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Healthy Schools: The Ontario Public Health Association Healthy Schools Workgroup / Ontario Healthy Schools Coalition

I Introduction

There is widespread consensus that schools have the potential to strongly influence the health of children and youth (Shain, Johnston, Dalton and Gauvin-Fleurant, 1998; Steinhauer, 1996; Burgher, Rasmussen and Rivett, 1999; Anderson, Kalnins, Raphael and McCall, 1999). With increasing concerns about fitness, obesity, diabetes, emotional health, violence and risk behaviours in young people, the health promoting school movement provides a timely framework for health promotion action. This article will build on OHPE 96.1, by Barbara Ronson, which provided an overview of the Health Promoting School and Comprehensive School Health models (see 96.1 at and the references at the end of this article for details about the models). It will give an update of activities that have since occurred in Ontario and explain the evolution and actions of the Ontario Public Health Association (OPHA) Healthy Schools Workgroup / Ontario Healthy Schools Coalition (OHSC).

Comprehensive approaches to school-based health promotion are known under a variety of names (such as Comprehensive School Health, Health Promoting Schools, Coordinated/Comprehensive School Health Program, Quality School Health, Healthy Active or Active Healthy School Communities, School Plus and Healthy Schools), but they always have several common core components: instruction; support services; supportive social environment; healthy physical environment; partnerships; active participation of all partners (particularly students and staff) in decision-making; mechanisms and processes to identify and address health-related issues in an ongoing, sustainable way; and overall promotion of a healthy, active lifestyle.

The issue of health promotion in school settings has increased in importance in Ontario since 1999. While we experienced significant progress with the release of a formal Ontario Health and Physical Education Curriculum in 1998-2000, and a tremendous compilation of curriculum support resources (coordinated through the Ontario Physical and Health Education Association {[OPHEA]), there was a dramatic increase in emphasis on math and literacy testing in the province. This resulted in less of a focus on health and physical education in many schools. Simultaneously, a combination of forces in the public health sector resulted in a reduction of public health nurses and other staff working directly in schools (Falk-Rafael, Fox and Bewick, 2001). In many parts of the province these forces included severe budget limitations and down-sizing; expansion of the understanding of health promotion; a movement in public health away from classroom teaching; a movement away from geographic assignments to topic-specific assignments for chronic disease prevention; and tremendous variation in interpretation of the 1989 and 1997 Public Health Branch Mandatory Health Programs and Services Guidelines (MPSG).

Current research highlights the clustering of risk behaviours in individuals, the significant impact of socio-cultural contexts on behaviours, and how comprehensive environmental "whole school" approaches are more effective than educational approaches alone in affecting health attitudes and behaviours (Scales, 1999; Weare, 2000; RNAO, 2002; Ontario PHRED, 1999; Anderson et al., 1999). There is "overwhelming evidence that pupils learn more effectively in all subjects, if they are happy in their work, believe in themselves, like their teachers and feel school is supporting them" (Weare, 2000, p. 5). Weare identifies the four elements crucial to effective schools: supportive relationships, a high degree of participation by staff and pupils, the encouragement of autonomy in staff and pupils and clarity about rules, boundaries and expectations (p. 40). She emphasizes the need to integrate the frameworks and principles of health promotion with those of education (p. 41). Symons, Cinelli, James and Groff (1997) state, "Further evidence suggests that exercise is associated with improved academic outcomes, maintenance of positive interpersonal relationships and reduced incidence of depression, anxiety and fatigue" (p. 224). Healthy students learn better and education level affects lifelong health. Many believe it is time to re-commit to schools as important settings for health promotion and to seriously examine how education, public health and other sectors can optimally contribute to the creation of healthy schools.

