Healthy schools and pupils

Local authorities’ role in mainstream education is primarily one of supporting schools.

Here, we focus on what local authorities can do to help schools deliver better educational outcomes, and promote healthy behaviours among children and their families.

How can education affect health?

Evidence from many countries confirms that there is a strong correlation between educational attainment, life expectancy and self-reported health, within and across generations. School is also an important setting for forming or changing health behaviours. But interventions need to be well targeted, and achieving improvements in behaviour among more deprived pupils may be more difficult and more costly (Matrix Evidence/NICE 2008).

  • Four more years of schooling reduces mortality rates by 16 per cent – equivalent to the life-expectancy gap between men and women – and reduces risks of heart disease and diabetes (Lleras-Muney and Cutler 2006).
  • Those with less education report being in poorer health; they are more likely to smoke, more likely to be obese and suffer alcohol harm (Department of Health 2008).
  • England has some of the widest education-related inequalities in self-assessed health in Europe, particularly for women; out of 19 countries, only Slovakia and the Czech Republic fare worse (Mackenbach et al 2007).
  • Better education for parents improves health outcomes for their offspring. The introduction of reforms to increase school leaving age for girls in the 1970s led to a reduction in overweight boys (Nakamura 2012).
  • Only half of 7 year olds are getting the recommended levels of physical activity with girls doing less well than boys (Griffiths et al 2013); schools have an important part to play.

What are the possible priority actions for local authorities?

There is much that can be done to reduce conduct disorders and exclusions, as well as bullying, which can be extremely detrimental to a person’s physical, emotional and mental health in the short and longer term. ‘Whole school’ approaches are important, since unhealthy behaviours cluster in children and adolescents (MacArthur et al 2013; Kipping et al 2012), just as they do in adults.

To support schools to deliver better educational outcomes, local authorities can:

  • learn from other successful interventions to reduce drop-out and exclusion rates, and focus on raising educational standards among the most vulnerable children and young people (Parsons 2009)
  • support and expect schools to take actions to reduce bullying through implementing evidence-based guidance (Farrington and Ttofi 2010)
  • support and expect schools to reduce the prevalence and impact of conduct disorders through programmes that have been shown to improve students’ social and emotional skills, attitudes, behaviours and attainment (NICE 2013a).

To promote schools as settings for healthy behaviours, local authorities can:

  • support schools to develop children’s life skills such as problem-solving, and to build self-esteem and resilience to peer and media pressure, this can reduce smoking initiation by 12 per cent (McLellan and Perera 2013)
  • encourage schools to incorporate more physical activity into the curriculum. Some programmes have succeeded in increasing children’s moderate and vigorous activity levels threefold, and reducing hours spent watching TV at home
  • help schools promote healthy diets, focusing on 6–12 year olds. Overall impacts in terms of reducing weight gains may be relatively small, but can lead to significant longer-term impacts, halving adult obesity rates (National Institute for Health and Care Excellence 2013a). Interventions can be just as effective with poorer children and can increase fruit and vegetable consumption – doubling the odds of fruit and vegetable consumption at lunch (Waters et al 2011) – and reduce total energy intake
  • develop targeted wellness services towards clusters of children identified as being at high risk of multiple poor behaviours, rather than providing single issue services only. Schools should be encouraged to foster a strong sense of culture and belonging, and connectedness with teachers. ‘Whole school’ approaches to improving health behaviours are likely to be more effective (Jackson et al 2012; Bond et al 2004)
  • support the use of resources such as the Department for Education’s Healthy Schools Toolkit (2013).

The business case for different interventions

Supporting and challenging schools to focus on achieving good social and emotional health outcomes, and enabling children to make healthy rather than unhealthy lifestyle choices, provides substantial paybacks to individuals, society and local authorities. The overall health benefits of a good education have been estimated to provide returns of up to £7.20 for every £1 invested (Lleras-Muney and Cutler 2006).

Schools that focus on developing pupils’ social skills and emotional health can provide long-term paybacks to society through the creation of well-adjusted adults. For instance, school-wide anti-bullying programmes can return almost £15 for every £1 invested in the longer term through higher earnings, productivity and public sector revenue (Knapp et al 2011); interventions to tackle emotional-based learning problems in schools have paid for themselves within the first year through reductions in social service, NHS and criminal justice system costs, and have recouped £50 for every £1 spent over five years (Knapp et al 2011).

Behaviour change interventions in schools have also proven to be very cost-effective when considering longer-term paybacks. For example, smoking prevention programmes have recouped as much as £15 for every £1 spent (Stephens et al 2000) and for every £1 spent on contraception to prevent teenage pregnancy, £11 is saved through fewer costs from terminations, antenatal and maternity care (Teenage Pregnancy Associates 2011).

Further resources and case studies

For references please see Improving the public's health: references appendix

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