The promotion of healthy universities : a systematic review

CPQ Women and Child Heal h (2018) 1:3 Re iew A icle The P omo ion o Heal hy Uni e si ies: A Sys ema ic Re iew Ma a Reis1,2,3*, Lúcia Rami o1,2, Diego Gomez-Baya4 & Ma ga ida Gaspa de Ma os1,2,5 *Co espondence o: D . Ma a Reis, Psychologis o sexual and clinical heal h, Facul y o Human Kine ics/ Uni e si y o Lisbon, Po ugal. 1A en u a Social - Faculdade de Mo icidade Humana /Uni e sidade de Lisboa, Po ugal Recei ed: 04 Oc obe 2018 Copy igh © 2018 D . Ma a Reis, e al. This is an open access a icle dis ibu ed unde he C ea i e Commons A ibu ion License, which pe mi s un es ic ed use, dis ibu ion, and ep oduc ion in any medium, p o ided he o iginal wo k is p ope ly ci ed. Keywo ds: Heal hy Uni e si ies; Heal h P omo ion; P e en i e In e en ions; Sys ema ic Re iew Ma a Reis, e al. (2018). The P omo ion o Heal hy Uni e si ies: A Sys ema ic Re iew. CPQ Women and Child Heal h, 1(3), 01-15. CIENT PERIODIQUE Published: 22 Oc obe 2018 Abs ac Uni e si ies a e impo an o ganiza ions in wha conce ns he c ea ion and imp o emen o heal h and wellbeing, hus heal hy uni e si ies ep esen a key applica ion o he heal h-p omo ing se ings app oach. The heal hy Uni e si ies concep has a s ong heo e ical basis, and i appea s appealing amongs uni e si ies wo ldwide. Howe e , he way in which he app oach has been implemen ed emains poo ly g ounded in heo y. This sys ema ic e iew aims o desc ibe how uni e si ies ha e implemen ed he Heal hy Uni e si ies concep in di e en cul u es. In o de o achie e his aim, we analyzed he ollowing aspec s o he implemen a ion o he Heal h P omo ing Uni e si y: (a) de ini ion o Heal hy Uni e si y; (b) p io i y a eas o ac ion; (c) subjec ma e s; (d) p ojec s and coo dina ion; and (e) p ojec e alua ion and possible esul s. 2ISAMB /Faculdade de Medicina da Uni e sidade de Lisboa, Lisboa, Po ugal 3Pos -doc o al S uden s o he Founda ion o Science and Technology, Po ugal 4Depa amen o Social, De elopmen al and Educa ional Psychology, Uni e sidade de Huel a, Huel a, Espanha 5Sabba ical G an Founda ion o Science and Technology, Po ugal CIENT PERIODIQUE Ma a Reis, e al. (2018). The P omo ion o Heal hy Uni e si ies: A Sys ema ic Re iew. CPQ Women and Child Heal h, 1(3), 01-15. Ma a Reis, e al., CPQ Women and Child Heal h (2018) 1:3 Page 2 o 15 Uni e si ies a e impo an o ganiza ions in wha conce ns he c ea ion and imp o emen o heal h and wellbeing, hus heal hy uni e si ies ep esen a key s a egy in he heal h-p omo ing se ings app oach [1-3]. As an o ganiza ion, highe educa ion plays a majo ole in shaping socie y, wi h signi ican social, economic and en i onmen al impac s a egional, na ional and global le els [4,5]. The indi iduals who cons i u e he uni e si y communi y (s uden s, p o esso s, esea che s, echnicians, e c.) a e, o will be, p o essionals, poli icians and leade s in di e en a eas o socie y, and may di ec ly in luence socie y wi h hei habi s, belie s and a i udes [5]. In oduc ion PsycINFO, ISI Web o Knowledge, ISI P oceedings, PubMed, Medline, Lilacs and Scielo we e sea ched o a icles on Heal h P omo ing Uni e si ies, published be ween 1997 and 2017. S udies de ailing he implemen a ion o a Heal h P omo ing Uni e si y app oach we e included. Resul s Fou een s udies we e iden i ied o in-dep h analysis. O hose, ou we e heo e ical pape s, and en we e in e en ion s udies. The p og ams desc ibed in he selec ed s udies a e mos ly based on he guidelines o he Edmon on Cha e . They inco po a ed he main a eas o ac ion and subjec ma e s p oposed by he Heal hy Uni e si ies amewo k. The implemen a ion o heal hy policies and he inco po a ion o heal h p omo ion in he cu iculum emain challenging. The e iew sugges s ha mos o he uni