Policies in SH Promotion, Safety, Social Development (HS)This is a featured page

This page contains a first draft of a summary of the evidence, experience and examples of effective policies for school-based and school-linked health promotion, safety, social development. Visitors to and members of this wiki-based community are invited to post comments using the "thread tool" at the bottom of the page or through the Discussions icon found in the top navigation bar. Visitors and members are also invited to edit the text of this page by using the "Easy Edit" tool found at the top of the page. (All versions of the page are automatically saved, so please feel free to make changes.) As well, visitors and members can still add case studies and other additional documents using the "Add a New Page" feature found in the left hand margin navigation menu.

BACKGROUND INFORMATION AND ACKNOWLEDGMENTS
Handbook Section: Policies in School Health Promotion, Safety and Social Development (First Draft prepared December 2009) This draft is open for discussion
Writer/Editor: Doug McCall, Coordinator, International School Health Network
Contributors: Additional Contributors, Writers are welcome. Please contact dmccall@internationalschoolhealth.org
Sponsors and Partners: To be determined
First Draft Posted for Discussion: September 15, 2009 First Edition Completed: December 15, 2009
Further Comments: This summary has been drafted from an unpublished paper prepared for WHO and the International Confederation of Principals
Permissions for Use: The authors, writers, editors, contributors, sponsors, partners and the International School Health Network retain the right to first publish this document or adapted versions thereof in accordance with regular copyright laws. However, web links to this page and excerpts from this document are encouraged. As well, visitors to and participants in this wiki-based community are encouraged to add sub-pages or links to additional case studies or other documents and thereby become a contributor to this document.
Related Resources. See Policy-Making Process, School Nutrition Policies and School, Agency, Ministry Substance Abuse Policies

Policies in School Health Promotion, Safety and Social Development

1. What is policy?This is a featured page

The term “policy” is most commonly understood to be a written statement, law or by-law, sometimes accompanied by a set of regulations, rules or procedures that is adopted by an elected or appointed governing body that is accountable to a community or constituency. Examples of this sort of policy include what to do in the event of a fire in the school, or expectations about appropriate behaviour for students or teachers.

However, not all “policy” is about regulations, rules and procedures. The term “policy” can also refer to a set of decisions and actions, or statements of intended action. At the federal or state/provincial government level, an example of this might be to increase the focus on literacy in schools for the education sector, or to increase spending on youth suicide prevention in the health sector. Often, these government policies are expressed in position papers, declarations, inter-ministry agreements or protocols, laws, regulations, directives, mission statements, job descriptions, written descriptions of ongoing programs or guidelines for professional practices or similar documents.

Policies are written documents that identify and describe an issue within the purview of the school, health authority or agency, that promote a clear set of school or agency goals and achievable objectives, describe how resources and roles will be changed or added to achieve those outcomes and establish, reinforce encourage norms or practices regarding the health of students, staff, parents or the community.

2. School health policies

School health policies provide an essential part of the comprehensive framework that guides schools and agencies in planning, implementing and evaluating their efforts to promote health. While such policies may or may not have an impact by their existence alone, the guidance, direction, roles and new or existing resources assigned by virtue of the policy statements will definitely have the potential for influencing student behaviours and conditions in the school community that will enhance or hinder health.

While some school and agency policies are specifically on school health promotion, many of these policies will be a part of other policies addressing other issues and mandates. For example, the role of public health nurses in schools may be part of a mission or mandate policy for local health authorities on health promotion/public health.

In other cases, the health aspect may not be explicitly understood. For example, a school board policy on school improvement may address school climate/ethos but not necessarily be considered as a “health” issue.

SH policies should incorporate input from all relevant constituents of the school community: students, teachers, parents, staff, administrators, health and other service personnel as well as other relevant voluntary and community organizations. In addition, school health policies should meet or exceed government, professional and local needs and standards. School health policies should be responsive and adapted to the health concerns, preferences and practices of different ethnic and cultural groups represented at school as well as a variety of student needs, health conditions and abilities.

Policies should be such that collaboration and coordination between the health, education, food and other sectors of the government, between local agencies and between the school and the community are encouraged or required. Indeed, "school health" polices are adopted and implemented by a variety of agencies, not just schools.

The basic principles, policy topics and the process of respecting community and professional input are much the same in all communities. But the differing contexts of developed and developing communities will lead to different sets and ranges of policies. There is a continuum of needs, resources and possible responses that will set out a context for policy-making. These varying levels of needs and resources exist in most countries around the world. In Canada, for example, there are schools that serve affluent urban neighbourhoods as well as schools situated in isolated villages and communities that lack many basic resources.

3. The Importance of Policy

Far too often, school board policy-making stops with the adoption of the policy. Consequently, the process can become one of wordsmiths and politicians. Good policy-making actually has three essential benefits for students, employees and the community.

First, policy-making should be a spring-board for action. It should-focus staff and resources and invite the community, students, parents and staff to participate in the decision-making process to gain their commitment to implementation of the policy.

Second, the policies of the school board should be the basis for evaluating the effectiveness of programs, schools, departments, and the relationships with other organizations.

Third, good school board policy-making can be a link to the community. If parents, other agencies, the media and the community at large feel involved in your policy-making, they will support your efforts in several ways.

