501005

2013
PED35210.1177/1757975913501005CommentaryI. Young et al.

Commentary

Health-promoting schools: working in partnership to

address global needs, a collaboration leading to the production
of practical tools for practitioners
Ian Young1, Lawrence St. Leger2 and Claire Blanchard3

Abstract: Modern schools do their best to motivate young people to live fulfilling, healthy and
productive lives and the United Nations has put school education at the heart of the Millennium
Development Goals. The context of education in schools is changing, but there is evidence from across
the world that school health promotion can make a difference to health and education outcomes. The
International Union for Health Promotion and Education (IUHPE) has recognized this potential in
schools and, for the last five years in its work globally, has been actively engaged in strengthening
efforts through successful partnerships. This commentary explores aspects of global partnerships in
school health and the progress of the IUHPEs leadership and partnership work in school health
promotion. It also provides some reflections on what has been achieved to date and what might lie
ahead in school health promotion globally. (Global Health Promotion, 2013; 20 Supp. 4: 122127).

Keywords: health-promoting schools, global school health, partnerships

Introduction ridiculed by many. How much has changed since

This commentary explores global partnerships in
school health and the progress of the International
Union for Health Promotion and Educations
(IUHPE) leadership and partnership work in school
health promotion. It also provides some reflections
on what has been achieved to date and what might
lie ahead in school health promotion globally.
Progress in global school health
partnerships
We cannot predict the future. When two of the
authors of this paper started working in health
education in the early 1980s the term health
promotion had not been reborn in its modern form,
Western countries thought complacently that they
were close to conquering infectious diseases, and the
idea that in a generation as many people would be
overfed rather than malnourished would have been
then. In addition, the urbanization of the planet and
the world of instant electronic communication
inhabited by most young people have radically
changed the social settings in which modern schools
do their best to motivate young people to live
fulfilling, healthy and productive lives.
Partnerships for broad dissemination
efforts evidence of school health
promotion effectiveness
However, we do not need a crystal ball to predict
that school health promotion can make a difference
globally to health and education outcomes. In fact,
evidence is available and being actively disseminated
by the IUHPE, the Centers for Disease Control and
Prevention (CDC) and other school health partners
globally.i IUHPE has fully recognized the potential
of schools, and for the last five years in its work

1. School Health Consultant, International Union for Health Promotion and Education, St Denis, France.
2. Deakin University, Melbourne, Australia.
3. International Union for Health Promotion and Education, St Denis, France.

Correspondence to: Ian Young, School Health Consultant, International Union for Health Promotion and Education, 42
boulevard de la Libration, 93203 St Denis cedex, France. Email: imyoung@blueyonder.co.uk

