health education related activities you can do at school

Teaching Health Education in School

Many parents are keenly interested in the basic academic education of their youngsters—reading, writing, and arithmetic—but are not nearly as conscientious in finding out about the other learning that goes on in the classroom. A comprehensive health education pro­gram is an important part of the curriculum in most school districts. Starting in kindergarten and continuing through high school, it pro­vides an introduction to the human body and to factors that prevent illness and promote or damage health.

The middle years of childhood are extremely sensitive times for a number of health issues, especially when it comes to adopting health behavior that can have lifelong consequences. Your youngster might be exposed to a variety of health themes in school: nutrition, disease prevention, physical growth and development, reproduction, mental health, drug and alcohol abuse prevention, consumer health, and safety (cross­ing streets, riding bikes, first aid, the Heimlich maneuver). The goal of this ed­ucation is not only to increase your child's health knowledge and to create positive attitudes toward his own well-being but also to promote healthy be­havior. By going beyond simply increasing knowledge, schools are asking for more involvement on the part of students than in many other subject areas. Children are being taught life skills, not merely academic skills.

It is easy to underestimate the importance of this health education for your child. Before long he will be approaching puberty and adolescence and facing many choices about his behavior that, if he chooses inappropriately, could im­pair his health and even lead to his death. These choices revolve around alco­hol, tobacco, and other drug use; sexual behavior (abstinence, prevention of pregnancy and sexually transmitted diseases); driving; risk-taking behavior; and stress management. Most experts concur that education about issues like alcohol abuse is most effective if it begins at least two years before the behav­ior is likely to start. This means that children seven and eight years old are not too young to learn about the dangers of tobacco, alcohol, and other drugs, and that sexuality education also needs to be part of the experience of elementary-school-age children. At the same time, positive health behavior can also be learned during the middle years of childhood. Your child's well-being as an adult can be influenced by the lifelong exercise and nutrition habits that he adopts now.

Health education programs are most effective if parents are involved. Par­ents can complement and reinforce what children are learning in school dur­ing conversations and activities at home. The schools can provide basic information about implementing healthy decisions—for instance, how and why to say no to alcohol use. But you should be a co-educator, particularly in those areas where family values are especially important—for example, sexu­ality, AIDS prevention, and tobacco, alcohol, and other drug use.

Many parents feel ill-equipped to talk to their child about puberty, repro­duction, sex, and sexually transmitted diseases. But you need to recognize just how important your role is. With sexual topics—as well as with many other ar­eas of health—you can build on the general information taught at school and, in a dialogue with your youngster, put it into a moral context. Remember, you are the expert on your child, your family, and your family's values.

Education seminars and education support groups for parents on issues of health and parenting may be part of the health promotion program at your school. If they are not offered, you should encourage their development. Many parents find it valuable to discuss mutual problems and share solutions with other parents. Although some parents have difficulty attending evening meet­ings, school districts are finding other ways to reach out to parents—for in­stance, through educational TV broadcasts with call-in capacities, Saturday morning breakfast meetings, and activities for parents and children together, or­ganized to promote good health (a walk/run, a dance, a heart-healthy luncheon).

In addition to providing education at home on health matters, become an advocate in your school district for appropriate classroom education about puberty, reproduction, AIDS, alcohol and other substance abuse, and other relevant issues. The content of health education programs is often decided at the community level, so make your voice heard.

As important as the content of a health curriculum may be, other factors are powerful in shaping your child's attitudes toward his well-being. Examine whether other aspects of the school day reinforce what your youngster is be­ing taught in the classroom. For example, is the school cafeteria serving low-fat meals that support the good nutritional decisions encouraged by you and the teachers? Is there a strong physical education program that emphasizes the value of fitness and offers each child thirty minutes of vigorous activity at least three times a week? Does the school district support staff-wellness programs so that teachers can be actively involved in maintaining their own health and thus be more excited about conveying health information to their students?

In addition to school and home, your pediatrician is another health educator for you and your child. Since your child's doctor knows your family, he or she can provide clear, personalized health information and advice. For in­stance, the pediatrician can talk with your child about the child's personal growth patterns during puberty, relate them to the size and shape of other family members, and answer questions specific to your youngster's own de­velopmental sequence and rate.

For most school-related health concerns, your pediatrician can provide you with specific advice and tailored guidance. You and your pediatrician may also consult with the school staff on how to deal most effectively with school time management of your child's health problem.

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3 Things Schools Can Do to REALLY Improve Student Health

If you were to travel across the United States asking schools how they approach health education, you’d get a VERY wide range of responses.

Some schools avoid the topic altogether. Some stress strict “Just Say No”-style messages. Others use a more comprehensive approach, emphasizing skills and decision making in class. Some schools even host teen clinics right on campus.

For adults who care about teenagers, it can be challenging to know what approach to take. Luckily, some new remarkable research from the Centers for Disease Control and Prevention (CDC) is helping clarify what actually works, with clear examples schools can emulate and start implementing immediately.

As this new study in the Journal of Adolescent Health explains, schools across the country have seen significant results when they implement these three specific strategies in their schools:

• Providing quality health education, including sexual health education.
• Implementing systems to increase student access to health care.
• Promoting activities to decrease bullying, increase parent engagement, and help students feel more connected to school.

The What Works In Schools program’s influence reached beyond the students who directly participated — and improved outcomes were seen for all students at schools where the program was implemented.

Findings from an evaluation of this approach showed that schools that implemented the What Works In Schools program model saw significant benefits for students in six outcome areas:

• Sexual history (have they ever had sex)
• Sexual partners (had 4 or more lifetime sexual partners)
• Sexual activity (they had sex in the last 3 months)
• School safety (have they missed school because of concerns for their safety)
• Rape (have they ever been forced to have sex)
• Drug use (ever used or currently use marijuana)

As a teacher in the San Francisco Unified school district, one of the districts featured in this study, I’ve been able to see firsthand how effective these strategies can be. The schools in the study received CDC funding and technical support through the CDC-DASH program , but the What Works In Schools strategies can be replicated by any district or school that wants to improve outcomes for young people.

If you, as a parent, an educator, or a community member, want to see healthier outcomes for teens, consider this your roadmap for how to get there. I’m thrilled to see this research demonstrating how effective these approaches are, and I hope this study serves as a catalyst for change in schools across the country.

Let’s take a closer look at how each of these three strategies works in schools.

1. Providing Quality Health Education, Including Sexual Health Education

As an organization, SHAPE America provides guidance and resources about effective health education , and recently published a position paper called “ Sex Education Is a Critical Component of School Health Education .” This reflects the guidance from the CDC, which says, “Quality sexual health education is a systematic approach to preparing students with the knowledge and skills needed to make informed health decisions to prevent HIV, STDs, and unintended pregnancy.”

Comprehensive, skills-based sexuality education is very effective, not just at reducing unplanned pregnancies and sexually transmitted infections, but also for helping students understand consent, avoid sexual harassment, and establish healthy relationships. Research even shows that sex ed in high school can be a powerful rape reduction tool .

The CDC details some of the characteristics of a quality sexual health education program :

• Sexual health education includes planned, progressive learning objectives and outcomes across grade levels (K–12).
• Sexual health education addresses knowledge and skills students need before risk behaviors and health issues emerge.
• Are taught by qualified and trained teachers
• Connect students to health services
• Engage parents and community partners
• Foster positive relationships between students and trusted adults.

In my district, we’ve been working diligently to expand our health classes into middle schools , partially in response to the California Healthy Youth Act , a 2016 law that requires that all students receive comprehensive sexuality education lessons at least once in middle school and once in high school.

I know that bringing programs like this to schools is hard work and sometimes encounters resistance. That’s part of the reason I’m so excited about this “What Works in Schools” report — it provides strong evidence that all those advocacy efforts really are worth it.

2. Implementing Systems to Increase Student Access to Health Care

We have become used to the idea of school nurses, but people don’t always think of schools becoming access points for sexual health care. According to this research, however, it’s something more schools should consider . Schools can connect students to sexual health services by providing the services on site or by referring students to youth-friendly health care providers in the community.

Sexual health services give students access to preventive health care, such as STD testing, HIV testing, contraception, and condoms, and referrals to appropriate treatment if needed. Although students may initially come in with a specific sexual health concern, these services can provide students with information, education, support, referrals, and counseling for a broad range of health behaviors and experiences that can affect healthy development.

As examples, educators can look to places like the Cleveland Metropolitan School District, which greatly expanded the number of middle and high school students it refers each year for sexual health services .

3. Promoting Activities to Decrease Bullying, Increase Parent Engagement, and Help Students Feel More Connected to School

Creating safe and supportive environments involves schools, communities, families, and youth working together to protect students’ health and improve academic performance. According to the CDC , these changes emphasize aspects of school settings and family relationships that can protect adolescents and reduce their risk for HIV, STDs, and unintended pregnancy.

