in accordance with the 2009 PRISMA statement [ 29 ] and registered it with PROSPERO (CRD42021229192). Search strategy and selection criteria Five electronic databases were searched for eligible studies: CINAHL, Embase, ERIC, MEDLINE and PsycINFO. The list of search terms (see Supplementary Materials ) were developed after scanning relevant literature for key terms. Searches took place during October 2020. Once the search terms had been agreed amongst the study team, pilot searches were run to check that key texts were appearing. Search terms were subsequently refined and this process was repeated until all key texts appeared. Search strategies such as truncations were used to maximise results. No restrictions were placed on publication date, country or language. Inclusion/exclusion criteria To be included studies had to be concerned with school-based peer education interventions designed to address aspects of the health of pupils aged 11–18 years old. We are interested in this age group in particular as it is a period when peers take on a particularly important role in young people’s lives. Peer education interventions concerned with health are defined here as interventions in which school-aged children deliver the education of other pupils for the purposes of improving health outcomes or awareness/literacy relating to health, including knowledge, behaviours and attitudes. Interventions must have taken place within a school, during school hours and must be universal, i.e. not targeted towards a specific sub-group of students or students with a particular health condition. Where comparators/controls existed, they had to include non-exposure to the interventions concerned, exposure to a differing version of the same intervention, or exposure to the intervention within a substantially differing context. Papers were excluded from data synthesis if they satisfied any of the following criteria: Peer education interventions only concerned academic outcomes (e.g., reading and writing achievement). Interventions concerning anger management, behavioural problems, or social skills. Interventions concerning traffic safety, health and safety, avoidance of injuries, or first aid. Interventions concerning cultural, social or political awareness (e.g., media literacy). Interventions in which health outcomes are secondary to other outcomes (e.g., interventions focused on reading that indirectly improve self-esteem). One-to-one mentoring interventions. Conference abstracts, research briefings, commentaries, editorials, study protocol papers and pre-prints. Primary outcome(s) Improvements in health, including health awareness and understanding as indicated by responses to questionnaires. Reductions in health problems or risk-taking behaviours. These outcomes may concern the peer educators and/or peer learners. Data extraction, selection and coding Two reviewers independently screened all papers according to the inclusion criteria above using the Rayyan online review platform. In cases where the reviewers were uncertain, or where the decision was disputed, the decision was discussed and agreed among the wider research team. Two reviewers (SD and EW) then divided the papers between them and independently extracted the data, discussing and queries that arose with each other and the wider team. Data extraction included the following: Bibliographic details – authors, year of publication, nation in which intervention was carried out Aims of the study Description of study design Sample size and demographic characteristics. Context into which the intervention is introduced (characteristics of the school involved, the area in which the school is located, characterisations of the student body, relevant policy considerations). Description of intervention (including duration of intervention). Outcome measures (measurement tools, time points of data collection). Data concerning improvements in health. Quality appraisal We used the Mixed Methods Appraisal Tool (MMAT) to assess quality of reporting procedures. This tool consists of five specific quality rating items depending on study design (qualitative, quantitative randomized, quantitative non-randomized, quantitative descriptive and quantitative mixed methods). There are 5 quality questions specific to each study design, so all papers are rated between 0 to 5. The following ratings were used to summarise study quality; 0–1 indicating poor quality, 2–3 indicating average quality and 4–5 indicating high quality. Two reviewers (SD and EW) completed quality ratings on each paper and discussed any discrepancies between them. Examples of randomized design quality questions included items such as: “ Is randomization appropriately performed ? And “ Are the groups comparable at baseline ?” Examples of non-randomized design quality questions included items such as: “ Are the participants representative of the target population?” and “Are there complete outcome data?” Effectiveness summary EW and SD completed data synthesis. Due to the volume of studies, and the large number and heterogeneity of outcome measures, in order to summarise effectiveness, we created the following scoring system to indicate effectiveness: Significant effects are effects where there was an improvement in health-related outcomes either after the peer education intervention, or when compared to a control group, with a p value of <0.05. Due to the volume of studies and varied follow-up periods, we looked at effectiveness at first follow-up, which in the majority of papers was immediately post-intervention. A total of 2125 articles were identified after the initial search and 73 articles were eligible for inclusion (see Fig. 1 for a flow diagram of the search). Study designs of the 73 articles were as follows: 23 were controlled trial designs (15 cluster or group randomised, 6 randomised controlled and 2 non-randomised). 15 used randomisation methods but were not controlled trials and the remaining 35 studies used uncontrolled non-randomised methods comparing intervention with a comparison group or using a pre-post survey. Prisma flow diagram of included studies Health and geographical areas The 73 quantitative papers included in this review demonstrated a wide range of health areas. The majority of papers evaluated interventions aimed at sex education/HIV prevention ( n  = 23), promoting healthy lifestyles ( n  = 17) and reducing alcohol, smoking and substance use ( n  = 16). Fig. 2 illustrates number of papers per health area by peer learner or peer educator outcome focus and Table 2 illustrates a summary of proportion of health areas, overall effectiveness and quality ratings. Number of papers by health area. NB See Supplementary Materials for full description of study designs and outcomes Papers mainly focussed on peer learner outcomes (67/73, 91.8%), with only six papers (8.2%) focussing solely on peer educator outcomes and only five papers (6.8%) reporting on both peer learner and peer educator outcomes. The majority of papers that focussed on peer educator outcomes were those concerned with sex education (n = 4) and mental health (n = 3). Papers typically reported knowledge, attitude and/or behavioural outcomes. Of the 73 papers, 42/73 (57.5%) reported knowledge outcomes, 43/73 (58.9%) reported attitude outcomes, 35/73 (47.9%) reported behavioural outcomes and 13/73 (17.8%) reported behavioural intentions. As well as a broad range of health areas, the papers included in the review also spanned several different countries (Fig. 3 ). Summary of number of papers by country We have summarised the results first by student type and then by health area. Results by student type Summary of peer learner outcomes. Of the 67 papers reporting peer learner health outcomes, 35/67 (52.2%) showed evidence of effectiveness (as per our thresholds shown in Table 1 ), 8/67 (11.9%) showed mixed findings and 24/67 (35.8%) found limited or no evidence of effectiveness. Of the 35 papers that demonstrated effectiveness, 9/35 studies (25.7%) were rated as high quality. Therefore only 9/67 (13.4%) of the total papers showed evidence of effectiveness and were rated as high quality. Twenty-one papers (31.3%) reported controlled trial designs (including 14 cluster or group randomised, and 5 randomised controlled and 2 non-randomised). Thirteen papers used randomisation methods but were not controlled trials and the remaining 33 papers used uncontrolled non-randomised methods comparing intervention with a comparison group or using a pre-post survey design. Summary of peer educator outcomes Of the 11 papers reporting on peer educator health outcomes, 4/11 (36.4%) showed evidence of effectiveness, 2/11 (18.1%) showed mixed findings and 5/11 (45.5%) showed limited or no evidence of effectiveness. Of the 4 papers showing evidence for effectiveness, 2 studies (50%) were rated as high quality. Four papers had a randomised design comparing intervention vs. control or ‘peer educators vs. classmates’ one of which was a cluster randomised controlled trial. The remaining 7 papers used non-randomised intervention vs. control ( n  = 2) or pre-post survey designs ( n  = 5). A full table of included studies, outcomes and effectiveness and quality ratings can be found in Supplementary Material 1 . Results by health area Sex education/hiv prevention. Twenty-three studies concerned sex education/HIV prevention [ 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ]. 9/23 studies had a randomised design with the 8 studies comparing peer-led to teacher-led or ‘lessons as usual’ and one study comparing peer-led with nurse-led. 14/23 involved non-randomised designs comparing intervention vs. control or a pre-post survey design. Studies covered a wide geographical range, among which there were 7 US studies, but also studies from Canada, UK, Africa, South Africa, Turkey and Greece. Of the twenty-three papers, 21 reported peer learner outcomes, 4 papers reported peer educator outcomes, with 2 papers reporting on both peer educator and peer learner outcomes. The mean number of participants across the studies was 2033 (range: n  = 106–9000). 