Good policy-making can help a school district:
  • Be more responsive to student and community needs
    An effective policy-making process will provide a forum and focus for the community, student needs, raise concerns and initiate change. Stress, in the form of political problems, occurs within a system when feedback is not easily transmitted to decision-makers.
  • Win internal support
    Similarly, a well designed policy-making process will develop more support within the school district. This is particularly important during the implementation and evaluation stages of the cycle.
  • Be more focused
    Good policies mean that resources are focused on current priorities.
  • Have more influence on instruction
    A National School Boards Association (NSBA) 1981, report summarizes how School Boards in the US supervised instruction through policy. Advice on an appropriate role for School Boards is also provided.
  • Be the Basis for Evaluation
    Good school board policy-making can help a school district;
  • Provide better direction to staff
    Employees work more effectively with clear direction established through consultants. Policy allocates resources and defined responsible conflicts or competing demands are recognized earlier.
  • Establish realistic expectations
    By clearly expecting an outcome in the policy department and implementation process, school districts can define realistic outcomes for students and ? not all be included in the policy or procedures.
  • Strengthen Links to the Community
    Good policy-making can help the school district to work more effectively with community organizations; municipalities, citizens and community members.
  • Gain external support
    Inviting community representatives to sit on advisory committees, inviting briefs from external organizations, and meeting with professionals while conducting needs assessments are all ways to maintain positive relationships with your community.
  • Identify needs and resources in the community
    The process of school board policy-making can identify needs in the community to be addressed by other agencies. It can also lead to change in their programs. As well, resources available in the community can be coordinated more closely with school programs.
4. School Health Policy & Policy-Making:

This section explains several key concepts related to school health policies. An understanding of these ideas will facilitate better policy-making and inter-sectorial cooperation.

a) Health and Health Promotion

The term “health” used in this paper denotes a broad view of health that includes wellness, social development and other aspects of child and adolescent development that are addressed by the social role of the school. We view physical health, mental health, emotional health, psychological health as all being part of health. Health is seen as more than the absence of disease, disorder or injury and as being a resource for daily living, learning and working.

Health promotion strategies as defined in the Ottawa Charter on Health Promotion (1986) include education and other means to develop personal health skills, re-orienting health services to enhance prevention, creating and maintaining healthy environments in places such as schools and healthy public policy.

b) Health promoting schools (HPS), comprehensive approaches to school health
A “health promoting school” uses a “comprehensive” and “coordinated” approach that is based on a holistic view of the child, an ecological understanding of the school environment and on systems-based strategies to influence sustainable change over time. Specific health and social issues are not treated independently but are seen within the context of the whole child. Interventions such as instruction, extra-curricular activities, school policies or parent involvement are linked within the whole school. School-based interventions are coordinated with school-linked services and programs that are provided by community agencies and voluntary organizations. In other words, we maintain a consistent view and approach that addresses the whole child, the whole school and the community surrounding the school in a holistic way.

In “health-promoting schools” strategies, programs and services delivered from a wide variety of education, health and other professionals, parents, youth, and others integrate their responses to health and social problems within the context of overall health, recognize the essential connection between health and learning, coordinate a variety of interventions, and hold a set of shared values that favour youth participation, parental involvement, school improvement and community development.

There are several terms related to health and schools that are used interchangeably in this paper that come from different parts of the world. For example, many European, Latin American, Pacific countries and the World Health Organization use the term Health Promoting Schools to denote school health promotion strategies/programs while the terms “Coordinated School Health” and “Comprehensive School Health” are used in North America.

c) Different communities have different policy needs

The basic principles, policy topics and the process of respecting community and professional input are much the same in all communities. But the differing contexts of developed and developing communities will lead to different sets and ranges of policies. There is a continuum of needs, resources and possible responses that will set out a context for policy-making. These varying levels of needs and resources exist in most countries around the world. In Canada, for example, there are schools that serve affluent urban neighbourhoods as well as schools situated in isolated villages and communities that lack many basic resources.

d) School Health Policy is a Shared Responsibility for Governments, Agencies and Schools

This section emphasizes that school health policy and programs are a shared responsibility among several sectors. The lack of clarity about the shared and overlapping roles of the health, education and other sectors is a major challenge in school health policy-making.

e) Schools are not the only authority that adopt School Health Policies

School health policies are adopted not only by schools and school boards, but also by national government departments, state/provincial ministries and local education and health authorities, health clinics, social service agencies, municipalities, recreation departments, police departments, employment/training agencies and other agencies with a public mandate. This includes voluntary health or social agencies acting under contract with governments.

For the most part within this paper, policy-making is seen as something that happens within mandated, publicly accountable systems comprised on ministries, local agencies and schools or health clinics/centres, not only within individual school buildings. Consequently, ministries and local agencies should set the stage through their own policies and thereby encourage policies at the school level.


The need for multi-level policies is very important in most school and health systems where the government decision-making is often shared with semi-autonomous local agencies and where day-to-day is often delegated to the school and local professional level.

f) Shared and interdependent roles of schools and agencies in school health promotion

The table below describes a realistic role for schools and for health agencies in promoting the health of students and staff. These roles should be considered in the development of each specific school health policy addressing health and social problems and in defining school, school board and education ministry roles in respect to the elements of a comprehensive approach to school health promotion and as well as an over-arching policy that requires such as comprehensive approach.

