synthesis essay on comprehensive school health and safety

• Comprehensive School Health

Comprehensive school health is an internationally recognized approach to supporting improvements in students’ educational outcomes while addressing school health in a planned, integrated and holistic way.

What is Comprehensive School Health?

Comprehensive school health  is an internationally recognized approach to supporting improvements in students’ educational outcomes while addressing school health in a planned, integrated and holistic way.

This whole-school model builds capacity to incorporate well-being as an essential aspect of student achievement. Actions address four distinct but inter-related components that comprise a comprehensive school health approach:

• social and physical environment
• teaching and learning
• partnerships and services.

When actions in all four components are harmonized, students are supported to realize their full potential as learners – and as healthy, productive members of society.

• Click here to download the Introduction to School Health – JCSH Summary (2006)
• Click here to download the Comprehensive School Health Framework 2-pager in PDF Format (2008/2016)
• Click here to download the Comprehensive School Health Framework Image Only

Why Do We Need Comprehensive School Health?

Health and education are interdependent: healthy students are better learners, and better-educated individuals are healthier. Research has shown that comprehensive school health is an effective way to enhance that linkage, improving both health 1  and educational outcomes 2  and encouraging healthy behaviours that last a lifetime.

In the classroom, comprehensive school health facilitates improved academic achievement and can lead to fewer behavioural problems 3 . In the broader school environment, it helps students develop the skills they need to be physically and emotionally healthy for life.

Comprehensive School Health:

• Recognizes that healthy students learn better and achieve more
• Understands that schools can directly influence students’ health and behaviours
• Encourages healthy lifestyle choices, and promotes students’ health and wellbeing
• Incorporates health into all aspects of school and learning
• Links health and education issues and systems
• Needs the participation and support of families and the community at large

Comprehensive School Health in Canada

Effective, sustainable progress in comprehensive school health depends on a common vision, shared responsibilities and harmonized actions among health, education and other sectors. The challenge is to coordinate these efforts so that partners pool resources and develop action plans together, with, and in support of schools.

In Canada, the Pan-Canadian Joint Consortium for School Health models, supports, and encourages the partnerships between health and education that are essential to comprehensive school health.

Different Terminology, Same Ideas

The term comprehensive school health is widely used in Canada. In other jurisdictions, the approach may be known as health promoting school and its components may be expressed in different ways. However, the underlying concepts are the same; they are all based on the World Health Organization’s Ottawa Charter for Health Promotion (1986).

• Click here to download the Healthy School Communities Concept Paper  (2012)

1  Stewart-Brown, S. (2006). What is the evidence on school health promotion in improving health or preventing disease and, specifically, what is the effectiveness of the health promoting schools approach? Copenhagen, WHO Regional Office for Europe (Health Evidence Network report;  http://www.euro.who.int/document/e88185.pdf , accessed 16 Sep. 2008).

2  Murray, N.D., Low, B.J., Hollis, C., Cross, A. Davis, S. (2007). Coordinated school health programs and academic achievement: a systematic review of the literature. Journal of School Health, 77 (9), 589-599.

Systems Capacity and Change

Key Organizational Capacities for Sustaining Comprehensive Approaches to Health Promoting Schools

In recent years, school health proponents, program planners, and policy-makers have recognized the need for a more systematic and policy-oriented approach to comprehensive school health.

Although there is little definitive research on effective implementation of a comprehensive integrated school health program, there is considerable evidence supporting the effectiveness of action in specific issue areas. Using a comprehensive approach has the potential to significantly expand on these successes. However, this approach is also complex and difficult to implement and sustain in a meaningful way.

Success rests on sharing a common vision and goals and developing school programs that address the common determinants of health and academic outcomes. Lawrence St. Leger and Don Nutbeam suggest an increasing coincidence of school-related outcomes, school-based intervention, and inputs such as curriculum, professional development, policy, and organizational practicies that affect both the education and health outcomes of students. They provide a map that is useful for joint school health planning and implementation, one where there can be agreement on the actions to take and the reasons for these actions.

