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Contents
Introduction
What works in schools and colleges to promote health and wellbeing – a whole school approach
Personal, social, health and economic education
Obesity prevention (healthy eating and physical activity)
Promoting emotional health and wellbeing......
Relationships and sex education
Drugs, alcohol and tobacco
Road safety
Online and e-safety
Date of issue: May2017
Version: 2.0
Introduction
This document provides a selection of‘evidence-based’ approaches for supporting children and young people’s health and wellbeing within school settings (across a range of topic areas), as well as links to example programmes/resources and their approximate costs where possible.
The list of example programmes/activities is not exhaustive, but the information aims to provide the principles for selection of a wide range of activities/interventions that take a ‘primary prevention’ and ‘whole-school’ approach to improving health and wellbeing of children and young people in school settings. All of the resources and links provided in this document were correct at the time of publication. If you are aware of other relevant services/providers that are available, and that could also be of benefit for other schools or colleges, please consider making the School Health Service aware as appropriate.
The topics included in this document do not cover all possible topics that can contribute to improved health and wellbeing of children and young people. The topics selected are the main areas that schools indicated were a priority during the 2016/17health improvement grants programme.
The activities and services signposted in this document are not a panacea, and some interventions will have stronger evidence of effectiveness than others. The fact that an activity or approach may have a strong evidence base does not automatically mean that it will be effective when implemented in your school setting. Many factors influence the success of an intervention and whether positive outcomes are achieved during its implementationin‘real world’ situations.
Further information to support selection of effective evidence-based activities and development of your Action Plan can be supplied by the East Sussex School Health Service.
The information provided in this document is designed to assistyou in developing or updatingyourHealth Improvement Action Plan and producing your Grant Expenditure Proposal (for approval by ESCC Public Health), following completion or update of your School Health Profile.
As detailed within your grant agreement,your Health Improvement Action Plan and Grant Expenditure Proposal should:
- Include a focus on addressing childhood obesity in line with recommendations of the national childhood obesity plan for action;[1]
- Include a focus on addressing emotional health and wellbeing in line with the recommendations of Public Health England’s associated guidance for head teachers and college principals;[2]
- Address an identified need within your School Health Profile that is responsive to insight generated through pupil and parent/carer voice (particularly in those instances where proposed grant expenditure does not relate to addressing childhood obesity);
- Include health improvement activities/approaches that are evidence based, support delivery of a whole-school approach and have a focus on primary prevention;
- Include a suggested timeline for delivery, and;
- Detail how you plan to evaluate the impact and outcomes of your proposed health improvement activities (evaluation to be proportional to the scale and intensity of the activity).
The following checklist can help establish whether the proposed activity is likely to meet the grant criteria.
Your activity- Does it specifically relate to improving children & young people’shealth and wellbeing (primary prevention[3]) using a whole-school approach?
- Evidence
(if it is an innovative activity, is there and sound basis for testing the approach and have you planned a sufficiently robust evaluation?) /
Does it reflect findings of pupil (and parent/carer) engagement activity? /
- Does it address identified needs within your school health profile?
- Does it include a realistic timeline for delivery?
- Does it identify evaluation and impact measures?
What works in schools and colleges to promote health and wellbeing – a whole school approach
Promoting the health and wellbeing of pupils not only has the potential to improve their health and wellbeing outcomes, but also their educational outcomes. For example, children and young people who are aerobically fit have been found to have higher academic scores, with the intensity and duration of exercise both linked to improved academic performance, including GCSE results at age 15 and notably girls’ results in science.[4]
Robust evidence shows that interventions taking a ‘whole school’ approach have a positive impact in relation to a range of health improvement outcomes, to include body mass index, physical activity, physical fitness, fruit and vegetable intake, tobacco use, and being bullied.[5]
A whole school approach is one that goes beyond the learning and teaching in the classroom to pervade all aspects of the life of a school including:
- Leadership, management and managing change
- Policy development
- Curriculum planning and resources, including working with outside agencies
- Learning and teaching
- School culture and environment
- Giving children and young people a voice
- Provision of support services for children and young people
- Staff professional development needs, health and welfare
- Partnerships with parents, carers and local communities
- Assessing, recording and reporting children and young people’s achievement.