8/23 (34.8%) of studies showed evidence of effectiveness, and all studies demonstrating effectiveness consisted of knowledge and attitude outcomes rather than behavioural change. Only 4/23 studies were rated high in quality (two of which showed evidence of effectiveness), whilst the majority of studies were rated medium quality (15/23) and 4/23 rated as low quality. Healthy lifestyles (exercise, nutrition, oral health, health information) Seventeen studies reported interventions addressing healthy lifestyles [ 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 ]. Of these papers, ten used a randomised controlled trial design primarily comparing peer-led vs. teacher-led or ‘lessons as usual’, but two oral health papers also used a dentist-led condition. Seven papers used non-randomised research designs comparing intervention vs. control or a pre-post survey design. The most common focus was nutrition and exercise, but interventions also covered oral health, accessing health information online and interventions taking a more general approach to health improvement. Regarding geographical spread, 5/17 papers reported interventions carried out in the USA, with Australia, China, India and UK represented by two papers per country. Sixteen of the seventeen papers reported peer learner outcomes, and only one reported peer educator outcomes. The mean number of participants per intervention was 1245 (range: n  = 76–4576). 7/17 papers in this health area were shown to be effective, 8/17 were found to be ineffective, and 2/17 showed mixed results. In other words, less than half (41.1%) showed evidence of effectiveness. Of the studies demonstrating effectiveness, the outcomes largely centred around knowledge and attitudes, but one study did demonstrate positive behaviour change [ 62 ]. Over half of the studies (9/17) were rated as high quality, 4/17 were rated medium quality and 4/17 low quality. Of the studies showing evidence for effectiveness, 4/7 (57.1%) were rated as high quality. Alcohol, smoking, substance use Sixteen papers were classified within the category of alcohol, smoking and substance use [ 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 ]. Ten of these papers had a randomised design (including 3 cluster randomised controlled trials) comparing peer-led (intervention) vs. teacher-led (control). Six papers were non-randomised and used either a pre-post survey design or intervention vs. control. The 16 papers varied in quality with six rated ‘high quality’, seven rated ‘medium quality’, and three rated ‘low quality’. Studies took place across more than 10 countries with one study being conducted internationally. The mean number of participants across all studies was 2165 (range: n = 105–10,730). Fifteen papers evaluated the effect of the intervention on peer learner outcomes and only one paper evaluated the effect of the intervention on peer educator outcomes. 8/16 (50%) papers showed evidence of effectiveness. 2/16 (12.5%) papers showed mixed findings and 6/16 (37.5%) showed little to no evidence for effectiveness, including the peer educator outcome paper. Of the eight papers demonstrating evidence for effectiveness, only four (50%) were rated as high quality. Of the studies demonstrating effectiveness, there was a combination of knowledge, attitude and behavioural outcomes, but more evidence for positive changes in knowledge and attitude. Mental health and well-being Six studies assessed mental health and well-being [ 27 , 86 , 87 , 88 , 89 , 90 ]. This category was inclusive of common mental health problems, self-harm and suicide prevention as well as broader topics such as self-esteem and social connectedness. Four of the six studies used non-randomised pre-post survey designs and two studies used randomised design, one of which was a cluster randomised controlled trial. Of the six studies, 5/6 explored peer learner outcomes, 3/6 explored peer educator outcomes, 2 of which explored both peer learner and peer educator outcomes. The average sample size across the seven mental health studies was 1118 (range: n  = 50–4128). Study quality was mixed, with two studies rated as high quality, three medium quality and one low quality. Outcome measures largely consisted of knowledge and attitude questionnaires, help-seeking behaviour and help-seeking confidence as well as condition-specific measures including body satisfaction and self-report of emotional and behavioural difficulties. The majority of mental health studies (5/6) were rated as showing evidence for effectiveness and one study was rated ineffective. Of the studies demonstrating effectiveness, only one reported positive behaviour change (help-seeking behaviours) and this behaviour changed was observed in peer educators as opposed to peer learners [ 86 ]. Disease prevention Four studies assessed outcomes relating to disease prevention [ 91 , 92 , 93 , 94 ] which included hepatitis, tuberculosis, cervical cancer and blood borne diseases. All four studies focused on peer learner outcomes and one study also included peer educator outcomes. Three of the four studies were non-randomised pre-post survey designs and one study was randomised. The average sample size across the four studies was 2116 (range: 1265–2930). Three out of the four studies (75%) showed evidence for effectiveness and one study showed mixed results. No studies were rated as high quality, three were rated medium and one was rated low. Outcomes were largely knowledge or intention based. Studies showing effectiveness mostly related to knowledge, intentions and attitudes and one study did find a positive change in behaviour [ 93 ]. Five included studies assessed asthma interventions [ 95 , 96 , 97 , 98 , 99 ]. 4/5 of these were randomised trials and one study used a non-randomised pre-post survey design. Average sample size across all studies was 427 (range: n  = 203–935). Three studies took place in Australia and two in the US. All papers evaluated the impact of the intervention on peer learner outcomes with none focussing on peer educator outcomes. 4/5 studies showed evidence for effectiveness with only one study showing no evidence for effectiveness. All studies were rated as medium quality. Measures ranged from asthma knowledge, quality of life, school absenteeism, asthma attacks at school and asthma tests. Effectiveness was largely observed for knowledge outcomes, there was less evidence for asthma attacks or symptoms. Two studies conducted in Italy assessed bullying by evaluating the ‘NoTrap!’ anti-bullying intervention [ 100 , 101 ]. The first study rated as high quality, evaluated two independent trials and focussed on peer learner outcomes ( n  = 622; n  = 461). This study found significant reductions in victimization, bullying, cybervictimization and cyberbullying and was rated as high quality. The second study, rated as medium quality, focussed on peer educator outcomes ( n  = 524) and used a non-randomised, pre-post survey design but overall, only showed some evidence of effectiveness amongst males in terms of reduced victimization and increased prosocial behaviour and social support. No evidence was found for effectiveness among females. Peer education interventions to improve student health cover a wide variety of topics and are used globally. This review aimed to summarise the results from peer education health interventions in secondary school students (aged 11–18-years-old), which were universal (rather than targeted interventions of sub-groups of students) and carried out at school. Due to the heterogeneity of findings, range of health areas, types of studies and diversity of outcome measurements used, it was not possible to perform a meta-analysis or formal data synthesis to assess effectiveness. However, some broad conclusions can be made. A number of interventions appear to demonstrate evidence for effectiveness which indicates that peer education interventions can be an important school-based intervention for health improvement. Asthma interventions appeared to be particularly effective. In terms of outcome measures, the strongest evidence was for a positive change in knowledge and attitude measures, but there was less evidence overall for health behaviour outcomes which supports previous findings [ 20 , 22 ]. Although many studies did demonstrate positive results, findings overall were very mixed and several studies were of poor quality. In addition to the shortcomings picked up on by our quality appraisal, many papers lacked methodological detail and clarity regarding the intervention procedure, particularly in regard to how peer educators were selected and trained, which seems to be an important factor in those studies that found positive results and was also emphasised in a previous review [ 10 ]. Further, there were widespread problems of data reporting including noting ‘significant’ results without providing any measure of effect size or between-study variability. Other problems included selective reporting of results, such as selective emphasis on anomalous positive results, or only revealing measures of statistical significance in the case of positive effects. Interestingly, there did not appear to be a relationship between study quality and findings, given that several studies rated as effective were rated both high and low quality with a similar picture for studies showing mixed effectiveness and ineffectiveness. In terms of frequency of health areas covered, our findings are similar to a recent ‘review of reviews’ of peer education for health and wellbeing which found that the majority of reviews