Global Health Promotion 1757-9759; Vol 20 Supp. 4: 122127; 501005 Copyright The Author(s) 2013, Reprints and permissions:
http://www.sagepub.co.uk/journalsPermissions.navDOI: 10.1177/1757975913501005http://ghp.sagepub.com
 I. Young et al.
globally it has had a successful partnership
agreement with the CDC in Atlanta, USA.
Objectives of the IUHPE / CDC
collaboration
The long-term objectives of the collaboration
with CDC have been:
to build the capacity of both the health and
education sectors to undertake initiatives in
school health promotion that are based on
evidence of effectiveness and which enhance the
fundamental role of school education;
to develop and disseminate resources/strategies
in three areas:
Advocacy, using evidence of outcomes;
Guidelines for Promoting Health in Schools,
setting out the principles of health promotion
in schools and supporting school health
planning and implementation; and
Implementation and sustainability.
to initiate and lead debates, presentations,
consultations and discussions on school
health to complement and add value to the
work at IUHPE global, regional and other
sponsored conferences and meetings, and
through the International School Health
Network (ISHN);
to build the capacity of government ministers of
health and education to form effective
partnerships to increase the number/proportion
of health-promoting schools;
to collaborate with other organizations, such as
WHO, UNICEF, other non-governmental
organizations (NGOs) and research institutes; to
identify the gaps and/or overlap in research and
evaluation in school health promotion; and to
develop a plan to address those issues.
Collaboration outcomes: key global
resources and tools to inform adapted
and tailored practice around the world
with a specific focus on low- and middle-
income countries
The first three resources produced from this
work are now well known globally, with translations
123
aiding dissemination and practical use. These
resources are:
the special edition of Promotion & Education
(now Global Health Promotion) on Global
School Health Promotion (1);
the Guidelines for Promoting Health in Schools
(2); and
the Advocacy tool Promoting Health in
Schools: from evidence to action (3).
Broad accessibility and dissemination of
resources
Dissemination efforts
In the course of the five-year agreement, wide
dissemination of these resources and key concepts
and principles of whole-of-school approaches was
achieved through:
translation into many languages (Arabic, Chinese
(traditional Chinese and simplified Chinese),
English, French, Italian, Japanese, Portuguese,
Russian and Spanish) to ensure broad accessibility
and culturally sensitive language versions and
availability on various electronic resources
including the IUHPE website;
referencing of documents in publications (46)
and other international project effortsii and
cross-referencing of the content of each of the
products to promote each other and encourage a
systematic approach to school health promotion
globally;
broad dissemination to key stakeholders
(Education Development Center, Inc.; Education
International; Save the Children; Child to Child
Trust, Partnership for Child Development;
Salaam Bombay Foundation; Health Related
Information Dissemination Amongst Youth
Student Health Action Network (HRIDAY
SHAN); Thai Health Promotion Foundation;
amongst others);
via the IUHPE network, CDC key contacts and
other various partners and networks in the
Western Pacific, Asia, Africa, Europe, Latin
America, North America and the Eastern
Mediterranean region (7);
numerous international workshops held under
the auspices of IUHPE in various regions of the
IUHPE Global Health Promotion Vol. 20, Supp. 4 2013
124
world: New Zealand 2008, Singapore 2008,
Tampa, USA, 2008, Torino, Italy 2008, Banff,
Canada, 2009, Perth, Australia, 2009, Vilnius,
Lithuania, 2009, Hong Kong 2009; Geneva
2011, Quebec 2011 and Taiwan, 2012.
Some examples of how the IUHPE / CDC
collaboration efforts informed practice
globally over the years
The efforts conducted under the IUHPE / CDC
collaboration with the former Division of Adolescent
and School Health (DASH) have enabled the
dissemination of key whole-of-school concepts
globally and informed policy and practice in various
countries with key resulting resources:
informing programme and policy development as
well as resource allocation in local regions and in
local government areas in a number of countries
in Asia, the Western Pacific and Africa (e.g.
informing the drafting of several programmatic
and strategic documents in Benin both at the
Ministry of Health and at the WHO Benin office);
informing advocacy and dialogue with ministries
and policy and decision makers in Quebec;
being used in training through courses,
workshops and seminars for teachers, health
promoters, school principals, school nurses and
public health specialists. In addition, being used
in undergraduate and post-graduate education
of teachers in school health in universities. This
has been reported in diverse countries of the
Asian, Western Pacific, European and Latin
American regions namely in Hong Kong,
Taiwan, France, Argentina, Uruguay, Chile,
Brazil, Colombia and Peru;
being used as the basis to inform key technical
efforts. The documents were influential in a