Personal, social, health and economic education
Personal, social, health and economic (PSHE) education provided in schools aims to equip young people with the knowledge, understanding, attitudes and practical skills to live healthily, safely, productively and responsibly. PSHE at school is an important part of the way in which schools can contribute to improving resilience and health among children. Children and young people appear to value PSHE and feel that it provides relevant and useful information, although older teenagers are less likely to be positive about the quality of PSHE that they receive.[6]
Public Health England has argued that providing high quality PSHE including SRE continues to be the most efficient route to ‘universally, comprehensively and uniformly targeting adolescent populations’ with the potential to contribute to a range of health outcomes.[7], [8]
ESCC Public Health supports four PSHE Hubs which were established following consultation with the Education Improvement Partnership (EIP) Executive and PSHE subject leads. PSHE Hubs are designed to bring together PSHE leads through termly twilight meetings and a virtual network, and provide a unique opportunity to:
•share and consider best practice;
•identify resources to support high quality teaching;
•learn about national and local perspectives on PSHE;
•network with colleagues in other schools, and;
•work collaboratively to enable improvement in PSHE education leadership, teaching and learning.
Secondary PSHE Hub
The PSHE Hub for secondary schools was set up in 2016 and covers all of East Sussex. It is facilitated by College Central.
Primary PSHE Hubs
There are three primary PSHE Hubs across the County and these are also coordinated and facilitated by a lead school:
- Ashdown, Wealden and Lewes EIP areas(facilitated by Meridian Community Primary School)
- Hastings, Rother and Rye EIPareas(facilitated by Pebsham Primary Academy)
- Eastbourne and Hailsham EIP areas(vacancy)
For further information,or to join aPSHE Hub, please contact the lead school for your area or
Obesity prevention (healthy eating and physical activity)
Today nearly a third of children aged 2 to 15 are overweight or obese, and younger generations are becoming obese at earlier ages and staying obese for longer. Reducing obesity levels will save lives as obesity doubles the risk of dying prematurely. Obese adults are seven times more likely to become a type 2 diabetic than adults of a healthy weightwhich may cause blindness or limb amputation. And not only are obese people more likely to get physical health conditions like heart disease, they are also more likely to be living with conditions like depression.
The burden is falling hardest on those children from low-income backgrounds. Obesity rates are highest for children from the most deprived areas and this is getting worse. Children aged 5 and from the poorest income groups are twice as likely to be obese compared to their most well off counterparts and by age 11 they are three times as likely.
Obesity is a complex problem with many drivers, including our behaviour, environment, genetics and culture. However, at its root obesity is caused by an energy imbalance: taking in more energy through food than we use through activity. Physical activity is associated with numerous health benefits for children, such as muscle and bone strength, health and fitness, improved quality of sleep and maintenance of a healthy weight. There is also evidence that physical activity and participating in organised sports and after school clubs is linked to improved academic performance. Long-term, sustainable change will only be achieved through the active engagement of schools, communities, families and individuals.
In August 2016 the government published its plan to reduce childhood obesity by supporting healthierchoices:Childhood Obesity A Plan for Action.[9] Aspects of the plan relating to schools’ contribution to achieving a reduction in childhood obesity include:
- Making school food healthier;
- Helping all children to enjoy an hour of physical activity every day,and;
- Creating a new healthy rating scheme for primary schools which will be taken into account during Ofsted inspections.
Why improve diet?
It is recommended that children eat at least five portions of a variety of fruit and vegetables per day. For children aged 11 years and over one portion is considered to be 80g;for younger children no specific portion size is recommended.
Data from the 2012 Health Survey for England (2013) shows that less than 1 in 5 children (16% of boys and 17% of girls) aged 5–15 years consumed at least five portions of fruit and vegetables per day; with children aged 11–12 years having the lowest consumption (2.3 portions for boys/2.8 portions for girls).
Figure 1 Mean intake of fruit and vegetable portions per day, by sex and age
In July 2015, the UK government adopted newly published advice to recommend that intake of sugar should not exceed 5% of total dietary energy for those aged two years upwards (halving the previous recommendation).
- Current estimates of UK sugar intakes from the National Diet and Nutrition Survey show that mean intakes are three times higher than the new 5% maximum recommendation in school-aged children (14.7% to 15.6% of energy intake).
- Soft drinks (excluding fruit juice) are the largest single source of sugar for children aged 11 to 18 years, providing 29% of daily sugar intake for this age group as a whole.
It is also recommended that no more than 11% of total food energy should come from saturated fat for children aged five years and over.
- All children significantly exceed this recommendation, with younger children aged 4–10 years obtaining significantly more of their food energy from saturated fat than older children aged 11–18 years (13.1% for boys and 13.3% for girls aged 4–10 years, compared to 12.7% for boys and 12.4% for girls aged 11–18 years).
Figure 2 Percentage of food energy from non-milk extrinsic sugars (NMES), by age and sex
Figure 3 Percentage of food energy from saturated fat, by sex and age
Why increase physical activity?
