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The purpose of this paper is to summarize a consensus statement generated on the current challenges, strategies, and potential of health promoting schools (HPS) at a 2011 colloquium at the Stellenbosch Institute for Advanced Study where 40 people from five continents came together to share their global and regional experience surrounding the World Health Organization (WHO) HPS model.

Using the consensus as its foundation, this review summarizes the underlying educational and social science concepts and factors that contribute to success or failure of HPS, and incorporates peer reviewed papers based on invited presentations at the colloquium and key related literature.

HPS increase knowledge and develop behaviors that benefit the health of children, such schools are also an investment in the well-being of the larger community. Importantly for their long-term psychological health “resilience” is generated by effective HPS programs. Professional development initiatives within schools can catalyze greater absorption of the healthy school approach and focus on best practices. Promotion, support, and evaluation of programs are aided by award schemes and oversight by local or national agencies. And significant educational benefits are accrued for trainees from centers of higher learning involved in HPS program delivery.

Educational initiatives that utilize the relative simplicity, low cost, and inherent flexibility of the HPS model can address many significant issues facing today's children. HPS offer an innovative and participatory way to increase the likelihood of the next generation becoming aware of practical ways to positively influence their lifestyle and future well-being. Successful programs are usually those that are relevant, resonate with students, and engage school communities so that they choose to “own” and sustain their program.

The consensus statement provides a benchmark of the current status of HPS, and outlines future directions for this model of health promotion.

The purpose of this paper is to explain the rationale and potential for the WHO health promoting schools (HPS) to improve children ' s oral health, and describe validated quantitative methodologies and qualitative approaches to measure program impact.

Critical discussion of the impact of poor oral health and potential for school-based educational intervention, and evaluation methodologies used by the authors.

Using HPS to improve oral health is relevant because dental caries and gingivitis/periodontitis negatively impact children ' s health and quality of life worldwide. WHO has called for effective community-based oral health promotion programs; intervention is simple and low cost; robust evaluation measures exist – the decayed missing filled teeth index and change in cavity rate allow quantitative comparison of oral health status; and questionnaires document changes in knowledge, practices, diet, health-related quality of life, and pain.

Poor oral health is a major health issue. Established measures to improve oral hygiene offer an achievable, low-cost HPS entry point; the “knowledge” and “healthy practices” components central to the WHO HPS model are tried and tested and multiple potential benefits are documented. Poor oral health is a non-stigmatized issue, hence intervention is readily accepted, and effective evaluation tools provide evidence of program effect over a short (two to three years) timeframe.

Oral health promotion is more affordable and sustainable than the cost of traditional restorative treatments especially in middle- and low-income countries. Success with oral health leads to confidence for expansion of HPS activities to address other health issues relevant to the school community.

The purpose of this paper is to describe the rationale for and potential of World Health Organization (WHO) health promoting schools (HPS) in Africa.

Overview of the related literature and presentations at the 2011 Stellenbosch international colloquium on HPS relating to sub-Saharan Africa.

Schools provide the most efficient and effective way to reach large portions of the population; however, no literature reporting evaluations of HPS from Africa existed ten years ago. The WHO now supports HPS strategies in over 32 African countries, recognizing that the burden of disease, disability and premature death is disproportionately high in the region, and that many of the causes are preventable. Novel applications of the WHO model are increasing; those applicable to Africa include: measures to address the widespread problem of poor oral health, hygiene and nutrition among children; a range of “entry point” activities to initiate HPS with validated evaluation methodology; initiatives centered on gardening relevant for sub-Saharan Africa; opportunities for cross-disciplinary learning opportunities generated by inter-sectoral collaborative HPS programs; and the use of social media and cell phone messaging to deliver health promotion to at-risk teen populations on the continent. Challenges include the need for multi-sectoral collaboration and Ministry leadership, paucity of human resources and stable funding and limited research and evaluation of best practices.

Africa faces significant challenges educating the next generation in the context of health. Strong political action, broad participation and sustained advocacy are required to capitalize on the proven potential of novel initiatives now available to disseminate “knowledge” and “healthy practices” through the WHO HPS model.

Use of HPS offers a flexible and inexpensive avenue of relevance where guidelines and process exist, and evidence of efficacy in Africa is accumulating.

The purpose of this paper is to describe activities used to initiate health promotion in the school setting.

