School health in Europe for active and healthy ageing (SHE4AHA): policy and implementation recommendations
Abstract
The European Commission Green Paper on Ageing and the Health Promoting Schools (HPS) paradigm can be connected through several key objectives, as both aim to promote health and wellbeing across the lifespan, with a particular focus on fostering positive habits from a young age that can support active healthy ageing. This book is an output of the ERASMUS+ School for Health in Europe for Active and Healthy Ageing (SHE4AHA) (ID KA220-SCH-2021-003), and presents evidence-based recommendations for the creation of national and European policies that promote the implementation of school health in Europe for active and healthy aging focused on the following four main objectives: i) to create conditions for health and wellbeing promotion life-course approach; ii) to support intergenerational solidarity in health promoting schools; iii) to support the implementation and monitoring of a flexible and adaptable health promotion teacher training curriculum to different local and regional contexts; iv) to advocate for the economic and social implications of early health education for active and healthy ageing.
Full text
School Health in Europe for Active and Healthy Ageing (SHE4AHA) Policy and Implementation Recommendations Teresa Vilaça Graça S. de Carvalho Anette Schulz Henriette Hansen Ingibjörg Guðmundsdóttir Sólveig Karlsdóttir Vesna Pucelj Branka Đukić Emily Darlington Florence Carrouel Adeline Darlington
School for Health in Europe for Active and Healthy Ageing (SHE4AHA) Policy and Implementation Recommendations ii Funded by the European Union. Views and opinions expressed are, however, those of the author(s) only and do not necessarily reflect those of the European Union or the European Education and Culture Executive Agency (EACEA). Neither the European Union nor EACEA can be held responsible for them.
School for Health in Europe for Active and Healthy Ageing (SHE4AHA) Policy and Implementation Recommendations iii Copyright © 2025 by the CIEC - Research Centre on Child Studies Institute of Education, University of Minho, Braga, Portugal All rights reserved Printed in Portugal www.ciec-um.com/ ISBN: 978-972-8952-92-1 Publisher Address requests about this publication of the School for Health in Europe for Active and Healthy Ageing (SHE4AHA) Project to: Research Centre on Child Studies Institute of Education University of Minho Campus de Gualtar 4710-057 Braga, Portugal e-mail: [email protected] The publication can be found at:
School for Health in Europe for Active and Healthy Ageing (SHE4AHA) Policy and Implementation Recommendations iv Co-partners Applicant organization Schools for Health in Europe Network Foundation (SHE) Partner organizations Icelandic Ministry of Health, the Division of Public Health. Lyon University, the Department of Educational Science. Minho University, the Research Centre on child Studies. Slovenian National Institute of Public Health. Financial support This report is included in the ERASMUS+ School for Health in Europe for Active and Healthy Ageing (SHE4AHA) (ID KA220-SCH-2021-003) and is financially supported by: The National Agency of the Erasmus+ Programme, KA220-SCH - Cooperation partnerships in school education action type. Schools for Health in Europe Network Foundation (SHE). The Portuguese national funds through the Foundation for Science and Technology (FCT) within the framework of the Research Centre on Child Studies (CIEC) of the University of Minho project under the reference UIDB/00317/2020. m Icelandic Ministry of Health, the Division of Public Health. The University Claude Bernard Lyon 1 (UCBL). Slovenian National Institute of Public Health.
School for Health in Europe for Active and Healthy Ageing (SHE4AHA) Policy and Implementation Recommendations v Table of Contents Table of contents ..................................................................................................................... V Acronyms ................................................................................................................................ VI Figures ................................................................................................................................... VII Tables .................................................................................................................................... VIII 1. Introduction .......................................................................................................................... 1 1.1. The SHE4AHA project ....................................................................................................... 1 1.2. Objectives of policy and implementation recommendations ........................................... 4 1.3. Characterization of case studies from different countries ................................................. 5 2. Context of SHE4AHA policy and implementation recommendations ............................... 13 2.1. Challenges addressed by the SHE4AHA project ............................................................ 13 2.2. Target audience needs and SHE4AHA solutions ............................................................ 15 3. Evidence-based policy and implementation recommendations ........................................ 23 3.1. Top ten contributions of health promoting schools to the implementation of the green paper on ageing .................................................................................................................... 23 3.2. Top ten evidence-based recommendations to use the pixie health promotion school guide and she material to create or maintain HPS ................................................................ 32 3.3. Recommendations on how to mainstream and implement the SHE4AHA resource package into already existing initiatives ................................................................................ 34 3.4. Top ten evidence-based recommendations on the role of the different stakeholders of the wider school community towards HPS ............................................................................. 36 3.5. Strategies for a successful sustainability of SHE4AHA website ...................................... 38 3.6. Recommendations for a sustainable use of SHE4AHA results by project partners ........ 39 3.7. Actions and policies that can benefit from the SHE4AHA results ................................... 41 4. Visions and challenges for future: international strategies for action ................................ 43 References .............................................................................................................................. 47