II. OPHA Healthy Schools Workgroup / Ontario Healthy Schools Coalition

The OPHA Healthy Schools Workgroup was formed as a result of interest expressed at the 1999 AGM in having OPHA explore the issue of comprehensive approaches to school-based health promotion. The workgroup began meeting in March 2000 with eight core members and twenty more who participated via email. The workgroup built on the tremendous groundwork that had already been done by the Community Health Nurses Initiatives Group of the Registered Nurses Association of Ontario and, subsequently, resolutions were passed at the October 2000 OPHA and CPHA AGM's. These resolutions primarily addressed

* raising awareness within the government and public of the need for comprehensive approaches to school-based health promotion,

* advocating for inter-ministerial policies and funding, and

* inclusion of the concept in the Ontario MPSG, which are currently under revision.

In December 2000, the OPHA Healthy Schools Workgroup merged with the University of Toronto Centre for Health Promotion School Health Interest Group and the Coalition of Ontario Agencies for School Health to form the Ontario Healthy Schools Coalition (OHSC).

The OHSC is an Ontario-wide, broad-based coalition, with members from health units, school boards, hospitals, mental health agencies, universities, health-related organizations, education-related organizations, parents and students. Our vision is that every child and young person in Ontario will have the opportunity to be educated in a "healthy school." A 'healthy school' promotes the physical, mental, social and spiritual health of the whole school community and constantly strengthens its capacity as a healthy setting for living, learning and working. The World Health Organization is spearheading a Global School Health Initiative and many countries have embraced these comprehensive approaches, including 41 European countries, Australia, the United States, and Canada. In Canada, the Canadian Association for School Health and Health Canada are successfully championing this cause in many provinces. The OHSC members feel it is essential that Ontario take steps to make this vision a reality in our province. In partnership with key stakeholders, who have an interest in the health and learning of the children and youth of Ontario, the OHSC will endeavour to

* raise awareness of the benefits of and need for "healthy schools";

* influence policy development and the provision of adequate public funding to guide the implementation of a "healthy schools" approach; and

* provide a forum to share new and ongoing initiatives across health, education and related sectors.

The OHSC now has an email distribution network of approximately 162 people, 45 of who are active members. An average of 18 people have been attending regular monthly meetings, approximately half by teleconference. The meetings serve as a sounding board for presenting and learning about projects and research related to school health across the province. We hear ongoing reports about many initiative, including

* a cross-national study on school health promotion by OISE/UT;

* the combined work of school boards and health departments in innovative regions such as Hastings-Prince Edward County, Durham Region, and many others;

* a school culture research project by the Centre for Addiction and Mental Health (DeWit et al., 2002);

* research in schools on healthy body image by the Hospital for Sick Children;

* the work of OPHEA, including its Active Schools Program and School Community Action Partnerships;

* the work of the Canadian Association for School Health (for which the OHSC serves as the Ontario chapter);

* nutrition programs in schools developed by the Milk Marketing Board;

* injury prevention research in schools by St. Michael's Hospital and Think First Foundation;

* an innovative "Friendship class" program developed by George Hull Centre for Children and Families and Toronto District School Board;

* a "Newmarket Youth Health and Active Living" project; and

* publications about school health in academic journals by our members.

The activities undertaken by the OHSC since its inception in 2000 include

* the submission of briefing notes to government task forces and committees (Interministerial Health and Education Committee, Task Force on Effective Schools, Education Equality Task Force reviewing the Education Funding Formula);

* presentations at conferences (OPHEA, OPHA);

* participation in forums/roundtables (Ontario Teachers Federation "Realizing the Promise of Public Education", National Children's Alliance "Developing a Public Policy Agenda for Children Ages 6 to12");

* the development of terms of reference, a three year plan that includes establishment of a coordinating centre and inservices across Ontario and funding proposals;

* developing and delivering, to leaders in health and education in all three political parties, a presentation explaining the concepts of Comprehensive School Health/Health Promoting Schools, the vision of our coalition and recommendations for action;

* exploration into the development of a "Healthy Schools Ontario" logo; and

* early stage development of a brochure to support continued advocacy.