To sustain implementation of comprehensive approaches, many countries and state/provinces are focusing on policy, coordination, and strengthening the organizational capacities of school, public health and other systems to institutionalize internal and external relationships, responsibilities, and accountabilities for school health promotion. The following key capacities have been identified from a review of several national school health policies, a World Health Organization guide, reviews of literature on interagency coordination, and interview with key informants in several countries.

Key Capacities

Coordinated policies  on school health, health issues and the elements of school health promotion are sometimes played out in local or provincial/territorial interagency agreements that may include financing, administration and organization. These explicit, comprehensive policy and managerial supports for inter-ministry, interagency and inter-disciplinary coordination and cooperation should include procedures in policy-making, program planning, and budget preparation to align responses to health and social issues undertaken through and with the school systems. As well, an overarching policy should favour inter-sectoral approaches and it should be reflected in guidance and directives to school, public health, police, social service and other local authorities and agencies.

Mechanisms for coordination  and cooperation, both formal and informal, help to manage the implementation process, avoid confusion, and capitalize on synergistic action. Mechanisms may include joint committees, job descriptions, written policy statements, joint in-service programs, joint planning, shared budget allocations, joint vision development and consensus building.

Assigned staffing and infrastructure , such as provincial/territorial and district school health coordinators, help to facilitate and support interdisciplinary coordination and cooperation in school health promotion. These staff assignments should include time for actively supporting voluntary cooperation and alignment of activities, programs, polices and practices. They should be based on explicit intergovernmental, inter-ministry, inter-agency and inter-disciplinary agreements and should ensure that the voices of youth, parents, professionals and volunteers are heard in the decision-making about policies and programs.

Continuous workforce development  ensures ongoing development for teachers, administrators as well as public health professionals. It includes explicit and sustained programs and processes to develop ministry and local agency workforces, through studies of current professional practices, guidance and support for the development of university and college pre-service preparation programs, and development of guidelines, models and materials for sustained staff development programs.

Knowledge transfer and exchange  within and across systems, includes mechanisms and processes to sharing evidence as well as local solutions and ideas for implementation, funding and evaluation with decision-makers and practitioners to describe lessons learned and promote promising practices. This would included evidence-based knowledge summaries published by a variety of sources, guidelines for policy, programs and practice from provincial, territorial and professional sources and tools and models that enable decision-makers and practitioners to reflect on their situation and their practice and to locate materials and models that can be adapted to their circumstance.

Collecting and sharing reliable data  entails the regular and timely collection and communication of data on the health outcomes, social behaviours and related learning of children and youth, and their connectedness to parents, schools and the community. These data are for use in appropriate decision-making and indicators systems and can be gleaned from periodic surveys of local agency policies, programs, and system capacities without implying a supervisory role or identifying survey participants. It is also important to develop explicit and agreed upon procedures and processes to conduct regular scans of health, social, educational environments to identify emerging trends, plan responses, and suggest actions for policymakers and agencies.

Long-term planning and sustained funding  are essential for sustainability. They ensure the continuance of programs that demonstrate effectiveness, based on regular evaluations that shed light on program process, context and outcomes. Financial resources are needed for staff, personnel training, infrastructure changes, coordination, intersectoral participation and dissemination to support continued implementation and school health promotion action and evaluation plans.

1 Lawrence St Leger and Don Nutbeam. 2000. A Model for Mapping Linkages Between Health and Education Agencies to Improve School Health. Journal of School Health. Feb;70(2):45-50.

2 Deschesnes M et al. 2003. Comprehensive approaches to school health promotion: how to achieve broader implementation? Health Promotion International. 18(4):387-396.

3 WHO, Rapid Assessment and Action Planning Process (RAAPP), A Method and Tools to Enable Ministries of Education and Health to Assess and Strengthen their Core Elements of Capacity to Promote Health Through Schools, n.d. See  http://www.who.int/school_youth_health/assessment/raapp/en/index.html

The 4 Components of Comprehensive School Health

There are 4 separate but interconnected components that address comprehensive school health. When actions in all four components are harmonized, students are supported to realize their full potential as learners – and as healthy, productive members of society.

Teaching and Learning

Student-centered learning and teacher training through resources, activities, and provincial/territorial curriculum. Students gain age-appropriate knowledge and experiences, helping to build skills to improve their health, well-being, and learning outcomes.