School for Health in Europe for Active and Healthy Ageing (SHE4AHA) Policy and Implementation Recommendations vi Acronyms EC European Commission HPS Health Promoting Schools SDEO The South Denmark European Office SDGs Sustainable Development Goals UN United Nations WHO World Health Organization
School for Health in Europe for Active and Healthy Ageing (SHE4AHA) Policy and Implementation Recommendations vii Figures Figure 1. The key objectives of Health Promoting Schools directly linked to European Commission's Green Paper on Ageing .................................................................................... 4 Figure 2. Case studies in Denmark .......................................................................................... 5 Figure 3. Teacher training in Denmark to becoming a health promoting school ................... 6 Figure 4. Case studies in France ............................................................................................. 7 Figure 5. Teacher training in France to becoming a health promoting school ....................... 8 Figure 6. Case studies in Iceland ............................................................................................. 8 Figure 7. Teacher training in Iceland to becoming a health promoting school ...................... 9 Figure 8. Case studies in Portugal ......................................................................................... 10 Figure 9. Teacher training in Portugal to becoming a health promoting school .................. 11 Figure 10. Case studies in Slovenia ....................................................................................... 12 Figure 11. Teacher training in Slovenia to becoming a health promoting school ................ 13 Figure 12. Main challenges addressed by the SHE4AHA project ......................................... 14 Figure 13. Children’ and students’ health and wellbeing need and solutions ...................... 16 Figure 14. School leaders’ needs and solutions for school health promotion ...................... 19 Figure 15. Parents’ needs and solutions to become involved on school health promotion . 20 Figure 16. Broader school need and solutions to become involved on school health promotion .............................................................................................................................. 21 Figure 17. Key policy needs and police recommendations to support school health promotion .............................................................................................................................. 22 Figure 18. Top 10 contributions of health promoting schools to Green Paper on Ageing .. 23 Figure 19. Top ten evidence-based recommendations to use Your Guide to Becoming a Health Promoting School and the SHE material .................................................................... 32 Figure 20. Recommendations on how to mainstream and implement the SHE4AHA resource package into already existing initiatives ................................................................................ 34 Figure 21. Top ten evidence-based recommendations on the role of stakeholders towards HPS ......................................................................................................................................... 36 Figure 22. Strategies for a successful sustainability of SHE4AHA website ............................ 38
School for Health in Europe for Active and Healthy Ageing (SHE4AHA) Policy and Implementation Recommendations viii Tables Table 1. Teachers’ needs and solutions for school health promotion ...................... 18 Table 2. Reasons to recommend using Your Guide to Becoming a Health Promoting School and the SHE material ..................................................................................... 33 Table 3. Reasons for proposing recommendations on how to mainstream and implement the SHE4AHA resource package and how they can be put into practice ................................................................................................................................... 35 Table 4 . Reasons for proposing recommendations on the role of stakeholders towards HPS and how they can be put into practice ................................................ 37
School for Health in Europe for Active and Healthy Ageing (SHE4AHA) Policy and Implementation Recommendations 1 1. Introduction 1.1. The SHE4AHA project The European Commission's Green Paper on Ageing (European Commission, 2021), adopted on January 27, 2021, serves as a foundational document to initiate a comprehensive policy debate on the multifaceted challenges and opportunities presented by Europe's ageing population. By initiating this dialogue, the European Commission aims to prepare the EU for the profound demographic transformations anticipated in the coming decades, reinforcing the World Health Organization (WHO) United Nations Decade of Healthy Ageing (2021-2030) (WHO, 2020) and the AgeFriendly City Framework (WHO, 2007) as international collaborative platforms to promote older people’s rights, health and wellbeing, while contributing to the United Nations (UN) Agenda for Sustainable Development Goals (SDGs) (UN, 2015), in particular SDG 3 promoting healthy lives and wellbeing for all at all ages, and SDG 11 promoting inclusive and sustainable cities and communities. Therefore, the European Commission’s Green Paper on Ageing constitute the cornerstones of the life-cycle approach, having highlighted concerns about intergenerational solidarity and social sustainability (Costa, 2022) and underscored the European Union's proactive approach to demographic shifts, aiming to foster sustainable and inclusive strategies that address the implications of an ageing society. Therefore, it serves as a catalyst for collaboration among member states, stakeholders, and citizens, fostering the development of cohesive policies that promote active ageing, intergenerational solidarity, and economic resilience. This proactive approach ensures that the EU remains adaptive and responsive to the needs of its ageing