Schools for All: A Synthesis Statement on the Social Role of the School in Human Development

A Summary of Several Approaches to School-based and School-linked Promotion

Prepared for the International School Health Network
www.internationalschoolhealth.org

This summary is based on the accumulation of research evidence and experience about
school programs that promote health, social development and learning. This overview and
ten key points about school-based and school-linked programs are an attempt to collate
and synthesize the wisdom from education, health and development sectors on several
different continents and countries. In this statement, we are not attempting to present yet
another model or paradigm, nor are we attempting to collapse the extensive knowledge
about different approaches and strategies to child development into one simplistic
checklist. Instead, we present this summary to show the similarities among the different
approaches so that we can learn from all of them. Further, we encourage advocates,
practitioners, officials and researchers to develop models and applications to their own
circumstances that address the issues most relevant to their schools and their children. If
you would like to discuss the ideas presented herein further, please join us and many
other organizations in the shared workspace and wiki-based web site that hosts World
Encyclopedia on School Health, Safety, Equity, Social and Sustainable Development. In
that ongoing knowledge exchange program uses this statement as a framework for
organizing discussions about many topics using webinars, web meetings, wiki-based
summaries and other web-based tools.
Overview
The school is a place or setting within the community that can promote health, equity,
social development/cohesion, human rights, global understanding, safety and
environmental citizenship as well as focus on learning, educational achievement and
school effectiveness. A health promoting, child-friendly school and similar whole
school strategies such as effective schools, safe schools, community schools, open
schools and eco-schools strives to have all facets of the school support the development
of the whole child. In particular, school-based and school-linked programs should address
the needs of all children, especially disadvantaged students. School feeding programs
often serve as the central part of UN interagency development and emergencies
programs in countries with low income or recovering epidemics, natural disasters and
wars/internal conflicts. Other coordinated programs have been brought together to
address HIV/AIDS, mental health or drug abuse.
National and regional developments of the school-based and school-linked approach have
added other important considerations in developing school health programs. For example,
the 1997 statement of delegates from several European countries suggests that
democratic principles, equity and other humanitarian values are the heart of such school
programs. A 1990 Canadian NGO statement defines a comprehensive approach is one
that addresses clusters of risk/protective behaviours and conditions, that coordinates
actions at various levels within systems and that uses synergistic combinations of
programs to be more effective. The 1989 American model describes eight specific
coordinated school health programs working together across several domains (policy,
instruction, services, social support and physical environment) are more effective than
single interventions/programs or project activities. Australia (2000) has helped us to

understand that the educational mandate and constraints of the school must be
respected and used a backbone in implementation. New Zealand (2006) has addressed
the need for a culturally relevant model for aboriginal students and schools.
Scotland, Hong Kong and the United States have developed coherent systems for
evaluating and monitoring their programs. England has provided similar leadership in
funding and supporting SH coordinators to promote local health-education authority
cooperation. Brazil has placed its programs within an extensive equity and community
development strategy. The Latin American experience has combined school health with
culture, music. Spain has benefited from leadership from school-based physicians.
Countries in the eastern Mediterranean and others have linked school programs with faithbased communities and religion.
The approach and programs need to be selected to match the local community context,
whose needs and strengths have been identified through data collection, regular
monitoring and analysis. These contexts include low-income countries, disadvantaged
communities in middle and high-income countries, aboriginal communities and
communities disrupted by war, disasters and epidemics.
Programs, policies and practices need to be implemented in partnership with students,
staff, parents, the community, local agencies and professionals. Programs should be
based on research evidence as well as experience and be implemented effectively
using knowledge about diffusion and systems change. Evidence and experience-based
implementation plans and other mechanisms that support or hinder implementation as
well as local drivers (history, people, incidents) should be identified.
Policy-makers, government and agency officials need to invest in long-term capacity
building and continuous improvement within professionals, schools, agencies and
communities to ensure sustainability. These capacities include the key functions of
assigning staff and developing mechanisms to support coordination at all levels and
across several systems, knowledge exchange & workforce development,
monitoring/reporting to the public, strategic issue management, sustainability planning
and overall coordinated policy and leadership.
Practitioners and researchers need to address the complex ecologies of schools and
other organizations as well as the key characteristics of open, loosely-coupled,
professional bureaucracies that are engaged in school health promotion so that their
efforts are more strategic and enduring.
Ten Common, Key Points about Promoting
Health, Safety, Equity, Social Development, Human Rights, Environmental
Sustainability & Learning through Schools
1. Address the needs of the whole child in a positive, principled values-based
approach over the life course. Truly understand the strengths/assets of young
people and the health, social and economic problems that will challenge as well
as the influence of the school on those assets and problems.
It is fitting that our first point comes from the education sector where research on brain

