Health promoting schools and health promotion in schools: two systematic reviews


The primary objective of this study was to evaluate the effectiveness of school-based health promotion interventions through a systematic review of primary studies of the effectiveness of the health promoting schools approach, and a systematic review of existing reviews of the effectiveness of other health promoting interventions in schools in the following areas: nutrition, exercise, safety, psychological aspects of health, sexual health, substance use, personal hygiene, environmental issues and family life education.


The health promoting schools initiative is a new, complex, developing initiative, and the optimum method of evaluation is currently under debate. There are indications that this approach is promising. The development of programmes to promote mental and social well-being would be likely to improve overall effectiveness and the impact of staff health and well-being needs more consideration. The development of measures of mental and social well-being is important for future evaluation. Continued investment, and ongoing evaluation are necessary to provide evidence about the effectiveness of this approach.

This review of reviews shows that school health promotion initiatives can have a positive impact on children's health and behaviour but do not do so consistently. It would appear that most interventions are able to increase children's knowledge but that changing other factors which influence health, such as attitudes and behaviour, is much harder to achieve, even in the short-term. Overall, a multifaceted approach is likely to be most effective, combining a classroom programme with changes to the school ethos and/or environment and/or with family/community involvement. This is consistent with the health promoting schools approach.

Conducted by: D Lister-Sharp1, S Chapman2, S Stewart-Brown2, A Sowden1

1. NHS Centre for Reviews and Dissemination; 2. Health Service Research Unit, Department of Public Health, University of Oxford

Further details

Project page on HTA Programme website


Lister-Sharp D, Chapman S, Stewart-Brown S, Sowden A. Health promoting schools and health promotion in schools: two systematic reviews. Health Technol Assess. 1999;3(22):1-207


Stewart-Brown S, Lister-Sharpe D, Chapman S, Sowden A. Health promotion in schools: a systematic review of systematic reviews. Faculty of Public Health Conference; 2000 July; Scarborough, UK


Commissioned by the HTA Programme