report produced for WHO Eastern Medite-
rranean Region of WHO (EMRO) a contextual
paper associated with the production of a
practical assessment tool for WHO member
states in the region. Technical groups
collaborating with the Pan American Health
Organization in developing guidelines and tools
for advancing the health-promoting schools
initiative in the Americas have also used these
documents as a main reference for their work.
IUHPE Global Health Promotion Vol. 20, Supp. 4 2013
Commentary
Though there was no reported experience of use
by Canadian first nations, Inuit communities operate
educational systems outside of the 10 big provincial
jurisdictions. As part of these separate efforts, they
are developing culturally appropriate curricula and
pedagogy that is reflective of Inuit cultural values
a very comprehensive and holistic approach to well-
being, and this fully supports the essential element
for health-promoting schools as outlined in the
IUHPE documents.
New resources
Two additional resources from this partnership
between IUHPE and CDC have just been finalized
(8,9). These are widely accessible, and it is expected
that these will continue to contribute to strengthening
efforts initiated under the partnership.
Facilitating Dialogue between the Health and
Education Sectors to Advance School Health
Promotion and Education
A first document on Facilitating Dialogue between
the Health and Education Sectors to Advance School
Health Promotion and Education (8) aims to facilitate
better dialogue between the health and education
sectors. It has become evident that sustaining health-
promoting schools at national level requires a
continuous active commitment and demonstrable
support by governments, with two or more ministries/
sectors working in partnership. Our experience
suggests that a lack of understanding between health,
education and other relevant ministries is often a
block to progress in many countries. With this goal in
mind, this briefing document supports the advocacy
and policy development work of health-promoting
school co-ordinators working at national and/or
regional/state level.
It explores issues such as: perceptions and
concepts of health education and health promotion,
sector priorities, language, leadership, budgetary
control and managing change, amongst others. It
offers practical advice based on examples of
successful practice. Aspects of the proposed
document were explored with participants in a
workshop during the international event on Health-
Promoting Schools in Montreal, Canada in
November 2011. Participants at that workshop
 I. Young et al.
provided specific advice and examples to strengthen
the main thrust of the work.
Monitoring and Assessing Progress in Health-
Promoting Schools: Issues for Policy Makers
to Consider
A second document for the dedicated IUHPE
webpages on Monitoring and Assessing Progress in
Health-Promoting Schools: Issues for Policy Makers
to Consider (9) explores the different types of tools
that are available at present for monitoring and
assessing progress in health-promoting schools and
offers a brief review of the practical issues that
practitioners have had to overcome in developing
such tools. It is designed to assist countries in an
early stage of monitoring progress towards health-
promoting schools.
It describes the barriers to the effective
implementation of inter-sectoral partnerships in
countries of the world, with government health
ministries and education ministries often expressing
a desire to co-operate but in effect often working
separately with different priorities and goals. Some
of the issues explored are:
different perceptions and concepts of health
education and health promotion in the health
and education sectors;
different sector priorities;
misunderstandings due to different use of
technical language;
professional career issues career advancement
and promotion may be more linked to evidence
of leadership than managing a partnership with
other sectors; and
budgetary control there may be tensions
between those who are in a position to be the
best networkers and those who control the
budget.
Based on examples of success, suggestions are
made for overcoming these barriers, and how genuine
partnership can work leading to more effective
management of health promotion in schools,
including effective monitoring and assessment of
progress (9).
The document highlights several initiatives at the
international level such as The Rapid Assessment
and Action Planning Process (RAAPP) (10), which is
125
a country-driven and evidence-based method which
enables ministries of education and health to assess
and improve their capacity to promote health
through schools. Given the link between health and
education, RAAPP is based on two concepts: Health-
Promoting Schools (HPS) and Focusing Resources
on Effective School Health (FRESH).
In addition the document makes reference to The
Egmond tool (11), and this is provided in an
appendix. It was developed from experience of the
successes and challenges of 20 years of development
work in Europe, including more than 10 years in
The European Network of Health-Promoting
Schools. It can be used flexibly in one-to-one
interviews with key stakeholders as well as providing
