**5. Health interventions that influence academic achievement**

The World Health Organisation observes that health is created and lived by people within the settings of their everyday life, where they learn, work, play and love. The Bangkok Charter for Health Promotion advocates setting-based approaches to health promotion. Schools therefore play a critical role in promoting the health and safety of young people and helping them establish lifelong healthy behaviours. School health programmes can play a vital role in reducing the prevalence of health risk behaviours among young people and have a positive effect on academic performance. Schools can be a context where children can learn and practise positive health behaviours within a health-promoting environment. In a May 2012 report, *Accelerating Progress in Obesity Prevention*, the Institute of Medicine evaluated obesity prevention strategies and concluded that we must 'strengthen schools as the heart of health' [5].

#### **5.1. Health-promoting school policies, procedures and environments**

Clearly, there are many possibilities for school-based health interventions. School staff and partners may gravitate towards classroom-based or individual-based health education because it is the traditional way to reach students at school. However, policies, procedures and 'environments' that promote healthy behaviours are also critical components for improving student health policy interventions (including changes in the school environment) can influence day-to-day norms of the school that will ultimately contribute toward behaviour change [27]. Examples of policies that may be implemented include the use of signpost to restrict smoking in some designated areas, restricting the availability of certain food products that are considered unhealthy and offering incentives to students to encourage them to lead healthy lifestyles.

#### **5.2. Information-based solutions**

Prevention is better than cure. Information has played a critical role in disease prevention and the cost of information-based solutions is much less compared to the cost of treating patients. Information is a useful resource in catalysing behaviour change among school children. Disseminating health information can improve knowledge transfer from health professionals to the student population, and helps them to maintain and improve their health. Schools can introduce health intervention strategies aimed increasing awareness on a number of health issues that include food and nutrition, sexual and reproductive health, alcohol and drug abuse, depression and anxiety, physical exercise among other key health topics. Schools should use a variety of media and channels to disseminate health information, including posters, websites, nurses and social media.

#### **5.3. Health-promoting curriculum, instruction and training**

Health education programmes can help students develop the knowledge, skills, attitudes and behaviours needed to adopt healthy behaviours. Educational interventions can also enhance knowledge and help-seeking among college students. Fitness and wellness courses have been seen as agents of change for modifying unhealthy lifestyles among college students. There is evidence that well-taught fitness and wellness classes have the potential to positively affect the attitudes and behaviours of the students that enrol in them. Educational modules are an important tool for health information dissemination and behaviour change. Conceptually based wellness courses, which are also referred to as lecture laboratories, have been designed to promote physical education and wellness among college students. The courses are an alternative to the traditional skill-based physical education courses. The courses consist of lectures and laboratory experiments. The lecture part of the course is designed to promote learning of conceptual information related to fitness and wellness and health behaviour change theory as well as learning of self-management skills that result in real-world application. The laboratory sessions are designed to provide students with hands on skills on matters related to wellness and physical exercises [28].

#### **5.4. Supportive health services**

**5. Health interventions that influence academic achievement**

**Figure 2.** Number of risk factors and academic achievement.

152 Health and Academic Achievement

**5.1. Health-promoting school policies, procedures and environments**

The World Health Organisation observes that health is created and lived by people within the settings of their everyday life, where they learn, work, play and love. The Bangkok Charter for Health Promotion advocates setting-based approaches to health promotion. Schools therefore play a critical role in promoting the health and safety of young people and helping them establish lifelong healthy behaviours. School health programmes can play a vital role in reducing the prevalence of health risk behaviours among young people and have a positive effect on academic performance. Schools can be a context where children can learn and practise positive health behaviours within a health-promoting environment. In a May 2012 report, *Accelerating Progress in Obesity Prevention*, the Institute of Medicine evaluated obesity prevention strategies and concluded that we must 'strengthen schools as the heart of health' [5].

Clearly, there are many possibilities for school-based health interventions. School staff and partners may gravitate towards classroom-based or individual-based health education because it is the traditional way to reach students at school. However, policies, procedures and 'environments' that promote healthy behaviours are also critical components for improving student health policy interventions (including changes in the school environment) can influence day-to-day norms of the school that will ultimately contribute toward behaviour change [27]. Examples of policies that may be implemented include the use of signpost to restrict smoking in some designated areas, restricting the availability of certain food products that are considered unhealthy and offering incentives to students to encourage them to lead healthy lifestyles.

Supportive health services are targeted interventions or support for selected students, as well as provision of a broad range of services that can influence health. For example, school nurses and counsellors refer students who currently smoke to cessation classes or other help for quitting. The Centers for Disease Control and Prevention observes that supportive services can have a high impact on individual students, but only for the selected students who would have been identified as students at risk. These services usually require relatively more staff resources to sustain. For example, individual counselling programmes for students at risk for substance abuse may effectively impact the behaviour of individual students, but may not impact the prevalence of substance abuse at the school as a whole, because they only reach a small number of students [29].

#### **5.5. Integrated school-based interventions**

As discussed earlier on in this article, health is a complex phenomenon that is influenced by multiple factors. Therefore, stand-alone interventions that focus on specific health problems may not be effective in addressing the overall health needs of students [30]. Many health promotion bodies that include the Jed Foundation and the National Centre for the Dissemination of Disability Research have advocated for integrated health intervention strategies. As an introduction to describing integrated school health interventions, the Centers for Disease Control and Prevention (CDC) notes on their Website:

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*Schools by themselves cannot—and should not be expected to—solve the nation's most serious health and social problems. Families, health care workers, the media, religious organizations, community organizations that serve youth, and young people themselves also must be systematically involved. However, schools could provide a critical facility in which many agencies might work together to maintain the well-being of young people* [31]*.* 

Intervention programmes that include more than one approach can create synergy, and eliminate unnecessary duplication of effort and wastage of resources (human and capital). The *Guide to Community Preventive Services*, which conducts rigorous reviews of health interventions, found strong evidence in support for the effectiveness of integrated health interventions. The review found a link between integrated interventions and reduction in violence and sexual risk behaviours in adolescents [32].