e si ies wo k owa ds simila goals, elying on he Heal hy Uni e si ies amewo k, ye ha he way in which ini ia i es a e implemen ed depends on he con ex . In Po ugal he e a e 116 highe educa ion ins i u ions (HEIs) [6], each a la ge and di e se communi y: he ex ensi e wo k o ce wi hin uni e si ies comp ises 32,580 p o esso s [7] and 361,943 s uden s [8]. Mo eo e , s uden s a ending uni e si y may be a a key ansi ion poin in hei li es - li ing away om home o he i s ime and ansi ioning om childhood o adul hood wi hou he close suppo o amily; o ha ing o balance he compe ing demands o wo k and amily li e wi h s udying and academic p ac ice. Uni e si y p o ides he oppo uni y o explo e and expe imen wi h new expe iences, build li e skills and de elop people’s po en ial. I is also a place whe e s uden s can cla i y hei alues, de elop as global ci izens and p epa e o hei u u e oles wi hin communi ies, wo kplaces and socie y as a whole [5,9]. Al hough he se ings app oach would appea o esona e wi h highe educa ion alues o engagemen , di e si y, pa icipa ion and collabo a ion, he concep o a heal hy uni e si y has been adop ed a a slow speed. A a Eu opean le el, he Heal h P omo ing Uni e si ies amewo k has been de eloped o e he pas decades h ough miles one e en s such as he In e na ional Con e ence on Heal h P omo ing Uni e si ies held in 1996; he publica ion o he guidelines o es ablishing Heal h P omo ing Uni e si ies by WHO- Eu o in 1998; and he Edmon on Cha e o Heal h P omo ing Uni e si ies o 2006 [10,11]. Ma a Reis, e al. (2018). The P omo ion o Heal hy Uni e si ies: A Sys ema ic Re iew. CPQ Women and Child Heal h, 1(3), 01-15. Ma a Reis, e al., CPQ Women and Child Heal h (2018) 1:3 Page 3 o 15 The amewo k s a es he objec i es ha mus be pu sued o build a Heal hy Uni e si y and men ions wha he expec ed ou comes should be. The objec i es o a Heal hy Uni e si y a e: (a) o p omo e heal hy and sus ainable policies and planning h oughou he uni e si y; (b) o p o ide a heal hy wo king en i onmen ; (c) o suppo he heal hy pe sonal and social de elopmen o he pe sons in ol ed; (d) o es ablish and imp o e p ima y heal h ca e; (e) o ensu e a heal hy and sus ainable physical en i onmen ; ( ) o encou age wide academic in e es and de elopmen s in heal h p omo ion; and (g) o de elop links wi h he communi y [10,12]. The esul s o a Heal hy Uni e si y p og am should demons a e he ex en o which heal h has been in eg a ed in he cul u e, s uc u e and p ocesses o he uni e si y; and he ex en o which he heal h o he membe s o he uni e si y communi y imp o ed. The implemen a ion o he key objec i es may be desc ibed in e ms o p ocess and impac , a he han ou comes, whe eby collabo a ion and ne wo king a e key elemen s [11,13]. Mo eo e , uni e si ies can also demons a e imp o emen s in e ms o se ice, academic pe o mance, and p o iding condi ions o good heal h. Se e al uni e si ies ha e assumed his commi men o heal h, bu only a mino i y has adop ed he whole sys em app oach ollowing he Heal h P omo ing Uni e si ies concep [2,10-13]. This concep was launched mo e han wo decades ago, and d aws on a numbe o di e en expe iences, including se ings- based in e en ions such as heal h-p omo ing schools, wo kplaces and hospi als, and he expe ise o he WHO Heal hy Ci ies P ojec O ice. The Heal hy Uni e si ies app oach was i s p omo ed in England in he mid-1990s. Since hen, ini ia i es ha e been de eloped in o he coun ies in Eu ope, Asia, and La in Ame ica [14-19]. As coun ies and cul u es di e , he con ex o implemen ing he app oach also a ies widely. Since heal h p omo ion in e en ions a e mo e e ec i e when hey a e adap ed o con ex [20], Heal h P omo ing Uni e si y ini ia i es should be adap ed o local cul u e, en i onmen al