population, securing social and economic wellbeing for all and, in this sense, the Green Paper draws attention to the important role of the WHO Global Platform for Monitoring School Health 1 . Health Promoting School initiatives adopt a comprehensive approach to health education, integrating health into all aspects of school life. This strategy not only benefits immediate student wellbeing but also lays the foundation for healthier adulthood, thereby contributing to the objectives outlined in the Green Paper on Ageing. The World Health Organization (WHO) has developed a series of documents to guide the implementation of Health Promoting Schools (HPS). Each document focuses on different aspects of the HPS approach. The Global Standards and Indicators (WHO & UNESCO, 2021a) establishes eight global standards aimed at creating a consistent framework for health promotion within schools. These standards include: Government Policies and Resources, which emphasizes the need for long-term government commitment and resource allocation to support HPS initiatives; School 1 WHO Global Platform to monitor school health: https://www.who.int/teams/maternal-newborn-childadolescent-health-and-ageing/adolescent-and-young-adult-health/school-health/global-platform-tomonitor-school-health
School for Health in Europe for Active and Healthy Ageing (SHE4AHA) Policy and Implementation Recommendations 8 Figure 5. Teacher training in France to becoming a health promoting school Iceland In Iceland, three compulsory schools were involved as case studies: Hraunvallaskóli School; Fossvogsskóli School; and Djúpavogsskóli School (Figure 6). Figure 6. Case studies in Iceland Hraunvallaskóli School, town Hafnarfjörðu Fossvogsskóli School, town Reykjaví Djúpavogsskóli School, small village Hraunvallaskóli School 7 is located in the capital in the town of Hafnarfjörður. Students from the 1st to 10th grades are over 800 (age 6-15). This school has been for many years a HPS and is working with the theory of growth mindset, as part of being a HPS. 7 Hraunvallaskóli Website: https://hraunvallaskoli.is/ 1st training day •Topics/ Strategies: •health promotion, HPS' principles, values and pillars, health and health determinants, the role of schools, the French situation with regards SHP and how this could evolve into the HPS framework. SHE material (Rapid Assessment Tool, Standards, factsheets, SHE Manual, evaluation focusses in the standards material for teachers in French version etc..). •Life skills and how to develop them. Reflect on how they could relate to their every day practice, and what activities they thought they already did to promote life skills in pupils. 2nd training day •Topics /Strategies: •Application by schools of The Rapid Assessment Tool. •Reflective activity which enabled participants to assess where they were in terms of health promotion in their schools, l, what they already did and put in place to promote pupils’ health wellbeing and life skills, and how they understood the concept of Health Promoting Schools after having had the first ession. •Plenary debriefed session with our team and the district advisors. This synthesis phase enabled the school heads, the teacher trainers from the school district and us to pool the result of the three assessments together and decide what th e common priorities would be for the future pilot projects. 3rd training day •Topics /Strategies: •The Pixie version was presented to the school leader. •The objective was to establish links with what had been seen during sessions 1 and 2. It was also an opportunity for the school leaders to clarify certain elements such as communicating with the families. •Finally, it allowed school leaders to discuss the partnership with the local authorities.
School for Health in Europe for Active and Healthy Ageing (SHE4AHA) Policy and Implementation Recommendations 9 Fossvogsskóli School 8 is in the capital Reykjavík. Students from de 1st to 7th grades are about 300 (age 6-12). It has been for many years a Health Promoting School. Now it is working with social relations and relationship building through physical activity during breaks and students’ and parents’ relationship through healthy diet, increasing fruit and vegetable intake. Djúpavogsskóli School 9 is located on the eastern side of Iceland in a small village (550 km from the capital), but the village is now part of a larger community spread throughout the east with some distance between villages/ towns. Students from the 1st to 10th grades are about 90 (age 6-15). This school is taking the first step of becoming a health promoting school but has been a Cittaslow school for many years. Their aim is to combine that with the structure of HPS through the implementation. SHE4AHA teacher training was developed in different phases with different targetpopulation (Figure 7). Figure 7. Teacher training in Iceland to becoming a health promoting school Portugal In Portugal four case studies in three different municipalities were developed: Monsenhor Elísio Araújo Elementary School; Basic School of Ribeira do Neiva; Basic School of Gualtar; and Vieira de Araújo Basic and Secondary School (Figure 8). 8 Fossvogsskóli School Website: https://fossvogsskoli.reykjavik.is/ 9 Djúpavogsskóli School Facebook: https://www.facebook.com/profile.php?id=100057643320708 Joint online meeting •There has been one joint meeting online for teachers with the aim to introduce the project. Joint workshop •Participants: Joint workshop with representatives of all the pilot schools. •Topics/ strategies: all the material related to the SHE4AHA project; introdution to all the Icelandic material and the SHE material with explanation of the differences. All participants completed the SHE rapid assessment tool (RAT), but they are also working on updated detailed checklists (build on the SHE RAT) developed for HPS in Iceland. They have chosen their priorities for the 2022-2023 school year and put that into a project that they are working on. Several individual meetings •Local: Each school •Topics/ strategies: All schools have gotten serval of individual meetings for supporting the project. Two joint workshops •Participants: Joint workshop with representatives of all the pilot schools. •Topics/ strategies: working with their living document for the project and another joint workshop discussing the difference and the need for the Pixi SHE4AHA)guide vs the Icelandic material Guide.