focused on sexual health and HIV/AIDS interventions [ 13 ]. This previous review focused on both children and adults, however, in line with our findings, it found mixed effectiveness and considerable diversity in methods, findings and rigour of evaluation. It was particularly noted that details of peer educator training were rarely provided in HIV/AIDS interventions which supports our findings. Notably, however, the quality of studies was actually highest for peer education programs in HIV/AIDS, which differed to our review which found few studies rated as high quality. This discrepancy may be due to the different measures used to assess quality. Like our study, this review concluded that each health area showed some promising results, but also pointed to a need for higher levels of quality and rigour in future evaluations. Despite the rising prevalence in mental health difficulties, there were relatively few studies focused on mental health outcomes, particularly more general preventative approaches to mental health and well-being, with many of the included studies focusing on suicide prevention, self-harm or specific disorders. However, many of mental health studies included in this review showed evidence for effectiveness, suggesting peer education approaches for mental health should be further studied and evaluated. Another key finding of our review is that papers tended to focus more on peer learner outcomes and therefore impacts of peer-led interventions on peer educators themselves appear to be under-explored. This has been reported by previous reviews [ 10 ] and highlights the importance of examining and comparing both peer educators’ and learners’ outcomes within studies. In this context, we found more evidence of peer learners benefitting from the interventions, with 55.2% of studies showing a positive effect, versus only 36.4% for peer educators. This contrasted with a previous review of mental health interventions that concluded peer educators seemed to yield more benefits from participating in the interventions, possibly due to the attention they are given during training and throughout the programmes [ 10 ]. Although common measures existed across studies, including health knowledge, health intentions, and health behaviours, many studies used novel or unvalidated measurements, indicating a need for more standardised health literacy measures and a need for future validation work in this area. This supports two systematic reviews carried out in 2015, firstly a review of health literacy measures which found a lack of comprehensive instruments to measure health literacy and suggested the need for the development of new instruments [ 102 ], and secondly a review of mental health literacy measures which found a number of unvalidated measures and lack of measures that measured all components of mental health literacy concurrently [ 103 ]. Although there are a number of existing reviews summarising the extent to which peer education may improve young peoples health, the literature is still lacking on why peer education is effective within the quantitative literature. It remains unclear which mechanisms involved in peer education lead to its effectiveness (or ineffectiveness). Although many peer education studies are grounded in theory such as Diffusion of Innovation Theory [ 104 ] and Bandura’s Social Cognitive/Social Learning Theory [ 105 , 106 ], the literature is lacking a more nuanced analysis of the mechanisms through which peer education improve young people’s health. This is therefore a key area for future research. A recent review of peer education and peer counselling for health and well-being highlights how peer education interventions are inherently difficult to quality control and evaluate [ 13 ], partly due to what makes peer education attractive; peer education defies the conventions of traditional formal education and allows young people to learn by more unstructured means, in more ‘real world’ ways, benefiting from meaningful examples and conversations with their peers. Although there are an increasing number of well-designed peer education studies [ 13 ], new evaluation methods may be needed given the complexity and multi-component nature of peer-education approaches (i.e., training, more informal teaching approaches and informal diffusion of knowledge). Limitations Despite our review being comprehensive, we acknowledge certain limitations. ‘Peer education’ is a complex and widely contested term and therefore how studies described their approach varied substantially. This may have meant some relevant studies were not picked up from our initial search. A previous review [ 10 ] also noted this potential limitation, with unclear and heterogeneous methods precluding meta-analysis. Therefore, a consensus on how to define ‘peer education’ and using standardised measures to assess effectiveness would facilitate more definitive synthesis of the evidence. Another potential limitation of our approach is that we only searched scientific databases, and therefore could have missed important evidence in the grey literature as we retrieved a relatively small number of initial records ( n  = 2125). Despite this, given the wide variety of study type, age range, health area and country reviewed, this suggests our search strategy was fairly robust, and yielded results that were representative of the breadth in the current literature base. This review focussed on universal peer education interventions delivered within the secondary school setting during school hours. Further research could explore the effectiveness of varying forms of peer education including 1:1 mentoring, more targeted (not universal) interventions, as well as peer education interventions in other settings including youth clubs or community and local organisations. Due to the breadth of this review, we did not conduct a detailed comparison between knowledge, attitude and behavioural outcomes, however the studies demonstrating effectiveness tended to show positive change on knowledge and attitude outcomes, but less evidence was seen for positive behavioural change. This is in line with previous reviews which have suggested that peer education better improves health knowledge but often does not lead to behavioural gains [ 13 , 107 ]. To this vein, it remains unclear the differential impact on behavioural intention and actual performance of behaviour, and therefore we urge future researchers to measure outcomes relating to knowledge and attitude, intentions, and actual behaviour in order to synthesise the evidence in a more standardised way. Although the literature is heterogeneous, there is available data to conduct distinct analysis on different outcome measures (knowledge, attitude and behaviour) to create a more nuanced understanding of each health area. Given the large number of studies and variation in outcome measures (behaviour, knowledge, attitude), this review focussed on findings at first follow-up (usually immediately after intervention) and therefore the effectiveness findings are not likely to represent longer-term effects of peer education interventions, which would require further research. In addition, due to the low number of optimally designed randomised-controlled trials identified, our review could not meaningfully compare results between randomised and non-randomised studies. However, as more high quality trials continue to be published in this growing area of research, a future review could be conducted that looks into the effect of randomisation on young people’s outcomes. Our results also focused on p-values rather than effect sizes due to the large variability in how and what studies measures, future researchers should aim to agree on more standardises ways of measuring outcomes to enable better synthesis. To conclude, school-based peer education interventions occur worldwide and span a number of health areas. A number of interventions appear to demonstrate evidence for effectiveness, suggesting peer education may be a promising strategy for health improvement in schools. However overall evidence for effectiveness and study quality are mixed. Improvement in health-related knowledge was most common with less evidence for positive health behaviour change. In order to synthesise the evidence and make more confident conclusions, it is imperative that more robust, high-quality evaluations of peer-led interventions are conducted and that studies follow reporting guidelines to describe their methods and results in sufficient detail so that meta-analyses can be conducted. In addition, further research is needed to develop understanding of the intervention mechanisms that lead to health improvement in peer education approaches as well as more focussed work on standardising and validating health literacy and behaviour measurement tools. Pre-registration This review was pre-registered on PROSPERO: CRD42021229192. One deviation was made from the original protocol which was the use of a different quality appraisal tool. Initially we had planned to use the Canadian Effective Public Health Project Practice (EPHPP) Quality Assessment Tool for Quantitative Studies and the Critical Appraisals Skills Programme (CASP) checklist for qualitative studies. 