con ex (e.g. u al, u ban) and ins i u ional cha ac e is ics [21]. Consequen ly, heal h- ela ed p og ams a e mo e e ec i e when hey a e adap ed o he a ge popula ion, and whe e uni e si y communi y membe s a e empowe ed h ough he implemen a ion p ocess o ac i e pa icipa ion h oughou he p og am, which is an impo an addi ional bene i [22]. The Heal hy Uni e si ies concep has a s ong heo e ical basis, and i appea s appealing amongs uni e si ies wo ldwide. Howe e , he way in which he app oach has been implemen ed emains poo ly g ounded in p ac ice. This sys ema ic e iew aims o desc ibe how uni e si ies ha e implemen ed he Heal hy Uni e si ies concep in di e en cul u es. In o de o achie e his aim, we analyzed he ollowing aspec s o he implemen a ion o he Heal h P omo ing Uni e si y: (a) de ini ion o Heal hy Uni e si y; (b) p io i y a eas o ac ion; (c) subjec ma e s; (d) p ojec s and coo dina ion; and (e) p ojec e alua ion and possible esul s. Howe e , his implemen a ion o heal hy uni e si ies, as al eady men ioned, has been e y slow, because he e is sca ci y o e idence o he e ec i eness o he se ings app oach - bo h gene ally and wi h ega d o heal hy uni e si ies in pa icula [1,3,23]. Al hough uni e si ies ha e eno mous po en ial o inc ease s uden and communi y wellbeing, i is a challenge o demons a e he added alue o he whole-sys em o he heal hy uni e si ies app oach bo h o heal h and o he ‘co e business’ o highe educa ion. Ma a Reis, e al. (2018). The P omo ion o Heal hy Uni e si ies: A Sys ema ic Re iew. CPQ Women and Child Heal h, 1(3), 01-15. Ma a Reis, e al., CPQ Women and Child Heal h (2018) 1:3 Page 4 o 15 To iden i y ele an published wo k on he implemen a ion o he Heal hy Uni e si ies app oach, a sea ch o PsycINFO, ISI Web o Knowledge, ISI P oceedings, PubMed, Medline, Lilacs and Scielo was pe o med in Janua y and Feb ua y 2018. The sea ch e ms used we e ‘Heal hy Uni e si y/ies’ OR ‘Heal h P omo ing Uni e si y/ies’ in ei he he i le o he abs ac . To selec ele an publica ions, he ollowing inclusion c i e ia we e used: (a) published be ween 1997 and 2017; (b) ull ex a ailable in English, Po uguese o Spanish; (c) explici e e ence o highe educa ion o uni e si y; (d) ocus on he imp o emen o heal h and well-being o he whole uni e si y; (e) desc ip ion o he implemen a ion p ocess o a Heal h P omo ing Uni e si y ini ia i e and inally ( ) being open access pape s. A sequen ial p ocess o examining he i le, abs ac and main ex o each a icle o book (chap e ) was unde aken, wi h exclusion o documen s occu ing a each s age. The e e ence sec ions o all a icles mee ing he inclusion c i e ia, as well as hose o p e ious e iew a icles, we e also sea ched o u he ele an s udies, which we e in u n acqui ed and checked agains he inclusion c i e ia. S udies we e excluded when hey: (a) did no e e o he p ocess o implemen a ion o he Heal h P omo ing Uni e si y app oach; o (b) duplica ion exis ed o (c) was no conside ed ele an o he p esen wo k. Pape s ha me he inclusion c i e ia we e sepa a ed in o heo e ical pape s and in e en ion s udies. The analysis o heo e ical documen s was done o each documen sepa a ely, while ha o in e en ion s udies was done join ly. Fo bo h ypes, he con en o he selec ed a icles was analyzed paying a en ion o he ollowing: (a) de ini ion o Heal hy Uni e si y; (b) p io i y a eas o ac ion; (c) subjec ma e s; (d) p ojec s and coo dina ion; and (e) p ojec e alua ion and possible esul s. In o ma ion ex ac ed om he a icles was summa ized in ables. Da a ex ac ion om he selec ed a icles was done by he i s au ho . Me hods Li e a u e Sea ch and Selec ion Analysis Ma a Reis, e al. (2018). The P omo ion o Heal hy Uni e si ies: A Sys ema ic Re iew. CPQ Women and Child Heal h, 1(3), 01-15. Ma