The “What Works in Schools” report identifies some of the ways this can work:

• Protective factors include school connectedness, parental monitoring, and parent-adolescent communication (both generally and specifically about sex).
• Safe and supportive environments connect adolescents to a network of caring peers and adults, including parents, other primary caregivers, and teachers.
• Improving environments can have a broad and lasting positive impact on health. It also establishes a context for sexual health education and sexual health services to be effective.

For example, the San Diego Unified School District improved the environment in its schools by creating safe spaces to report bullying and harassment , and visibly taking actions to address incidents and ensure that students feel supported. Each one of the three strategies identified by the CDC — Sexual Health Education, Sexual Health Services, and Creating a Safe and Supportive Environment — is powerful on its own. In combination, they work even better. “ What Works In Schools ” is a fantastic guide for anyone trying to make healthy changes in our schools.

Additional Resources

• Health Education Blog Series
• Health Education Program Checklist
• Essential Components of Health Education

Christopher Pepper is an award-winning educator with the San Francisco Unified School District and a member of the SHAPE America Health Education Council . His work has been featured in Edutopia, the San Francisco Chronicle, and The New York Times. You can reach him through his website, mrhealthteacher.com , or on Twitter at @mrhealthteacher .

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Popcorn Day

This can be a day of nutritional education related to the many ways to use corn. A poster with the nutritional value of corn along with popcorn treats for the students is sure to get their attention.

“POP Your LID”

Many science projects have addressed the subject of sodas and their effect on weight and the decay of teeth… Put up a display and fill containers with teaspoons for sugar equivalent to the amount in each object. Include regular and diet sodas, candy, jelly, Ketchup and others. Kids are amazed when they see the sugar in the cans or baggies.

Summer Safety

Have the middle school student’s team up and create a booklet about summer safety. Two or three students per team with names like “The Grillers” (barbecue safety). “The Sharks” (water safety), The Hornets” (stings and bites) etc. Students learn from researching their topic, each team creates their page using the internet and other programs. Each family gets a copy of the finished project as a reference for home.

Dressing for Winter Weather

Team up with local community members who may donate hat and gloves. Talk to the students about the importance of dressing warm during the cold season. Include outside sports and when to know it is time to go in and warm up. Students can be gifted with the hats and gloves or names can be picked for the recipients.

“Go Nuts”

A display of various nuts and berries is a welcome reminder of how important theses are to our nutrition. Use a poster with squirrels as the characters. Be creative and go nuts!

Be the Beat

Heart education can be fun. Use the 60’s Beatnik theme. Students snap their fingers after each act and the drums are played to the chanting of “Be the Beat”. Have a group of student’s role play the important things to keep your heart healthy. Use a drum and have students repeat out loud “Be the Beat” at the end of each act. Have the Bad “Fat” brothers and the “Trans” sisters talk about nutrition. One student dresses like a doctor and examines the heart of another student using a stethoscope and blood pressure cuff. A group of students jump rope, hula hoop etc and talk about the importance of exercise in daily routines. Another group speaks out against not smoking to protect heart health.

Build Your Body (Anatomy and Physiology)

This teaching tool is a great way to teach students about the anatomy and physiology of the body. It can be taught in an age appropriate format. Have each student trace their silhouette on a large piece of roller paper. Cut out the tracing and hand it on the wall. Throughout the next few weeks, discuss the various organs, have an enlarged picture of the organ for each child to cut out and glue onto their body. Talk about the purpose, location and how to care for their boy. Lungs, Heart, Brain, Bones, Mouth, Eyes, and stomach are a few that the little ones recognize. You can include the liver, kidneys, gallbladder, pancreas and spleen for the older students. This activity has proven to be an ongoing educational tool with a constant reminder of how o ne pre-K student told the school nurse he was “lung less”. She didn’t understand what he meant until the teacher explained that he was absent the day they talked about lungs so his boy was “lung less!”

Bedtime at School

The kids love to come to school in their pajamas! This is a fun way to teach students how important it is to get enough sleep. Studies show that you cannot “catch up” on much needed sleep on the weekends. Children need 8-16 hours of sleep per day depending on their age. Consistent bed times are important to their ability to achieve academically. Provide a handout to send home for parents talking about the importance of sleep in a child’s day  and for academic success. More Information Available: http://www.webmd.com/parenting/guide/sleep-children

Green Eggs and Ham (Nutrition)

What better way to support Dr. Seuss Day than to serve the students a healthy breakfast of eggs, ham, wheat toast, juice and milk. Have green food coloring available for those who dare try the green eggs. The kids can make Cat in the Hat paper hats to wear. Flyers can home with students reinforcing to parents how important a healthy breakfast is before coming to school.

Teacher Relaxation Day

Our teacher and staff’s health is very important to our schools. Every teacher deserves a little pampering. The past few years, usually right before the holidays, we have a day where our teachers can take a few minutes to relax away from the hustle and bustle of the lunch room. Prepare a light, healthy lunch in a quiet corner of the school. Dim the lights using flameless candles or Christmas lights. Have soft relaxation music playing and a few soft chairs to sit in. Bring in a massage chair or pad to sit on, a foot massager and other spa items. Ask your local salons to donate items or even their time to come and pamper the teachers. A gift of lotion, nail products, hair products can be provided. A raffle prize of a day at the spa is a huge hit! The teachers can take turns coming in to the room as able throughout the day. Staff or volunteers can help cover the classrooms during these times.

Hygiene and Puberty

This topic is usually a top priority for the 5th grade teachers as students begin to experience the physical changes of growing up. Good hygiene and oral care need stressed at this age as their bodies mature and grow. There are many DVDs available and written material. To really capture the student’s attention, the speaker can dress in a robe, shower cap and slipper for the lecture. For more information log on to: http://kidshealth.org/teen/your_body/take_care/hygiene_basics.html

Halloween Safety

Many hospitals offer programs for schools related to safety during trick and treat time. Students benefit from education at school demonstrating how masks block their view, costumes can cause accidents, safety related to visiting houses etc. Dress up in costume and have many props to hold the student’s attention. For more information log on to: www.halloween-Safety.com/halloween_safety_kids.html 

Baby Sitting and Childcare Education

Many students are assuming charge of siblings and other children at a very young age. Consider having a babysitting course at your school that would include: differences in infants, toddlers, pre-school and school age children. Address activity, eating, toileting, playing, discipline, routines and other topics. Include safety, first aid, emergencies such as fire, strangers etc. Your local hospital may be able to help. Many “Safe Sitters” Programs are available throughout the state. If you are interested in creating such a program, call Nurse Mary Ann at Wheeling Catholic Elementary 304-233-1515.

Safe Toy and Gift Ideas

Put up a display of toys and gifts that are GOOD to purchase and those that are NOT ideal for children. You can do this along with a fundraiser offering “babysitting “ on a Saturday morning or an evening at your school while parents go Christmas shopping. Charge a fee for the service and have it go towards student health, class trips or a charitable organization.

Healthy Fruit and Vegetable Snack Time

They say it takes at least 10-12 introductions for a child to begin to eat new foods. Try this throughout the school year. Three times a week, each student is encouraged to try a “new” fruit or vegetable. Start a “two bite” club” where students agree to take at least two bites of the new food.

Johnny Appleseed Day (Nutrition)

This famous adventurer and lover of nature is a great way to accent the importance of apples in our diets. Students can make paper “pot hats” to wear, sample various ways apples can be eaten, visit apple orchards in the community etc. This was a big hit at our school as the teachers all wore pots on their head and students sampled applesauce, apple pie, apple juice, and apple butter.

The Great American Smoke Out

This event is always in November. To enhance posters and hand outs, have students write a letter to someone they know who they would like to quit smoking. If they don’t know anyone who smokes, they can write to a parishioner and the letters can be shared with the pastor. Award prizes for the best letters and include them in your display.

Fruit and Vegetable Identification

Gather a variety of fruits and vegetables in a box. Have each student put on a blind fold, tough, smell and sometimes taste the item to try to identify the fruit or vegetable. The students then place it in a basket with fruits or vegetables. Talk about how it is grown, where it can be grown and health benefits of eating them.

Spiritual Health – Lenten Activity

Try making a “crown of thorns” out of bread dough and tooth picks. Student can participate in preparing the dough, baking it while reminding them of the reason for Lent. During the season, they remove one “thorn” for good deeds done. We have also made tiny loaves for each student to take home. For more information, log on to:  http://www.ehow.com/facts_5801367_meaning-crown-thorns_.html

Well Friend Visit to the Doctor

Help to alleviate the fears of the little ones when they visit the doctor’s office or hospital by exposing them to the many things used by nurses and doctors. Set up a room with things like stethoscope, blood pressure machine, bandages, ace wrap, scrub clothes, masks, syringe, tongue depressor, etc. Let each child bring in a doll or stuffed animals as a “patient.” They tell the doctor what is wrong with their friend. Apply band aids, slings, etc. Give the child a “prescription” to take home with what they said was wrong with their friends and instructions on how to treat the condition. Parents get a big kick out of this. Contact your local hospital or doctor office to borrow supplies. Some hospitals offer such visit as field trips for the students.