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The funding body played no role in the design, analysis, interpretation or writing of the manuscript. Author information Steven Dodd and Emily Widnall are joint first authors. Authors and Affiliations Faculty of Health and Medicine, Lancaster University, Lancaster, UK Steven Dodd & Mark Limmer Population Health Sciences, University of Bristol, Bristol, UK Emily Widnall & Judi Kidger College of Medicine and Health, University of Exeter, Exeter, UK Abigail Emma Russell Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK Esther Louise Curtin Mental Health Foundation, London, UK Ruth Simmonds You can also search for this author in PubMed   Google Scholar Contributions All authors contributed to the design of the systematic review. SD led on designing the search strategy with input from all co-authors. SD carried out the initial searches across four databases. SD and EW led on retrieving papers and screening abstracts and full papers. EW and SD led on data extraction with support from AR. SD and EW drafted the initial manuscript. All co-authors reviewed the manuscript and approved the final version. Corresponding author Correspondence to Emily Widnall . Ethics declarations Ethics approval and consent to participate, consent for publication, competing interests. None to declare. Additional information Publisher’s note. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Supplementary Information Additional file 1., rights and permissions. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. 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BMC Public Health 22 , 2247 (2022). https://doi.org/10.1186/s12889-022-14688-3 Download citation Received : 09 August 2022 Accepted : 21 November 2022 Published : 02 December 2022 DOI : https://doi.org/10.1186/s12889-022-14688-3 Share this article Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative Peer education School-based interventions Systematic review School health Adolescents BMC Public Health ISSN: 1471-2458 General enquiries: [email protected] MEMBER DIRECTORY Member Login Publications Clinician Well-Being Culture of Health and Health Equity Fellowships and Leadership Programs Future of Nursing U.S. Health Policy and System Improvement Healthy Longevity Human Gene Editing U.S. Opioid Epidemic Staff Directory Opportunities Action Collaborative on Decarbonizing the U.S. Health Sector Climate Communities Network Communicating About Climate Change & Health Research and Innovation Culture of Health Fellowships Emerging Leaders in Health & Medicine Culture & Inclusiveness Digital Health Evidence Mobilization Value Incentives & Systems Substance Use & Opioid Crises Reproductive Health, Equity, & Society Credible Sources of Health Information Emerging Science, Technology, & Innovation Pandemic & Seasonal Influenza Vaccine Preparedness and Response Preventing Firearm-Related Injuries and Deaths Vital Directions for Health & Health Care NAM Perspectives All Publications Upcoming Events Past Events MEMBER HOME Health Literacy and Health Education in Schools: Collaboration for Action Introduction This NAM Perspectives paper provides an overview of health education in schools and challenges encountered in enacting evidence-based health education; timely policy-related opportunities for strengthening school health education curricula, including incorporation of essential health literacy concepts and skills; and case studies demonstrating the successful integration of school health education and health literacy in chronic disease management. The authors of this manuscript conclude with a call to action to identify upstream, systems-level changes that will strengthen the integration of both health literacy and school health education to improve the health of future generations. The COVID-19 epidemic [10] dramatically demonstrates the need for children, as well as adults, to develop new and specific health knowledge and behaviors and calls for increased integration of health education with schools and communities. Enhancing the education and health of school-age children is a critical issue for the continued well-being of our nation. The 2004 Institute of Medicine (IOM, now the National Academies of Sciences, Engineering, and Medicine [NASEM]) report, Health Literacy: A Prescription to End Confusion [27] noted the education system as one major pathway for improving health literacy by integrating health knowledge and skills into the existing curricula of kindergarten through 12th-grade classes. The NASEM Roundtable on Health Literacy has held multiple workshops and forums to “inform, inspire, and activate a wide variety of stakeholders to support the development, implementation, and sharing of evidence-based health literacy practices and policies” [37]. This paper strives to present current evidence and examples of how the collaboration between health education and health literacy disciplines can strengthen K–12 education, promote improved health, and foster dialogue among school officials, public health officials, teachers, parents, students, and other stakeholders. This discussion also expands on a previous NAM Perspectives paper, which identified commonalities and differences in the fields of health education, health literacy, and health communication and called for collaboration across the disciplines to “engage learners in both formal and informal health educational settings across the life span” [1]. To improve overall health literacy, i.e., “the capacity of individuals to obtain, process, and understand basic health information and services needed to make appropriate health decisions” [42], it is important to start with youth, when life-long health habits are first being formed. Another recent NAM Perspectives paper proposed the expansion of the definition of health literacy to include broader contextual factors, including issues that impact K–12 health education efforts like state rather than federal control of education priorities and administration, and subsequent state- or local-level laws that impact specific school policies and practices [39]. In addition to addressing individual needs and abilities, socio-ecological factors can impact a student’s health. For example, the Centers for Disease Control and Prevention (CDC) uses a four-level social-ecological model to describe “the complex interplay” of (1) individuals (biological and personal history factors), (2) relationships (close peers, family members), (3) community (settings such as neighborhoods, schools, after-school locations), and (4) societal factors (cultural norms, policies related to health and education, or inequalities between groups in societies) that put one at risk or prevent him/her from experiencing negative health outcomes [11]. Also worth examining are protective factors that help children and adolescents avoid behaviors that place them at risk for adverse health and educational outcomes (e.g., self-efficacy, self-esteem, parental support, adult mentors, and youth programs) [21,59]. Recognizing the influence of this larger social context on learning and health can help catalyze both individual and community-based solutions. For example, students with chronic illnesses such as asthma, which can affect their school attendance, can be educated about the impact of air quality or housing (e.g., mold, mites) in exacerbating their condition. Students in varied locations and at a range of ages continue, often with the guidance of adults, to take health-related social action. Various local, national, and international examples illustrate high schoolers taking social action related to health issues such as tobacco, gun safety, and climate change [18,21,57]. By employing a broad approach to K–12 education (i.e., using combined principles of health education and health literacy), the authors of this manuscript foresee a template for the integration of skills and abilities needed by both school health professionals and children and parents to increase health knowledge for a lifetime of improved health [1,29,31]. The right measurements to evaluate success and areas that need improvement must be clearly identifed because in all matters related to health education and health literacy, it is vital to document the linkages between informed decisions and actions. Often, individuals are presumed to be making informed decisions when actually broader socio-ecological factors are predominant behavioral influences (e.g., an individual who is overweight but has never learned about food labeling and lives in a community where there are no safe places to be physically active). Health Education in Schools Standardized and broadly adopted strategies for how health education is implemented in schools—and by whom and on what schedule—is a continuing challenge. Although the principles of health literacy are inherently important to any instruction in schools and in community settings, the most effective way to incorporate those principles in existing and differing systems becomes a key to successful health education for children and young people. The concept of incorporating health education into the formal education system dates to the Renaissance. However, it did not emerge in the United States until several centuries later [26]. In the early 19th century, Horace Mann advocated for school-based health instruction, while William Alcott also underscored the contributions of health services and the school environment to children’s health and well-being [17]. Public health pioneer Lemuel Shattuck wrote in 1850 that “every child should be taught early in life, that to preserve his own life and his own health and the lives of others, is one of the most important and abiding duties” [43]. During this same time, Harvard University and other higher education institutions with teacher preparation programs began including hygiene (health) education in their curricula. Despite such early historical recognition, in the mid-1960s, the School Health Education Study documented serious disarray in the organization and administration of school health education programs [45]. A renewed call to action, several decades later, introduced the concepts of comprehensive school health programs and school health education [26]. From 1998 through 2014, the CDC and other organizations began using the term “coordinated school health programs” to encompass eight components affecting children’s