a Reis, e al., CPQ Women and Child Heal h (2018) 1:3 Page 5 o 15 Fou heo e ical pape s ha deal wi h he implemen a ion o he Heal h P omo ing Uni e si y concep we e ound in he li e a u e. The i s documen was de eloped by he Uni e si y College Dublin (UCD) as an implemen a ion guide o Heal hy Uni e si ies, namely in I eland [24]. The UCD Heal h P omo ion S a egic Plan - ‘Heal hy UCD’, aims o wo k in pa ne ship wi h Highe Educa ion Ins i u es o de elop a heal h p omo ing campus model o heal h p omo ion. As s a ed in he UCD S a egic Plan 2015-2020, hei mission is o “con ibu e o he lou ishing o Dublin, I eland, Eu ope and he wo ld (…) p o iding a suppo i e communi y in which e e y membe o he Uni e si y is enabled o achie e hei ull po en ial.” Heal hy UCD ou lines an ambi ious p og am o heal h p omo ion wi hin he uni e si y communi y om 2015 o 2010 and beyond ha will acili a e he deli e y o he key objec i es ha o m he basis o hei uni e si y s a egic plan and di ec ion o he nex pe iod. Success ul implemen a ion o Heal hy UCD will help c ea e an o ganiza ion ha has acul y and s a who a e engaged, commi ed and p oduc i e, and s uden s who g adua e wi h a holis ic educa ion ha places emphasis on heal h and wellbeing o hemsel es and he global communi y hey inhabi . As a heal h p omo ing uni e si y, UCD will be seen as a posi i e and suppo i e en i onmen in which o s udy and wo k, ensu ing o a ac and e ain he b igh es s uden s and mos inspi ing and c ea i e acul y and s a . The p oposed ac ions included: he c ea ion o a cul u e o heal h o he s uden o ma ion; he de elopmen o heal hy en i onmen s; and he implemen a ion o heal hy policies. Al hough he impo ance o e alua ion was men ioned, no guidance was p o ided on how o ca y ou an e alua ion o a Heal hy Uni e si y. The second documen aims o con ibu e o he deba e on Heal h P omo ing Uni e si ies and Colleges (HPUC) mo emen in Po ugal and i no only p esen s a gumen s o heal h p omo ion in he na ional highe educa ion se ing and examples o heal h p omo ion ini ia i es ca ied ou by Po uguese highe educa ion ins i u ions, bu also challenges hese ins i u ions o ake some measu es ha would accele a e he ans o ma ion ad oca ed by he HPUC mo emen [25]. I de ined a Heal h P omo ing Uni e si y as an ins i u ion ha is commi ed o c ea ing an en i onmen and cul u e ha encou ages heal h and well-being o all i s membe s’. P oposed ac ions included: he implemen a ion o heal hy policies; he c ea ion o an o ganiza ional s uc u e o coo dina e all ac ions ela ed o heal h, and he p o ision o a heal hy physical en i onmen . This pape ecommended ha he highes uni e si y au ho i y should lead he s a egy, and ha he e should be a coo dina ing eam and a wo king g oup in ol ing di e en membe s o he uni e si y communi y. The implemen a ion and he e alua ion we e ecognized as use ul o imp o e and edesign he p og am, bu de ails on how o e alua e a Heal h P omo ing Uni e si y we e no gi en. The hi d one was a glossa y add essing key concep s associa ed wi h Heal hy (o Heal h P omo ing) Uni e si ies in Chile [26]. This glossa y de ined a Heal hy Uni e si y as ‘an ins i u ion ha includes heal h p omo ion wi hin hei educa ional p ojec o imp o e he heal h o hei communi y membe s’. Ac ions ha we e p oposed included: in o ma ion and awa eness- aising on heal h issues, online educa ional ac i i ies, ins i u ional changes and imp o emen o he physical en i onmen . The glossa y highligh ed he impo ance o de eloping heal hy policies ha in eg a e he concep o heal hy li es yle in he cu iculum and ins i u ional cul u e. E alua ion was ecognized as an impo an bu complica ed p ocess, he success o which depends on he physical-en i onmen al con ex and a ailable human esou ces. Resul