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.
Harry Rutter is a public health physician. He is a senior clinical research fellow at the London School of Hygiene and Tropical Medicine; senior strategic adviser on obesity to Public Health England; an adjunct professor of public health at University College Cork; and an honorary senior clinical lecturer at the University of Oxford. He was the founder director of the National Obesity Observatory for England 2007-2011, led the development of the English National Child Measurement Programme childhood obesity surveillance system, chaired the NICE Programme Development Group (PDG) for guidance on promoting walking and cycling, was a member of the NICE PDG on preventing obesity and the Department of Health Expert Panel on obesity, sat on the management group of the Foresight Obesity project, and has helped to lead the development of the WHO Europe Health Economic Assessment Tool (WHO HEAT). He is currently involved in research assessing the role of social and environmental factors on both obesity and physical activity, and the research and policy implications of intervening in complex system.
Professor Feder’s expertise includes Cardiovascular health – in particular the diagnosis and management of angina and using cardiovascular risk as a basis of treatment decisions. He was was a co-applicant on our successful bid to secure funding for the Identification and Referral to Improve Safety (IRIS): Improving the response to domestic violence and abuse project and is working with us from his base at the University of Bristol.
Anna is an NIHR funded PhD student evaluating the implementation of a primary care domestic violence training programme. Anna’s work relates to our Identification and Referral to Improve Safety (IRIS): Improving the response to domestic violence and abuse project.
She has an interest in translational research, qualitative methods, gender, health inequalities and participatory approaches to research.
I lead a research team investigating the drivers of long-run improvements in longevity and, particularly, socioeconomic inequalities in morbidity and mortality trends and projections.
Since 2009, my research at UCL has been supported by Legal and General Assurance Society where I am Principal Scientist (Epidemiology) in the Longevity Science Team. Uniquely within the pensions industry, this is a successful example of an embedded industry/academia collaboration to support independent research which is both scientifically novel and of practical relevance to the industry.
Before joining UCL, I was in a senior civil servant at the Office for National Statistics (Deputy Director, Social and Healthcare Analysis); the Chair of Eurostat’s ‘Partnership in Health’ programme; and a Consultant Advisor to the Department of Health’s health survey programme. I began my career as a health analyst at the Department of Primary Care, Imperial College London after completing my PhD in SOAS (University of London).
Based within the Department of Health Services Research and Policy at the London School of Hygiene and Tropical Medicine, I work on a joint Greater London Authority (GLA) and CLAHRC funded project that aims to evaluate the Healthy Schools London (HSL) programme. HSL was established in 2013 with the aim of improving children’s health and well-being. My responsibility using qualitative methodologies is to conduct an evaluation of HSL’s impact, and in an iterative process, inform the further development of HSL to (i) assess the potential for the HSL programme to influence educational achievement, promote healthy lifestyle behaviours, and reduce health inequalities in London, (ii) explore the extent to which becoming a Healthy School is associated with changes in school-level policies, activities, and agenda. This includes key indicators of health-related knowledge, attitudes, and behaviours, (iii) assess the nature and level of engagement with the HSL programme by schools and any differential uptake by socio-economic factors, and to understand the drivers and barriers to becoming a Healthy School.
Caroline has completed a BSc in Psychology at University of Mannheim in Germany and an MSc in Health Psychology at University of Surrey. Throughout her undergraduate degree in Mannheim she worked as a Research Assistant in the Judgement and Decision Making lab. She has experience in both qualitative and quantitative research methodology. Caroline’s research interests include the development of complex interventions, treatment and illness perceptions in chronically ill patients, adherence to treatment as well as behaviour change in general.
NIHR CLAHRC North Thames conducts ground-breaking research that directly impacts the health of patients with long term conditions and the health of the public.