Health

A new study published in Health Promotion International highlights the importance of comprehensive health promotion policies in schools for developing pupils’ health literacy – that is, their ability to find, understand, evaluate and use information to make decisions that are beneficial to their health.

The article, ‘The settings approach to health promotion in schools: examining the role of school policies in fostering student health literacy’, is based on data collected from 46 primary schools, involving 2,325 pupils, 552 teachers and 46 headteachers.

Health literacy is not developed solely in the classroom

The study shows that pupils’ health literacy is the result of a combination of individual, family, social and school-related factors. The socio-economic context remains significant: the mother’s level of education and the proportion of pupils receiving subsidised meals are, in particular, associated with the level of health literacy. However, the results also show that schools have their own levers of influence that they can utilise.

Pupils attending schools that implement the most comprehensive and integrated health promotion policies are more likely to have a high level of health literacy. This holistic approach does not rely on a single isolated initiative or programme. It incorporates various aspects of school life: the organisation and management of the school, teaching and learning, the physical and social environment, the involvement of pupils and staff, relationships with families and the community, and access to health and social services.

Other factors also appear to be key: collaboration with parents, teacher training in health promotion and teachers’ own levels of well-being are all associated, regardless of socio-economic factors, with better health literacy amongst pupils.

Moving from isolated measures to a coherent school policy

These findings support the so-called ‘settings approach’, which underpins the health-promoting schools model. It is no longer simply a matter of offering pupils specific health education lessons, but of creating an environment in which health is integrated into the day-to-day activities of the school.

One of the key findings of the study is therefore that the quality, consistency and degree of integration of the policy implemented matter. A health promotion policy cannot be viewed simply as an intervention that is either present or absent: the way in which its various dimensions are interlinked appears to play a role in the skills developed by pupils.

Collaboration with families also becomes meaningful when it forms part of this overarching strategy: the results suggest that an isolated partnership initiative is less likely to have an impact than a coherent approach across the whole school.

Supporting teachers: a key factor in pupils’ health

The study also reveals a particularly important finding concerning education professionals. Teachers’ training and well-being are not merely professional issues: they contribute to the conditions that enable pupils to develop their health literacy.

Analyses show that pupils whose teachers are better trained in health promotion and report higher levels of well-being are more likely to demonstrate high levels of health literacy.

This finding suggests that teachers should be considered key players within the school ecosystem. An ambitious policy to promote pupils’ health therefore also requires providing professionals with the skills, resources and working conditions necessary to take action.

A key challenge: tackling health inequalities from early childhood

Social inequalities continue to have a significant impact on children’s health literacy. However, the study shows that school policy features and teachers’ resources remain associated with health literacy even after taking these socio-economic differences into account.

Comprehensive whole-school approaches could therefore help to mitigate the effects of social inequalities on health literacy. Analysis of the different school profiles confirms, in particular, that it is not a single factor that makes the difference, but the combination of social context, health promotion policies, teacher training and professional well-being. Developing children’s health literacy involves creating school environments that effectively empower them to understand, evaluate and apply this knowledge in their lives.

The study thus provides new arguments in favour of sustained investment in health-promoting schools, in the professional development of teaching staff, and in their well-being. It also calls for further longitudinal research to better measure, over time, the effects of changes in school policies on pupils’ health literacy, health and educational pathways.

Reference
Didier Jourdan, Ting-Ya Kuo, Min-Chien Tsai, Fu-Li Chen, The settings approach to health promotion in schools: examining the role of school policies in fostering student health literacy, Health Promotion International, Volume 41, Issue 5, October 2026, daag129, https://doi.org/10.1093/heapro/daag129