s Theo e ical Pape s Ma a Reis, e al. (2018). The P omo ion o Heal hy Uni e si ies: A Sys ema ic Re iew. CPQ Women and Child Heal h, 1(3), 01-15. Ma a Reis, e al., CPQ Women and Child Heal h (2018) 1:3 Page 6 o 15 The ou h documen was de eloped by he Minis y o Heal h o Pe u as an implemen a ion guide o Heal hy Uni e si ies [27]. I e e ed o a Heal hy Uni e si y as an ins i u ion ha implemen s heal h policies, encou ages lea ning o heal h, and p omo es he pa icipa ion o all hose in ol ed in he decision making p ocess, and desc ibed i as also con ibu ing o he e adica ion o po e y, hunge , ma e nal mo ali y, and o he heal h challenges. The p oposed ac ions included: he c ea ion o a cul u e o heal h o he s uden o ma ion; he de elopmen o heal hy en i onmen s; and he implemen a ion o heal hy policies. Al hough he impo ance o implemen a ion and e alua ion was men ioned, no guidance was p o ided on how o ca y ou an e alua ion o a Heal hy Uni e si y. Ten in e en ion s udies desc ibing he implemen a ion o he Heal h P omo ing Uni e si y concep we e iden i ied in he li e a u e. Two s udies epo ed he indings o a na ional-le el quali a i e s udy, one s udy ca ied ou in England and he o he ca ied ou in B azil, p o iding a summa y o he ac i i y de eloped by a ious ins i u ions [3,28]. The o he eigh s udies desc ibed one in e en ion. The in o ma ion ex ac ed om hese s udies is summa ized below. All s udies p oposed a de ini ion o Heal hy Uni e si ies o Heal h P omo ing Uni e si y, Facul y o School (see Table 1). Among he s udies, a Heal hy Uni e si y was de ined as an ins i u ion ha : in eg a es heal h in i s educa ional p ojec ; p o ides a suppo i e en i onmen o heal h; p o ec s heal h and p omo es he well-being o all communi y membe s h ough heal hy policies. Some s udies added ha a uni e si y is based on he alues o espec , ac i e ci izenship and solida i y. In e en ion S udies In all s udies, es ablishing Heal hy Uni e si ies en ails se e al a eas o ac ion (see Table 2). Se en s udies men ioned he de elopmen o pe sonal skills and knowledge ega ding heal h, he c ea ion o heal hy en i onmen s and he inco po a ion o heal h issues in he cu iculum [12-15,19,29,30,31]. Six s udies men ioned he de elopmen o heal hy policies [2,12,13,19,28,32]; and i e s udies men ioned ac i i ies wi h he local communi y [2,12,19,28,31]. The con inued p o ision o heal h se ices was named in wo s udies [19,28], and in o he wo s udies he subjec o heal hy wo kplaces was also add essed [12,31]. In one s udy, esea ch was also conside ed an a ea o ac ion [2]. Rega ding he issue subjec ma e s - hese cons i u e he heal h issues ha a e add essed in he con ex o a Heal hy Uni e si y. The p e en ion o alcohol and d ug abuse was men ioned mos o en, in nine o he en s udies [2,12,13,15,28-32]; eigh s udies men ioned ac i i ies ocused on heal hy ea ing [2,15,19,28- 32], i e s udies men ioned ac i i ies ocused on men al heal h [2,12,13,19,30], and sexual heal h and STD/ AIDS p e en ion [2, 12,15,19,29]. Physical ac i i y was men ioned in ou s udies [2,19,30,31], and smoking cessa ion and p omo ion o smoke- ee spaces [19,29,30,31]. Road sa e y and anspo a ion we e men ioned in h ee s udies [2,12,32], and he p e en ion o ch onic diseases in o he h ee s udies [29,30,32]. O he issues men ioned included building design [2,3], heal hy sleep [15]; o al heal h [29], amily-s udies ela ionship [29] and academic pe o mance [29]. Ma a Reis, e al. (2018). The P omo ion o Heal hy Uni e si ies: A Sys ema ic Re iew. CPQ Women and Child Heal h, 1(3), 01-15. Ma a Reis, e al., CPQ Women and Child Heal h (2018) 1:3 Page 7 o 15 P ojec s and coo dina ion we e also analyzed. In ou s udies, he acul ies o medical sciences o ela ed ca ee s we e esponsible