The ‘whole school’ environment
As well as a setting for health promotion, each school is a
distinct society. Local factors like children's success in examinations or their pattern of attendance shape that environment.10 For Americans aged around 15 years, the social
dimension of their health is correlated with ‘school connecedness’ in that learning environment.11 However, it is
important not to extrapolate measures from affluent countries to low income nations where only elementary education
may be accessible, and to societies where school may promote
values like reverence (whereas Americans may ‘encourage
student self-management’).11 For example in Bhutan12 only
7% of adults had any secondary education but cultural preservation and nature conservation are esteemed.13
Within a ‘school age’ population spanning 5e18 years,
biological growth underpins development of mental, physical
and social health.14,15 Worldwide, huge inequities in child
development are apparent.16 UNESCO and partner agencies
have stimulated work around the developing child through
Focusing Resources on Effective School Health (FRESH). FRESH
is based on the consensus that a child's ability to attain her or
his full potential is directly related to the synergistic effect of good health, good nutrition and appropriate education.17 Not
all school-based interventions produce the positive effects
intended, for example an unforeseen problem with the US
school breakfast programme was ‘stigma associated with
participation in a program intended for youth from low income families’.