an agenda to structure group discussions.
The document concludes that the tools most
likely to be successful and sustainable are ones that
have considered ownership and cultural issues and
therefore involved practitioners in their development
(12).
The new IUHPE document (9) points out that in
the early years of health promotion in schools it was
mainly the health sector which took the initiative (1).
It is now better understood that there is a need to be
sensitive to the education systems ways of working
and methods of assessment. The consequence of this
is a requirement for genuine partnership-working
between the education and health sectors.
School Health and the Millennium
Development Goals progress and
challenges
The United Nations has put school education at
the heart of its Millennium Development Goals
(MDG) (13). The second MDG goal relates to
achieving universal primary education. The third
MDG goal relates to promoting gender equality and
empowering women, and one of the ways of
achieving this is to ensure that girls get the same
educational opportunities as boys.
Considerable improvement in enrolment in
primary education has occurred, reaching 89 per
cent in the developing world in 2008, and increasing
by 18 percentage points in sub-Saharan Africa
between 1999 and 2008. However, despite the
second target being relatively modest, as it only
applies to a basic education, it is not being met. The
progress is insufficient to ensure that, by 2015, all
IUHPE Global Health Promotion Vol. 20, Supp. 4 2013
126
660 million young people who should be receiving
an education will complete a full course of primary
schooling.
In global terms, approximately 69 million school-
age children were not going to school in 2008, a
significant improvement from 106 million children
in 1999. Almost three-quarters of children out of
school are in sub-Saharan Africa (31 million) or
Southern Asia (18 million). Drop-out rates in sub-
Saharan Africa remain high. Achieving universal
primary education requires more than full enrolment.
It also means ensuring that children continue to
attend classes. Only 87 out of 100 children in the
developing regions complete primary education.
This issue casts a shadow over all our work in
school health promotion if we have reducing
inequalities as a major priority. Health-promoting
schools require children to attend as a prerequisite
for success. It is both a political and economic issue,
and all international agencies and governments need
to keep up the pressure to ensure the gains that have
been achieved are sustained and that all school-age
children receive a basic education wherever they are
born. This will require a large investment in
infrastructure and in the training of teachers.
Conclusions
We have the evidence lets use it and
continue efforts
For the great majority of children who do attend
school we have enough evidence, skills and
experience to determine what needs to be done in
the context of health-promoting schools. We now
understand the nature of the prerequisites for
effective partnerships between the health and
education sectors. In fact, experiences of specific
countries and international programmes are
demonstrating that it is achievable if there is a
political will to support a partnership approach. We
have to continue to translate this understanding
into policies and political action.
Partnerships founded on beneficial
relationships an essential ingredient to
successful international efforts
There is now a high level of international
co-operation in the sharing of these ideas, challenges
IUHPE Global Health Promotion Vol. 20, Supp. 4 2013
Commentary
and evidence relating to school health promotion. In
addition to the networks that exist on all continents,
there is the unifying work of IUHPE and other
agencies. A special mention should be given to the
work of the ISHN, set up by Douglas McCall in
Canada. This global network has recently been
involved in a significant series of webinars sharing
both evidence and experience in regard to
implementation, capacity and sustainability issues
in school health. These have covered topics such as
capacity and capacity-building, systems thinking,
inter-agency policies, collaboration and leadership
and evidence-based practices in complex systems. In
addition, the work of Carmen Aldinger and
colleagues at the Educational Development Center
in Boston, USA, resulted in the production of Case
Studies in Global School Health Promotion: From
Research to Practice. This publication provides
evidence and inspiration of what has been achieved
globally and gives pointers for future development
needs and practice (14).
In India, the country with the worlds biggest
population of school-age children, colleagues such
as Padmina Somani at The Salaam Bombay
Foundation work tirelessly towards empowering
children to live their life free from the threat of
tobacco and to become confident, healthy adults.
In the important area of teacher training, there is
an on-going collaborative international study
looking at teacher education and health education,
led by Didier Jourdan, Professor at Blaise Pascal
University in France, with Patricia McNamara of
the University of Limerick in Ireland.
These are some of the many partners that have