development led to movements for more holistic approaches to learning. Too often the
health, welfare and law enforcement sectors have been focused on short term results on
one or a few problems without looking for clusters of problems, conditions and strengths
among children, schools or communities. As well, the first European descriptions of health
promoting schools identified the need for programs to be based on values and principles
rather than simple production/ medical models.
Detailed Points:
1.1 Programs should address the needs of the whole child (intellectual, social, physical,
psychological, emotional) and identify and address all of the health/social/economic
problems, assets, factors and conditions that affect their health, learning and
development. The child's development will be affected by several social determinants.
There are several behaviour theories to explain the complex interactions that occur among
the child, family, neighbourhood, community and the school.
1.2 Programs should seek to prevent specific health and social problems and reduce harms
but also build positive individual resilience and personal assets as well as family,
community and organizational strengths by promoting health, cohesion and social
development
1.3 Programs should promote values and principles such as empowerment, equity, ethics,
social responsibility.
1.4 Programs should be based on a recognition that health and social behaviours, personal
health & physical conditions as well as knowledge/attitudes and skills occur and develop
over the life course. This should include a recognition of the developmental stages/tasks,
and key transitions in young people's lives.
1.5. Programs should be based on a clear, evidence-based understanding of the nature
and prevalence of the health or social problems, strengths/assets, conditions or
behaviours being addressed and the impact of the physical and social environment of the
school on those problems, strengths/assets, conditions or behaviours.
1.6 Programs should be based on a clear understanding of the influence of the social and
physical; environment of the school on the health or social problem being addressed.
2. Serve all children, especially vulnerable children, families and communities.
Although all sectors identify the need to serve the disadvantaged, there is rarely a
program or service or school-based approach that truly places the needs of the poor
above the needs of the mainstream. This idea emerged first in the health sector with the
adoption of the Ottawa Charter in 1986.
Detailed points:

2.1 Programs should address the needs of all children, but should also include special
measures for more vulnerable children, families and sub-populations, or for particularly
high risk behaviours or situations. (eg Children of alcoholic parents)
2.2 Programs should explicitly address social, economic, cultural or geographical
determinants and seek to alleviate disadvantages relating to such families or
communities.
3. Understand the context.
Ecological approaches have identified the need to identify issues and subsequently plan
programs that suit specific contexts and communities. Instead, in traditional,
issue/program focused approaches local context is seen only as a factor in the delivery of
a good program rather than the starting and end point of our endeavours.
Detailed Points:
3.1 Program planning should take into account the different, overlapping and interacting
contexts (home, school, neighbourhood, community) that affect the health, learning and
development of children and families.
3.2 Program planning should first understand the community context and then specifically
address the elements of that context that most affect children and youth.
4. Use multiple, evidence-based and experience-tested interventions in several
domains (policy, instruction, services, social & physical environment) within a
defined or coordinated set of multi-system, multi-level comprehensive
approaches, coordinated agency-school programs or whole school strategies.
The consistent use of research-based and experience-tested programs still remains an
elusive goal, as nations and research funding agencies have only recently begun to invest
more in intervention and implementation research.
Detailed Points:
4.1 Policy-makers, officials, administrators, and practitioners should select evidence-based
and experience-tested programs, policies and practices.
4.2 Multiple interventions (policies, programs, services, practices) should be delivered in
several domains. These include:
a) Policies, mandates & procedures adopted and implemented by school boards,
health authorities, other agencies and ministries (eg School Health Policies)
b) Instruction & informal education
c) Health, social & other services

d) Positive social environment and social support (school climate) & trusting
relationships)
e) Healthy physical environment & practical resource

5. Strive towards a comprehensive multi-level, multi-system approach, a

coordinated agency-school district program or whole school strategy while
addressing specific problems and implementing specific programs.
The need to identify and work with synergistic combinations of programs, programs that
address more than one issue or problem, and the need to establish linkages across
sectors and among different levels in the same system while still responding to the urgent
issue of today has emerged as a challenge worldwide .
ISHN has clarified the terms that are often used synonymously. In this statement, a
comprehensive approach involves more than one health or social issues as well as
multiple levels within multiple systems working with school systems. The term
coordinated-school program means that school district and agency staff are assigned to
implement agency and school district policies and to deliver education, services to
students and families, various forms of social support and changes to the physical
environment in or near schools. The term whole school strategies refers to multiple
intervention programs delivered solely by educators and only at the school level.
Most of the research in school health and development has been focused on specific
interventions on specific social issues or health topics in specific contexts using random
controlled trials (RCTs), often testing the intervention only at the school level.
Consequently, systematic reviews are limited to clusters of these topic specific studies and
have not really tested a truly comprehensive, multi-level, multi-system approach over
several years. Further, there are limits to the ability of RCTs to capture the complexity of
the ever-changing, multiple-interactions that occur between the children, the school,
families, neighbourhoods, education, health and other systems. As well, recent discussion
about RCT-based studies have called for greater clarity about the exact nature of the
control group or situation, which, in the real world may be very similar to the intervention
being tested. This makes for less significance between these two similar conditions rather
than the more easily controlled medical trials that compare a dose to no dose or to
carefully controlled dosages in all groups.
Detailed points:
5.1 Policy-makers, officials, administrators, and practitioners should build a comprehensive
approach while simultaneously addressing specific urgent issues or the
elements/programs within a coordinated set of interventions. This means that data on
child/youth needs (See list of behaviours/conditions above) as well as other needs and
capacities should be assessed, monitored and reported regularly. Relevant multiple

