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Can schools be convinced to make a priority of promoting children’s health? Kendra Inman reports.

For some children breakfast is a bag of crisps munched on the way to school and lunch is a bag of crisps followed by a fizzy drink. Professionals know unhealthy eating habits are harmful and in the long term downright dangerous. But in the midst of a childhood obesity epidemic can schools be recruited to help children and young people to adopt a healthier lifestyle?

The government believes education and health staff can make a difference through the National Healthy School Standard (NHSS), a drive to improve the health and well-being of all members of the school community. While nutrition is one aspect of the programme, the NHSS is in the words of one report, "about more than chips and skipping".

Funded by the Department of Health and Department for Education and Skills, and delivered by the Health Development Agency, the initiative was launched in 1999 to promote healthy environments that encouraged pupils to learn.

Once health in schools meant no more than the nit nurse, and was strictly a matter for the NHS. In these days of multi-agency working, education and health professionals have joined forces to deliver the healthy schools agenda. Each area has a healthy schools programme, accredited by the HDA and run by the primary care trust and local education authority.

The NHSS also dovetails with the government’s social exclusion agenda and, in a bid to reduce health inequalities, new targets were set in December last year. By 2006 all schools in England with a fifth or more pupils eligible for free schools meals are expected to reach NHSS level 3 status.

In practice this means about 7,000 schools will need to show an understanding of local health issues - such as poor dental health or high rates of teen pregnancy. In addition they will need to provide an environment that promotes social inclusion, reduces health inequalities, as well as agree targets, show how the work is contributing to the school’s development and how they are measuring its impact.

This should mean more schools take their own responsibilities to protect children’s health seriously. For example, despite evidence that dehydration damages children’s ability to learn as well as putting them at risk of long-term health problems such as kidney infections and continence problems, many schools provide no access to drinking water.

Another issue is shade in the playground. While the Department of Health is busy warning parents to keep their children out of the midday sun, many schools still expose children to full sun for large parts of the school day.

Schools serving the most deprived communities have been targeted because mounting evidence shows the NHSS has had a bigger impact in schools serving areas of socio-economic disadvantage. Teachers in participating schools have reported an improvement in pupil behaviour and government inspectors’ reports have noted a link between schools adopting the standard and a rise in standards of work in the classroom.

The government’s enthusiasm for target-setting in education has been widely criticised. So is the NHSS seen as yet another stick to beat schools with? No, says Gill Morris, Camden LEA’s advisory teacher for personal, health and social education (PHSE). The programme is flexible, and designed to address local priorities, she says.

"The school decides what it wants to prioritise and together we identify how we can help." Sometimes this means bringing in outside expertise. "For example if a school needs to know how to improve the playground we can put them in touch with an environmental network," says Morris. Schools are expected to take a "whole school approach" which means what is taught in the classroom should be reflected in how the school is run. Goals can include everything from access to drinking water during the day to an effective anti-bullying strategy.

After the initial flurry of activity that takes place when schools sign up to the scheme, local programmes are given the job of keeping them on board. Morris says the team must encourage schools to keep health on their agendas.

So far the programme has 84 of Camden and Islington’s 123 schools signed up. These schools are auditing their health work and producing detailed plans year upon year giving health a high priority. They hope to get all their schools to this standard by 2006 as per government targets. But for those schools who can’t commit to the same extent the programme runs projects that tackle one aspect of health such as last year’s focus on introducing fruit tuck shops.

The local teams can be led by health or education staff - Camden and Islington’s team includes a public health professional. In some areas school nurses take the lead role. Programmes also draw on the expertise of organisations specialising in sex or drugs education.

Research by health think-tank the King’s Fund, published in May 2002, showed young people share adults’ concerns about health at school. When pupils in 650 London secondary schools were asked what health priorities should be, three issues emerged as major concerns: quality, price and appropriateness of school food, opportunities for enjoyable exercise and the problem of bullying. The report, Health in Schools, called for stress, including bullying, to be recognised as taking its toll on the mental health and well-being of some pupils.

Persuading schools to embrace the NHSS while they are so focused on exam and inspection results is one of the challenges faced by the local programmes. The fact that the targets are not statutory has not been a problem so far, says Marilyn Toft, co-ordinator of the National Healthy Schools Standard, at the Health Development Agency. Although membership of a healthy schools programme is not required by Ofsted, a recent trawl of inspection reports revealed health was mentioned more than a thousand times. All encouraging signs that educationalists are taking healthy schools seriously, according to Toft.

Joe Harvey, director of the Health Education Trust is less convinced. While the healthy schools standard is led by the DoH, "the schools don’t need to take it seriously. They can take it or leave it," says Harvey.

Toft agrees that the relationship between health and education professionals needs strengthening. But she points out that the initiative is breaking new ground and that serious progress has been made.

The NHSS is based around themes that include PHSE, citizenship, drug education, emotional health and well-being, healthy eating, physical activity, safety, sex and relationship education. Guidance produced by the HDA says the themes can be prioritised according to local needs such as a reduction in smoking rates among girls aged 11-16 or improving the management of asthma in the school.

As well as targeting the most deprived school populations, NHSS local programmes are expected to continue to support all the schools in their area. In Camden and Islington, schools involved for more than two years are asked to re-audit and look at the progress they have made on each of the 10 healthy school topic areas.

Being a healthy school will be a continuous process. Once targets are met, new ones will be set. Says Gill Morris, "health is and should be always on the agenda".

- For further information see www.wiredforhealth.gov.uk and www.ci-healthyschools.net.