Fresh thinking

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.