Resources and activities should include school health policies and guidelines, culturally-relevant contexts, and school community assets.

Social and Physical Environment

The social environment is:

• the quality of the relationships among and between staff and students in the school
• the emotional well-being of students
• influenced by relationships with families and the wider community
• Supportive of the school community in making healthy choices by building competence, autonomy, and connectedness.

The school’s social environment supports the school community in making healthy choices by building competence, autonomy, and connectedness.

The physical environment is:

• the buildings, grounds, play space, and equipment in and surrounding the school
• basic amenities such as sanitation, air cleanliness, and healthy foods
• spaces designed to promote student safety and connectedness and minimize injury
• Safe, accessible, and supportive of healthy choices for all members of the school community.

The physical environment is safe and accessible and supports healthy choices for all members of the school community.

Partnerships and Services

Community – and school – based partnerships and services are essential links for student achievement and the health and well-being of everyone in the school community. They enhance the range of supports and opportunities for students, parents, educators, and others. Examples of partnerships and services are:

• health and education sectors working together
• community organizations supporting school activities, student safety, risk interventions, or curriculum
• donations of product or labour from a company towards the creation of a school garden or lunch program
• contracts with fruit and vegetable growers/distributors for school fundraising initiatives.

The management practices, decision-making processes, rules, procedures, policies, and guidelines at all levels that promote student wellness and achievement, and shape a respectful, welcoming, and caring school environment for all members of the school community.

Comprehensive School Health Core Documents

• WHO Technical Report – Promoting Health Through Schools
• Ottawa Charter for Health Promotion

Provincial Comprehensive School Health Resources

• CSH Four-Pillar Activity
• CSH Knowledge Guide
• Comprehensive School Health Resource for Health Professionals
• Healthy Schools Network

If you would like help finding the resources you need, contact the Joint Consortium for School Health today!

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COMPREHENSIVE SCHOOL HEALTH AND SAFETY

SAFETY FIRST

HYGIENE IS PART OF SAFETY

REFLECTIONS ON COMPREHENSIVE SCHOOL SAFETY

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SAFETY STARTS WITH YOU

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WHO guideline on school health services [Internet]. Geneva: World Health Organization; 2021.

WHO guideline on school health services [Internet].

Web annex c systematic overview of systematic reviews of comprehensive school health services: methodology and select findings.

• Acknowledgements

Drafting of the guideline

Mary Louisa Plummer, Child and Adolescent Health Consultant, United States of America, and David A. Ross, Department of Maternal, Newborn, Child and Adolescent Health and Ageing, WHO headquarters.

GRADE methodologist

Nandi Siegfried, Public Health Medicine Specialist, South Africa.

Steering Group (WHO staff unless otherwise noted)

Coordination.

David Ross and Kid Kohl, Department of Maternal, Newborn, Child and Adolescent Health and Ageing.

Jamela Al-Raiby, WHO Regional Office for the Eastern Mediterranean; Wole Ameyan, Department of Global HIV, Hepatitis and Sexually Transmitted Infections Programmes; Valentina Baltag, Department of Maternal, Newborn, Child and Adolescent Health and Ageing; Faten Ben-Abdelaziz, Department of Health Promotion; Paul Bloem, Department of Immunization, Vaccines and Biologicals; Sonja Caffe, WHO Regional Office for the Americas; Marie Clem Carlos, Department of Noncommunicable Diseases; Shelly Chadha, Department of Noncommunicable Diseases; Venkatraman Chandra-Mouli, Department of Sexual and Reproductive Health and Research; Katrin Engelhardt, Department of Nutrition and Food Safety; Kaia Engesveen, Department of Nutrition and Food Safety; Regina Guthold, Department of Maternal, Newborn, Child and Adolescent Health and Ageing; Joanna Herat, United Nations Educational, Scientific and Cultural Organization (UNESCO); Symplice Mbola Mbassi, WHO Regional Office for Africa; Rajesh Mehta, WHO Regional Office for South-East Asia; Denise Mupfasoni, Department of Control of Neglected Tropical Diseases; Martina Penazzato, Department of Global HIV, Hepatitis and Sexually Transmitted Infections Programmes; Marina Plesons, Department of Sexual and Reproductive Health and Research; Leanne Riley, Department of Noncommunicable Diseases; Chiara Servili, Department of Mental Health and Substance Use; Stéphanie Shendale, Department of Immunization, Vaccines and Biologicals; Marcus Stahlhofer, Department of Maternal, Newborn, Child and Adolescent Health and Ageing; Howard Sobel, WHO Regional Office for the Western Pacific; Martin Weber, WHO Regional Office for Europe; and Juana Willumsen, Department of Health Promotion.