Hot and Cold Application for Injury

This activity allows the students to gain an understanding of when heat is used for an injury and when it is better to use cold for treatment. Allow the students to make small rice bags that they can stitch up and take home. Squares of flannel work well. Fill the bags with rice. They can be frozen for a cold pack or microwaved for 2 minutes for a hot pack.

Online Safety

Local officials are usually very helpful with this topic. The Attorney General’s office has done presentations in a few schools in the northern panhandle.

Fire Safety

To reinforce what your local fire department educators present, have paper drills with students. Put paper flames in an area of the school and guide the students in how to react.

ATV/Bicycle Safety

Local hospitals and police departments will usually help with this project. They have even brought in their bicycles, helmets and an ATV for students to view and discuss the safety related to these activities.

Let’s Talk Health

Have middle school children each pick a topic, make a poster, and give a brief presentation to other school members. This activity is similar to a science fair. The displays can be open to parents and families to view.

Kids Can Cook!

Use this activity to promote healthy eating through simple cooking projects with healthy recipes. Try “Zucchini Day,” letting kids make zucchini in many different forms. Examples: sliced with fat free ranch; fried in olive oil; breaded in brand flakes; zucchini bread, or; baked with tomatoes, onions, mozzarella cheese. Enhance your school lunch at holiday time by having each class make the side dishes. Thanksgiving and Christmas can include: Cranberry and diet 7-up punch, walnut, celery, apple, plain yogurt and cranberries salad. Pumpkin custard with fat free or sugar free whip cream. Whole wheat rolls.

Breakfast of Champions

Heroes are part of every child’s world. Invite local officials such as a policeman, fireman, mayor, priest, minister, teachers, doctor, nurse, and others who make a difference in your community to breakfast with your students. The guests enjoy the experience as much as the kids do! Each guest can receive a token of appreciate like a small picture frame with a verse about heroes inside. The program can be simple with introductions of the guests, serving eggs, bacon, toast, juice etc. and mingling with the students. We were able to get out local newspaper to come and write an article for Wheeling Catholic Elementary. Another twist is to invite your high school football or basketball team players to come and eat with the kids. The elementary and middle school kids look up to these youth in awe!

Dirty and Clean

Fill a bowl with glitter or soil. Have students put their hands in it. Now, have them use hand sanitizer to try and get the glitter off. Next, let them wash with good old soap and water. The glitter should wash all off. Hand sanitizers are OK if there is no water. They are not good for viruses or visible dirt.

“Witchey Poo and the Witchey Flu”

Using a Halloween theme, dress up like a good witch (Witchy Poo) and have a small doll like witch (Witchy Flu) that you can remove the stuffing to be able to place your hand in the doll like a puppet. Fill a small spray bottle with water and insert it in the doll so the spray will come out of “Witchy Flu’s” mouth simulating a sneeze. You can also use other character bath mitts for any time of year putting a hole in the mouth and inserting a spray bottle. The kids love it! Talk about how to use your “Witches’ cape, Batman cap etc.” or sleeve to cover a sneeze. Use a tape measure to show students how far a sneeze can spray on others. Have tissues and show students how to tuck them up their sleeve or in their sock if they don’t have a pocket.

Infection Control and Hand Washing

The number one way to prevent the spread of infection is by practicing good hand washing. There are many ways to teach staff and students the proper technique. Visit these sites for some ideas, games and videos. http://www.henrythehand.com/ www.scrubclub.org/home.aspx http://www.ehow.com/how_4785417_children-good-hand-washing-techniques.html http://www.cdc.gov/Features/HandWashing/ http://www.eduref.org/Virtual/Lessons/Health/Process_Skills/HPS0200.html 

Building the Habits of Health

Lessons and activities for K-5 that inspire a healthy lifestyle

A free educational program designed to help build healthy habits in grades K-5.

We know developing healthy habits early contributes to students’ well-being, but it can be hard to find the right lessons and activities. This K-5 program addresses five pillars of health and well-being, called the Habits of Health: eating and hydration, movement, mind, sleep, and environment. The lessons are easy to follow and implement right away, and the activities are engaging for kids, with the goal to help them develop critical healthy habits early on.

Get Your Healthy Habits Lessons

Help your K-5 students build healthier lives.

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Inside the Grades K-2 Kit: Why Do Animals and People Sleep? Plus, four more!

The sooner we build good, healthy habits, the easier it is to make them a part of living a healthy life. We’re excited to share these five Habits of Health lesson plans and activities to help your K-2 students build healthier lives.

Here’s what you’ll get:

1. Build a Better Plate for Fueling Your Body.  This lesson gets kids thinking about what makes a healthy, balanced meal. They’ll learn about food categories and then play a fun game, building healthy meals to share their learning.

2. Fun Ways To Fit in Fitness.  Getting kids moving safely in a classroom can be a game changer that improves learning. These circuit cards can be used in a classroom to create movement stations that kids use independently.

3. How I Know I’m in the Zone.  Helping kids regulate their emotions gives them back the control they need to have confidence. This lesson and activity help kids identify what their emotions feel like, both physically and mentally.

4. Why Do Animals and People Sleep?  Kids love to learn about animals, and this lesson has a home-school connection activity that shows how much sleep animals and people need. You may discover something surprising!

5. Grow Your Concentration Powers.  The interesting thing about distractions is that once you learn how to identify them, you gain more control over your focus. Kids will love discovering different kinds of distractions!

Inside the Grades 3-5 Kit: Teaching Kids to Cook, plus four more!

As students get older, they want more control over their world. Kids in grades 3-5 are ready to learn healthy habits in a more comprehensive way. Here are five Habits of Health lesson plans and activities to help your grades 3-5 students build healthier lives.

1. Setting Routines for Super Sleep.  This lesson helps kids develop habits for sleeping more soundly. Healthy sleep is critical for student success.

2. Curious Chefs Cook for Their Families.  Let’s get kids thinking about what goes into the meals they eat. Cooking with their families demystifies the kitchen and opens the door for healthy food.

3. Calm, Cool, and In Check With Our Emotions.  Here’s how students can learn self-soothing strategies so they can help themselves stay calm and manage their emotions.

4. Taking Small Steps to Get Active.  Learning about microHabits that foster an active lifestyle is key to getting all kids moving their bodies. This lesson helps kids set individual activity goals.

5. Taking Charge of Your Choices in Tricky Situations.  From staying focused during class to managing relationships, kids have to make choices every day. This lesson teaches them how to make a choice and follow through.

What If Healthy Habits Were Second Nature For All?

Healthy Habits For All gives kids and their families the most powerful gift of all: the education and skills necessary to transform their health and wellness destinies.

The Healthy Habits For All curriculum is based on the Habits of Health®️ Transformational System.

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• v.2020; 2020

Health Literacy and Health Education in Schools: Collaboration for Action

M. elaine auld.

Society for Public Health Education

Marin P. Allen

National Institutes of Health (ret.)

Cicily Hampton

University of North Carolina at Charlotte

J. Henry Montes

American Public Health Association

Cherylee Sherry

Minnesota Department of Health

Angela D. Mickalide

American College of Preventive Medicine

Robert A. Logan

U.S. National Library of Medicine and University of Missouri-Columbia

Wilma Alvarado-Little

New York State Department of Health

July 20, 2020

Introduction

This NAM Perspectives paper provides an overview of health education in schools and challenges encountered in enacting evidence-based health education; timely policy-related opportunities for strengthening school health education curricula, including incorporation of essential health literacy concepts and skills; and case studies demonstrating the successful integration of school health education and health literacy in chronic disease management. The authors of this manuscript conclude with a call to action to identify upstream, systems-level changes that will strengthen the integration of both health literacy and school health education to improve the health of future generations. The COVID-19 epidemic [ 10 ] dramatically demonstrates the need for children, as well as adults, to develop new and specific health knowledge and behaviors and calls for increased integration of health education with schools and communities.

Enhancing the education and health of school-age children is a critical issue for the continued well-being of our nation. The 2004 Institute of Medicine (IOM, now the National Academies of Sciences, Engineering, and Medicine [NASEM]) report, Health Literacy: A Prescription to End Confusion [ 27 ] noted the education system as one major pathway for improving health literacy by integrating health knowledge and skills into the existing curricula of kindergarten through 12th grade classes. The NASEM Roundtable on Health Literacy has held multiple workshops and forums to “inform, inspire, and activate a wide variety of stakeholders to support the development, implementation, and sharing of evidence-based health literacy practices and policies” [ 37 ]. This paper strives to present current evidence and examples of how the collaboration between health education and health literacy disciplines can strengthen K–12 education, promote improved health, and foster dialogue among school officials, public health officials, teachers, parents, students, and other stakeholders.