This sharing of responsibility between the school and external agencies will be a constant challenge for decision-makers faced with scarce resources. Experience suggests that there will be a constant negotiation of the overlaps between the essential roles described here. Consequently, whenever it is possible to establish written, explicit and well-understood role definitions based on this general description, this opportunity should be acted upon by stating such in policies on specific topics.

Shared Roles in School Health Promotion, Safety and Social Development

The Roles of the Education Sector
The Roles of Health and other Sectors

Responding as Part of the Community: Schools must be part of community-wide strategies to prevent or reduce the impact of health and social problems facing young people. Schools also employ a significant proportion of the work force in most countries. However, schools cannot be a substitute for actions, programs or services that should be taken on by other agencies, communities or parents.

Instructing Students: The instructional role should be a primary focus for schools in responding to health and school problems. It is more effective and more efficient for schools to establish a mandatory, comprehensive health curriculum that covers all of the health and social problems confronting youth.

Training teachers Developing teacher skills in the various strategies such as cooperative learning and active learning, school systems can ensure the best possible teaching.

Involving Parents Designing home-based learning activities to support classroom learning. Also parent education and support programs as well as mobilizing parent advocate on health issues are appropriate roles for educators at all levels.

Creating a Healthy School Climate Peer helper programs, student leadership activities, school discipline rule, the mission and philosophy of schools can all create a positive school climate. Ensuring a Healthy Physical Environment Ministries, school boards and schools should ensure that their school facilities, equipment and grounds are safe and healthy. This includes a variety of specific actions, including sanitation, air and water quality, control and prevention of infectious disease, emergency procedures, staff training in life-saving and first aid provisions among others.

Providing Some Services Guidance services should address several problems of the youth. Other school-based student services need to be coordinated with health or social services provided by others.

Advocating or Negotiating for Other Services School leaders need to advocate and negotiate for the services needed by children and families. Use Public and private requests, studies and meetings to focus attention on this role of other agencies.

Ensuring a Healthy Workplace School systems should be active in promoting the health of teachers, administrators and other employees.

Supporting Community Programs Schools can support community programs and initiatives by offering space in buildings, helping to recruit students and parents and taking part in their campaigns and programs.
Creating an Overall Community Effort Health, social service, municipal and other agencies and their respective ministries and professionals need to create, maintain and coordinate multi-level, community-wide strategies to prevent or reduce the impact of health and social problems facing young people. As part of that mandate publicly funded and voluntary agencies have a responsibility to work with, assist and support schools through a variety of ongoing school-based or school-linked programs and services that are sustained and sensitive to the academic, vocational, custodial and other roles of the school in society.

Instructing Students Health ministries, agencies and professionals should support the instructional role of educators through expert advice, the development and dissemination of educational resources and direct assistance to teachers. Recognizing that a comprehensive curriculum covering all health issues is more effective, the health sector should develop materials that integrate responses to specific health issues within a holistic view of the child rather than constantly creating disease specific programs.

Training of Health and Other Agency Staff Developing teacher knowledge and awareness about health and specific health and social problems is part of the health sector mandate. However, health and other agencies also need to ensure that their staff who are assigned to work with schools have adequate knowledge about child and adolescent development, educational and organizational change as well as techniques to promote cooperation and coordination.

Involving Parents Local agencies can encourage and support schools to involve parents in their children’s health education as well as support schools in providing parent education, training and information sessions. Parent resource centres that coordinated with school programs are effective and efficient.

Creating a Healthy School Climate Peer helper programs, student leadership activities, school discipline rules, the mission and philosophy of schools can all create a positive school climate. Local agencies can work with school staff to encourage student engagement in such activities as well their involvement in decision-making within schools. As well, agencies can ensure that youth voices are represented in decision-making about agency youth programs and policies.

Monitoring and Assisting the School Physical Environment Public health inspectors, nutritionists, police officers and others need to include schools as part of their mandate to ensure basic public health and safety.

Providing Preventive Health Services and Ensuring Referral and Follow-up from Treatment Services Health, social service, municipal and other publicly funded agencies have a responsibility to provide preventive health and social service to children, youth and their families. The school provides a cost-effective site within the community to deliver many of those services. Further, public health and other agencies mandated to provide community coordination services should also have policies and procedures to ensure that school staff can refer students to treatment services and receive adequate feedback about subsequent school support for rehabilitation of those students back into regular schooling.

Advocating or Negotiating for School Health Programs and Resources Agency staff and health professionals have a responsibility to advocate for and promote adequate policies, programs and resources within education systems to address the health and social needs of children and youth.

Ensuring a Healthy Workplace Health, social and other agencies should work with school systems to promote the health of teachers, administrators and other employees in the education sector and thereby reach a significant proportion of the workforce..

Including Schools within Community Programs Agencies can ensure that schools are an essential part of community-wide programs and initiatives by involving them in program planning, policy development and evaluation of such initiatives. Agencies and schools should ensure that there is ongoing cooperation between community-based and school-based youth programs so that they do not compete for resources or youth participants and that the use of school and community facilities is maximized.

5. Principles and Practical Advice on Policy-making

There are a number of key principles that should be respected when adopting, implementing or evaluating school health policies. Other practical steps that should be included in school health policy-making include ensuring transparency and consistency in all policy-making, having a consistent format, including key common elements in all policy statements and continuously updating the individual policies relevant to the health of students, staff and schools.

a) Key principles

The following principles are suggested as guidelines to be respected in the policy-making process.