Evidence review and synthesis

Systematic overview of systematic reviews of comprehensive school health services.

Julia Levinson, Kid Kohl, Valentina Baltag and David Ross.

Systematic reviews of the effectiveness and acceptability of comprehensive school health services

Paul Montgomery, University of Birmingham, United Kingdom; Jacoby Patterson, Independent Senior Research Consultant, United Kingdom; and Anders M. Bach-Mortensen, University of Oxford, United Kingdom.

Review of global WHO health service interventions for 5–19-year-olds

Mary Plummer, Kid Kohl and David Ross.

Survey of expert opinion on school health services

Mary Plummer; Ace Chan, Stigma and Resilience Among Vulnerable Youth Centre (SARAVYC), School of Nursing, University of British Columbia, Vancouver, Canada; Kid Kohl; Ashley Taylor (SARAVYC); Elizabeth Saewyc (SARAVYC); and David Ross.

Brief exploratory review of school health services globally

Mary Plummer, Kid Kohl and Valentina Baltag.

Guideline Development Group

Rima Afifi, University of Iowa, United States of America; Habib Benzian, New York University, United States of America; Harriet Birungi, Population Council, Kenya; Rashida Ferrand, Biomedical Research and Training Institute, Zimbabwe; Jorge Gaete, Universidad de los Andes, Chile; Najat Gharbi, Ministry of Health, Morocco; Murthy Gudlavalleti Venkata Satyanarayana, Indian Institute of Public Health, India; Henrica J. M. Fransen, University of Tunis El Manar, Tunisia; Julia Levinson, Boston University, United States of America; Erin D. Maughan, National Association of School Nurses, United States of America; Ella Cecilia Naliponguit, Department of Education, Philippines; Atif Rahman, University of Liverpool, United Kingdom; Elizabeth Saewyc (Chair), University of British Columbia, Canada; Susan Sawyer, University of Melbourne, Australia; Hui-Jing Shi, Fudan University, China; and Sharlen Vigan, World Bank, Togo.

External Review Group

Bruce Dick, Adolescent Health Consultant, Switzerland; Chris Kjolhede, Bassett Health Care Network, United States of America; Regina Lee, Professor of Nursing, University of Newcastle, Australia; Maziko Matemvu, Her Liberty, Malawi; Antony Morgan, Glasgow Caledonian University, United Kingdom; Blanca Pianello Castillo, International Federation of Medical Students’ Associations, Spain.

Financial support

The United Kingdom Department for International Development, the Bill and Melinda Gates Foundation and the United States Agency for International Development.

• Abbreviations

A MeaSurement Tool to Assess systematic Reviews

non-randomized controlled study

Preferred Reporting Items for Systematic reviews and Meta-Analyses

randomized controlled trial

school health services

systematic overview of systematic reviews

A glossary of terms used throught the guidance and its web annexes is provided in the guidance document .

Web Annex C summarizes the methodology and select findings from the systematic overview of systematic reviews (SOSR) of comprehensive school health services (SHS) ( 1 ).

C.1. SOSR methodology

This overview was conducted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) ( 2 ). A protocol was developed a priori that outlined the overview objectives, aims, operational definitions, search strategy, inclusion/exclusion criteria and quality appraisal methods.

C.1.1. Search strategy

PubMed, Web of Science, ERIC, PsycINFO and the Cochrane Library were searched systematically. A detailed search strategy was iteratively developed in consultation with a librarian experienced in systematic reviews and an expert in SHS. The search strategy was developed for PubMed and then adapted for the other four databases. Searches were performed on 15 June 2018. Any existing overviews or systematic reviews of systematic reviews that emerged from the searches were not themselves included, but the systematic reviews within them were extracted and screened. Additionally, reference lists of included articles were scanned for any relevant systematic reviews.