interventions should then be identified and coordinated in a recognized school multiple

intervention program.
5.2 Holistic approaches can address clusters of problems and conditions using
combinations of synergistic programs policies, services and other interventions.
5.3 Programs should be developed and implemented at multiple levels within systems and
across several systems and then delivered using the school as a hub.
6. Coordinate multiple programs, services and policies.
The coordination of multiple programs has been proven to be more effective than single
interventions in the prevention of a variety of health and social problems. This multiprogram coordination goal often develops as an extension of earlier work on curriculumbased strategies. A variety of multi-component models has been developed internationally
and in countries, states and local communities around the world. The Community Schools
model first emerged in the early 1900s and accelerated in the 1950s around the notion
of community development, democracy and social inclusion. In health promotion, the
Health Promoting School model that first emerged in Europe was focused in values and
beliefs such as youth empowerment, inclusion and democracy. School health and
nutrition programs emerged in low resource countries from the school-based feeding
programs as well as others working on hygiene, sanitation and the prevention of infectious
diseases. The Coordinated School Health Program model in the US the first to identify
eight selected core programs as the basis of an approach. Canadas comprehensive
approach was among the first to describe the shared responsibility among several
systems to deliver and support such programs in schools. Germanys model started with
the premise that health and social programs needed to contribute to educational
achievement in the good and healthy school. School-related relief aid work has focused
on emergencies in education caused by conflict, disasters and epidemics. There are
several variations on the term safe schools that include safe social environments free of
bullying and aggression as well as the physical environment such as earthquake and
emergency-preparedness.
Detailed points:
6.1 Policy-makers, officials, administrators, and practitioners should select or develop a
"school multiple intervention plan, model or framework (SMIP). This plan can be a
comprehensive approach, coordinated agency-school program or whole school strategy
used to coordinate several programs, policies, practices and services across five domains
(policy, instruction, services, social environment, physical environment/resources) to
achieve maximum impact in whole school and school-community strategies. The plan or
model can then be developed into a Multi-Intervention Program (MIP) with specific
interventions that are feasible and appropriate to the local context and capacities of the
school, community or agency.
6.2 Policy-makers, officials, administrators, and practitioners should seek to influence the
whole school environment, not just deliver programs or interventions within the school.

6.3 Policy-makers, officials, administrators, and practitioners should initiate, and support
community-school Interactions.

7. Identify the local mechanisms, drivers of change, implementation and

sustainability and make use of evidence-based implementation strategies.
New methods in health promotion research and practice have identified the need to
examine the factors within communities, organizations and schools that will help or hinder
the implementation, the system, organizational and professional capacities required and
changes in education and other systems to promote the sustainability and
institutionalization of programs
Detailed Points:
7.1 Identify, consider and use key mechanisms and local drivers that will hinder or help
the adoption and implementation of programs and comprehensive approaches
7.2 Use an evidence-based implementation process and model that includes a) required
parent involvement b) required student involvement c) required community involvement
d) required staff involvement e) required expert review f) required consultation and g)
evaluation and reporting procedures
7.3 Consider carefully how the innovation or multi-intervention approach will be
distributed, disseminated, diffused or brought to a larger scale.
7.4 Consider and select the systems change approach and model that is most appropriate
to your circumstance

8. Seek congruence with education mandate, constraints, customs, professional

norms and essential procedures
Work in Australia, Germany, Switzerland and other parts of the world have emphasized the
need to work closely and in a practical way with educators and their goals, core mandates,
methods and constraints.
Detailed Points:
8.1 Policy-makers, officials, administrators, and practitioners should seek congruence with
the educational mandate of school
8.2 Policy-makers, decision-makers and practitioners should and anticipate competition
and conflicts caused by divergence or competition with the academic/ educational
roles/needs of the school.

9. Build baseline and operational capacity at all levels in the multiple systems
that need to engaged with school health promotion, social development, safety
and the environment
The need to build capacity has been recognized in education and public health sectors.
These capacities include baseline capacities in terms of staffing, funding and time
available in the curriculum as well as operational capacities such as leadership, policy
coordination, workforce development, monitoring and reporting, coordination and
cooperation and strategic planning.
Detailed Points:
9.1 Build baseline capacities (and research/documentation to support this) in regard to
minimum staffing, service levels, and time available in the curriculum and professional
development programs.
9.2 Build different types of capacities including:
a) Coordinated policy/leadership
b) Staff assigned to coordination at all levels
c) Formal & informal mechanisms for cooperation
d) Ongoing knowledge synthesis & exchange
e) Ongoing Workforce development
f) Monitoring & Reporting & Evaluation
g) Joint issue management, priority-setting, trend analysis
h) Explicit sustainability planning
9.3 Build capacities at all levels (government, agency, school, professional, community)
10. Use a strategic approach to system characteristics and organizational
cultures.
Open, loosely-coupled and bureaucratic systems have boundaries, middle managers and
other traits that need to be addressed.
Detailed Points:
10.1 Understand the nature of open systems and the impact of openness
10.2 Understand decision-making in loosely-coupled systems
10.3 Understand the features of professional bureaucracies

10.4 Know about working across multiple systems