This discussion also expands on a previous NAM Perspectives paper, which identified commonalities and differences in the fields of health education, health literacy, and health communication and called for collaboration across the disciplines to “engage learners in both formal and informal health educational settings across the life span” [ 1 ]. To improve overall health literacy, i.e., “the capacity of individuals to obtain, process, and understand basic health information and services needed to make appropriate health decisions” [ 42 ], it is important to start with youth, when life-long health habits are first being formed.

Another recent NAM Perspectives paper proposed the expansion of the definition of health literacy to include broader contextual factors, including issues that impact K–12 health education efforts like state rather than federal control of education priorities and administration, and subsequent state- or local-level laws that impact specific school policies and practices [ 39 ]. In addition to addressing individual needs and abilities, socio-ecological factors can impact a student’s health. For example, the Centers for Disease Control and Prevention (CDC) uses a four-level social-ecological model to describe “the complex interplay” of (1) individuals (biological and personal history factors), (2) relationships (close peers, family members), (3) community (settings such as neighborhoods, schools, after-school locations), and (4) societal factors (cultural norms, policies related to health and education, or inequalities between groups in societies) that put one at risk or prevent him/her from experiencing negative health outcomes [ 11 ]. Also worth examining are protective factors that help children and adolescents avoid behaviors that place them at risk for adverse health and educational outcomes (e.g., self-efficacy, self-esteem, parental support, adult mentors, and youth programs) [ 21 , 59 ].

Recognizing the influence of this larger social context on learning and health can help catalyze both individual and community-based solutions. For example, students with chronic illnesses such as asthma, which can affect their school attendance, can be educated about the impact of air quality or housing (e.g., mold, mites) in exacerbating their condition. Students in varied locations and at a range of ages continue, often with the guidance of adults, to take health-related social action. Various local, national, and international examples illustrate high schoolers taking social action related to health issues such as tobacco, gun safety, and climate change [ 18 , 21 , 57 ].

By employing a broad approach to K–12 education (i.e., using combined principles of health education and health literacy), the authors of this manuscript foresee a template for the integration of skills and abilities needed by both school health professionals and children and parents to increase health knowledge for a lifetime of improved health [ 1 , 29 , 31 ].

The right measurements to evaluate success and areas that need improvement must be clearly identified because in all matters related to health education and health literacy, it is vital to document the linkages between informed decisions and actions. Often, individuals are presumed to be making informed decisions when actually broader socio-ecological factors are predominant behavioral influences (e.g., an individual who is overweight but has never learned about food label-ling and lives in a community where there are no safe places to be physically active).

Health Education in Schools

Standardized and broadly adopted strategies for how health education is implemented in schools—and by whom and on what schedule—is a continuing challenge. Although the principles of health literacy are inherently important to any instruction in schools and in community settings, the most effective way to incorporate those principles in existing and differing systems becomes a key to successful health education for children and young people.

The concept of incorporating health education into the formal education system dates to the Renaissance. However, it did not emerge in the United States until several centuries later [ 26 ]. In the early 19th century, Horace Mann advocated for school-based health instruction, while William Alcott also underscored the contributions of health services and the school environment to children’s health and well-being [ 17 ]. Public health pioneer Lemuel Shattuck wrote in 1850 that “every child should be taught early in life, that to preserve his own life and his own health and the lives of others, is one of the most important and abiding duties” [ 43 ]. During this same time, Harvard University and other higher education institutions with teacher preparation programs began including hygiene (health) education in their curricula.

Despite such early historical recognition, in the mid-1960s, the School Health Education Study documented serious disarray in the organization and administration of school health education programs [ 45 ]. A renewed call to action, several decades later, introduced the concepts of comprehensive school health programs and school health education [ 26 ].

From 1998 through 2014, the CDC and other organizations began using the term “coordinated school health programs” to encompass eight components affecting children’s health in schools, including nutrition, health services, and health instruction. Unfortunately, the term was not broadly embraced by the educational sector, and in 2014, CDC and ASCD (formerly the Association for Supervision and Curriculum Development) unveiled the Whole School, Whole Community, Whole Child (WSCC) framework [ 36 ]. This framework has ten components, including health education, which aims to ensure that each student is healthy, safe, engaged, supported, and challenged. Among the foundational tenets of the framework is ensuring that every student enters school healthy and, while there, learns about and practices a healthy lifestyle.

At its core, health education is defined as “any combination of planned learning experiences using evidence based practices and/or sound theories that provide the opportunity to acquire knowledge, attitudes, and skills needed to adopt and maintain healthy behaviors” [ 3 ]. Included are a variety of physical, social, emotional, and other components focused on reducing health-risk behaviors and promoting healthy decision making. Health education curricula emphasize a skills-based approach to help students practice and advocate for their health needs, as well as the needs of their families and their communities. These skills help children and adolescents find and evaluate health information needed for making informed health decisions and ultimately provide the foundation of how to advocate for their own well-being throughout their lives.

In the last 40 years, many studies have documented the relationship between student health and academic outcomes [ 29 , 40 , 41 ]. Health-related problems can diminish a student’s motivation and ability to learn [ 4 ]. Complications with vision, hearing, asthma, occurrences of teen pregnancy, aggression and violence, lack of physical activity, and low cognitive and emotional ability can reduce academic success [ 4 ].

To date, there have been no long-term sequential studies of the impact of K–12 health education curricula on health literacy or health outcomes. However, research shows that students who participate in health education curricula in combination with other interventions as part of the coordinated school health model (i.e., physical activity, improved nutrition, and/or family engagement) have reduced rates of obesity and/or improved health-promoting behaviors [ 25 , 30 , 34 ]. In addition, school health education has been shown to prevent tobacco and alcohol use and prevent dating aggression and violence. Teaching social and emotional skills improves academic behaviors of students, increases motivation to do well in school, enhances performance on achievement tests and grades, and improves high school graduation rates.

As with other content areas, it is up to the state and/or local government to determine what should be taught, under the 10th Amendment to the US Constitution [ 48 ]. However, both public and private organizations have produced seminal documents to help guide states and local governments in selecting health education curricula. First published in 1995 and updated in 2004, the National Health Education Standards (NHES) framework comprises eight health education foundations for what students in kindergarten through 12th grade should know and be able to do to promote personal, family, and community health (see Table 1 ) [ 12 ]. The NHES framework serves as a reference for school administrators, teachers, and others addressing health literacy in developing or selecting curricula, allotting instructional resources, and assessing student achievement and progress. The NHES framework contains written expectations for what students should know and be able to do by grades 2, 5, 8, and 12 to promote personal, family, and community health.

SOURCE: Centers for Disease Control and Prevention. 2020. National Health Education Standards. Available at: National Health Education Standards Website. https://www.cdc.gov/healthyschools/sher/standards/index.htm (accessed June 19, 2020).

The Coordinated Approach to Child Health (CATCH) model, which was first developed in the late 1980s with funds by the National Heart, Lung, and Blood Institute, serves to implement the NHES framework and was the largest school-based health promotion study ever conducted in the United States. CATCH has 25 years of continuous research and development of its programs [ 24 ] and aligns with the WSCC framework. Individualized programs like the CATCH model develop programming based on the NHES framework at the local level, so that local control still exists, but the mix and depth of topics can vary based on need and composition of the community.

Based on reviews of effective programs and curricula and experts in the field of health education, CDC recommends that today’s state-of-the-art health education curricula emphasize four core elements: “Teaching functional health information (essential knowledge); shaping personal values and beliefs that support healthy behaviors; shaping group norms that value a healthy lifestyle; and developing the essential health skills necessary to adopt, practice, and maintain health enhancing behavior” [ 13 ]. In addition to the 15 characteristics presented in Box 1 , the CDC website has more detailed explanations and examples of how the statements could be put into practice in the classroom. For example, a curriculum that “builds personal competence, social competence, and self-efficacy by addressing skills” would be expected to guide students through a series of developmental steps that discuss the importance of the skill, its relevance, and relationship to other learned skills; present steps for developing the skill; model the skill; practice and rehearse the skill using real-life scenarios; and provide feedback and reinforcement.