health in schools, including nutrition, health services, and health instruction. Unfortunately, the term was not broadly embraced by the educational sector, and in 2014, CDC and ASCD (formerly the Association for Supervision and Curriculum Development) unveiled the Whole School, Whole Community, Whole Child (WSCC) framework [36]. This framework has ten components, including health education, which aims to ensure that each student is healthy, safe, engaged, supported, and challenged. Among the foundational tenets of the framework is ensuring that every student enters school healthy and, while there, learns about and practices a healthy lifestyle. At its core, health education is defined as “any combination of planned learning experiences using evidence-based practices and/or sound theories that provide the opportunity to acquire knowledge, attitudes, and skills needed to adopt and maintain healthy behaviors” [3]. Included are a variety of physical, social, emotional, and other components focused on reducing health-risk behaviors and promoting healthy decision making. Health education curricula emphasize a skills-based approach to help students practice and advocate for their health needs, as well as the needs of their families and their communities. These skills help children and adolescents find and evaluate health information needed for making informed health decisions and ultimately provide the foundation of how to advocate for their own well-being throughout their lives. In the last 40 years, many studies have documented the relationship between student health and academic outcomes [29,40,41]. Health-related problems can diminish a student’s motivation and ability to learn [4]. Complications with vision, hearing, asthma, occurrences of teen pregnancy, aggression and violence, lack of physical activity, and low cognitive and emotional ability can reduce academic success [4]. To date, there have been no long-term sequential studies of the impact of K–12 health education curricula on health literacy or health outcomes. However, research shows that students who participate in health education curricula in combination with other interventions as part of the coordinated school health model (i.e., physical activity, improved nutrition, and/or family engagement) have reduced rates of obesity and/ or improved health-promoting behaviors [25,30,34]. In addition, school health education has been shown to prevent tobacco and alcohol use and prevent dating aggression and violence. Teaching social and emotional skills improves the academic behaviors of students, increases motivation to do well in school, enhances performance on achievement tests and grades, and improves high school graduation rates. As with other content areas, it is up to the state and/or local government to determine what should be taught, under the 10th Amendment to the US Constitution [48]. However, both public and private organizations have produced seminal documents to help guide states and local governments in selecting health education curricula. First published in 1995 and updated in 2004, the National Health Education Standards (NHES) framework comprises eight health education foundations for what students in kindergarten through 12th grade should know and be able to do to promote personal, family, and community health (see Table 1 ) [12]. The NHES framework serves as a reference for school administrators, teachers, and others addressing health literacy in developing or selecting curricula, allotting instructional resources, and assessing student achievement and progress. The NHES framework contains written expectations for what students should know and be able to do by grades 2, 5, 8, and 12 to promote personal, family, and community health. The Coordinated Approach to Child Health (CATCH) model, which was first developed in the late 1980s with funds by the National Heart, Lung, and Blood Institute, serves to implement the NHES framework and was the largest school-based health promotion study ever conducted in the United States. CATCH has 25 years of continuous research and development of its programs [24] and aligns with the WSCC framework. Individualized programs like the CATCH model develop programming based on the NHES framework at the local level, so that local control still exists, but the mix and depth of topics can vary based on need and composition of the community. Based on reviews of effective programs and curricula and experts in the field of health education, CDC recommends that today’s state-of-the-art health education curricula emphasize four core elements: “Teaching functional health information (essential knowledge); shaping personal values and beliefs that support healthy behaviors; shaping group norms that value a healthy lifestyle; and developing the essential health skills necessary to adopt, practice, and maintain health enhancing behavior” [13]. In addition to the 15 characteristics presented in Box 1 , the CDC website has more detailed explanations and examples of how the statements could be put into practice in the classroom. For example, a curriculum that “builds personal competence, social competence, and self-efficacy by addressing skills” would be expected to guide students through a series of developmental steps that discuss the importance of the skill, its relevance, and relationship to other learned skills; present steps for developing the skill; model the skill; practice and rehearse the skill using real-life scenarios; and provide feedback and reinforcement. In addition, CDC has developed a Health Education Curriculum Analysis Tool [14] to help schools conduct an analysis of health education curricula based on the NHES framework and the Characteristics of an Effective Health Education Curriculum. Despite CDC’s extensive efforts during the past 40 years to help schools implement effective school health education and other components of the broader school health program, the integration of health education into schools has continued to fall short in most US states and cities. According to the CDC’s 2016 School Health Profiles report, the percentage of schools that required any health education instruction for students in any of grades 6 through 12 declined. For example, 8 in 10 US school districts only required teaching about violence prevention in elementary schools and violence prevention plus tobacco use prevention in middle schools, while instruction in only seven health topics was required in most high schools [6]. Although 8 of every 10 districts required schools to follow either national, state, or district health education standards, just over a third assessed attainment of health standards at the elementary level while only half did so at the middle and high school levels [6]. No Child Left Behind legislation, enacted in 2002, emphasized testing of core subjects, such as reading, science, and math, which resulted in marginalization of other subjects, including health education [22,31]. Academic subjects that are not considered “core” are at risk of being eliminated as public school principals and administrators struggle to meet adequate yearly progress for core subjects, now required to maintain federal funding. In addition to the quality and quantity of health education taught in schools, there are numerous problems related to those considered qualified to provide instruction [5,7]. Many school and university administrators lack an understanding of the distinction between health education and physical education (PE) [9,16,19] and consider PE teachers to be qualified to teach health education. Yet the two disciplines differ regarding national standards, student learning outcomes, instructional content and methods, and student assessment [5]. Kolbe notes that making gains in school health education will require more interdisciplinary collaboration in higher education (e.g., those training the public health workforce, the education workforce, school nurses, pediatricians) [29]. Yet faculty who train various school health professionals usually work within one university college, focus on one school health component, and affiliate with one national professional organization. In addition, Kolbe notes that health education teachers in today’s workforce often lack support and resources for in-service professional development. Promising Opportunities for Strengthening School Health Education Comprehensive health education can increase health literacy, which has been estimated to cost the nation $1.6 to $3.6 trillion dollars annually [54]. The National Action Plan to Improve Health Literacy by the US Department of Health and Human Services (HHS) includes the goal to “Incorporate accurate, standards-based, and developmentally appropriate health and science information and curricula in childcare and education through the university level” [49]. HHS’s Healthy People Framework presents another significant opportunity for tracking health in education as well as health literacy. The Healthy People initiative launched officially in 1979 with the publication of Healthy People: The Surgeon General’s Report on Health Promotion and Disease Prevention [50]. This national effort establishes 10-year goals and objectives to improve the health and well-being of people in the United States. Since its inception, Healthy People has undertaken extensive efforts to collect data, assess progress, and engage multi-stakeholder feedback to set objectives for the next ten years. The Healthy People 2020 objectives were self-described as having input from public health and prevention experts, a wide range of federal, state, and local government officials, a consortium of more than 2,000 organizations, and perhaps most importantly, the public” [51]. In addition to other childhood and adolescent objectives (e.g., nutrition, physical