Description of successful pilot Health Promoting School (HPS) initiatives in Canada and Uganda and the validated measures central to each program. Evaluation methodologies: quantitative data from the tools used complimented by descriptive/qualitative methods.

Previously validated tools/methodologies used include: The World Health Organization (WHO) growth charts for comparison of children ' s height, weight, head circumference, and BMI against multi-ethnic standards; a 24-h dietary recall instrument to assess dietary diversity as a proxy measure of nutritional adequacy; urine analysis to evaluate baseline renal function and the effect of supplemental hydration; “photo-voice” to aid discussion of personal and community issues of concern; “role play” to promote dialogue and promote social competence; and fitness training. Each activity can combine the “curriculum content” and “healthy practices” components central to HPS concepts. All activities engaged more than 95 percent of pupils enrolled, generated positive responses, and had the potential to impact behaviors and promote health.

All the activities are inexpensive and straightforward to initiate, offer schools interested in health-promotion-driven education a broad range of potential “entry points” that can be matched to the interests/challenges of individual communities, and use validated methodologies aiding objective evaluation.

These activities foster a community empowerment (“bottom up”) approach, but are also relevant for policy makers exploring HPS to address disease prevention through lifestyle change (“top down” approach). Engagement of communities and ultimately their “ownership” of the HPS initiative have been achieved with these entry point activities.

Although medical schools do well in preparing the next generation of practitioners to diagnose and clinically treat illness, they struggle in preparing them with capabilities in the areas of health promotion and disease prevention. Similarly, health promoting schools (HPS) face challenges in working to enhance the health and educational outcomes of children. The paper aims to discuss these issues.

The authors draw from their local and international collaborative work as practitioners and medical educators to examine how health professions schools can work in partnership with HPS for mutual benefit.

Health advocacy is a core competency in medical education. A primary focus is on health promotion and disease prevention. However, providing practical, experiential opportunities – “learning-by-doing” – is a challenge. To overcome this difficulty, medical schools may be well served by partnering with HPS. This can provide mutually beneficial learning opportunities that will enable emerging physicians to develop health promotion-related knowledge and advocacy skills while the emerging generation of citizens (the children) are enabled to live healthier and more productive lives.

The parallel development of Health Promoting Schools and the teaching of health advocacy to health professionals has proceeded to the point where convergence of the gathered knowledge and experience can provide a powerful and synergistic model to advance both initiatives. This conceptual paper focuses outlines the actions that might achieve this.

The purpose of this paper is to provide a review of an Australian health promoting schools (HPS) project to identify key features of the concept of resilience and how it can be used in a school setting to develop and strengthen protective factors in young people, as a mechanism for improving social functioning and reducing involvement in risk behaviours.

Methods used in the “Resilient Children and Communities” project are described. Then a revue of the academic literature published on theoretical and empirical findings from the “Resilient Children and Communities” project is presented.

The papers reviewed indicate there is a developing body of evidence to show that the “HPS” is an efficient and effective approach to building resilience amongst school children. Underpinned by Bronfenbrenner's broad ecological framework, benefits have been derived not only for students, but for the whole school community. Such benefits include not only building self-esteem and self-efficacy, peer relationships and relationships between students, teachers and parents, but also school connectedness and feelings of belonging.

The findings from this project provide a strong evidence base identifying the central role of “resilience” in the school culture. This role is cross-cultural and transnational and evidence that resilience can strengthen protective factors has clear implications for the African context, where communicable diseases and neglected tropical diseases pose intractable problems, typically in resource restricted environments.

These findings provide insight into the central role of the school setting in building resilience. Resilience, in turn, can help students survive and thrive under challenging and adverse conditions.

Successful implementation of Health Promoting Schools (HPS) depends on putting the model in the schools’ context for both health improvement and school improvement. HPS can only be effective if the change can be sustained over an extended duration. The purpose of this paper is to discuss development of the HPS process by University Research Centre in Hong Kong, resulting in an award scheme, where no additional resources were initially provided by the authorities.

The team adopted a step-by-step approach starting with capacity building of key stakeholders and comprehensive needs assessment, leading to development of a system of evaluation and monitoring and establishment of a “Healthy School Award” system. The system was built on data derived from several different sources and made use of qualitative and quantitative information and were intended to be used to guide practice and actions for improvement.