Characteristics of an Effective Health Education Curriculum

• 1. Focuses on clear health goals and related behavioral outcomes.
• 2. Is research-based and theory-driven.
• 3. Addresses individual values, attitudes, and beliefs.
• 4. Addresses individual and group norms that support health-enhancing behaviors.
• 5. Focuses on reinforcing protective factors and increasing perceptions of personal risk and harmfulness of engaging in specific unhealthy practices and behaviors.
• 6. Addresses social pressures and influences.
• 7. Builds personal competence, social competence, and self-efficacy by addressing skills.
• 8. Provides functional health knowledge that is basic, accurate, and directly contributes to health-promoting decisions and behaviors.
• 9. Uses strategies designed to personalize information and engage students.
• 10. Provides age-appropriate and developmentally appropriate information, learning strategies, teaching methods, and materials.
• 11. Incorporates learning strategies, teaching methods, and materials that are culturally inclusive.
• 12. Provides adequate time for instruction and learning.
• 13. Provides opportunities to reinforce skills and positive health behaviors.
• 14. Provides opportunities to make positive connections with influential others.
• 15. Includes teacher information and plans for professional development and training that enhance effectiveness of instruction and student learning.

SOURCE: Centers for Disease Control and Prevention. 2020. Characteristics of an Effective Health Education Curriculum. Available at: https://www.cdc.gov/healthyschools/sher/characteristics/index.htm (accessed June 19, 2020.)

In addition, CDC has developed a Health Education Curriculum Analysis Tool [ 14 ] to help schools conduct an analysis of health education curricula based on the NHES framework and the Characteristics of an Effective Health Education Curriculum.

Despite CDC’s extensive efforts during the past 40 years to help schools implement effective school health education and other components of the broader school health program, the integration of health education into schools has continued to fall short in most US states and cities. According to the CDC’s 2016 School Health Profiles report, the percentage of schools that required any health education instruction for students in any of grades 6 through 12 declined. For example, 8 in 10 US school districts only required teaching about violence prevention in elementary schools and violence prevention plus tobacco use prevention in middle schools, while instruction in only seven health topics was required in most high schools [ 6 ].

Although 8 of every 10 districts required schools to follow either national, state, or district health education standards, just over a third assessed attainment of health standards at the elementary level while only half did so at the middle and high school levels [ 6 ]. No Child Left Behind legislation, enacted in 2002, emphasized testing of core subjects, such as reading, science, and math, which resulted in marginalization of other subjects, including health education [ 22 , 31 ]. Academic subjects that are not considered “core” are at risk of being eliminated as public school principals and administrators struggle to meet adequate yearly progress for core subjects, now required to maintain federal funding.

In addition to the quality and quantity of health education taught in schools, there are numerous problems related to those considered qualified to provide instruction [ 5 , 7 ]. Many school and university administrators lack an understanding of the distinction between health education and physical education (PE) [ 9 , 16 , 19 ] and consider PE teachers to be qualified to teach health education. Yet the two disciplines differ regarding national standards, student learning outcomes, instructional content and methods, and student assessment [ 5 ]. Kolbe notes that making gains in school health education will require more interdisciplinary collaboration in higher education (e.g., those training the public health workforce, the education workforce, school nurses, pediatricians) [ 29 ]. Yet faculty who train various school health professionals usually work within one university college, focus on one school health component, and affiliate with one national professional organization. In addition, Kolbe notes that health education teachers in today’s workforce often lack support and resources for in-service professional development.

Promising Opportunities for Strengthening School Health Education

Comprehensive health education can increase health literacy, which has been estimated to cost the nation $1.6 to $3.6 trillion dollars annually [ 54 ]. The National Action Plan to Improve Health Literacy by the US Department of Health and Human Services (HHS) includes the goal to “Incorporate accurate, standards-based, and developmentally appropriate health and science information and curricula in childcare and education through the university level” [ 49 ].

HHS’s Healthy People Framework presents another significant opportunity for tracking health in education as well as health literacy. The Healthy People initiative launched officially in 1979 with the publication of Healthy People: The Surgeon General’s Report on Health Promotion and Disease Prevention [ 50 ]. This national effort establishes 10-year goals and objectives to improve the health and well-being of people in the United States. Since its inception, Healthy People has undertaken extensive efforts to collect data, assess progress, and engage multi-stakeholder feedback to set objectives for the next ten years. The Healthy People 2020 objectives were self-described as having “input from public health and prevention experts, a wide range of federal, state, and local government officials, a consortium of more than 2,000 organizations, and perhaps most importantly, the public” [ 51 ]. In addition to other childhood and adolescent objectives (e.g., nutrition, physical activity, vaccinations), Healthy People 2020 specified social determinants as a major topic for the first time. A leading health indicator for social determinants was “students graduating from high school within 4 years of starting 9th grade (AH-5.1)” [ 52 ]. The Secretary’s Advisory Committee report on the Healthy People 2030 objectives includes the goal to “eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being of all” [ 53 ]. The national objectives are expected to be released in summer 2020 and will help catalyze “leadership, key constituents, and the public across multiple sectors to take action and design policies that improve the health and well-being of all” [ 53 ].

In terms of supports in federal legislation, the Every Student Succeeds Act (ESSA) of 2015 recognized health education as a distinct discipline for the first time and designated it as a “well-rounded” education subject [ 2 , 22 ]. According to Department of Education guidelines, each state must submit a plan that includes four academic indicators that include proficiency in math, English, and English-language proficiency. High schools also must use their graduation rates as their fourth indicator, while elementary and middle schools may use another academic indicator. In addition, states must specify at least one nonacademic indicator to measure school quality or school success, such as health education. Under the law, federal funding also is available for in-service instruction for teachers in well-rounded education subjects such as health education. These two items open additional pathways for both identifying existing or added programs and having the capacity to collect data.

While several states have chosen access to physical education, physical fitness, or school climate as their nonacademic indicators of school success, the majority (36 states and the District of Columbia) have elected to use chronic absenteeism [ 2 ]. Given the underlying causal connection between student health and chronic absenteeism, absenteeism as an indicator represents a significant opportunity to raise awareness of chronic health conditions or other issues (e.g., student social/emotional concerns around bullying, school safety) that contribute to absenteeism. It also represents a significant opportunity for schools to work with stakeholders to prevent and manage such health conditions through school health education and other WSCC strategies to improve school health. Educators are more likely to support comprehensive health education if they are made aware of its immediate benefits related to student learning (e.g., less disruptive behavior, improved attention) and maintaining safe social and emotional school climates [ 31 ].

In an assessment of how states are addressing WSCC, Child Trends reported that health education is either encouraged or required for all grades in all states’ laws, with nutrition (40 states) and personal health (44 states) as the most prominent topics [ 15 ]. However, the depth and breadth of such instruction in schools is not known, nor if health education is being taught by qualified teachers. In 25 states, laws address or otherwise incorporate the NHES as part of the state health education curriculum.

The authors’ review of state 2017–2018 ESSA plans, analyzed by the organization Cairn, showed nine states that have specifically identified health education as one of its required well-rounded subjects (Florida, Georgia, Indiana, Louisiana, Maine, Maryland, Nevada, North Dakota, and Tennessee) [ 8 ]. Cairn recommends that most states include health education and physical education in state accountability systems, school report card indicators, school improvement plans, professional development plans, needs assessment tools, and/or prioritized funding under Title IV, Part A.

In 2019, representatives of the National Committee on the Future of School Health Education, sponsored by the Society for Public Health Education (SOPHE) and the American School Health Association (ASHA), published a dozen recommendations for strengthening school health education [ 5 , 31 , 55 ]. The recommendations addressed issues such as developing and adopting standardized measures of health literacy in children and including them in state accountability systems; changing policies, practices, and systems for quality school health education (e.g., establishing Director of School Health Education positions in all state and territory education agencies tasked with championing health education best practices, and holding schools accountable for improving student health and well-being); and strengthening certification, professional preparation, and ongoing professional development in health education for teachers at both the elementary and secondary levels. Recommendations also call for stronger alignment and coordination between the public health and education sectors. The committee is now moving ahead on prioritizing the recommendations and developing action steps to address them.

Integrating Youth Health Education and Health Literacy: Success Stories

Minnesota statewide model: integrating school health education and health literacy through broad partnership.

The Roundtable on Health Literacy held a workshop on health literacy and public health in 2014, with examples of how state health departments are addressing health literacy in their states [ 28 ]. One recent example of a strong collaboration between K–12 education and public health agencies is the Statewide Health Improvement Partnership (SHIP) within the Minnesota Department of Health’s Office of Statewide Health Initiative [ 35 ].

SHIP was created by a landmark 2008 Minnesota health reform law. The law was intended to improve the health of Minnesotans by reducing the risk factors that lead to chronic disease. The program funds grantees in all of the state’s 87 counties and 10 tribal nations to support the creation of locally driven policies, systems, and environmental changes to increase health equity, improve access to healthy foods, provide opportunities for physical activity, and ensure a tobacco-free environment [ 35 ]. Local public health agencies collaborate with partners including schools, childcare settings, workplaces, multiunit housing facilities, and health care centers through SHIP.

SHIP models the integration of (1) law, (2) policy, (3) goal setting, and (4) resource building and forging some 2,000 collaborative partnerships and measuring outcomes. SHIP sets a helpful example for others attempting to create synergies across the intersections of state government, health education, local communities, and private organizations. The principles of health literacy are within these collaborations.