Approximately two in ten children aged 5-15 years current meet the government recommendations for physical activity (boys 21%, girls 16%). In terms of adults, 67% of men and 55% of women currently meet new government recommendations for levels of physical activity (minimum of 150 minutes of moderate intensity per week in bouts of at least ten minutes).[10]
A recent review of the evidence[11] on the outcomes of physical activity participation among children aged 5 – 11 years, has shown that a strong positive association exists between physical activity and cardio-metabolic health, muscular strength, bone health, cardiorespiratory fitness, self-esteem, anxiety and stress, academic achievement, cognitive functioning, attention/concentration, confidence, and peer friendship.
What are the physical activity guidelines for children and young people (5 – 18 years)?
- all children and young people should engage in moderate to vigorous intensity physical activity for at least 60 minutes and up to several hours every day
- vigorous intensity activities, including those that strengthen muscle and bone, should be incorporated at least three days a week
- all children and young people should minimise the amount of time spent being sedentary for extended periods.[12]
Moderate intensity physical activities will cause childrento get warmer and breathe harder and their hearts to beatfaster, but they should still be able to carry on aconversation. Examples include bike riding and playground activities.
Vigorous intensity physical activities will cause children to get warmer and breathe much harder and their hearts tobeat rapidly, making it more difficult to carry on aconversation. Examples include fast running and sports such as swimming or football.
Physical activities that strengthen muscle and bone involve using body weight or working against aresistance. Examples include swinging on playground equipment. hopping and skipping, and sports such as gymnastics or tennis.
Minimising sedentary behaviour may include:
- Reducing time spent watching TV, using the computer or playing video game
- Breaking up sedentary time such as swapping a longbus or car journey for walking part of the way
Individual physical and mental capabilities should be considered when interpreting the guidelines.
What works in schools and colleges to prevent obesity – healthy eating and physical activity
Evidence highlights the effectiveness of multi-component interventions in schools focused on improving both diet and physical activity, including: specialised educational curricula, trained teachers, supportive school policies, a formal PE program, healthy food and beverage options, and a parental/family component [13][14][15]. For example, Waters et al[16] found strong evidence to support the beneficial effects of child obesity prevention programmes on BMI, particularly for programmes targeting children aged six to 12 years. Whilst it is not easy to determine those programme components which are most effective, this review highlighted the following as promising policies and strategies:
- school curriculum that includes healthy eating, physical activity and body image
- increased sessions for physical activity and the development of fundamental movement skills throughout the school week
- improvements in nutritional quality of the food supply in schools
- environments and cultural practices that support children eating healthier foods and being active throughout each day
- support for teachers and other staff to implement health promotion strategies and activities (e.g. professional development, capacity building activities)
- parent support and home activities that encourage children to be more active, eat more nutritious foods and spend less time in screen based activities.
Other systematic reviews[17][18][19] have also highlighted intervention components in theschool setting that have been shown to significantly reduceweight in children. These include
- combined diet and physicalactivity interventions
- interventions that include a home/family involvement
- longer-term interventions asopposed to short-term interventions
- improving access to physical activity facilities and healthful food choices such as fruits and vegetables both at school and home.
NICE[20]public health guidance also recommends that:
- Head teachers and chairs of governors, in collaboration with parents and pupils should assess the whole school environment and ensure that the ethos of all school policies helps children and young people to maintain a healthy weight, eat a healthy diet and be physically active, in line with existing standards and guidance. This includes policies relating to building layout and recreational spaces, catering (including vending machines) and the food and drink children bring into school, the taught curriculum (including PE), school travel plans and provision for cycling.
- Head teachers and chairs of governors should ensure that teaching; support and catering staff receive training on the importance of healthy-school policies and how to support their implementation.
- Interventions should be sustained, multicomponent and address the whole school, including after-school clubs and other activities. Short-term interventions and one-off events are insufficient on their own and should be part of a long-term integrated programme.
- Staff delivering physical education, sport and physical activity should promote activities that children and young people find enjoyable and can take part in outside school, through into adulthood. Children’s confidence and understanding of why they need to continue physical activity throughout life (physical literacy) should be developed as early as possible.
- Children and young people should eat meals (including packed lunches) in school in a pleasant, sociable environment. Younger children should be supervised at mealtimes and, if possible, staff should eat with children.
- Staff planning interventions should consider the views of children and young people, any differences in preferences between boys and girls, and potential barriers (such as cost or the expectation that healthier foods do not taste as good).
- Where possible, parents should be involved in school-based interventions through, for example, special events, newsletters and information about lunch menus and after-school activities
- school staff should implement a food policy which takes a 'whole settings' approach to healthy eating, so that foods and drinks made available during the day reinforce teaching
- about healthy eating.
There is also evidence for five effective elements of school health promotion found to be similar across three behavioural domains examined (substance abuse, sexual behaviour, nutrition): these are the use of theory; addressing social influences, especially social norms; addressing cognitive-behavioural skills; training of facilitators; and employing multiple components.[21]