School for Health in Europe for Active and Healthy Ageing (SHE4AHA) Policy and Implementation Recommendations 10 Figure 8. Case studies in Portugal Monsenhor Elísio Araújo Basic (Primary) School Ribeira do Neiva Basic (Primary) School Gualtar Basic (Primary) School Basic and Secondary School Vieira de Araújo Monsenhor Elísio Araújo Elementary School is part of the School Cluster of Vila Verde 10 . Located in the parish of Regalados, about 5 km from the Municipality of Vila Verde, of which it is part, is a rural school from pre-school education to the 9th grade with over 700 students aged 6-14 years old (grades 1-9) and about 300 children from 3 to 5 years old. The school has several leisure clubs and projects, such as school sports, book restoration, theatre club, journalism club, constructions and model making, gardening club, science and sexuality education club. The SHE4AHA project was based in a whole school approach, continuing the dynamics of the school as a HPS. Ribeira do Neiva Basic School is integrated in the School Cluster of Moure and Ribeira do Neiva 11 . It is located in the Union of Parishes of Ribeira do Neiva, about 14 km from the Municipality of Vila Verde, of which it is part. This rural schools with over 800 students aged 6-14 years old (grades 1-9) and about 300 children from 3 to 5 years old. This school is part of a community where agriculture and pastoralism play a fundamental role in supplementing family income. The school has several leisure clubs and projects, greatly appreciating its participation in the Eco-Schools Project. The SHE4AHA project was based in a whole-class approach. Basic School of Gualtar is an urban school which belongs to Carlos de Amarante School Cluster 12 located at the Municipality of Braga. It has around 700 students from the 5th to the 9th grade (10 to 14 years old). This school currently has the Healthy School seal and the Eco-Schools seal. The school has several clubs and projects, for example, the health education project, the school vegetable garden, the integrative project, the math 10 School Cluster of Vila Verde Website: https://aevv.edu.pt/ 11 School Cluster of Moure and Ribeira do Neiva Website: https://www.aemourerneiva.com/ 12 Website Carlos Amarante School Cluster Website: https://aecarlosamarante.pt/
School for Health in Europe for Active and Healthy Ageing (SHE4AHA) Policy and Implementation Recommendations 11 workshop and the music club. SHE4AHA project was based in a whole school approach, continuing the dynamics of the school as a HPS. Vieira de Araújo Basic and Secondary School, from the Vieira do Minho Municipality, is a semi-urban preparatory and secondary school that belongs to the Vieira de Araújo School Cluster 13 . It has about 700 students from the 5th to the 12th grade (10 to 17 years old). The school has participated in several ERASMUS+ and eTwinning projects and has several clubs and other complementary activities, such as the arts club, school sports, robotics club and “living science” club. SHE4AHA project was based in a whole school approach, giving also continuity to the dynamics of the school as a HPS. SHE4AHA teacher training was carried out at the Research Centre of Child Studies (https://ciec-um-minho.webflow.io/) of the University of Minho (Figure 9). Figure 9. Teacher training in Portugal to becoming a health promoting school Slovenia The Slovenian team collaborate with the three primary schools case studies because they have been members of the network for many years. They are the following small 13 Website Vieira de Araújo School Cluster Website: https://www.aeva.pt/site/ 10 hoursonline Course (2 weekly chats of 2 hours each) •Participants: Invited teachers with experience in implementing health promotion and education projects in his/her school. •Topics: concepts of health, health determinants, health promotion and ethics in health promotion (SHE values), the setting approach, and the SHE Pillars. The SHE rapid assessment tool was completed. The SHE website was also explored and participants were invited to explore the Material for Teachers on Health Promotion at home in more depth. •Bridging activity: At this stage, these teachers wanted to expand the group and involve more teachers and some technicians from the school. By suggestion of one of the schools, a new school was involved. 25 hours-faceto-face Course (3 days: 1 day per month) •Local: University of Minho •Topics: revisit the concepts worked on in the online training and to present the SHE materials, the Revised SHE School Manual, and the SHE Standards and indicators. Subsequently, cocreation worked on, and the implementation theory of Evert Vedung and an identification of an implementation strategy to promote health at school was made. Sharing of experiences regarding concrete pilot projects initiated by schools; reflecting on what they are doing and what they have learned; learning from the experiences of other schools. (Please see SHE4AHA website: The Good Practice Catalogue) 25 hours at the school setting •Local: Each school •Topics:Organization of participants as acommunity of practice to co-create, implement and evaluate the school project Pedagogical supervision at the school setting •Local: Each school •Topics:Throughout the project, the trainer supported the group at school to give them feedback, to evaluate the process and results, and to create conditions for the sustainability of the project.