ŸPolicy-making should be seen as a springboard for action. The consultation, decision-making and implementation process is equally important to the words that end up on paper, because through the process of consultation and adoption the school personnel, volunteers and community/parents become engaged and committed to the implementation of the policy.

ŸPolicies should be adopted with clear and specific references to the human and financial resources required to implement them. Policies should identify the qualifications and training required for their implementation. Any changes in job descriptions or professional roles should be the subject of consultations or negotiations with relevant associations or unions.

The policy-making process should be cyclical in nature, including adequate provisions to identify emerging health issues, appropriate consultations and surveys, transparency in public decision-making, stipulated reporting procedures and evaluation criteria and opportunities to review and enhance the written policies.

Policy development should include staff representation, parental involvement, youth involvement and representation from appropriate health and social agencies or professions.

Wherever possible, policies should be based upon and should refer to available scientific evidence supporting the proposed interventions. However, experience and common sense are also good guides to effective policy-making, so decision-makers should not always wait for the research evidence to accumulate before acting.

School Health Policies should be comprehensive in nature and encourage coordinated interventions that include instructional, environmental and services elements. For example, a school tobacco policy would include no smoking rules and enforcement steps, critical outcomes for curriculum and instruction, minimum instructional time, adequate guaranteed access to information, adequate access to cessation services, encouraging student peer helper programs, stipulating procedures for parental involvement etc.

School Health Policies need to be coordinated between schools and various agencies. For example, the enforcement of a smoke-free policy in schools is going to be more difficult if students just go off school property to smoke and there is no agreement among education, health, municipal and police authorities as to who will enforce the rules when they are off school property.

b) Transparency and Consistency

Policy and policy-making should be open and transparent through the methods used by decision-makers such as :
§ adoption and evaluation of the policies in open, well-publicized forums,
§ open and convenient access to policy manuals, reports and evaluations,
§ explicit references to national, state/provincial or local laws, regulations and by-laws
§ explicit consultation, adoption and evaluation procedures.

The ongoing involvement of students, parents, staff, agencies and other stakeholders from the community should be built into the decision-making process at each of the stages of the policy-making cycle. This includes active consultations and surveys to identify issues, broad-based consultations to frame the issues, formal and informal consultation in the adoption stages, active involvement and feedback during implementation and surveys, meetings and other means being used to evaluate the impact of the policy.

c) Suggested Elements of School Health and Other Policies

The formats of policies will vary among jurisdictions and authorities but they should be addressing these elements in one way or another:

Comprehensiveness and Coordinated Policy
  • How does the new policy relate to existing policies of the organization? Which, if any, of these policies need to be revised or updated if this issue is addressed?
  • How does the new policy relate to government guidelines, laws or regulations?
  • How does the organization view the issue/problem being addressed? How will addressing this issue impact the health and learning of students, staff and the community? What approach will the organization take in addressing the issue?
  • How does this approach relate to the mission and priorities of the organization? How does this issue relate to the mission and mandates of other organizations? Will their cooperation be sought as part of this policy?
Instruction
  • Will there be modifications to the instructional program of students as a result of this policy? What are they? Will there be specialized instructional programs for specific types of students?
  • What are the expected learning outcomes and the related new standards of practice for teachers and others?” Will there be new criteria for authorizing or recommending teaching/learning materials? Will there be new training or qualifications required for teachers?
Environment
  • Will there need to be changes to the physical environment or resources of the school?
  • Will the organization require or fund programs to influence the social environment of the school on this issue (peer, parent, community involvement, rules, procedures)?
Services
  • Will there be new or re-allocated preventive or referral services in or near the school?
  • Will there be specialized early identification/screening, referral, treatment, re-integration services required for student, staff or families?
  • Will the role, training and qualifications of student services, health services or other personnel be changed?
Communication/Adoption/Evaluation
  • Will the organization consult with an advisory committee in developing, implementing and evaluating the policy?
  • Will the policy include a timetable for implementation and reporting?
  • What are the criteria for successful implementation and for the success of the policy impacts?
  • How will the policy be communicated to students, parents, staff and the community?
  • Which employees will be responsible for implementing the policy? Do they need additional time, training or authority?
d) Conduct an Active Policy Review instead of simply editing a Policy Manual

d) Conduct an Active Policy Review instead of simply editing a Policy Manual


Most large organizations already have a policy manual, so the idea of reviewing policies on a regular basis is not new. However, this review of existing policies should be done with interactions with the stakeholders rather than a review simply by organizational staff.

The practical criteria for undertaking a review of existing polices shown here is an example of such a review process. (This example is taken from the state of Queensland, Australia.

The process of policy review should have a regular place on the agendas of decision-makers and should be organized systematically as well as in anticipation of emerging issues.

There does not need to be a lock-step, chronological approach. Organizations can include policy reviews as part of their annual strategic planning sessions. By anticipating issues in advance and by planning a policy review as part of the process, the exercise becomes more meaningful and effective.

It is recommended that schools, school boards, health authorities and governments authorize their respective School Health Advisory Committees and Policy Committees to build and coordinate a broad range of policies that relate to the health of students/staff and school health promotion.

The first step would be to use this paper to do an assessment and inventory of current policies that relate to health promoting schools. This can be done by examining the policies of government ministries and departments, relevant laws, operating plans and budgets, policy papers and declarations, school, school board and local agency policies.