Grantees throughout the state have received technical assistance and training to improve school nutrition and physical activity strategies (see Figure 1 ). SHIP grantees and their local school partner sites set goals and adopt best practices for physical education and physical activity inside and outside the classroom. They improve access to healthy food environments through locally sourced produce, lunchrooms with healthier food options, and school-based agriculture. In 2017, SHIP grantees partnered with 995 local schools and accounted for 622 policy, systems, and environmental changes.

SOURCE: Minnesota Department of Health, Office of Statewide Health Improvement Initiatives. 2012. Statewide Health Improvement Partnership Evaluation Data, Minnesota Department of Health Legislative Report 2017. Reported by SHIP grantees using the REDCap system. This data represents the activities and reach of partner sites active between September 24, 2016, and August 25, 2017.

Minnesota has also undertaken a broad approach to health literacy by educating stakeholders and decision makers (i.e., administrators, food service and other staff, students, community partners, and parents) about various health-related social and environmental issues to reduce students’ chronic disease risks.

SHIP grantees assist in either convening or organizing an established school health/wellness council that is required by USDA for each local education agency participating in the National School Lunch Program and/or School Breakfast Program [ 46 , 47 ]. A local school wellness policy is required to address the problem of childhood obesity by focusing on nutrition and physical activity. SHIP also requires schools to complete an assessment that aligns with the WSCC model and provides annual updates. Once the assessment is completed by a broad representation of stakeholders, SHIP grantees assist schools in prioritizing and working toward annual goals. The goal setting and assessment and goal-setting cycle is continuous.

The Bigger Picture: A Case Study of Community Integration of Health Education and Health Literacy

Improving the health literacy of young people not only influences their personal health behaviors but also can influence the health actions of their peers, their families, and their communities. According to the SEARCH for Diabetes in Youth study funded by the CDC and the National Institutes of Health’s National Institute of Diabetes, Digestive, and Kidney Diseases, from 2002 to 2012, the national rate of new diagnosed cases of Type 2 diabetes increased 4.8% [ 32 ]. Among youth ages 10–19, the rate of new diagnosed cases of Type 2 diabetes rose most sharply in Native Americans (8.9%) (although not generalizable to all Native American youth because of small sample size), compared to Asian Americans/Pacific Islanders (8.5%), non-Hispanic blacks (6.3%), Hispanics (3.1%), and non-Hispanic whites (0.6%).

Since 2011, Dean Schillinger, Professor of Medicine in Residence at the University of California San Francisco and Chief of the Diabetes Prevention and Control Program for the California Department of Public Health, has led a capacity-building effort to address Type 2 diabetes [ 23 , 28 , 44 ].

This initiative called The Bigger Picture (TBP) has mobilized collaborators to create resources by and for young adults focused on forestalling and, hopefully, reversing the distressing increase in pediatric Type 2 diabetes by exposing the environmental and social conditions that lead to its spread. Type 2 diabetes is increasingly affecting young people of color, and TBP is specifically developed by and directed to them.

TBP seeks to increase the number of well-informed young people who can participate in determining their own lifelong health behaviors and influencing those of their friends, families, communities, and their own children. The project aims to create a movement that changes the conversation about diabetes from blame- and-shame to the social drivers of the epidemic [ 23 ].

TPB is described by the team that created it as a “counter-marketing campaign using youth-created, spoken-word public services announcements to re-frame the epidemic as a socio-environmental phenomenon requiring communal action, civic engagement, and norm change” [ 44 ]. The research team provides a description of questionnaire responses to nine of the public service announcements in the context of campaign messages, film genre and accompanying youth value, participant understanding of film’s public health message, and the participant’s expression of the public health message. The investigators also correlate the responses with dimensions of health literacy such as conceptual foundations, functional health literacy, interactive health literacy, critical skills, and civic orientation.

One of the campaign partners, Youth Speaks, has created a toolkit to equip and empower students and communities to become change agents in their respective environments, raising their voices and joining the conversation about combating the spread of Type 2 diabetes [ 56 ].

In a discussion of qualitative evaluations of TBP and what low-income youth “see,” Schillinger et al. note that “TBP model is unique in how it nurtures and supports the talent, authenticity, and creativity of new health messengers: youth whose lived experience can be expressed in powerful ways” [ 44 ].

COVID-19: Health Crisis Affecting Children and their Families and a Need for Health Education and Health Literacy in K-12

In a recent op-ed, Rebecca Winthrop, co-director of the Center for Universal Education and Senior Fellow of Global and Economic Development of the Brookings Institution asked, “COVID-19 is a health crisis. So why is health education missing from school work?” [ 58 ] She notes that “helping sustain education amid crises in over 20 countries, I’ve learned that one of the first things you do, after finding creative ways to continue educational activities, is to incorporate life-saving health and safety messages.” Her call is impassioned for age-appropriate, immediately available resources on COVID-19 that can be easily incorporated into distance lesson plans for both children and families. Many organizations, such as Child Trends, are curating collections of such resources. Framing these materials using principles of health literacy and incorporating them into health education messages and resources may be an ideal model for incorporating new pathways for public health K–12 learning.

Call to Action for Collaboration

Strategic and dedicated efforts are needed to bridge health education and health literacy. These efforts would foster the expertise to provide students with the information needed to access and assess useful health information, and to develop the necessary skills for an emerging understanding of health.

Starting with students in school settings, learning to be health literate helps overcome the increased incidence of chronic diseases such as Type 2 diabetes, and imbues a sense of self-efficacy and empowerment through health education. It also sets the course for lifelong habits, skills, and decision making, which can also influence community health.

Pursuing institutional changes to reduce disparities and improve the health of future generations will require significant collaboration and quality improvement among leaders within health education and health literacy. Recommendations provided in previous reports such as IOM’s 1997 report, Schools and Health: Our Nation’s Investment [ 26 ]; the 2004 IOM report on Health Literacy [ 27 ]; and the 2010 National Action Plan to Improve Health Literacy [ 49 ] should be revisited. More recently, a November 2019 Health Literacy Roundtable Workshop (1) explored the necessity of developing health literacy skills in youth, (2) examined the research on developmentally appropriate health literacy milestones and transitions and measuring health literacy in youth, (3) described programs and policies that represent best practices for developing health literacy skills in youth, and (4) explored potential collaborations across disciplines for developing health literacy skills in youth [ 38 ]. With its resulting report, the information provided in the workshop should provide additional insights into collaborations needed to reduce institutional barriers to youth health literacy and empowerment.

At the national level, representatives from public sector health and education levels (e.g., HHS’s Office of Disease Prevention and Health Promotion, CDC, Department of Education) can collaborate with school-based nongovernmental organizations (e.g., SOPHE, ASCD, ASHA, National Association of State Boards of Education, School Superintendents Association, Council of Chief State School Officers, Society of State Leaders of Health and Physical Education) to provide data and lead reform efforts. Leaders of higher education (e.g., Association of American Colleges and Universities, Association of Schools and Programs of Public Health) can join with philanthropies and educational scholars to pursue curricular reforms and needed research to further health education and health literacy as an integral component of higher education.

Among the approaches needed are (1) careful incorporation of key principles of leadership within systems; (2) the training and evaluation of professionals; (3) finding and sharing replicable, effective examples of constructive efforts; and (4) including young people in the development of information and materials to ensure their accessibility, appeal, and utility. Uniting the wisdom, passion, commitment, and vision of the leaders in health literacy and health education, we can forge a path to a healthier generation.

Acknowledgments

The authors would like to express our gratitude to Melissa French and Alexis Wojtowicz for their support in the development of this paper.

Funding Statement

The views expressed in this paper are those of the authors and not necessarily of the authors’ organizations, the National Academy of Medicine (NAM), or the National Academies of Sciences, Engineering, and Medicine (the National Academies). The paper is intended to help inform and stimulate discussion. It is not a report of the NAM or the National Academies.

Conflict-of-Interest Disclosures: Wilma Alvarado-Little has no relevant financial or non-financial relationships to disclose. She contributed to this article based on her experience in the field of health literacy and cultural competency and the opinions and conclusions of the article do not represent the official position of the New York State Department of Health. Cherylee Sherry discloses that she works for the Minnesota Department of Health in the Office of Statewide Health Improvement Initiatives which oversees the Statewide Health Improvement Partnership Program funded by the State of Minnesota.

Contributor Information

M. Elaine Auld, Society for Public Health Education.

Marin P. Allen, National Institutes of Health (ret.)

Cicily Hampton, University of North Carolina at Charlotte.

J. Henry Montes, American Public Health Association.

Cherylee Sherry, Minnesota Department of Health.

Angela D. Mickalide, American College of Preventive Medicine.

Robert A. Logan, U.S. National Library of Medicine and University of Missouri-Columbia.