enabled and facilitated IUHPE and CDC efforts
over recent years. It will be important for all partners
to encourage the rapid uptake and use of all the
documents produced by the partnership agreement
with CDC, to ensure that developments in countries
new to this work are based on sound evidence and
the broad principles outlined in the published
documents resulting from the collaboration.
IUHPEs continuing commitment
IUHPE remains committed to facilitating dialogue
between the health and education sectors in relation
to school health promotion. In addition, it will
continue to nurture partnerships with other relevant
players in school health promotion such as WHO,
 I. Young et al.
continental HPS networks, ISHN, Education
International, the CDC, and the Education
Development Center.
The setting of schools has attracted great interest at
the last three IUHPE global conferences. It is vital that
we continue to build on this work at the 2013 event
in Thailand to ensure that the progress to date is
sustained. There are at least 660 million school-aged
young people who can benefit from this vital work.
Funding
Some of the efforts described in this commentary were
supported by the International Union for Health Promotion
and Education (IUHPE) and the US Centers for Disease
Control and Prevention (CDC) and received financial
support from the United States Centers for Disease Control
and Prevention (CDC), an Agency of the Department of
Health and Human Services, under Cooperative Agreement
Number CDC RFA DP07-708 on Building Capacity of
Developing Countries to Prevent non-Communicable
Diseases. The content of this commentary is solely the
responsibility of the authors and does not necessarily
represent the official views of CDC.
Notes
i. Education Development Center, Inc.; Salaam Bombay
Foundation; Health Related Information Dissemination
Amongst Youth Student Health Action Network
(HRIDAY SHAN); International School Health
Network (ISHN); National Institute of Health
Education and Prevention (INPES Institut National
de prevention et education pour la sant); Network of
Teacher Training Universities (Rseau des Instituts
Universitaires de Formation des Maitres RIUFM);
National Public Health Institute of Quebec / Institut
National de Sante Publique du Qubec (INSPQ);
Schools for Health in Europe; amongst others.
ii. Both documents were cited in the introduction to a
rapid review of health promotion action for school
health in low- and middle-income countries, as part
of a Mainstreaming Health Promotion project led by
the World Health Organization.
References
1. Young I. Health promotion in schools a historical
perspective. Promot Educ. 2005; 12(3,4): 112117.
2. St Leger L, Young I. Guidelines for Promoting Health
in Schools. Saint Denis, France: IUHPE; 2008.
127
3. St Leger L, Young I, Blanchard C. Health Promotion in
Schools: From Evidence to Action. Saint Denis, France:
IUHPE; 2010.
4. Global Advocacy for Physical Activity. NCD
Prevention: Investments that Work for Physical
Activity. GAPA; 2011.
5. Promoting health in schools from evidence to action -
International Union for Health Promotion and Education
(IUHPE) a cura di: Lawrence St Leger, Ian Young, Claire
Blanchard, Martha Perry. Educazione Sanitaria e
Promozione della Salute. 2010; 33(2): 206219.
6. St Leger L, Young I. Creating the document Promoting
health in schools: from evidence to action. Glob
Health Promot. 2009; 16(4): 6971.
7. Using the Achieving Health Promoting Schools:
Guidelines for Promoting Health in Schools and
Promoting Health in Schools: from Evidence to
Action. -Some examples of how the IUHPE / CDC
collaboration efforts informed practice globally over
the years (2012 working document). Available from:
http://www.iuhpe.org/uploaded/Activities/Scientific_
Affairs/CDC/School%20Health/
IUHPECDCCollaborationEfforts_ExamplesofInform
edPracticeGlobally%20over%20the%20years.pdf on
(accessed January 3, 2013).
8. St Leger L, Young I, Blanchard C. Facilitating Dialogue
between the Health and Education Sectors to Advance
School Health Promotion and Education. Saint Denis,
France: IUHPE; 2012. Available from: http://www.
iuhpe.org/index.html?page=516&lang=en on
(accessed January 7, 2013).
9. Young I, St Leger L, Blanchard C. Monitoring and
Assessing Progress in Health Promoting Schools:
Issues for Policy Makers to Consider. Saint Denis,
France: IUHPE; 2012. Available from: http://www.
iuhpe.org/index.html?page=516&lang=en on
(accessed January 7, 2013).
10. The RAAPP tool is available at http://www.who.int/
school_youth_health/assessment/raapp/en/index.
html.
11. Young I (Ed). The Egmond Agenda in a Report of a
European Conference on linking education with the
promotion of health in schools 6973. Woerden, The
Netherlands: NIGZ; 2012.
12. Barnekow V, Buijs G, Clift S, Jensen BB, Paulus P,
Rivett D, et al. Health Promoting Schools: a resource
for developing indicators. Copenhagen, Denmark:
IPC, WHO Regional Office for Europe; 2006.
13. United Nations Millennium Development Goals.
Available from: http://www.un.org/millenniumgoals
14. Vince Whitman C, Aldinger C (Eds). Case Studies in
Global School Health Promotion: From Research to
Practice. New York, USA: Springer Science and
Business Media; 2009.
IUHPE Global Health Promotion Vol. 20, Supp. 4 2013