It should be noted that many forms of policy do exist and these documents are all sources for such policy materials. It should also be noted that often local agencies or schools do not develop explicit policy statements because they are already covered by supervisory bodies, or are explicit and understood in various declarations, policy papers or annual plans. There is no need to create new policy statements unless the issue (not the existing document) requires a review.



Policy Review Checklist

Name of Policy: ______________________________________


YesNo
Does the policy provide some background information or rationale explaining why the policy was adopted and the nature of the problem or goal being addressed?

Does the policy clearly state its intended outcomes in terms of student behaviours/achievement, staff conduct as well as its goals and objectives?

Is the policy stated in language that all members of the school community can understand?

Does the policy use and explain appropriate terms and concepts?

Are the related regulations and procedures clearly stated and consistent wioth the goals of the policy?

Does the policy describe the intended changes in the following areas where they are relevant to the policy?

a) classroom teachers


b) school principals


c) school-based support and professional personnel


d) external support staff (nurses, social workers, police officers, psychologists)


e) school district staff and administration


f) health authority or other agency staff and administration


g) ministry staff (education, health, others)


Does the policy reflect and meet requited legal obligations?

Is the policy consistent at all levels (federal departments, state ministries, local authorities and agencies, school and professional guidelines)?

Were students, parents, relevant personnel, community and experts involved in developing, adopting and evaluating the policy?

Has the policy been reviewed in the past three years?

Is there a stipulated time/process for reporting on the results of the implementation of the policy?


* Revision of the policy is likely required if three or more answers to the above are negative.

It is not necessary that all policy gaps identified from this list and inventory of existing policies be filled immediately. Indeed, it is better that new or revised policy statements are done when a policy issue emerges in the community or in schools. This will help to ensure that staff, community, parents and decision-makers are engaged in a meaningful process rather than a theoretical exercise.

An artificial, paper-oriented exercise to publish or compile a policy manual does not always lead to good policy. Nevertheless, a process to compile and consolidate policies from a variety of sources can be a good process and should be undertaken. This can be done first by staff, to consolidate existing policies from a variety of sources.

Using that local inventory of existing policies and the list of topics presented in this paper, the School Health Committee and Policy Committee of school boards and health agencies can be given the task of building a broad range of policies that relate to school health. They can start with a consultation among stakeholders to identify the more urgent or more important issues. They can use health and other surveys to document the more urgent health needs of their students and staff. They can review the policy agendas of state/provincial or national authorities to determine or predict policy issues that will come from those directions.

By building a broadly-based range of policies one at a time, by acting in response to real issues emerging in schools or the community or by anticipating policy requests from external organizations and by having the four school health cornerstones in place at the outset, local and government policy-makers can ensure relevance, stability and timeliness to their policy decisions.

6. Strategic Advice about the Policy-making Process

This section introduces and discusses several ideas that will help to make policy-making more strategic and effective.

A 1996 report of the World Health Organization noted that policy issues were at the forefront of the challenges hindering progress in school health promotion at the community and provincial/state level. The need to coordinate, to align the efforts of various agencies and to have overarching policies that integrate various issue-specific strategies and initiatives is still urgent, almost ten years later.

a) Greater Clarity is Needed

The notion of shared and independent responsibilities between schools and other agencies presented earlier in this paper is, unfortunately, often not described in health and education system policy statements. Similarly, although everyone knows that schools and health agencies are usually part of multi-level systems, that realist view is often not reflected in the policy statements.

b) Policy should be an Element of a Comprehensive Approach

A comprehensive approach to school-based and school-linked health promotion includes interventions that address formal instruction, preventive health and other services, a healthy physical environment and changes to the social environment or influences that affect health.

Explicit, written, implemented and evaluated policy is required to guide those multiple interventions in a coherent way and to ensure that those interventions are sustainable and effective.

Further, written policy established by mandated decision-makers ensures that those interventions are coordinated within a comprehensive school-home-community approach, that they are based on the best available research evidence and that they are driven by values and beliefs that favour youth, parent, staff and community development. c) Policy Alone is Often Not Enough
Studies of the behavioural impact of no-smoking policies in schools reported marginal results unless they were accompanied by instruction and cessation services. Bowen et al (1995) studied the impact of school smoking policies on student behaviours. Their national study of American schools examined policies as well as related resources and compliance. They found that there was considerable variation in the nature of the policies, with elementary and secondary schools being significantly different. They also found differences between students and staff. Their review of smoking prevention showed that many of these instructional programs did not teach the necessary psychosocial skills. Enforcement procedures and the availability of cessation programs also varied. They concluded that smoking policies alone would not lead to reductions in tobacco use.

d) Policies Make a Difference

The research evidence is accumulating that appropriate and effective school health policies can have an impact on health behaviours, short term health outputs, learning/academic achievement and social development. Four general examples from the research are cited here.

In England, a major policy decision has been made (and recently renewed) by the education and health ministries to invest in a comprehensive school health policy and program. The National Healthy School Standard has recently been evaluated (Warwick et al, 2004) by using a variety of standardized survey data, objective evaluations from the School Inspection service and other sources of data. The evaluators found that the “healthy schools” developed under this national policy had several promising results over their 3-5 years of efforts, including positive changes in health behaviours such as sexual risk taking, drug use and bullying as wall as less truancy, better attitudes towards school and improved self-esteem.