School for Health in Europe for Active and Healthy Ageing (SHE4AHA) Policy and Implementation Recommendations 12 village schools quite far from Ljubljana: OŠ Bistricaob Sotli; Dutovlje Primary School; and Osnovna šola Toneta, Tomšiča Knežak (Figure 10). Figure 10. Case studies in Slovenia OŠ Bistricaob Sotli Dutovlje Preparatory School Primary School Tone Tomšič Knežak Osnovna šola Bistrica ob Sotli (OŠ Bistrica ob Sotli) 14 , located in the Municipality of Bistrica ob Sotli, is a public preparatory school, from the 1st to the 9th grades, and had approximately 130 students enrolled. This school emphasizes a comprehensive educational approach, focusing on the holistic development of students and preparing them for further education. It offers various programs and activities aimed at fostering both academic and personal growth. The school actively participates in international projects to enhance educational experiences. In recognition of its innovative teaching methods, OŠ Bistrica ob Sotli received the European Award for Innovative Teaching in 2021. This accolade highlights the school's commitment to adopting creative and effective educational practices. Dutovlje Preparatory School 15 , located in the Municipality of Sežana, is a public preparatory school, from the 1st to the 9th grades, and had approximately 256 students enrolled. In the 2023/2024 school year, Dutovlje Elementary School strived to continue the tradition of a quality and locally recognizable school, trying to enable students to achieve optimal results according to their abilities and involving them in numerous projects that are the result of high-quality cooperation between students, teachers and external collaborators. The school place special emphasis on intergenerational cooperation and cooperation with other educational institutions, trying to encourage students to be open and accept diversity, to learn tolerance and help people. Primary School Tone Tomšič Knežak (Osnovna šola Tone Tomšiča Knežak) 16 , in the Municipality of Ilirska Bistrica, is also a public preparatory school, from the preschool to the 9th grade. In the 2023/24 school year, the school has 129 students, 9 independent classes, three extended-stay classes, and four preschool classes. Classes are held in one shift according to the curriculum. SHE4AHA teacher training was implemented by The National Institute of Public Health, which coordinates the HPS network, with the support of the Ministry of Health and the 14 OŠ Bistricaob Sotli Website: https://www.osbistricaobsotli.si/ 15 Dutovlje Preparatory School Website: https://www.os-dutovlje.si/ 16 Osnovna šola Toneta Tomšiča Knežak Website: https://www.os-knezak.si/
School for Health in Europe for Active and Healthy Ageing (SHE4AHA) Policy and Implementation Recommendations 13 Ministry of Education. Usually, these coordinators of the National Institute have regular meetings with the schools involved in the HPS network (every two months, occasionally even more or less often), training sessions, and regular contact via email or telephone. They also send all relevant materials to the schools. Into this SHE4AHA Teacher training 2 days-joint training were carried out followed by meetings with school every two month (Figure 11). Figure 11. Teacher training in Slovenia to becoming a health promoting school 2. Context of SHE4AHA policy and implementation recommendations 2.1. Challenges addressed by the SHE4AHA project The School Health in Europe for Active and Healthy Ageing project was initiated to tackle several challenges associated with the demographic changes in Europe, particularly the ageing population. The project addresses main eight interconnected primary challenges (Figure 12). 2-days Course •Participants: teachers from the three schools together. •Topics: Health as a concept, Health determinants, Health promotion, The setting approach (participation, action competence, implementation, sustainability, ...), Health literacy, 5 steps to HP School, Presentation of Schools for Health in Europe Network Foundation (SHE), Presentation of the SHE material (The SHE website; Manual on how to become a health promoting school,HE rapid assessment tool; Materials for Teachers– about Health Promotion and health literacy; standards and indicators), process mapping tool (purpose/use) Practical guidance at the school setting •Participants:each school. •Topics:Throughout the project, there were meetings with each school every two months to provide practical guidance on implementation, evaluation, communication and promotion of project sustainability.
