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,
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music. Spain has benefited from leadership from school-based physicians. Countries in the eastern
Mediterranean and others have linked school programs with faith-based 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
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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.
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, 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.
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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. Strive towards a comprehensive approach 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
program, and linkages across sectors and among different levels in the same system emerged in Canada and the
United States.
Detailed points:
4.1 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.
4.2 Holistic approaches can address clusters of problems and conditions using combinations of synergistic
programs policies, services and other interventions.
4.3 Programs should be developed and implemented at multiple levels within systems and across several
systems and then delivered using the school as a hub.
5. Use multiple, coordinated evidence-based interventions (policy, instruction, services, social & physical
environment) in comprehensive approaches, coordinated agency-school programs or in whole school
strategies
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. The consistent use of research-based programs still remains an elusive goal, as nations and states have
only recently begun to invest more in intervention research, knowledge translation, knowledge exchange and
work force development.
Detailed Points:
5.1 Policy-makers, officials, administrators, and practitioners should select evidence-based programs, policies
and practices.
5.2 Multiple programs should be delivered in several domains. These include:
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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
6 Identify the local mechanisms/drivers of change, implementation and sustainability and use 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, capacity required and
changes in education and other systems to promote the sustainability and institutionalization of programs
Detailed Points:
6.1 Identify, consider and use key mechanisms and local drivers that will hinder or help the adoption and
implementation of programs and comprehensive approaches
6.2 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
6.3 Consider carefully how the innovation will be distributed, disseminated or diffused (brought to a larger scale)
6.4 Consider and select the systems change approach and model that is most appropriate to your circumstance
7. 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 program coordination goal was first described by SH
proponent s in the United States as an extension of their earlier work on curriculum-based strategies. A variety of
eight part, three part and other models has been presented around the world.
Detailed points:
7.1 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
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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.
7.2 Policy-makers, officials, administrators, and practitioners should seek to influence the whole school
environment, not just deliver programs or interventions within the school.
7.3 Policy-makers, officials, administrators, and practitioners should initiate, and support community-school
Interactions.
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
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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
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