Wilma Alvarado-Little, New York State Department of Health.

Kim Parson, KPCG, LLC.

School health activities not only support the sustainable development goals for health (SDG 3) and education (SDG 4), but also SDG 2 (reducing hunger), SDG 5 (gender equality) and SDG 6 (clean water and sanitation). School health programs represent a great investment.

Building on the lessons of the Millennium Development Goals, the SDGs work along a similar path of development objectives, as well as encourage new strategies for long term sustainable development by linking activities across sectors. Educators working in school health see synergistic collaboration across many sectors.

Making education equal for all children

The most important SDG for school health activities is SDG 4: Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all .

Research has demonstrated that school health activities promote equitable access to, and participation in, quality education through activities such as deworming (providing medicine to fight intestinal worms, which can cause anemia, stunting, lethargy, impaired cognitive development, poor short-term memory, and increased absenteeism), micronutrient administration, school meals, provision of water and sanitation facilities.

Other programs also boost efforts under SDG 4: reproductive health education, prevention education on HIV and other sexually-transmitted infections, counseling and support services for orphans and vulnerable children, and life-skills education.

It is commonplace to observe that school health activities level the playing field for all students, supporting goals for equitable access and participation in a quality education. Each of these key school health activities, by definition and practice, also overlaps with other important SDGs.

Fighting hunger through schools

SDG 2 – End hunger, achieve food security and improved nutrition and promote sustainable agriculture – is addressed directly by school feeding activities. There is strong evidence that a mother’s education improves her children’s nutrition, but school-based feeding activities are a real-time response to the immediate needs of school age children.

School feeding reduces the economic burden on families by providing a meal at school or take-home rations, and can be complemented by micronutrient (vitamins and minerals) administration. These activities are often linked with nutrition education, and they make a lasting impact on families by building the capacity of children and communities for resilience to food insecurity deriving from economic and agricultural shocks.

Learning to be healthy in school

SDG 3 – Ensure healthy lives and promote well-being for all at all ages – not only addresses the provision of quality health care, but also improved health knowledge and healthy behaviors. It is directly supported through school health activities that often are implemented in coordination with ministries of health.

Activities such as provision of clean water and sanitation (latrines), STI and HIV prevention education, provision of reproductive health services, school-based deworming, vision screening, and vaccination programs, are a few examples of school health activities that either provide health services to school age children, improve health knowledge, or promote health seeking behavior.

Making gender equality a reality

SDG 5 – Achieve gender equality and empower all women and girls – is one of the goals that education is best-suited to address through its own processes, as well as through school health activities. Education enables girls and women to reach their full potential – in parity with men and boys – in their homes, communities, workplaces and institutions of influence. This is a fundamental attribute of classroom-based education as well as distance and non-formal educational opportunities for all persons in a community.

School health activities that promote gender equity and equality in participation and attainment of education include provision of clean water and separate sanitation facilities for girls, menstrual hygiene management, provision of hygiene kits, reproductive health education, STI and HIV prevention, prevention of unwanted pregnancy, of early marriage, of gender based violence and other forms of abuse, life skills education, and school safety promotion. Comprehensive sexuality education and reproductive health services in schools are other important ways school-based health activities serve SDG 5. All of these school-based health activities also link synergistically to SDG 3.

Clean water and sanitation for all

SDG 6 – Ensure availability and sustainable management of water and sanitation for all –  The goal promoting clean water and sanitation is fundamentally promoted by school-based provision of quality infrastructure for education, including water points, hand-washing stations, as well as separate sanitation facilities for girls and boys.

Hygiene promotion activities in school health also promote synergy with SDG 3 (helping to prevent water-borne diseases) and SDG 5 (by de-stigmatizing menstruation and promoting improved menstrual health practices at schools and in communities.)

Learn more about how education interacts with all SDGs

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Wow! All my recent thoughts in one article! Bravo! Thank you for sharing such an insightful piece. The lack of proper health education and knowledge how it impacts development of a society and economy is an everyday problem in most countries. I hope your ideas, Mr. Strickland, and GPE efforts reach the masses

In reply to Slam dunk article by Haddy Coulibaly

Thank you for your kind comments. You might also have like this volume of articles providing the compelling evidence on school health and its effectiveness for education outcomes. http://dcp-3.org/resources/child-and-adolescent-health-and-development-… . There are also a couple of other resources on the GPE website you might find interesting - a fact sheet, and an infographic - both linked here; https://www.globalpartnership.org/content/better-education-outcomes-thr… ; https://www.globalpartnership.org/multimedia/infographic/how-improve-he… Forward with Progress!

The link to the factsheet seems to be faulty - here is the link provided again. Thank you! Brad https://www.globalpartnership.org/content/better-education-outcomes-thr…

J'ai beaucoup apprécié et je également beaucoup appris. À partir de là, je pourrais mieux aider la communauté.

Je suis Président du Conseil d'Administration d'une ONG du secteur de la santé et de l'éducation.Mes préocupations concernent: 1.Trouver un réseau pour répondre à l'objectif 3 Apprendre à etre en bonne santé par des lecons spécifiques au primaire,secondaire et autres niveaux à l'école 2.Comment creér une synergie entre écoles engagées dans la promotion de la santé par des lecons 3.Qui peut nous appuyer 4.Comment interresser les différents Ministeres de l'éducation à integrer nos programmes dans le cursus scolaire

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Healthy Activities

Schools are an avenue for participation in a number of activities outside of the traditional classroom environment. As much as possible, these activities should continue to be provided to students to support engagement, health, mental wellbeing, and development.

Provide recess

• Do not limit children’s access to recess, the schoolyard, or fixed play equipment
• Wash or sanitize hands before and after recess or using high-touch equipment
• Increase supervision to limit high-risk behaviors
• Stagger recess times, or, if necessary, separate classes by schoolyard area

Recess, often the only opportunity to participate in unstructured free-play during the otherwise structured and sedentary school day, is beneficial to children’s development of autonomy, participation in physical activity and various sensory and physical experiences, practice of social and motor skills, and attention restoration. As different areas of the schoolyard afford different levels of physical activity, types of play, and social interactions, consider the impact of new recess policies on children’s ability to confer the benefits of recess. Schools can develop strategies to reduce the risk of COVID-19 transmission in order to allow for continued use of fixed equipment (play structures) and portable equipment.

One of the most important steps that can be taken is for children and teachers to wash their hands with soap and water both before and after recess. Hand sanitizer containing at least 60% ethanol or 70% isopropanol can be used in situations when this is not feasible. Schools may consider having students use hand sanitizer before and after using high-touch equipment (e.g., fixed equipment or play structures). Supervision could be increased to ensure safe practices are followed, particularly during high-risk times (start/end of recess) and in high-risk locations (enclosed or small, hard-to-see places on fixed equipment, or anywhere with high child density). Supervisors should maintain physical distance from students and continue to wear masks. Physical distance between students should be promoted as much as possible. Schools may consider offering physical activity options that allow students to maintain physical distance while they are playing. However, transient interactions while masked are lower risk and should not be used as the basis for limiting all activities.

Ideally, recess times could be staggered so that children in different classes or cohorts would not interact (to maintain group distancing). If classes or cohorts must share the same recess time, entry and exit times could be staggered, or different entry and exit locations could be used for each group. If the schoolyard is large and diverse enough to provide adequate space and variety to each class (including access to all types of schoolyard locations and equipment), classes or cohorts could be provided with designated spaces on the schoolyard in which to play (if recess times cannot be staggered). These designated spaces could be rotated frequently (e.g., daily, weekly, depending on the variety available) to provide children access to a variety of schoolyard experiences.

Schools can allow use of shared portable equipment (e.g., balls, wheeled toys) as play with portable equipment promotes physical activity and allows children to practice motor and social skills. Shared equipment can be disinfected between each class/cohort, and students should wash hands after using shared equipment. Schools may also allow children to “sign out” pieces of equipment and clean each piece between uses. When possible, schools could consider how to modify games/activities to promote safe play. For example, the game “tag” could be replaced with “shadow tag,” in which children step on each other’s shadows instead of touching each other directly.

Modify physical education

• Hold physical education classes outdoors when possible
• Modify activities to limit the amount of shared equipment
• Choose activities that limit close contact over those with a high degree of personal interaction
• Limit use of locker rooms

Physical education aims to develop children into physically literate individuals who have the skills, fitness, and motivation necessary to participate in physical activity across the lifespan. Importantly, while both facilitate physical activity participation, recess and physical education have unique benefits and should not be substituted for one another.

When designing lesson plans, schools could choose activities that limit the amount of shared equipment (e.g., children rotate through stations and equipment is cleaned before/after each use) and contact between students (e.g., children have their own pool noodle to tag others with instead of their hands and to remember to keep distance). As some children may be less physically fit due to limited participation in activities over the previous months, schools could apply progressive overload to allow for safe, gradual increases in workload. Physical distancing, washing hands, and healthy building strategies are particularly important during indoor physical education due to increased breathing rates of students. Locker room access should be limited or staggered. Furthermore, physical education is much more than just physical activity, so schools may consider focusing on teaching the components and values of physical activity and physical fitness, as well.

