School-based interventions to increase health and wellbeing
The health and wellbeing of school children is a pressing concern in England, with a growing prevalence of obesity and diabetes in childhood. It is also widely recognised that a child’s emotional health and wellbeing influences their cognitive development and learning, as well as their physical and social health and mental wellbeing in adulthood.
These increased concerns, aligned with a better recognition of the emotional and mental health needs of children, led the Greater London Authority (GLA) to develop and co-ordinate a school based health programme to improve health and wellbeing for all pupils in London.
The result was the development of the GLA’s Healthy Schools London programme (HSL) launched in April 2013 and co-ordinated by the Greater London Authority (GLA). The programme encourages schools to adopt a whole school approach to combat the specific health and wellbeing needs of their pupils by developing their policies and procedures. HSL recognises and rewards the schools’ endeavours through a system of awards: Bronze, Silver, and Gold.
A CLAHRC North Thames project recently completed a two-year evaluation of the programme. The aim of the evaluation was to assess the contribution of the programme to improving educational attainment, and health and well-being, among schoolchildren in London. It was funded jointly by the GLA and the CLAHRC, and was conducted between 2014 and 2016 by Dr Harry Rutter and Dr Andrew Barnfield from the London School of Hygiene and Tropical Medicine (LSHTM).
We conducted literature reviews, focus groups in 20 schools, interviews with 6 directors of public health and directors of children’s services, focus groups with borough leads, interviews with the GLA core team and borough leads, and two assessment visits to special schools. We also conducted an online survey across all participating schools, with a total of over 450 responses.
Was HSL effective in its aims?
- Assessed the potential for the HSL programme to influence educational achievement, promote healthy lifestyle behaviours, and reduce health inequalities in London
- Investigated the extent to which becoming a Healthy School is associated with changes in school-level policies, and activities.
- Assessed the nature and level of engagement with the HSL programme by schools, including any differential uptake by socio-economic factors, and to understand the drivers and barriers to becoming a Healthy School
- Provided recommendations to inform the ongoing development of the HSL programme
The evaluation concluded that HSL provides a valuable mechanism to encourage change at school level. Among a suite of recommendations, the evaluation suggested that:
- HSL would be strengthened by encouraging schools to work more closely together.
- A mentoring programme could help to spread best practice between schools,
- There is scope for stronger links between school sand local communities.
- The implementation of a programme to enhance health and wellbeing provision in early year’s settings could provide an additional mechanism for health improvement, and promote school preparedness among the capital’s children.
The London Evening Standard features CLAHRC research in a story on the impact of air pollution on the capital’s younger asthma sufferers.
Our newly published research highlights poor asthma control and knowledge among London secondary school pupils and is referenced in the piece, which also includes contributions from CLAHRC researchers Professor Jonathan Grigg and Kate Harris.
The paper has campaigned extensively on the quality of London’s air, and the health impact on young and developing lungs. Poor asthma control, as highlighted in our work, can make things worse for those already living with respiratory conditions.
Professor Jonathan Grigg, CLAHRC child health theme and Principal Investigator on the study runs a severe asthma clinic at the Royal London hospital, said: “If you have asthma and it is not well-controlled, you are going to be more likely to suffer from these days of high pollution.If you have poor control, you run a risk of having a severe episode. The number of children who die is very small, but we are not really treating asthma as seriously as we should. In other countries, they say, ‘If you have got asthma, make sure you take your medication on the next few days’. That is what I would do. I would say, ‘There is an air pollution event. Make sure you take it.’ ”
Another researcher on the project Katherine Harris was quoted in the ES story, saying it was the first childhood asthma study carried out in schools: “We know from previous work about asthma in children that there were high levels of hospitalisation and asthma-related deaths were higher than Europe.One reason could be due to poor levels of asthma control in children. What we concluded is that there is a prevalence of poor control in children. There are also low levels of knowledge. A lot of children don’t understand what their medication does or how it was helping them.”
Newly published CLAHRC research has revealed that nearly half of secondary school pupils living with asthma have sub-optimal control of their condition and gaps in knowledge around symptoms, triggers and treatments.
The findings, published in the Journal of Asthma, emerged from the results of nearly 800 pupils from across London schools completing questionnaires incorporating the asthma control test (ACT) – a validated tool for assessing control in asthmatic children aged 12 years and older. Using the ACT, we sought to assess asthma control and knowledge in London secondary school children.
Results showed a high prevalence of poor asthma control, poor asthma knowledge, and a high morbidity in London children with asthma.
799 children with doctor-diagnosed asthma completed the questionnaire;
- suboptimal asthma control was reported by 49.6% of students
- over a third (42.4%) prescribed a short-acting β2-agonist inhaler felt uncomfortable using it at school, and 29.2% reported not using this inhaler when wheezy
- 56.4% of those with regular inhaled corticosteroids did not take them as prescribed, and 41.7% did not know what this inhaler was for.