The English example shows that comprehensive national government policy requiring and encouraging cooperation between the health and education sector can lead to improved health and academic gains.

As well, research also shows that policies on specific interventions such as school-based immunization procedures can also lead to real improvements. In Canada, two provinces, Alberta and Quebec, have made policy decisions to use the school as the primary delivery vehicle for immunization programs after cost-benefit studies (Guay et al, 2003; Sadoway et al, 1990) showed that it cost less per vaccination and that more children were immunized if schools, rather than community clinics or physicians’ offices were used as the primary implementation site. The Guay et al study reported savings of $23.00 per child and a 90% participation rate (compared to a 73% participation rate) in using schools rather than community clinics.

Several studies in developing countries (Agha,. 2003; Eggleston et al , 2000; Martiniuk et al, 2003; Mbizvo, 1997; Rusakaniko et al, 1997) have shown that a policy decision to require or promote sexual health education in schools would have a significant impact on HIV, STI , unwanted pregnancies and overall reproductive health. Similarly, the 1985 American School Health Education Evaluation study showed that if developed countries required and reinforced their health education curricula, that gains would be possible in several aspects of health and behaviours.

e) Understanding the Context is Critical

It is critical that policy-makers understand and act upon the advice, needs, capacities and system capabilities when developing, implementing and evaluating policies.

The needs, norms and natural patterns of the communities, provinces/states and countries will vary significantly and this will have an impact on the policies to be established by education and health authorities.

The views, needs and aspirations of the community need to be understood. The problems being identified in the policy-making process need to be articulated by the community, parents educators, health professionals and youth. The strengths and weaknesses of the community as well as the public systems that serve the community need to be assessed. Formal and informal information and data needs to be gathered in an organized and representative manner.

The capabilities, professional norms and specific political and leadership qualities of the public systems need to be understood and recognized in the policy adoption and policy implementation stages. Realistic decisions about roles, resources, training and the time that is required for the adoption of change all need to be part of the policy considerations.

The evaluation and re-orientation stages of the policy need to return to the community, parents and students for adequate input and feedback.

Each community is different, even within the same state/province or country. However, for the purposes of the discussions and illustrations in this paper, we have tried to provide two basic types of community contexts; developed communities and developing communities.

Most countries, and many states/provinces in the world have both of these types of local communities. So, hopefully, our strategy of illustrating our principles and specific points will be more relevant.

For example, later in this paper we suggest that each authority and each community strive to develop a wide range of policies that relate to school health promotion.

f) Staff development and involvement is the key to implementation

Staff involvement is critical to the success of any policy. As Fullan (1991) three-dimensional model of educational change has noted, changes to “materials” (such as policy statements, curriculum or formal job descriptions) are only one part of educational change or innovation. The other two important parts, namely the “beliefs, attitudes and understanding” of the staff, as well as the gradual change in “practice, skills and behaviours” are equally important. Policy-making is the opportunity to build the necessary support within the other two dimensions. Fullan’s model can be used to describe how the implementation of a school health policy can be properly planned. The plan should include changes in beliefs, attitudes and understandings, changes in practices, behaviours or skills and changes in materials or structures.

In his more recent work, Fullan has argued that policy and education change should be tri-level and should come from the top-down, bottom-up and outside-in.

This reflects the work of pioneers in diffusion and dissemination such as Rogers, who advises that the mobilization, adoption, implementation and evolution phases are different and distinct. Policy-making needs to reflect those different stages.

g) Policy is more about process than product

Wallat and Piazza (1991) stress that policy is more than the written product or policy statement. The processes of problem identification, policy formulation, implementation and evaluation are all very significant in determining the impact of a policy.

A team working on parent participation in Tasmania, Australia (Parent Participation Team, 2003) has described some of the complexities of the process of policy-making. Carol Bacchi (1999) argues that specific policy proposals actually construct the nature of the problem they are supposed to be addressing. This perspective goes beyond suggesting that the definition of a problem is an ‘iterative process’, to consider how policy proposals by their nature convey a particular understanding of a problem, an understanding which has all sorts of effects. This approach also recognizes that arriving at policy ‘solutions’ is not a simple matter.

Policies are generally the result of processes of consultation and contestation, and this inevitably involves compromise. Policy documents often hold diverse ideas and implied actions together in some tension. Stephen Ball (1998, p. 127) aptly captures the blend of politics, pragmatics and opportunistic mimesis involved in policy making when he says

“Policy making is inevitably a process of bricolage: a matter of borrowing and copying bits and pieces of ideas from elsewhere, drawing upon and amending locally tried and tested approaches, cannibalising theories, research, trends and fashions and not infrequently flailing around for anything at all that looks as though it might work.”

In addition, significant policy-making almost always occurs in the public arena and is subject to a range of input and media commentary. This inevitably plays out in both wording and strategy: Consequently, policy makers not only must understand the issues, but must then also work to ensure that their community endorses this understanding.

Further, policies are taken up and translated into administrative guidelines and processes, management responses and grass roots interpretation in ways that are far from predictable or universal. In individual schools, policies are incorporated into particular histories, ways of doing things, priorities and understandings by a particular group of staff serving a particular school community. Policies are more often diffracted and refracted, than simply implemented.