School for Health in Europe for Active and Healthy Ageing (SHE4AHA) Policy and Implementation Recommendations 14 Figure 12. Main challenges addressed by the SHE4AHA project The first challenge of the SHE4AHA project is to responded to Policy on Ageing by developing and implementing strategies that support active and healthy ageing from an early age. The second challenge is implementing the Health Promoting School framework across Europe, fostering environments that support students' physical, mental, social, intellectual, spiritual, occupational and environmental wellbeing throughout their educational journey. To cope with this challenge SHE4AHA team challenged itself to develop accessible and flexible training materials to assist schools in adopting health promoting practices, ensuring that teachers develop their knowledge and competences to implement these strategies. The fourth challenge of the SHE4AHA is to reduce disparities in health outcomes among different socioeconomic groups at local, national and international levels by starting with the promotion of inclusive health promotion strategies within schools. Therefore, it is also a challenge in the SHE4AHA project enhancing health and wellbeing in schools through the implementation of co-created projects aimed at improving students' wellbeing and creating supportive school environments. 1. Aligning SHE4AHA to the European Commission's Green Paper on Ageing with European 2. Integrating the HPS approach into schools across Europe 3. Developing Training Materials for Health Promoting Schools 4. Addressing Health Inequalities 5. Enhancing Health and Wellbeing in Schools 6. Promoting Healthy Lifestyles from an Early Age 7. Evaluating and Disseminating Best Practices 8. Enhancing Cross-Border Collaboration
School for Health in Europe for Active and Healthy Ageing (SHE4AHA) Policy and Implementation Recommendations 15 Recognizing that habits formed during childhood significantly impact health in later years, SHE4AHA has as its sixth challenge to encourage the adoption of healthy behaviours early on to prevent age-related health issues. To face this challenge, SHE4AHA has also the challenge to evaluate and encourage schools to evaluate health promotion activities and sharing successful strategies among schools to encourage widespread adoption of best practices. To finalize, the eighth main SHE4AHA challenge is to enhancing cross-border collaboration. The project facilitated cooperation among schools in various European countries, promoting the exchange of best practices and collaborative solutions to common health challenges. By addressing these main challenges, SHE4AHA aimed to create a comprehensive framework for promoting health and wellbeing throughout individuals' lifespans, starting from early education laying a solid foundation for healthier, more active ageing across Europe by addressing key health determinants during the formative school years. 2.2. Target audience needs and SHE4AHA solutions SHE4AHA ERASMUS+ project implementation found a multifaceted need of key target audiences involved in the school community: children and students, teachers, school leaders, parents, policymakers, and the broader school community. Children and students’ health and wellbeing needs and solutions This project shows that most of health and wellbeing target audience needs and strategies to dealt with them are common in different European countries. Figure 13 shows solutions to reach these five key needs identified: “Need of a safe, inclusive, and active learning environment”; “Need of participatory and health and wellbeing action competences”; “Need for predictability and structure in school, family and society”; “Need of movement and engagement”; and “Need of social cohesion”. To deal with the first need requires a combination of strategies that address physical safety, a culture of respect, belonging and inclusion, the support of student mental health and wellbeing and a culture of respect, and making learning accessible to everyone. Specific strategies described on Figure 13 are part of the Health Promoting Schools Approach (Vilaça et al., 2017) and the majority of them were validated on the SHE4AHA project when schools implemented the “Your Guide to Becoming a Health Promoting School” (Schulz et al., 2025).To meet the second need, not only the SHE and SHE4AHA material is suitable, but also other ERASMUS+ projects involving members of the SHE research-group, such as the Co-creating Wellfare (KA202-2016-12), CoCreating Wellbeing (KA220-VET-ADD1022F) and the Rural eHealth Facilitators - REACT (KA220-ADU-2D9650FE) projects which, among others, are great sources of inspiration.