activity, vaccinations), Healthy People 2020 specified social determinants as a major topic for the first time. A leading health indicator for social determinants was “students graduating from high school within 4 years of starting 9th grade (AH-5.1)” [52]. The Secretary’s Advisory Committee report on the Healthy People 2030 objectives includes the goal to “eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being of all” [53]. The national objectives are expected to be released in summer 2020 and will help catalyze “leadership, key constituents, and the public across multiple sectors to take action and design policies that improve the health and well-being of all” [53]. In terms of supports in federal legislation, the Every Student Succeeds Act (ESSA) of 2015 recognized health education as a distinct discipline for the first time and designated it as a “well-rounded” education subject [2,22]. According to Department of Education guidelines, each state must submit a plan that includes four academic indicators that include proficiency in math, English, and English-language proficiency. High schools also must use their graduation rates as their fourth indicator, while elementary and middle schools may use another academic indicator. In addition, states must specify at least one nonacademic indicator to measure school quality or school success, such as health education. Under the law, federal funding also is available for in-service instruction for teachers in well-rounded education subjects such as health education. These two items open additional pathways for both identifying existing or added programs and having the capacity to collect data. While several states have chosen access to physical education, physical fitness, or school climate as their nonacademic indicators of school success, the majority (36 states and the District of Columbia) have elected to use chronic absenteeism [2]. Given the underlying causal connection between student health and chronic absenteeism, absenteeism as an indicator represents a significant opportunity to raise awareness of chronic health conditions or other issues (e.g., student social/emotional concerns around bullying, school safety) that contribute to absenteeism. It also represents a significant opportunity for schools to work with stakeholders to prevent and manage such health conditions through school health education and other WSCC strategies to improve school health. Educators are more likely to support comprehensive health education if they are made aware of its immediate benefits related to student learning (e.g., less disruptive behavior, improved attention) and maintaining safe social and emotional school climates [31]. In an assessment of how states are addressing WSCC, Child Trends reported that health education is either encouraged or required for all grades in all states’ laws, with nutrition (40 states) and personal health (44 states) as the most prominent topics [15]. However, the depth and breadth of such instruction in schools is not known, nor if health education is being taught by qualified teachers. In 25 states, laws address or otherwise incorporate the NHES as part of the state health education curriculum. The authors’ review of state 2017–2018 ESSA plans, analyzed by the organization Cairn, showed nine states that have specifically identified health education as one of its required well-rounded subjects (Florida, Georgia, Indiana, Louisiana, Maine, Maryland, Nevada, North Dakota, and Tennessee) [8]. Cairn recommends that most states include health education and physical education in state accountability systems, school report card indicators, school improvement plans, professional development plans, needs assessment tools, and/or prioritized funding under Title IV, Part A. In 2019, representatives of the National Committee on the Future of School Health Education, sponsored by the Society for Public Health Education (SOPHE) and the American School Health Association (ASHA), published a dozen recommendations for strengthening school health education [5,31,55]. The recommendations addressed issues such as developing and adopting standardized measures of health literacy in children and including them in state accountability systems; changing policies, practices, and systems for quality school health education (e.g., establishing Director of School Health Education positions in all state and territory education agencies tasked with championing health education best practices, and holding schools accountable for improving student health and wellbeing); and strengthening certification, professional preparation, and ongoing professional development in health education for teachers at both the elementary and secondary levels. Recommendations also call for stronger alignment and coordination between the public health and education sectors. The committee is now moving ahead on prioritizing the recommendations and developing action steps to address them. Integrating Youth Health Education and Health Literacy: Success Stories Minnesota statewide model: integrating school health education and health literacy through broad partnership. The Roundtable on Health Literacy held a workshop on health literacy and public health in 2014, with examples of how state health departments are addressing health literacy in their states [28]. One recent example of a strong collaboration between K–12 education and public health agencies is the Statewide Health Improvement Partnership (SHIP) within the Minnesota Department of Health’s Office of Statewide Health Initiative [35]. SHIP was created by a landmark 2008 Minnesota health reform law. The law was intended to improve the health of Minnesotans by reducing the risk factors that lead to chronic disease. The program funds grantees in all of the state’s 87 counties and 10 tribal nations to support the creation of locally driven policies, systems, and environmental changes to increase health equity, improve access to healthy foods, provide opportunities for physical activity, and ensure a tobacco-free environment [35]. Local public health agencies collaborate with partners including schools, childcare settings, workplaces, multiunit housing facilities, and health care centers through SHIP. SHIP models the integration of (1) law, (2) policy, (3) goal-setting, and (4) resource building and forging some 2,000 collaborative partnerships and measuring outcomes. SHIP sets a helpful example for others attempting to create synergies across the intersections of state government, health education, local communities, and private organizations. The principles of health literacy are within these collaborations. Grantees throughout the state have received technical assistance and training to improve school nutrition and physical activity strategies (see Figure 1 ). SHIP grantees and their local school partner sites set goals and adopt best practices for physical education and physical activity inside and outside the classroom. They improve access to healthy food environments through locally sourced produce, lunchrooms with healthier food options, and school-based agriculture. In 2017, SHIP grantees partnered with 995 local schools and accounted for 622 policy, systems, and environmental changes. Minnesota has also undertaken a broad approach to health literacy by educating stakeholders and decision-makers (i.e., administrators, food service and other staff, students, community partners, and parents) about various health-related social and environmental issues to reduce students’ chronic disease risks. SHIP grantees assist in either convening or organizing an established school health/wellness council that is required by USDA for each local education agency participating in the National School Lunch Program and/or School Breakfast Program [46,47]. A local school wellness policy is required to address the problem of childhood obesity by focusing on nutrition and physical activity. SHIP also requires schools to complete an assessment that aligns with the WSCC model and provides annual updates. Once the assessment is completed by a broad representation of stakeholders, SHIP grantees assist schools in prioritizing and working toward annual goals. The goal-setting and assessment and goal-setting cycle is continuous. The Bigger Picture: A Case Study of Community Integration of Health Education and Health Literacy Improving the health literacy of young people not only influences their personal health behaviors but also can influence the health actions of their peers, their families, and their communities. According to the SEARCH for Diabetes in Youth study funded by the CDC and the National Institutes of Health’s National Institute of Diabetes, Digestive, and Kidney Diseases, from 2002 to 2012, the national rate of new diagnosed cases of Type 2 diabetes increased 4.8% [32]. Among youth ages 10-19, the rate of new diagnosed cases of Type 2 diabetes rose most sharply in Native Americans (8.9%) (although not generalizable to all Native American youth because of small sample size), compared to Asian Americans/Pacific Islanders (8.5%), non-Hispanic blacks (6.3%), Hispanics (3.1%), and non-Hispanic whites (0.6%). Since 2011, Dean Schillinger, Professor of Medicine in Residence at the University of California San Francisco and Chief of the Diabetes Prevention and Control Program for the California Department of Public Health, has led a capacity-building effort to address Type 2 diabetes [23,28,44]. This initiative called The Bigger Picture (TBP) has mobilized collaborators to create resources by and for young adults focused on forestalling and, hopefully, reversing the distressing increase in pediatric Type 2 diabetes by exposing the environmental and social conditions that lead to its spread. Type 2 diabetes is increasingly affecting young people of color, and TBP is specifically