- suboptimal control was associated with a greater proportion of students reporting that they were “somewhat”, “hardly” or “not at all” comfortable using inhalers at school (52.7% vs 29.1 %) and outside school (22.8% vs. 14.8%)
Since suboptimal control by ACT is a risk factor for future severe exacerbations, and should prompt more intense clinical monitoring, our results suggest a need for interventions aimed at addressing poor asthma control in UK schoolchildren.
Read the full paper below
Asthma control in London secondary school children
Katherine Harris , MSc, Gioia Mosler Centre for Genomics and Child Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK , PhD, Samson A. Williams , BSc, Abigail Whitehouse , MBChB, Rosalind Raine , MBBS, PhD & Jonathan Grigg , MD
Journal of Asthma
The Doctors Against Diesel campaign that was launched in December 2016 and has already received widespread media coverage with ongoing interest from the health community, local government and media. The campaign is led by health professionals and is calling for the use of diesel fuels to be banned in urban areas and progressively phased out elsewhere. On February 22nd the CLAHRC’s Professor Jonathan Grigg led a workshop of nurses, doctors and allied health professionals to formulate health messaging and decide next steps in the campaign to reduce diesel use.
CLAHRC Deputy Director and Child Health Theme Lead Professor Jonathan Grigg is a prominent member of the campaign group and co-author of the Royal Colleges Report Every Breath We Take. Professor Grigg is a practising paediatrician with experitse in respiratory health, seeing first hand how pollution damages young and developing lungs. He also leads our School Asthma project which aims to improve management of the condition among children and young people.
Diesel engines are the single biggest source of nitrogen dioxide, which accounts for the vast majority of breaches of legal air pollution limits in the UK. Exposure to pollution can impact children and young people’s current and future health as strong evidence suggest it impairs lung growth in children.
Our Asthma Schools project is investigating asthma control among young people in schools and developing interventions to help them manage the condition better.
The project worked with Greenwich and Lewisham Young People’s Theatre (GLYPT) to produce a short film – Breaking the Jump – about the importance of asthma awareness among young people. It carries an important message for all young people living with the condition.
The film was shot at the LEAP Parkour Park in Westminster, London.
Children and young people are a key population for everyone working in the NHS and Public Health. Involving them in commissioning and designing services makes for more appropriate care that’s more likely to be taken up by those who need it
Our ground-breaking diabetes project worked with young people impacted by the condition in east London – we trained young co-inquirers in research skills so they could run community engagement events and analyse feedback on how to improve local diabetes services.
Our work was integral in shaping new NHS “how to” guidance to help commissioners and providers think through and develop youth forums to support person-centred commissioning of children and young people in health and care services.
The ‘how to guide’ is a recipient of the NHS England’s Celebrating Participation in Healthcare grant award scheme and has been authored by the University of East London (UEL)
Professor Jonathan Grigg is one of the UK’s top paediatricians and an international leader in paediatric respiratory research. Since 2003, he has obtained over £11M in research grants as PI and co-applicant from MRC, NIHR, DH and charities. These funds supported air pollution and asthma research with national and international impact. He is the lead paediatrician for government advice on air pollution and children’s health as a member of the Committee on the Medical Effects of Air Pollution, and provides ad hoc advice on respiratory toxicity to the Committee on Carcinogens. He co-chairs the Royal College of Physicians Committee into “air pollution throughout the life course”. In leading the national paediatric research agenda, he organises all paediatric input into British Thoracic Society’s meetings, and as elected secretary to the Royal College Paediatrics and Child Health’s Academic Board, organises its Annual Meeting. He develops national research priorities in paediatric respiratory medicine as Chair of the British Paediatric Respiratory Society, ex chair and, now member, of the Clinical Study Group (Respiratory) for the Medicines for Children network, NIHR Programme Grant Experts Panel. He leads on paediatric respiratory infection and immunology as elected chair of this group in the European Respiratory Society. Nationally, he evaluates the cost effectiveness of therapies, as the paediatric lead of NICE Appraisal Panel A, and is an RCPCH-appointed expert adviser on asthma therapies to other appraisal panels. Locally, he leads on paediatric non-medicines research in NE London as regional LCRN representative to the national committee, and supports academic training as the RCPCH regional academic advisor.
Professor Monica Lakhanpaul leads a multi-disciplinary translational research group at UCL, that focuses on Health Services Research which has direct impact on health policy and clinical practice. Her research program aims to take a multi-disciplinary, integrated and collaborative approach to improving outcomes for children. Her research also aims to transform services for patients.
Professor Lakhanpaul’s research focuses on the translation of evidence into clinical practice and health policy, drawing together education, primary and secondary research to improve health outcomes for children. Her research crosses primary, community and hospital care, social care and education.
Professor Lakhanpaul’s research falls under four main themes; Applied Translation of Evidence In to Policy and Practice (through systematic review, guideline development, decision and prediction rule development), Improvement Science (with a particular focus on partnership production with parents, patients and health professionals; co-production with communities to develop tailored health interventions: MIA study), Conditions (with a specific interest in respiratory illness; asthma, and the acutely sick child) and Inequalities in Health (tailoring interventions for hard to reach groups, health tourism and the use of translators and interpreters to reduce inequalities).