Systems Capacity and Change
Key Organizational Capacities for Sustaining Comprehensive Approaches to Health Promoting Schools
In recent years, school health proponents, program planners, and policy-makers have recognized the need for a more systematic and policy-oriented approach to comprehensive school health.
Although there is little definitive research on effective implementation of a comprehensive integrated school health program, there is considerable evidence supporting the effectiveness of action in specific issue areas. Using a comprehensive approach has the potential to significantly expand on these successes. However, this approach is also complex and difficult to implement and sustain in a meaningful way.
Success rests on sharing a common vision and goals and developing school programs that address the common determinants of health and academic outcomes. Lawrence St. Leger and Don Nutbeam suggest an increasing coincidence of school-related outcomes, school-based intervention, and inputs such as curriculum, professional development, policy, and organizational practicies that affect both the education and health outcomes of students. They provide a map that is useful for joint school health planning and implementation, one where there can be agreement on the actions to take and the reasons for these actions.
To sustain implementation of comprehensive approaches, many countries and state/provinces are focusing on policy, coordination, and strenghtening the organizational capacities of school, public health and other systems to institutionalize internal and external relationships, responsibilities, and accountabilites for school health promotion. The following key capacities have been identified from a review of several national school health policies, a World Health Organization guide, reviews of literature on interagency coordination, and interview with key informants in several countries.
Coordinated policies on school health, health issues and the elements of school health promotion are sometimes played out in local or provincial/territorial interagency agreements that may include financing, administration and organization. These explicit, comprehensive policy and managerial supports for inter-ministry, interagency and inter-disciplinary coordination and cooperation should include procedures in policy-making, program planning, and budget preparation to align responses to health and social issues undertaken through and with the school systems. As well, an overarching policy should favour inter-sectoral approaches and it should be reflected in guidance and directives to school, public health, police, social service and other local authorities and agencies.
Mechanisms for coordination and cooperation, both formal and informal, help to manage the implementation process, avoid confusion, and capitalize on synergistic action. Mechanisms may include joint committees, job descriptions, written policy statements, joint in-service programs, joint planning, shared budget allocations, joint vision development and consensus building.
Assigned staffing and infrastructure, such as provincial/territorial and district school health coordinators, help to facilitate and support interdisciplinary coordination and cooperation in school health promotion. These staff assignments should include time for actively supporting voluntary cooperation and alignment of activities, programs, polices and practices. They should be based on explicit intergovernmental, inter-ministry, inter-agency and inter-disciplinary agreements and should ensure that the voices of youth, parents, professionals and volunteers are heard in the decision-making about policies and programs.
Continuous workforce development ensures ongoing development for teachers, administrators as well as public health professionals. It includes explicit and sustained programs and processes to develop ministry and local agency workforces, through studies of current professional practices, guidance and support for the development of university and college pre-service preparation programs, and development of guidelines, models and materials for sustained staff development programs.
Knowledge transfer and exchange within and across systems, includes mechanisms and processes to sharing evidence as well as local solutions and ideas for implementation, funding and evaluation with decision-makers and practitioners to describe lessons learned and promote promising practices. This would included evidence-based knowledge summaries published by a variety of sources, guidelines for policy, programs and practice from provincial, territorial and professional sources and tools and models that enable decision-makers and practitioners to reflect on their situation and their practice and to locate materials and models that can be adapted to their circumstance.
Collecting and sharing reliable data entails the regular and timely collection and communication of data on the health outcomes, social behaviours and related learning of children and youth, and their connectedness to parents, schools and the community. These data are for use in appropriate decision-making and indicators systems and can be gleaned from periodic surveys of local agency policies, programs, and system capacities without implying a supervisory role or identifying survey participants. It is also important to develop explicit and agreed upon procedures and processes to conduct regular scans of health, social, educational environments to identify emerging trends, plan responses, and suggest actions for policymakers and agencies.
Long-term planning and sustained funding are essential for sustainability. They ensure the continuance of programs that demonstrate effectiveness, based on regular evaluations that shed light on program process, context and outcomes. Financial resources are needed for staff, personnel training, infrastructure changes, coordination, intersectoral participation and dissemination to support continued implementation and school health promotion action and evaluation plans.
School Health Links
Want to know more about specific initiatives under way in other jurisdictions? Follow the links below for up to date information on school health promotion and related activities across Canada and around the world.
JCSH Member Sites
- British Columbia
- New Brunswick
- Nova Scotia
- Prince Edward Island (Lead Province)
- Newfoundland and Labrador
- Northwest Territories
- Public Health Agency/Health Canada
Other Canadian Sites
- Physical and Health Education (PHE) Canada: We strive to achieve our vision by supporting schools in becoming "Health Promoting Schools", that include the provision of Quality Daily Physical Education and fostering healthy school communities. We support schools through a range of programs, resources and initiatives.
- Chronic Disease Prevention Alliance of Canada (CDPAC) : is a network of national organizations who share a common vision for an integrated system of research, surveillance, policies, and programs for maintaining health and prevention of chronic disease in Canada.
- ParticipACTION: is a national not-for-profit organization solely dedicated to inspiring and supporting active living and sport participation for Canadians.
- Canadian Partnership Against Cancer (CPAC) : is an independent organization funded by the federal government to accelerate action on cancer control for all Canadians. The Partnership works with cancer experts, charitable organizations, governments, cancer agencies, national health organizations, patients, survivors and others to implement Canada's cancer control strategy.
- Canadian Teachers' Federation (CTF) :is a national alliance of provincial and territorial teacher organizations that represent nearly 200,000 elementary and secondary school teachers across
Canada. CTF is also a member of the international body of teachers, Education International (www.ei-ie.org).
- Health Canada :Health Canada is the Federal department responsible for helping Canadians maintain and improve their health, while respecting individual choices and circumstances.
- Canadian Education Association (CEA) is a network of passionate educators advancing ideas for greater student and teacher engagement in public education
- Promoting Relationships and Eliminating Violence Network (PREVNet) :is a coalition of Canadians concerned about bullying. The primary goal of PREVNet is to translate and exchange knowledge about bullying to enhance awareness, to provide assessment and intervention tools, and to promote policy related to the problems of bullying.
- World Health Organization (Global School Health Program)
- Center for Disease Control (Division of Adolescent and School Health)
- Schools for Health in Europe (SHE) Network
- PAHO Network of Health Promoting Schools
- Scotland Health Promoting Schools Program
- New Zealand Health Promoting Schools Association
- Australia Health Promoting Schools Association
- United Nations Children's Fund (UNICEF)
- United Nations Educational, Scientific and Cultural Organization (UNESCO)
1 Lawrence St Leger and Don Nutbeam. 2000. A Model for Mapping Linkages Between Health and Education Agencies to Improve School Health. Journal of School Health. Feb;70(2):45-50.
2 Deschesnes M et al. 2003. Comprehensive approaches to school health promotion: how to achieve broader implementation? Health Promotion International. 18(4):387-396.
3 WHO, Rapid Assessment and Action Planning Process (RAAPP), A Method and Tools to Enable Ministries of Education and Health to Assess and Strengthen their Core Elements of Capacity to Promote Health Through Schools, n.d. See http://www.who.int/school_youth_health/assessment/raapp/en/index.html