A similar list of factors that will influence the policy making process has been identified by the Canadian Association of School Administrators (McCall, 1992). These factors include:
  • Ÿ the existing web of relationships within the organization and external organizations (Hunt, 1990)
  • Ÿ the micro-politics of the school and the relationships within the schools most affected by the policy (Ball, 1987)
  • Ÿ differing political ideologies within the school board or agency (Mitchell, 1980)
  • Ÿ The decision-making process used by school district or school-based administrators (Hannaway & Crowson, 1989)
  • Ÿ relationships with external organizations and groups such as the business community, the media, equity groups etc (Hunt, 1990)
  • Ÿ collective bargaining, contracts and unresolved grievances with employee groups as well as their levels of professionalism (McDonnell, 1990)
  • Ÿ the relationship between the elected school board/agency and the chief executive officer (Odden , 1991)
  • Ÿ the relationship between the school board and the community it serves (Townsend, 1980)
  • Ÿ the relationship between the school board/local agency and government officials (Ovsiew, 1980)

h) Systems-based thinking will set realistic goals

Howell & Brown (1983) argue that systems theory should be used to study school board policy-making. They apply Easton’s model of policy-making that shows how political systems convert “wants” into allocations of resources. Recent research is now explaining how “open”, “loosely-coupled” and “professional bureaucracies “ such as education and health systems are governed by consensus, knowledge transfer and layered approaches to addressing the “concerns” of staff rather than “command and control models of decision-making (Weijck, 1982; McCall et al, 1999; Pidwirny, nd; Graham, 2003). Consequently, well-developed, consensus-driven policies are an even more important tool in school health promotion.

Further, there is increasing interest in how systems can be strengthened to implement school health promotion programs. The developing knowledge about organizational capacity is exemplified in the World Health Organization (2003) Rapid Assessment and Action Planning Program. That set of criteria included
  • Explicit policy and managerial support for coordination of school
  • Adequate staffing/infrastructure at the provincial and local/regional levels
  • Formal and informal mechanisms to support coordination
  • Adequate time/resources to gather, analyze and disseminate knowledge
  • Ongoing and adequate pre-service and inservice activities as well as work place health programs
  • Timely, reliable and usable surveillance ongoing monitoring of the policies, programs, practices
  • Early identification and appropriate management of emerging issues

Policies developed schools, school boards, agencies, health authorities, governments and others should state clearly how these capacities and practices will be addressed and modified as a result of the policies. As well, there should be specific policies stating clearly how these roles and capacities will be managed, implemented and evaluated.

i) Common mistakes/risks in policy-making

There are two risks involved with the preparation of written policy statements. The first is that the statements become so broad and encompassing that it is difficult for people working in the systems to discern what is intended. Sometimes this happens when the people drafting the policy statement become engrossed in understanding the problem and do not stipulate how the various elements of a comprehensive approach will be changed or adjusted to respond to the problem. The policy should state clearly how curriculum or instruction will be changed, which or how preventive health services will be delivered in the school, new procedures for maintaining the physical environment, new reporting requirements for teachers, etc. The policy should be as specific as possible on how the roles or practices of staff, nurses, students, volunteers or others will change as a result of the policy.

The second is that the written document becomes a set of procedures that never address the substance of the issue nor define the outputs to be achieved by the policy. This often happens when the people writing the statement define only the reporting procedure or the process of decision-making while not stipulating the outputs expected on the system. The types of questions that decision-makers need to ask and answer in the policy formulation process are these: What new information or skills will; the students learn, how will parents be involved or informed differently? How will programs and services delivered by agencies be more accessible of more convenient to students?

7. Topics that should be covered by School Health Policies

This section introduces the areas and topics that should be covered by school health policies. There are numerous topics that health, education and other authorities can address. Indeed, policy-making is a process that is never concluded. Even when written policy statements are adopted, they need to be in constant use, revision and updating. In that way, such policies truly become tools for action, reflection and planning rather than duties onto themselves.

Four cornerstones

There are four cornerstones to creating a process that will lead to each authority or agency having an appropriate, broadly-based range of school health policies:
a) having a policy on policy-making to ensure a proper decision-making and review process
b) having a comprehensive policy on health-promoting schools to ensure that health issues are approached with a consistent, coherent approach.
c) developing a series of policies on the elements of a comprehensive approach to school health promotion/ health promoting schools (eg healthy physical environment, health services etc)
d) developing a series of policies on specific health and social problems, behaviours or risk/protective factors.

It is not productive to try to define a minimum set of policies that address items three and four above. Having the first two is critical. Then, gradually building a set of policies on different aspects of school health promotion and different health issues can follow; one by one.

a) Establish policy on policy-making

The first cornerstone, having a policy on policy-making, is likely already in place for most health and education authorities. Having a policy on policy-making such that proper consultations, adoption procedures, implementation steps, evaluation criteria and reporting steps are always part of the policy-making process.

Downey (1988) has underlined the importance of school boards defining a “meta-policy” or policy on policy-making. This meta-policy should stipulate the purposes of the board or agency in developing, approving and implementing policy statements, describe the procedures to be used, the groups to be consulted and the steps that will be taken to evaluate the impact of the policies as well as review their ongoing relevance and appropriateness.