Schools measured their own performance against established school and student health profiles. The validated system of evaluation and monitoring led to a Healthy School Award scheme for participating schools with “accredited” and “award” designations. The award system evaluated six key HPS areas and identified exemplars of HPS as resource schools to form a strong network.

HPS can be regarded as new paradigm of schooling rather than an add-on programme.

HPS can be regarded as new paradigm of schooling rather than an add-on programme. The advantage of an academic institution masterminding the development process lies with their strength in education and research, building on the professionalism of school educators in health promotion and developing evidence-based HPS practice.

This paper discusses an approach for addressing the key factors associated with initiation of innovation and management of change in an education setting. The involvement of both higher education and an award scheme can act strong catalysts to drive change, resulting in a strong evidence base with and results demonstrating effectiveness, which then led to government support.

The purpose of this paper is to respond to food insecurity and environmental sustainability through school food gardens in Johannesburg, South Africa.

Permaculture is a method of organic agriculture where the garden design maintains a stable and productive ecosystem, mimicking natural processes and thereby creating a more natural and sustainable environment. Organic permaculture food gardens were established and integrated with the curriculum at two schools over the course of one year. A nutrition study of dietary intake and assessment of dietary diversity score was undertaken with a sample of 68 children.

Permaculture food gardens can contribute to children ' s physical, mental, and emotional health and can be a resource for teachers and learners. To achieve sustainability, practical and cultural challenges must be addressed.

The project was implemented at only school sites, findings may not be applicable to all schools in all settings. This assessment was conducted after one year of implementation, impacts, and sustainability would be best assessed after three years. Conclusions are therefore based both on this case study and on the wider literature.

When implementing a school food garden there must be long-term support and mentoring for school staff.

The value of a school food garden goes beyond the provision of nutrition and addressing food insecurity. Participation in gardening can increase students’ interactions with the natural world, and contribute to skills development, academic achievement, and well-being.

This paper informs discussion and practice related to school food gardens’ influence on holistic health and broader educational benefits. It is of relevance to health promotion and education practitioners, school garden developers, and funders.

The purpose of this paper is to measure prevalence and predictors of mobile phone access and use among adolescents in Soweto, South Africa.

The current study was an interviewer-administered, cross-sectional survey among adolescents 14-19 years living in a hyper-endemic human immunodeficiency virus (HIV) setting in South Africa.

Of 830 participants; 57 per cent were female. The median age was 18 years (IQR: 17-18). Mobile phone access was high (91 per cent). Almost half of participants (42 per cent) spent more than five hours daily using their mobile phones. Two-thirds (62 per cent) had access to the internet, most (84 per cent) accessed the internet via their mobile phones. Mobile phone access was more likely amongst Sotho language speakers (aOR: 2.87, 95 per cent CI: 1.30-6.36), those living in formal housing (aOR: 3.55, 95 per cent CI: 1.97-6.42) and those who reported heterosexual orientation (aOR: 2.37, CI: 1.35-4.16).

This study substantially contributes to the literature about mobile phones usage and patterns among school-going adolescents in Soweto, South Africa.

The purpose of this paper is to understand how a Canadian intervention based on a professional development (PD) model did or did not influence schools’ capacities to absorb a Healthy School (HS) approach into their operations. This study is the second part of a research project: previously published results regarding this research provided a detailed description of the PD model and highlighted the relevance and effectiveness of PD in improving actors’ HS-related knowledge and practices. The present paper focuses on the organizational impact of such PD intervention.

The design was based on a realist evaluation approach, which helps to elicit a theory explaining how an intervention leads to particular outcomes. A multi-site case study of three schools with pre- (T ₀) and post- (T ₁) intervention comparison was adopted. Multiple qualitative methods were used to capture how the changes were achieved by collecting data from various stakeholders involved in the intervention.

The PD model tested reinforced the schools’ capacities to absorb this type of initiative. For one of the capacities examined, “exploitation”, i.e., the ability to incorporate and maintain the initiative into schools operation, the evidence was less apparent. In congruence with the realist evaluation, the results are rendered in the form of a contextualized intervention theory identifying the links between the PD and the mechanisms that were likely necessary to explain what led to the changes in “absorptive” capacities (which refers to the capabilities of schools to acquire and assimilate HS knowledge, and also to transform and exploit them, in the context).

The refined theory, based on empirical findings, can enable facilitators and practitioners to gain a deeper understanding of the action mechanisms shown to be determining in the success of HS implementation.