Reimagine music and theater classes

• Replace higher-risk music and theater activities with safer alternatives
• Move outdoors
• Increase space between performers

Music education is associated with numerous benefits, including higher academic scores, better memory recall, and the development of areas of the brain related to language and reasoning. Music and theater education should continue, but there are ways they can be made safer. Instruments that do not involve blowing air from the mouth, such as percussion or strings instruments, could be used instead of higherrisk wind instruments, which have the potential for spread of aerosols and droplets because masks cannot be worn while playing. Singing and voice projection are also higher-risk activities that carry a higher risk of viral transmission because of the higher emission rates of aerosols and droplets. Indoor instruction of these higher-risk activities can be replaced with outdoor practice (weather permitting), music theory, theater history, or vocal anatomy lessons. Another option is to continue online instruction for certain instruments, choirs, or ensembles, or practice outdoors in smaller, well-spaced groups. If schools decide to practice indoors, additional precautions are necessary. Practice should only take place in rooms with enhanced ventilation and filtration and where maximum physical distancing can be achieved (minimum six feet). Additional distancing beyond six feet is required for unmasked wind instrument players. Masks should be worn at all times for string instruments players, singers, and performers who are projecting their voice, and for wind instrument players at all times when not actively playing the instrument (e.g., during instrument setup, between songs).

Additionally, all equipment, even student’s personal instruments, should be cleaned routinely. Smaller music spaces such as individual practice rooms may be difficult to properly ventilate, so there should be time set aside to keep the door open and clean the room in between uses, or the rooms can be temporarily closed. In theater classes, it may be preferable to focus on rehearsing monologues, remote performances, more performances with small casts that do not require close interaction or performances that can be rehearsed outdoors.

Continue sports with enhanced controls

• Offer every sport if the right controls are in place
• Play outdoors as much as possible
• Limit time spent in close contact and in big groups
• Limit shared equipment, shared spaces, and the number of contacts of the team
• Modify the season schedule and restrict game attendance if feasible
• Analyze each element of practices and games to identify ways to reduce risk
• Wash or sanitize hands before and after practice, games, or using high-touch equipment

Sport participation offers students a number of psychological and physical benefits and drives physical activity both in childhood and later in adulthood. The risk of transmission for each sport will depend on a number of factors, so decisions regarding specific sports will need to be nuanced. All sports carry some risk of transmission, and that risk varies by the activity. For example, some sports may be a higher risk during competition but can be a lower risk during practice and drills. But even for sports with lower overall risk, there can be periods of higher risk times during practice or in the locker room. The overall risk is not necessarily about the sport, per se, but about the activities taking place within each sport. The flow chart provided in this section may help decision-makers identify the overall risk level of sports activities across three factors: location, distancing, and group size.

Outdoor sports may be less risky than indoor sports, so hold as many practices and games outdoors as possible. Individuals being in close contact increases risk of transmission, so strategies to limit close contact of players should be employed. For example, limit full gameplay to competitions and focus practices on other elements of skill development. Also, consider limiting the number of competitions in a season overall or hold within-team or within-school competitions. To the extent possible, teams should avoid competing with teams that are not local or not part of their conference or league. If big groups are present during the sport, implement strategies to de-densify (e.g., alternate work out days/times for different parts of the team) and maintain physical distancing as much as possible. Teams may also consider ways to shorten the duration of time spent indoors for a particular practice or competition when feasible.

Regardless of overall risk level, there are some strategies that can be implemented in all sports to reduce risk of transmission. An overarching goal is to limit shared spaces and close contact. This means not using locker rooms or staggering locker room use, and avoiding team huddles and high fives, and washing hands or using hand sanitizer frequently. In-person meetings (e.g., team meetings) should take place remotely, outdoors, or in spaces where physical distancing can be maintained. Workouts, practices, and drills could be completed individually or in small cohorts to maintain physical distancing and so that equipment can be cleaned between uses. A certain number of practices per week could also be dedicated to at-home workouts.

Consider limiting the number of competitions in a season overall or hold within-team or within school competitions. To the extent possible, teams should avoid competing with teams that are not local or not part of their conference or league.

The number of people in direct contact with the team and/or staff can be reduced by eliminating or limiting the number of attendees and other non-essential personnel at sporting events. Physical distance between spectators should be maintained, and schools should clearly mark six foot distances in lines, hallways, and/ or seating. Spectators, if allowed at all, should wear masks and be asked to bring signs and applaud the players instead of yelling and cheering; playing music on a loudspeaker at certain times during the event may help improve energy without the cheering.

To limit risk during practices and competitions, players, coaches, and attendees should wear face masks at all times, including on the sidelines/bench, in locker rooms, and/or during gameplay. To ensure anyone wearing masks stays hydrated, they should be encouraged to take mask-free water breaks, while physically distanced from others and while following safe mask removal techniques (e.g. only touching the mask from its straps). Team members could have a spare in case the mask gets too sweaty. In addition, coaches can create areas far removed from other people and near areas of good ventilation where athletes can take short mask breaks (e.g., near the gym door). Athletes with asthma or other breathing problems should consult with their physician if there are concerns about mask use during physical activity. Finally, coaches are recommended to analyze every element of practices and games to identify ways to reduce risk, such as using hand or electronic whistles instead of whistles that touch the mouth, and to consider sport-specific strategies.

Add structure to free time

• Establish occupancy limits and clear physical distancing guidelines in common spaces like a library or cafeteria
• Encourage students to remain outside when not in class
• Replace unstructured time with supervised study halls, if feasible

Children in older grades often have more freedom than younger children. Although breaks from classes are important, safety precautions need to be maintained. When possible, schools could have students spend free blocks outside where there is more fresh air, and physical distancing is easier. If inside, schools may consider assigning student classes to specific common spaces (to preserve group distancing), putting limits on the number of students allowed in each space, and creating clear rules and demarcations on how to maintain physical distance. To limit unsupervised time further, schools may consider entirely replacing free blocks with supervised study halls.

When possible, schools could have students spend free blocks outside where there is more fresh air, and physical distancing is easier.

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• Resource Library
• Healthy Meals Incentives

Healthy Activities to Do at Home

Fostering healthy behaviors, staying active, and eating nutritiously at home are vital for children’s development for many reasons, in addition to the obvious. Practicing health at home:

• Helps build resilience and the ability to better manage stressors
• Helps prevent disease and boosts the immune system
• Reinforces lessons learned at school and helps create a 360-degree healthy environment

When kids are out of school for any reason, whether it’s the weekend, a holiday break, or a school closure, parents and caregivers can use these activities and resources to keep their kids moving, learning, and eating healthily.

Movement & Play

• Practice yoga techniques and poses to build strength and flexibility and help relax.
• Get “family fit” using activity points to encourage movement.
• Create a backyard (or basement) fitness circuit course .
• Use common household objects for some fitness fun and games.
• Have recess at home by playing old school throwback games , jumping rope , or doing any of these 50 ideas .
• Play! Try sensory play or play on the go to encourage kids’ imaginations whenever, wherever.
• Do a nature scavenger hunt to get kids exploring the outdoors.
• Have active screen time using these fun, kid-friendly physical activity videos compiled by Active Schools.

Healthy Eating & Nutrition

Visit our Healthy Eating Toolkit for dozens more tips and ideas, but here are some easy-to-implement activities.

• Incorporate nutrition education into your home routine.
• Start the day with a healthy breakfast , and keep them going with healthy snacks .
• Introduce new foods with a taste test (and get creative with how items are prepared). Here are ideas for whole grains , dairy , and fruits and veggies .
• Try mindful eating .
• Cook a dish or meal with your kids trying one of these recipes.
• Grow fresh veggies out of kitchen scraps .
• Go the distance to make your food and meals last longer .

Mindfulness & Emotional Health

• Try journaling, breathing exercises, and more .
• Explore feelings through art and color.
• Talk about feelings with these family conversation starters.
• Use movement to express emotions .
• Set intentions with your children .
• Learn basic mindfulness techniques together .
• Create a letter-writing tradition in your family.

Visit Edutopia’s list of social emotional learning resources for parents to see other ways you can encourage empathy, foster gratitude, help kids navigate the digital social sphere, and more.

Sign up to get other tips and resources from Action for Healthy Kids.

Categories: Health at Home , Physical Activity, PE, & Play

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Improving School Health

Schools play a critical role in supporting children and adolescents in eating healthy and getting regular physical activity. Schools can provide learning opportunities to reinforce these healthy behaviors by implementing wellness policies and practices and using an effective health education curriculum.

Healthy Youth

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