developed by and directed to them. TBP seeks to increase the number of well-informed young people who can participate in determining their own lifelong health behaviors and influencing those of their friends, families, communities, and their own children. The project aims to create a movement that changes the conversation about diabetes from blame-and-shame to the social drivers of the epidemic [23]. TPB is described by the team that created it as a “counter-marketing campaign using youth-created, spoken-word public services announcements to reframe the epidemic as a socio-environmental phenomenon requiring communal action, civic engagement, and norm change” [44]. The research team provides a description of questionnaire responses to nine of the public service announcements in the context of campaign messages, film genre and accompanying youth value, participant understanding of fi lm’s public health message, and the participant’s expression of the public health message. The investigators also correlate the responses with dimensions of health literacy such as conceptual foundations, functional health literacy, interactive health literacy, critical skills, and civic orientation. One of the campaign partners, Youth Speaks, has created a toolkit to equip and empower students and communities to become change agents in their respective environments, raising their voices and joining the conversation about combating the spread of Type 2 diabetes [56]. In a discussion of qualitative evaluations of TBP and what low-income youth “see,” Schillinger et al. note that “TBP model is unique in how it nurtures and supports the talent, authenticity, and creativity of new health messengers: youth whose lived experience can be expressed in powerful ways” [44]. COVID-19: Health Crisis Affecting Children and their Families and a Need for Health Education and Health Literacy in K-12 In a recent op-ed, Rebecca Winthrop, co-director of the Center for Universal Education and Senior Fellow of Global and Economic Development of the Brookings Institution asked, “COVID-19 is a health crisis. So why is health education missing from school work?” [58] She notes that “helping sustain education amid crises in over 20 countries, I’ve learned that one of the first things you do, after finding creative ways to continue educational activities, is to incorporate life-saving health and safety messages.” Her call is impassioned for age-appropriate, immediately available resources on COVID-19 that can be easily incorporated into distance lesson plans for both children and families. Many organizations, such as Child Trends, are curating collections of such resources. Framing these materials using principles of health literacy and incorporating them into health education messages and resources may be an ideal model for incorporating new pathways for public health K–12 learning. Call to Action for Collaboration Strategic and dedicated efforts are needed to bridge health education and health literacy. These efforts would foster the expertise to provide students with the information needed to access and assess useful health information, and to develop the necessary skills for an emerging understanding of health. Starting with students in school settings, learning to be health literate helps overcome the increased incidence of chronic diseases such as Type 2 diabetes, and imbues a sense of self-efficacy and empowerment through health education. It also sets the course for lifelong habits, skills, and decision making, which can also influence community health. Pursuing institutional changes to reduce disparities and improve the health of future generations will require significant collaboration and quality improvement among leaders within health education and health literacy. Recommendations provided in previous reports such as IOM’s 1997 report, Schools and Health: Our Nation’s Investment [26]; the 2004 IOM report on Health Literacy [27]; and the 2010 National Action Plan to Improve Health Literacy [49] should be revisited. More recently, a November 2019 Health Literacy Roundtable Workshop (1) explored the necessity of developing health literacy skills in youth, (2) examined the research on developmentally appropriate health literacy milestones and transitions and measuring health literacy in youth, (3) described programs and policies that represent best practices for developing health literacy skills in youth, and (4) explored potential collaborations across disciplines for developing health literacy skills in youth [38]. With its resulting report, the information provided in the workshop should provide additional insights into collaborations needed to reduce institutional barriers to youth health literacy and empowerment. At the national level, representatives from public sector health and education levels (e.g., HHS’s Office of Disease Prevention and Health Promotion, CDC, Department of Education) can collaborate with school-based nongovernmental organizations (e.g., SOPHE, ASCD, ASHA, National Association of State Boards of Education, School Superintendents Association, Council of Chief State School Officers, Society of State Leaders of Health and Physical Education) to provide data and lead reform efforts. Leaders of higher education (e.g., Association of American Colleges and Universities, Association of Schools and Programs of Public Health) can join with philanthropies and educational scholars to pursue curricular reforms and needed research to further health education and health literacy as an integral component of higher education. Among the approaches needed are (1) careful incorporation of key principles of leadership within systems; (2) the training and evaluation of professionals; (3) finding and sharing replicable, effective examples of constructive efforts; and (4) including young people in the development of information and materials to ensure their accessibility, appeal, and utility. Uniting the wisdom, passion, commitment, and vision of the leaders in health literacy and health education, we can forge a path to a healthier generation. Join the conversation! Download the graphics below and share them on social media! Allen, M., E. Auld, R. Logan, J. Henry Montes, and S. Rosen. 2017. Improving collaboration among health communication, health education, and health literacy. NAM Perspectives. Discussion Paper, National Academy of Medicine, Washington, DC. https://doi.org/10.31478/201707c Alliance for a Healthier Generation. 2018. Every Student Succeeds Act Frequently Asked Questions. 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Washington, DC. https//doi.org/10.31478/202007b Author Information M. Elaine Auld, MPH, MCHES is Chief Executive Officer, Society for Public Health Education. Marin P. Allen, PhD, is Deputy Associate Director, Office of Communications and Public Liaison and Director of Public Information, Office of the Director, National Institutes of Health (retired). Cicily Hampton, PhD, MPA, is Adjunct Assistant Research Professor, University of North Carolina at Charlotte. J. Henry Montes, MPH, is former Chair, Public Health Education and Promotion Section, American Public Health Association. Cherylee Sherry, MPH, MCHES is Healthy Systems Supervisor, Office of Statewide Health Improvement Initiatives, Minnesota Department of Health. Angela D. Mickalide, PhD, MCHES, is Vice President, Programs and Education, American College of Preventive Medicine. Robert A. Logan, PhD, is Senior Staff, U.S. National Library of Medicine (retired) and Professor emeritus, University of Missouri-Columbia. Wilma Alvarado-Little, MA, MSW, is Associate Commissioner, New York State Department of Health and Director, Office of Minority Health and Health Disparities Prevention. Kim Parson, BA, is Principal, KPCG LLC. Acknowledgments The authors would like to express our gratitude to Melissa French and Alexis Wojtowicz for their support in the development of this paper. Conflict-of-Interest Disclosures Wilma Alvarado-Little has no relevant financial or nonfinancial relationships to disclose. She contributed to this article based on her experience in the field of health literacy and cultural competency and the opinions and conclusions of the article do not represent the official position of the New York State Department of Health. Cherylee Sherry discloses that she works for the Minnesota Department of Health in the Office of Statewide Health Improvement Initiatives which oversees the Statewide Health Improvement Partnership Program funded by the State of Minnesota. Correspondence Questions or comments about this manuscript should be directed to M. Elaine Auld at [email protected]. The views expressed in this paper are those of the authors and not necessarily of the authors’ organizations, the National Academy of Medicine (NAM), or the National Academies of Sciences, Engineering, and Medicine (the National Academies). The paper is intended to help inform and stimulate discussion. It is not a report of the NAM or the National Academies. Copyright by the National Academy of Sciences. All rights reserved. Join Our Community Sign up for nam email updates. Verkhnyaya Salda Overview Map Directions Satellite Photo Map Overview Map Directions Satellite Photo Map Tap on the map to travel Locales in the Area Titanium valley. Nizhnyaya Salda Type: Town with 49,000 residents Description: town in Sverdlovsk Oblast, Russia Categories: administrative territorial entity of Russia , city or town and locality Location: Sverdlovsk Oblast , Urals , Russia , Eastern Europe , Europe View on Open­Street­Map Verkhnyaya Salda Satellite Map Popular Destinations in Sverdlovsk Oblast Curious places to discover. 