C.1.2. Eligibility criteria

Systematic reviews were included in this overview if at least 50% of the studies within the systematic review fulfilled the following criteria: (a) participants were children (ages 5–9) or adolescents (ages 10–19) enrolled in schools; (b) interventions were within school-based or school-linked health services, involved a health provider and were of any duration or length of follow-up; (c) intervention effectiveness was compared to either no intervention, an alternative intervention, the same intervention in a different setting (not in schools), an active control or a waitlist control; (d) interventions aimed to improve some aspect of health; and (e) study designs were either randomized controlled trials (RCTs), non-randomized controlled studies (NCSs) or other non-randomized intervention studies. There were no date restrictions on publication of included systematic reviews.

In addition to these criteria for included studies, the systematic reviews themselves had to fulfil the following criteria: (a) include the words “systematic review” in the title or abstract; (b) outline inclusion criteria within the methods section; (c) be published in peer-reviewed journals and indexed before 15 June 2018; and (d) be published in the English language. In addition to systematic reviews that did not meet these inclusion criteria, systematic reviews were excluded if the review was superseded by a newer version.

C.1.3. Study selection

Citations identified from the systematic search were uploaded to Covidence systematic review software and duplicates were automatically deleted. Two reviewers screened all titles and abstracts using the inclusion/exclusion criteria and excluded all articles that were definitely ineligible. Articles that received conflicting votes (ineligible versus potentially or probably eligible) were discussed and consensus was reached. The same two reviewers screened the full text of all the potentially or probably eligible articles using a ranked list of the inclusion criteria. Reasons for exclusion were selected from the ranked list. If consensus was not possible during title/abstract or full-text screening, a third reviewer, who had the casting vote, would have been asked to independently screen the article. However, this was never required as consensus was always reached.

C.1.4. Data collection

One reviewer extracted summary data from each selected article using a customized standard form with independent data extraction performed for 15% of included systematic reviews by one of the other reviewers. There was 92% agreement between reviewers for all items within the standard form, with discrepancies only in level of detail. Data items included the research design of the systematic review and primary studies, sample description and setting, intervention characteristics, outcomes, meta-analysis results, quality appraisal and conclusions.

C.1.5. Synthesis of results

Due to the heterogeneity of the systematic reviews included in this overview, it was not possible to perform a meta-analysis. Outcome measures were collected from included studies.

C.1.6. Risk of bias

Risk of bias across systematic reviews was determined using Ballard and Montgomery’s four-item checklist for overviews of systematic reviews ( 3 ). These items include: (1) overlap (see below), (2) rating of confidence from the checklist for AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews 2) ( 4 ), (3) date of publication and (4) match between the scope of the included systematic reviews and the overview itself.

C.2. Select SOSR findings

Interventions with evidence for effectiveness addressed autism, depression, anxiety, obesity, dental caries, visual acuity, asthma and sleep ( Table C.1 ). No review evaluated the effectiveness of a comprehensive SHS intervention addressing multiple health areas. Strongest evidence supports implementation of anxiety prevention programmes, indicated asthma education and vision screening with provision of free spectacles.

Table C.1 Findings from systematic overview of systematic reviews of comprehensive SHS

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Statistically significant result.

BDI: Beck Depression Inventory. BMI: body mass index. CI: confidence interval. MD: mean difference. NA: no meta-analysis performed. ODD: oppositional defiant disorder. PF: prevented fraction. PRP: Penn Resiliency Program. RR: risk ratio. SAD: separation anxiety disorder. SMD: standardized mean difference. STI: sexually transmitted infection.

C.3. SOSR conclusions

This SOSR presents multiple effective interventions that may be offered as a part of SHS delivered by a health provider. However, it is difficult to formulate an overarching answer about the effectiveness of SHS for improving the health of school-age children and adolescents due to the heterogeneity of systematic reviews found and the evident gaps in the systematic review literature. More than half of included systematic reviews analysed mental health and oral health interventions and no systematic reviews were found that assessed some other relevant health areas, such as vaccinations, communicable diseases and injuries. Further, no systematic reviews evaluated comprehensive SHS. In order for policy-makers and leaders in school health to make evidence-based recommendations on which services should be available in schools, who should deliver them and how they should be delivered, more systematic reviews must be done. These systematic reviews must assess routine, comprehensive SHS and the characteristics that make them effective, with special attention to content, quality, intensity, method of delivery and cost.

