Implementation of Healthy School more successful at some schools than at others

In their final report ‘Under what conditions does Healthy School make a difference?’ and the accompanying factsheet, the researchers make recommendations to substantially improve, in particular, regional support from the Municipal Public Health Services and the actual implementation of the approach in schools. According to the researchers, however, this depends on more structural government funding for the Healthy School programme.

Regional differences

Many schools in the Netherlands work according to the Healthy School approach to encourage a healthy lifestyle among young people. Funded by ZonMw, scientists sought to answer the question of under what conditions the Healthy School approach makes a difference. The study at primary schools, secondary schools and vocational education institutions shows that the extent to which the Healthy School approach is actually implemented in schools and the regional support provided by the Municipal Public Health Services are particularly important factors.

The level of support varies greatly by region. While some Municipal Public Health Service regions have, for example, as much as 2.5 FTE per 100 schools available for support, in other regions this is limited to just a few hours per week. The researchers also found major differences in the practical implementation of the Healthy School approach. At some schools, for example, a special working group consisting of a coordinator, teachers, parents and pupils is responsible for implementing the Healthy School approach, while at other schools everything falls on the shoulders of a single staff member. In their recommendations, the researchers call for greater investment in support and for strengthening implementation in schools.

Conditions

The scientists see that Healthy School can be a valuable programme. However, the most important conditions must be met, stresses research leader Maria Jansen, emeritus professor of Population-Based Health Policy in Maastricht. “It should really be self-evident that schools promote a healthy lifestyle for pupils and students. This does require structural government funding for the Healthy School programme and a basic capacity of at least 2.5 FTE per 100 schools for advice and guidance from the Municipal Public Health Service. It should be normal for health to receive attention throughout the school, in lessons but also in the environment, identification of problems and policy,” Jansen explains as she outlines the concrete features of a Healthy School. “This includes education, but also a healthy lunch or healthy lunchbox policy, a ban on soft drinks and water taps instead, a healthy treats policy, a green schoolyard and, if possible, walking or cycling to school. And, of course, no fast food near schools. Parents and pupils themselves should certainly be involved as well.”

Healthy School evaluation study

The Healthy School evaluation study was carried out by three academic collaborative centres (AWPG Limburg, AMPHI and AGORA), the TNO research institute and eight Municipal Public Health Services (Amsterdam, Kennemerland, Limburg-Noord, Zuid Limburg, IJsselland, Gelderland-Midden, Gelderland-Zuid, Noord- en Oost-Gelderland), and answers the question ‘Under what conditions does Healthy School make a difference?’ The researchers examined conditions for regional support for the Healthy School approach from Municipal Public Health Services and its practical implementation in schools (primary education, special education, secondary education and secondary vocational education).

They also looked at differences between schools and whether these differences could be explained by school (population) characteristics.

• Both existing and newly collected data were used for the study: questionnaires, interviews, observations, school visits, comparisons between schools and available health data.
• The study began in 2019 and was completed in August 2023.
• The study was funded by ZonMw (the Netherlands Organisation for Health Research and Development). The commissioning body is the Ministry of Health, Welfare and Sport.
• The findings and recommendations for policy, practice and research will be incorporated as input into the new multi-year Healthy School strategy (from 2025).
• Healthy School is a collaboration between the PO-Raad, VO-raad, MBO Raad, GGD GHOR Nederland and the National Institute for Public Health and the Environment (RIVM). Healthy School is made possible financially by the ministries of Health, Welfare and Sport, Education, Culture and Science, Agriculture, Nature and Food Quality, and Social Affairs and Employment.

What is the Healthy School approach?

The aim of the Healthy School approach is to make a healthy lifestyle the obvious choice for pupils and students. Participating schools use a step-by-step plan to work on a health topic chosen by the school itself. Examples of topics include: Well-being, Nutrition, Physical Activity and Sport, Media Literacy, or Relationships and Sexuality.

Each school has a Healthy School coordinator. This person leads the implementation of the Healthy School approach at the school and is the point of contact for the education team, parents and carers, and the Healthy School adviser. This adviser from the Municipal Public Health Service supports schools at every step of the Healthy School approach and also helps them apply for the Healthy School certificate.