o leading he Heal hy Uni e si y p og am [12,13,15,30]. One s udy men ioned ha he p ojec was an ini ia i e o he uni e si y’s au ho i ies [32]. Ano he s udy indica ed ha he p ojec was a collabo a ion be ween go e nmen al agencies suppo ed by WHO [19]. O he se ices in cha ge we e he human esou ces/occupa ional heal h, academic depa men , s uden se ices and spo s depa men [2,30,31]. The p esence o a s ee ing g oup was men ioned in se en s udies [2,12,13,28,30-32], six o which had ep esen a i es om di e en membe s o he uni e si y communi y [2,12,19,28,31,32]. Conce ning he issue adap a ion o he con ex - Six o he en s udies p o ided in o ma ion ega ding adap a ion o he cul u al con ex , ha ing aimed o make he p og am mo e cul u ally sensi i e [2,12,15,19,31,32]. Ac ions men ioned in his ega d we e he in ol emen o s uden s and o academic and non-academic s a in he planning and implemen a ion o he ini ia i e. Fou s udies highligh ed he pa icipa ion o olun ee s uden s in he implemen a ion h ough pee educa ion p ojec s on issues such as sexual heal h and d ug use [2,12,19,31], hus ensu ing g ea e c edibili y and accep abili y by he es o he uni e si y communi y. The de elopmen o heal h educa ion ma e ial ailo ed o p oblems ha we e speci ic o he uni e si y communi y was men ioned in ou p og ams [12,15,19,31]. In h ee p og ams, in o ma ion on he needs o hose in ol ed was collec ed h ough a diagnos ic p ocess in an e o o adap he p og am o he cul u al con ex [2,15,32]. While he impo ance o e alua ion was acknowledged in all s udies, de ails on he ype o e alua ion pe o med we e p o ided only in se en s udies [2,15,19,29-32]. Mos e alua ions in ol ed he use o ques ionnai es o in e iews wi h s uden s, eache s and/o wo ke s [2,15,19,29-32]. Ques ionnai es we e used ei he o measu e modi ica ions in knowledge and heal h- ela ed beha io s, o o iden i y needs and opinions abou di e en aspec s o he p ojec . Only wo s udies epo ed he esul s o he e alua ion p ocess [12,19], obse ing imp o emen s in he well-being o membe s o he uni e si y communi y and in he physical and social en i onmen . An inc ease in heal h- ela ed knowledge and dec ease in ha m ul beha io s among s uden s we e also epo ed in hese s udies. Table 1: Gene al cha ac e is ics and de ini ion o Heal hy Uni e si ies acco ding o he di e en s udies Re e ence Coun y Name o he p ojec S a ing da e Concep - A Heal hy Uni e si y is one ha … Xiangyang, Lan, Xuping, Tao, Yuzhen, & Jagusz- yn (2003) China Heal h P omo ing Uni e si y 1997 P o ec s he heal h and p omo es he well-being o s uden s, s a and he wide communi y h ough hei policies and p ac ices. Rela es heal h p omo ion o eaching and esea ch. De elops heal h p omo ion alliances and ou each in o he communi y. Doo is (2002) England Heal h P omo ing Uni e si y 1995 Encou ages ac i e pa icipa ion o he communi y. In eg a es wi hin he uni e si y’s cul u e a commi men o heal h. P omo es heal h and well-be- ing o s a , s uden s and he wide communi y. Ma a Reis, e al. (2018). The P omo ion o Heal hy Uni e si ies: A Sys ema ic Re iew. CPQ Women and Child Heal h, 1(3), 01-15. Ma a Reis, e al., CPQ Women and Child Heal h (2018) 1:3 Page 8 o 15 Doo is & Dohe y (2010b) England Heal hy Uni e si y, Heal hy Campus, Heal h P omo ing Uni e si y Di e en ini ia i es began be ween 1995 and 2008 P omo es heal h in a speci ic g oup like s uden s o wo ke s. Raises he p o ile o heal h wi hin he cul u e, s uc u es and p ocesses o he uni e si y. Baños, Ley a, Quin ana, & de A mas 2001) Cuba Heal h P omo ing School No men- ioned Is based on con i iali y, espec and solida i y. Unde s ands ha heal h is he esul o many en i onmen- al, social and indi idual ac o s. G anados, Alba, & Bece a (2009) Colombia Heal