School for Health in Europe for Active and Healthy Ageing (SHE4AHA) Policy and Implementation Recommendations 16 Figure 13. Children’ and students’ health and wellbeing need and solutions Need of a safe, inclusive, and active learning environments Solutions: Creating safe spaces that promote both social and academic wellbeing *Ensuring safe physical spaces and physical safety *Fostering a culture of respect and inclusion: promoting zero-tolerance policies for bullying and discrimination; teaching conflict resolution skills; establishing clear rules and expectations for respectful behavior; implementing inclusive curricula regarding gender, sexual and cultural diversity and cultural awareness; training staff to recognize signs of mental health struggles and provide necessary support; creating safe spaces where students can express themselves freely. *Supporting student mental health and wellbeing: providing counseling services and promoting mental health awareness; encouraging mindfulness and stress-management activities in the classroom (e.g., brain breaks, mindfulness, teamwork); reduce academic pressure by promoting growth mindset approaches. *Making learning accessible to everyone: adapting teaching methods to different learning styles and abilities; exploring the flexible classroom system; using Universal Design for Learning to make content more accessible; ensuring students with disabilities receive appropriate accommodations and support Need of participatory and health and wellbeing action competences Solutions: Developing participatory policies that promote decison making processes, genuine participation and action-oriented projects which foster ownership, action competence, wellbeing and motivation for learning *Encouraging open communication: seting up student feedback channels, such as student councils, suggestion boxes or participanting in focus groups; training teachers to practice active listening and address student concerns promptly; using peer mentoring programs where older students support younger ones. *Supporting participatory and action-oriented projects: participatory approach in SHE material emphasize student involvement in shaping a healthy school environment identifying health-related challenges in their schools, taking an active role in decisionmaking, and engaging in collaborative problem-solving with teachers, parents, and the community. Need for predictability and structure in school, family and society Solutions: Creating structured school, family and social environments allowing for flexibility and adaptability while ensuring students feel safe, supported, and prepared for changes * Establishing a consistent and supportive environment in school: clear rules and routines; structured learning plans; visual schedules; smooth transitions; regular teacher check-ins, counseling support, and mentoring programs . * Providing stability and emotional security in family: consistent routines at home; open and honest communication; family meetings; and emotional predictability, being family a model of calm and consistent emotional responses, helping children feel secure. *Creating a stable and inclusive community: safe and structured public spaces; support for families and schools; transparent social systems; and community involvement encouraging student participation (e.g. youth groups or volunteering) Need of movement and engagement Solutions: Encouraging active learning and movement-based strategies in school, movement at home and active and engaging communities *Active learning and movement-based strategies in school: movement into lessons; physical education more engaging; active breaks; outdoor learning; and hands-on learning *Encouraging active and engaging families and community: family walks, bike ride, active transport , imposing limits to screen time; community movement-friendly public spaces. Need of social cohesion Solutions: Provinding group walks, shared reading, and trust-building exercises that encourage peer connections and create a sense of togetherness across age levels.
School for Health in Europe for Active and Healthy Ageing (SHE4AHA) Policy and Implementation Recommendations 17 Thirdly, students need school, family, and social environments that provide flexible and adaptable predictability and structure, ensuring children and students feel safe, supported, and prepared for changes, as these elements create a sense of security, reduce anxiety, and enhance learning. In the school, some strategies to meet this need are: well-defined schedules, behavioural guidelines that are consistently enforced; lesson plans that outline daily objectives to help students knowing what to expect; posting daily or weekly timetables in classrooms to provide students with a clear sense of what is coming next; countdowns, signals, or structured transitions between activities to minimize anxiety; and regular teacher check-ins, coaching-support, and mentoring programs to ensures students always know where to seek help. Providing stability and emotional security in family is also crucial to answer this need. Regular meal times, bedtime routines, and study schedules help to create a stable environment as these strategies impose consistent routines at home. Parents should explain changes or upcoming events to children in advance to reduce uncertainty, communicating openly and honestly. Promoting regular family informal meetings to discuss about schedules, concerns, and expectations also create a sense of structure and inclusion. Emotional predictability of caregivers giving consistent emotional responses, also help children to feel secure. Creating a stable and inclusive community implies that schools, parks, and community centres offer predictable environments where students can engage in safe, supervised activities. Governments and organizations can promote programs that assist families with childcare, mental health support, and academic resources. Public institutions, based on transparent social systems, should provide clear guidelines and consistent policies to help young people understand societal expectations and community should encourage student participation in local events, youth groups, or volunteer programs, fostering a sense of belonging and stability. The need for movement and engagement can be met incorporating movement into lessons, using strategies such as role-playing, hands-on activities, and interactive games, brain breaks (short physical activities between lessons) to boost focus and energy and standing desks or flexible seating to allow movement while learning. It is also crucial to meet this need offering a variety of activities beyond traditional sports (e.g., water sports, yoga, dance, martial arts, or parkour, depending on the school context). In the same line of action providing student choice in Physical Education activities increases student motivation, participation and engagement. Lessons also could encourage students’ movement teaching science, math, or reading lessons outside to make learning more dynamic or organizing nature walks or outdoor research activities. Encouraging team projects involving experimenting and using inquiry-based learning where students solve real-world problems is also a good strategy. Movement also should be encouraged at home, for example creating a daily movement routine, such as family walks, bike rides, or dance breaks, using active transport (walking, biking, or scootering to school) and limiting screen time to balance sedentary activities with physical play. Encouraging gardening or cooking are also good strategies.