References 1

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• Cite this Page WHO guideline on school health services [Internet]. Geneva: World Health Organization; 2021. Web Annex C, Systematic overview of systematic reviews of comprehensive school health services: methodology and select findings.
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Comprehensive school safety (CSS) policy case study: Protecting children in emergencies by law in the Philippines

With a high natural hazard risk and lack of comprehensive policy addressing the wellbeing of children in emergencies, Philippines developed a comprehensive policy of supporting the security and well-being of children in emergencies and enacted the Children's Emergency Relief and Protection Act, so as to support the physical and psychological health of children in emergency situations.

This case study is part of a series of case studies documenting how countries have been developing and implementing Comprehensive School Safety (CSS) policies that address the three CSS pillars: safer learning facilities (pillar 1), school disaster management (pillar 2), and risk reduction and resilience education (pillar 3).

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• Comprehensive school safety policy: Case studies
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Rethinking School Safety

Comprehensive school safety planning & development.

What do we mean when we say comprehensive school safety? Comprehensive school safety refers to preparedness strategies which address all hazards. Schools must consider all areas of school safety relevant to their site and community and remember to include representatives from each stakeholder group when creating a fully developed safety plan.

Mental & Behavioral Health

Strong mental and behavioral health resources and programs are critical to a safe school environment. Learn more about how community and school-based mental health providers, multi-disciplinary threat assessment teams, and mental & behavioral health resources can help ensure and enhance your school’s safety.

Featured Resources: National Association of School Psychologists  |  Suicide Prevention Resource Center  |  Substance Abuse and Mental Health Services Administration  |  StopBullying.gov

Health & Wellness

From allergy care to trauma care, to spotting signs of abuse or neglect, to promoting healthy nutrition and physical activity, to stress management and self care, promoting the health and wellness of our school community can help us build healthier, safer, and more successful learning environments.

Featured Resources: National Association of School Nurses  |  CDC Healthy Schools  |  World Health Organization | U.S. Department of Health and Human Services | National Institutes of Health

Physical Safety & Security

Ensuring physical safety and security requires knowledge of building use, infrastructure & design, safety & security,  impacts of weather & natural disaster, and the tools & technology available to help us. Learn more about creating naturally protective buildings and campuses to ensure the safety of your school community.

Featured Resources:  Crime Prevention Through Environmental Design  |  National Center on Safe Supportive Learning Environments | Partner Alliance for Safer Schools

Culture, Climate & Community

Creating a safe and welcoming environment is essential to the safety and success of a school community. Explore resources and programs that foster understanding, build relationships, and strengthen your school’s culture, climate & community engagement.

Featured Resources: Choose Love Movement |   Final Report of the Federal Commission on School Safety  |  National Center on Safe Supportive Learning Environments

Leadership, Law & Policy

Maintaining school safety includes adhering to federal, state and local laws and regulations. In this section, explore resources to help your school community stay current and compliant with codes and laws such as FERPA, ADA, fire, and IDEA, and plan for the continual costs associated with keeping current for safety.

Featured Resources: FERPA  |  School Safety Law Blog  |  Lock Don’t Block  |  Americans with Disabilities Act | PASS Safety and Security Guidelines |  National Fire Protection Association

Operations & Emergency Management

The policies, protocols, and practices that support safety in day-to-day activity through times of crisis are the cornerstones of school safety. From bus safety to reunification, and prevention through recovery, learn more about how strong operations and emergency management build a safer school community.

Featured Resource:  NFPA 3000™  |  FEMA PrepTalks: Rethinking School Safety  |  National Association of School Resource Officers  |  The Standard Response Protocol & The Standard Reunification Method

In order for you to be an effective safety leader in your school community, you must understand all the areas encompassing school safety. Rethink school safety by using the comprehensive school safety model to help you assess, plan and develop, and audit safety solutions.

Keep our Framework for Comprehensive School Safety Planning & Development in mind as you use our Straight-A Safety Toolkits to Assess, Act  and  Audit  your school safety plans.

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