323 IMAGES Essay on Health Education Health Literacy In Health Education Development of a Health Education Program Essay on Health Education Essay on Health Essay on Health & Hygiene VIDEO Health Education Staff Training and CPD in Schools Ai is bad for schools, essay Welcome Video from Former President Chirag Patel Good Health Essay What does a healthy school look like? COMMENTS Health Literacy and Health Education in Schools: Collaboration for Action This paper strives to present current evidence and examples of how the collaboration between health education and health literacy disciplines can strengthen K-12 education, promote improved health, and foster dialogue among school officials, public health officials, teachers, parents, students, and other stakeholders. Essay on Health Education for Students and Children 500 Words Essay on Health Education. We all know that health education has become very important nowadays. It refers to a career where people are taught about healthcare. Professionals teach people how to maintain and restore their health. In other words, health does not merely refer to physical but also mental, social and sexual health. School as ideal setting to promote health and wellbeing among young In the view of the holistic individual development, the primary commitment of school systems - along with students' academic achievements - should be the improvement of children's physical, mental and social wellbeing. 4 In our vision, school may represent the optimal setting to display educational health-related interventions, 5-8 as educators can have the opportunity to positively ... Public Health and School Health Education: Aligning Forces for Change Leading educators and health professionals have long documented the interdependent relationship between health and education (Basch, 2011; Institute of Medicine, 1997; Kolbe, 2019).School-age children and adolescents experiencing health issues such as stress, physical and emotional abuse, hunger, safety concerns, vision, hearing or dental problems, asthma, or other chronic illnesses have ... Making every school a health-promoting school In the past year, the effect of the COVID-19 pandemic on schools has reinforced the profound links between children's health, wellbeing, and learning. In addition to deleterious effects on student engagement, learning outcomes, and educational transitions, there is growing evidence of the impact of school closures on children's and adolescents' emotional distress and mental health.1 There are ... PDF Healthier Students Are Better Learners focus of this essay is the infl uence of selected health factors on educational outcomes. The Role of Schools It is neither reasonable nor realistic to expect that, on their own, schools can close the gaps in education or eliminate health disparities among the nation's youth. Schools should not be solely responsible for PDF Comprehensive Health Education in Schools National Health Education standards provide a framework for schools to use to facilitate the mastery of knowledge and skills regarding health topics and promote healthy behaviors and outcomes for school-age youth (CDC, 2018). The Global School-Based Student Health Survey indicates priorities for health education as follows: Critical perspectives on health and wellbeing education in schools Critical health and well-being education in schools has emerged as a result of the "critical turn" which called into question the politics of health education via a focus on power relations and their effects (Gottesman, 2016). In seeking out papers that explicitly embrace a critical approach we intend to showcase how scholars engage with ... PDF Mental health promotion in schools: A comprehensive theoretical ... Although the concept of school mental health dates back to the early 1900s, as reflected in the publication of the first recorded scientific paper on the topic, entitled "Mental Health of School Children" (Anonymous, 1906), efforts to define mental health in schools continue to be hampered by a lack of precise terminology and Health Education and Health Promotion: Key Concepts and Exemplary One problem with school health education is that in many countries school staff may become overwhelmed by the supply of a great variety of school health education programs and time constraints. Low program fidelity has been found to be a serious problem (Dusenbury et al., 2003). Integrative programs addressing multiple risk behaviors may have ... UNESCO and WHO urge countries to make every school a health-promoting UNESCO and the World Health Organization today launched the Global Standards for Health-promoting Schools, a resource package for schools to improve the health and well-being of 1.9 billion school-aged children and adolescents. The closure of many schools around the world during the COVID-19 pandemic has caused severe disruptions to education. An estimated 365 million primary school students ... The Importance of Mental Health Awareness in Schools The Importance of Mental Health Awareness in Schools. by Nancy Barile, Award-Winning Teacher, M.A.Ed. Mental health awareness is an important issue for all educators, who are often the first line of defense for their students. Education professionals have recognized the impact that a student's mental health has on learning and achievement, and ... Teaching Health Education in School Teaching Health Education in School. Many parents are keenly interested in the basic academic education of their youngsters—reading, writing, and arithmetic—but are not nearly as conscientious in finding out about the other learning that goes on in the classroom. A comprehensive health education pro­gram is an important part of the ... PDF Health Literacy and Health Education in Schools Table 1 | National Health Education Standards. Standard 1. Students will comprehend concepts related to health promotion and disease prevention to enhance health. Standard 2. Students will analyze the infl uence of family, peers, culture, media, technology, and other factors on health behaviors. Standard 3. Back-to-School Health Education The National Health Education Standards 3rd Edition is an initiative of the National Consensus for School Health Education (NCSHE). The eight standards and performance expectations reflect, update, and refine previous versions of the standards and performance indicators for health education. PDF Policy Brief Advocating for Health Education in Schools Policy Brief Advocating for Health Education in Schools This policy brief examines the Every Student Succeeds Act of 2015 (ESSA), the nation's primary federal K-12 education statute, and explores avenues to advocate for health education curricula in the U.S. school systems. Included is a brief description of each School-based peer education interventions to improve health: a global Peer education, whereby peers ('peer educators') teach their other peers ('peer learners') about aspects of health is an approach growing in popularity across school contexts, possibly due to adolescents preferring to seek help for health-related concerns from their peers rather than adults or professionals. Peer education interventions cover a wide range of health areas but their ... A critical consideration of 'mental health and wellbeing' in education Although the specific focus in this paper is on ideas and practices in England (e.g. Department for Education, 2019; Department of Health and Department for Education, 2017), the conclusions have wider international significance as schools internationally are called upon to meet the mental health needs of children and young people (WHO, 2017). PDF Increasing and Improving Physical Education and Physical Activity in Increasing and Improving Physical Education and Physical Activity in Schools: Benefits for Children's Health and Educational Outcomes . Position. Physical educ ation in the nation's schools is an important part of a student's comprehensive, well-rounded education program and a means of positively affecting life-long health and well-being. 2024 "MindSpeak" Essay Competition Open to All NJ Middle ... Shiv's Third Eye, a non-profit organization in New Jersey, is calling all young creative minds and compassionate hearts from across the state to participate in the 2024 "MindSpeak" Youth Mental Health Literacy and Health Education in Schools: Collaboration for Introduction. This NAM Perspectives paper provides an overview of health education in schools and challenges encountered in enacting evidence-based health education; timely policy-related opportunities for strengthening school health education curricula, including incorporation of essential health literacy concepts and skills; and case studies demonstrating the successful integration of school ... Verkhnyaya Salda Map Verkhnyaya Salda is a town in Sverdlovsk Oblast, Russia, located on the Salda River, 195 kilometers north of Yekaterinburg. Population: 46,221 ; 51,195 ; 55,246 . Photo: Ludvig14, CC BY-SA 4.0. Photo: Ludvig14, CC BY-SA 4.0. Ukraine is facing shortages in its brave fight to survive. Novouralsk Novouralsk (Russian: Новоура́льск, lit. new town in the Urals) is a closed town in Sverdlovsk Oblast, Russia, located on the eastern side of the Ural Mountains, about 70 kilometers (43 mi) north of Yekaterinburg, the administrative center of the oblast. Population: 78,479 (2021 Census)[8] 85,522 (2010 Census); [2] 95,414 (2002 Census). Verkhnyaya Pyshma Within the framework of the administrative divisions, it is, together with the town of Sredneuralsk and twenty-seven rural localities, incorporated as the Town of Verkhnyaya Pyshma [1] —an administrative unit with the status equal to that of the districts. [9] As a municipal division, Verkhnyaya Pyshma and twenty-four rural localities are incorporated as Verkhnyaya Pyshma Urban Okrug. [4] Flag of Svobodny, Sverdlovsk Oblast, Russia (2003) : r/vexillology 93 votes, 10 comments. 655K subscribers in the vexillology community. 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