By having a “policy on policy-making” schools and agencies can be consistent with the processes that are used in their policy-making, implementation and evaluation. As well, the evaluation and regular review of these policies will help to keep the content of these policies relevant to current needs.

b) Have a policy to require a comprehensive approach

The second is to create a policy on health-promoting schools or school health. This cornerstone policy should ensure that a comprehensive, systematic approach will be used for each specific issue and that coordinated policies are developed by all relevant health, education and other agencies that work with schools on that issue.

It is highly recommended that schools and agencies develop an over-arching policy about school health promotion that requires that is policies, programs and practices be based on a comprehensive approach that integrates responses to different health and social problems and coordinates interventions, programs and services delivered by the school or other agencies. Section Six of this paper provides examples of such policies requiring a comprehensive approach that have been established at the national, state/provincial, agency and local level.

As part of that comprehensive HPS approach, due consideration should be given to the elements of the approach (such as instruction, health services, social environment, physical environment) as well as the system capacities that need to be in place (such as designated leadership, coordination infrastructure, knowledge transfer , workforce development, surveillance and monitoring)

c) Have policies on the specific elements of a comprehensive HPS approach

The third cornerstone is to gradually build up policy on the various elements of a comprehensive approach. These topics include topics such as health education, health services and a healthy physical and social environment. It is not likely that these topics will be urgent or of a crisis nature, because they are policy solutions rather than policy problems. However, as the more that you are able to define generalizable policies on these topics, the more efficient your policy-making will be on specific health and social problems.

As well, many of these school health policy topics are actually part of other issues and are likely already part of the policy manuals of most agencies. For example, schools and school boards will likely already have policies on parental involvement or student participation. By including them in our list of topics listed here, we are simply noting their health-promoting value and perhaps adapting them slightly to enhance their impact on health.

As we have already noted in this paper, the local context will and should always define the policy activity undertaken by health and education authorities. So, policy-makers should address the priority concerns of their constituencies and students first. There is little or no value in having a process to prepare a policy manual on all of the topics listed in this paper. This would likely be an artificial exercise. Instead, policy-makers should use surveys, research, assessments and consultations to build and constantly re-build the list of policy topics that are of most concern to their communities.

Pursuant to the above discussion, it is suggested here that schools, school boards, health agencies and governments develop policies that describe expectations, resources and evaluation criteria for the elements of a comprehensive approach to school health promotion. These include topics such as health education, health services and a healthy social and physical environment as well as different aspects such as coordination/capacity building, and student, parent or community involvement. These topics include:
Coordinated Policy
Ÿ Systems Capacity, Coordination and Leadership
Ÿ Community role and advisory committee
Environment (Social and Physical)
Ÿ Youth engagement
Ÿ Parent involvement
Ÿ Community and volunteer involvement
Ÿ School discipline, organization, climate
Ÿ Grounds, facilities, buses, buildings
Ÿ Occupational health & safety/staff wellness
Instruction
Ÿ Curriculum and instruction
Health and Other Services
Ÿ Health, social, employment and student services
Ÿ Inter-ministry, agency, disciplinary coordination
Ÿ After school programs
Ÿ Pre-school programs

d) Develop Policies on Specific Health and Social Issues as the Need Arises

The fourth cornerstone is the development of policies on these specific health and social problems. Keeping in mind that policy-making authorities do not need to have policies on all of these topics and their particular aspects (unless they are relevant to the current needs of their communities) these policies can be developed, one by one, over time. If a particular topic becomes urgent, it can simply be moved forward on the policy agenda.

Further, it is suggested here that school, school boards, health agencies and governments can develop policies on at least 25 topics that relate to the health of children and youth. Many of these topics are focused on specific health or social problems and risks such as tobacco use, bullying, or exposure to sun. Others focus on specific behaviours such as physical activity, personal hygiene or healthy eating while other topics address developmental issues such as character education or social development.

The list of topics also includes areas of knowledge that relate to health, including basic health literacy as well as knowledge and skills that enhance personal health, basic knowledge about family life and home economics, personal planning and career education, education about physical movement, skills and recreation and preparation for careers in health.

The list of specific topics includes consideration of a variety of specific sub-populations of children and youth, including those based on gender, ethnicity, ability, chronic health conditions and others. These topics include:
  • Ÿ Tobacco use
  • Ÿ Injury prevention
  • Ÿ Drug, alcohol and other addictions
  • Ÿ Anti-social behaviours/bullying/violence/crime
  • Ÿ Sexual health
  • Ÿ HIV/AIDS
  • Ÿ Personal Hygiene/prevention and control of Parasites
  • Ÿ Nutrition (Healthy diet, food security, food safety, disorders)
  • Ÿ Physical activity/sports/recreation
  • Ÿ Mental health and illness
  • Ÿ Environmental health, allergies
  • Ÿ Exposure to sun
  • Ÿ Basic health literacy, knowledge, beliefs, skills, personal planning
  • Ÿ Family life, parenting and home economics
  • Ÿ Personal and social development, character, citizenship
  • Ÿ Gender equity
  • Ÿ Cultural diversity/human rights
  • Ÿ Oral and Dental Health
  • Ÿ Child Abuse & Neglect/Child Sexual Abuse/Family Violence
  • Ÿ Careers in health/health in society
  • Ÿ Students with chronic health needs/medical conditions
  • Ÿ Health needs of students with disabilities
  • Ÿ Alleviating economic disadvantage and promoting social inclusion
  • Ÿ Occupational health and safety/staff wellness
  • Ÿ Emergency preparedness



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