hy Uni e si y 2003 De elops ac ions o p omo e heal h. Encou ages ac i e pa ici- pa ion o he communi y. Bece a-Bulla, Pinzón- Villa e, & Va gas-Zá a e (2011) Colombia Heal h P omo ing Uni e si y 2009 Inco po a es heal h p omo ion in o he educa ional p ojec . P omo es human de elopmen o imp o e he quali y o li e o all i s mem- be s. Bece a, H. S. (2013) Pe u Heal hy Uni e si y 2011 P o ides a heal hy en i onmen and inco po a es heal h issues in i s cu iculum. P omo es compliance wi h public heal h policies.P o ides in o ma ion on heal hy li es yles. Knigh (2013) England Heal hy Uni e si y 2011 In eg a es heal h and heal h p o- mo ion in o he uni e si y cul u e. Adap s uni e si y policies, p o- cesses and s uc u es o p omo e heal h. Nahas, Ba os, de Assis, Hallal, Flo indo, & Kon- and (2009) B azil Heal h P omo ing Uni e si y Heal hy Uni e si y 2009 P omo es heal h in a speci ic g oup like s uden s. In eg a es heal h and heal h p omo ion in o he uni e si- y cul u e. De elops heal h p omo- ion alliances and ou each in o he communi y. Nahas, Ba os, de Assis (2014) B azil Heal hy Uni e si y 2014 P o ides a heal hy en i onmen and inco po a es heal h issues in schools / uni e si ies Ma a Reis, e al. (2018). The P omo ion o Heal hy Uni e si ies: A Sys ema ic Re iew. CPQ Women and Child Heal h, 1(3), 01-15. Ma a Reis, e al., CPQ Women and Child Heal h (2018) 1:3 Page 9 o 15 Table 2: A eas o ac ion, subjec ma e s, p ojec and coo dina ion, and e alua ion in Heal hy Uni e si ies acco ding o he di e en s udies. Re e ence Coun y A eas o ac ion Subjec ma e s P ojec and Coo dina ion E alua ion Xiangyang, Lan, Xuping, Tao, Yuzhen, & Jagusz yn (2003) China Uni e si y policies; heal h suppo ing en i onmen s; pe sonal skills; heal h se ices; ac ions wi h he com- muni y. Smoking con ol; men al heal h; STD/ AIDS p e en ion; sexual heal h; physi- cal exe cise and heal hy die . Heal h and ed- uca ion au ho - i ies o Beijing. Suppo ed by he WHO. Yes. Quali a i e/ o ma i e and quan i a i e/ summa i e. Doo is (2002) England The policy p ocess; s uden de elopmen ; heal hy wo kplace; heal hy en i onmen s; academic de elopmen ; heal h o he wide communi y. Sexual heal h; building design; anspo and men al well-being. Facul y o Heal h in pa - ne ship wi h o he acul ies and se ices. Yes. No epo ed. Doo is & Dohe y (2010b) England Heal hy policy; heal hy en i onmen s; cu ic- ulum; esea ch; social suppo sys ems; o gani- sa ional cul u e; ela ion wi h he communi y. Men al heal h; physical ac i i y; heal hy ea ing; alcohol; sexual heal h; smoking con ol; d ugs; sus ainabili y and anspo . Human esou ces/ occupa ional heal h, academ- ic depa men s, s uden se - ices and spo depa men . Yes. Quali a i e/ o ma i e and quan i a i e/ summa i e. Baños, Ley a, Quin ana, & de A mas 2001) Cuba Heal hy en i onmen s; sel -ca e educa ion; cu icula changes; p e en ion o diseases. Heal hy die ; ca - dio ascula isks; alcohol; o al heal h; sexual heal h; academic pe o mance. Facul y o Heal h. Yes. Quan i a i e/ summa i e. G anados, Alba, & Bec- e a (2009) Colombia Ins i u ional a icu- la ion; in eg a ion o heal h in he educa i e p og am; p e en ion o diseases. Heal hy die ; smoking con ol; alcohol; p e en- ion o ch onic diseases; secu i y; a ic sa e y edu- ca ion. Uni e si y Vice p esidency. Yes. Quan i a i e/ summa i e. Bece a-Bulla, Pinzón-Villa- e, & Va gas- Zá a e (2011) Colombia Cu icula chang- es; heal h educa ion; heal hy en i onmen s; in eg a ion o heal h ac oss all acul ies. A p esen , only heal hy ea ing habi s. In he u u e he aim is o wo k also on physical ac i i y; alcohol; smoking con ol; d ugs; men al heal h. Ca ee o Nu- i ion and he S uden Heal h Depa men . Yes. Quali a i e/ Fo ma i e and quan i a i e/ summa i e.