This year the OHSC drafted and submitted to three political parties a succinct Healthy Schools Ontario proposal that identified the key pieces that need to be put in place in Ontario to enhance schools as health-promoting settings. These were grounded in the experience of the European Network of Health Promoting Schools and the realities of Ontario. The nine key pieces are

* an overarching policy statement;

* a coordinating office;

* coordinating staff in every school board;

* a school profile tool;

* a Healthy School team/committee and coordinator in every school;

* adequate public health staff;

* adequate access to social and other services;

* full implementation of the Health and Physical Education curriculum; and

* full implementation of the Comprehensive School Guidance Program "Choices Into Action."

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III Conclusion

This next year -- an election year -- will be an important one for Ontario. Ontario was the birthplace of the "Ottawa Charter on Health Promotion," and health promotion in school settings has been widely embraced internationally. Other provinces, states and countries have formalized their inter-ministerial support for Comprehensive School Health/Health Promoting Schools. The research evidence linking the physical, mental, emotional and social health of school settings with academic success continues to mount. The Ontario Healthy Schools Coalition supported by the Ontario Public Health Association in collaboration with the Centre for Health Promotion, University of Toronto, invites representatives from all health units, school boards and other committed organizations to join our efforts to secure commitment in this province, so that every child and young person in Ontario will have the opportunity to be educated in a "healthy school." The Ontario Healthy Schools Coalition also welcomes any suggestions regarding action or possible sources of funding.

IV. References

Anderson, A., Kalnins, I., Raphael, D. and McCall, D. (1999). Partners for health: Schools, communities and young people working together. Toronto: University of Toronto. Retrieved from

Burgher, M. S., Rasmussen, V. B., and Rivett, D. (1999). The European Network of Health Promoting Schools: the alliance of education and health. Copenhagen: WHO Regional Office for Europe. Retrieved September 3, 2002 from

DeWit, D. J. et al. (2002). Sense of school membership: A mediating mechanism linking student perception of school culture with academic and behavioural functioning (Baseline Data Report of the School Culture Project). Toronto: Centre for Addiction and Mental Health.

Ontario Public Health Research Education and Development Program (1999). Effectiveness of school-based interventions in reducing adolescent risk behaviour: A systematic review of reviews. Toronto, Ontario: Ministry of Health

Falk-Rafael, A., Fox, J., and Bewick, D. (2001). A survey of nurses in public health: The nature and scope of public health nursing practice in Ontario. International Council of Nurses, 22nd Quadrennial Congress, Copenhagen, Denmark, June 9-15th.

Ontario Ministry of Education. (1999). Choices Into Action: Guidance and Career Education Program Policy for Ontario Elementary and Secondary Schools. Retrieved from

Registered Nurses Association of Ontario. (2002). Enhancing Healthy Adolescent Development. Toronto, Canada: Registered Nurses Association of Ontario.

Ronson, B. (March 19, 1999). The Health Promoting School Movement. OHPE Bulletin 96.1. Retrieved October 10, 2002, from

Scales, P. (1999). Reducing risks and building developmental assets: Essential actions for promoting adolescent health. Journal of School Health, 69 (3), 113-119.

Shain, M., Johnston, M., Dalton, T. and Gauvin-Fleurant, A. (1999). Influences on the health of adolescents at school: In search of the modifiable. Issues in Health Promotion Series

HP-10-0107. Toronto: Centre for Health Promotion at the University of Toronto

Steinhauer, P. D. (1996, August). Toward improved developmental outcomes for Ontario children and youth. Ontario Medical Review, 43-50

Symons, C. W., Cinelli, B., James, T. C. and Groff, P. (1997). Bridging student health risks and academic achievement through comprehensive school health programs. Journal of School Health. 67 (6): 220-227

Weare, K. (2000). Promoting mental, emotional and social health: A whole school approach. London: Routledge.