School for Health in Europe for Active and Healthy Ageing (SHE4AHA) Policy and Implementation Recommendations 24 Contribution 1. Early introduction of physical activity, healthy nutrition, mental health, sexuality and wellbeing promotion practices Health Promoting Schools emphasizes health and wellbeing promotion practices as preventive efforts like movement-based learning, mindfulness, and health and wellbeing practices from a young age. Impact Promoting long-term physical and mental health, reduces the risk of chronic illnesses and mental health challenges in older age. Examples of SHE4AHA In Danish schools, initiatives like Brain Breaks, yoga, and mindfulness were implemented, improving pupils' readiness for learning while establishing habits that can prevent health decline later in life. In France, The Flexible Classroom Project at the Ecole Primaire du Mas is also a piece of good-evidence regarding student wellbeing. With the objective to work school climate, it was set up a flexible classroom. This involved installing equipment and physically organizing the classroom to best meet the needs of the pupils. Hraunvallaskóli in Iceland shows a piece of good evidences regarding how to promote mental health and resilience with the Growth Mindset implementation program that is a four-year intervention among all staff and students at the compulsory level of the school. The implementation seeks to use both a growth mindset and mindfulness to create a learning community that is characterized by trust, a positive mindset, individual self-confidence and good relationships among students and staff. With a strong mindset, everyone will be better equipped to take on their tasks and challenges. All of this is aimed at increased wellbeing and better accomplishment. In Portugal, at the Basic School of Gualtar, mindfulness was also implemented and an action-oriented project inter-classes was develop regarding "Affections at School". In this project, students suggested a set of actions 17 to promote socio-affective health that included: sessions of the promoting socio-emotional skills program "Slow we go far away"; the "Week of Affections" 18 , with exchange of messages, clothesline of compliments, music and emotions, relaxation, origami of gratitude, meditation on selfesteem, walking in pairs, friendship workshop, friendship tree, mail from friends; peer education on “Love is in the decisions we make every day”; development of a "Youth Space" 19 by students, and participation in the "Youth Parliament" with the theme "Mental health - what challenges and answers". In Slovenia, a big project was carried out at the Primary School Dutovlje, involving children from the 1st to the 5th grade (from 6 to 10 years old). The main goal of this project was to create a booklet to promote a healthy lifestyle called "Dutomajček in the 17 Socio-emotional actions: https://padlet.com/martakrus/jovens-em-a-o-rzvqenfoglh6vmxf 18 Week of Affections: https://padlet.com/martakrus/semana-dos-afetos-e1u73lbhlkuwps73 19 Youth Space: https://padlet.com/martakrus/espa-o-jovem-mx2mkmtmggchzkau
School for Health in Europe for Active and Healthy Ageing (SHE4AHA) Policy and Implementation Recommendations 25 Healthy School," which introduces children to a healthy lifestyle in entertaining and playful way, with the help of Dutomajček - the bunny from Karst region in Slovenia, called Karst. During this time, few charity events at school, allowing pupils to complete some tasks of the book at school were organized. However, for certain tasks, parents helped the children, or they completed the tasks together. Over the course of a day, seven workshops for children and parents, all thematically related to the tasks from the booklet were also implemented by teachers, psychologists, and nurses from the local Health Centre in Sežana. The day concluded with exchange of books, board games, and toys, along with the announcement of the results of the physical activity challenge. A second project carried out in Slovenia entitled “Let's walk around Slovenia", at the Bistrica ob Sotli Primary School, aimed at encouraging all students at the school to be more physically active. The staff began to encourage them to be physically active during their free time (waiting for classes in the morning or afternoon waiting for the bus and during long breaks). They came up with the idea of walking around the school playground for a distance equivalent to the length of the Slovenian border (1370 km). The activity was presented to all pupils, and all staff were involved. Pupils were instructed to walk two laps around the playground track each day in their free time. After completing the task, they could engage in any activity of their choice. The goal set at the beginning of the task was not only achieved, but exceeded. The length of the Slovenian border was covered almost three times. In addition to the students, teachers, school visitors (parents, local community, etc.) also contributed to the kilometer count. Another project "Let's get active on Friday!", carried out at the Slovenian Primary school Tone Tomšič Knežak, aimed at involving on physical activity as many students and employees at the school as possible. The main break on Fridays for the activities was chosen, and each class, together with their class teachers, prepared a 10-15 minutephysical activity based on a predetermined list performed in the school gym. The oldest pupils started, and the youngest - first graders finished. Students chose and organized very different physical activities (stretching exercises, strength exercises, breathing exercises, games, and dance...). The pupils were enthusiastic about active Fridays and considered them important for better physical health, increased their productivity in subsequent school hours, and reduced stress. Contribution 2. Developing lifelong healthy and wellbeing habits Health Promoting Schools encourage healthy lifestyle habits such as physical activity, healthy nutrition, and mental wellbeing practices early in life. Integrating movement into education, demonstrate how physical activity supports both physical and mental health. Impact Encouraging sustainable behaviors that carry into adulthood and old age, support active and independent living. Establishing lifelong physical activity habits, reduce risks of cardiovascular diseases, obesity, and mobility issues in older age.
School for Health in Europe for Active and Healthy Ageing (SHE4AHA) Policy and Implementation Recommendations 26 Examples of SHE4AHA Schools like Blåbjerg Children’s Universe in Denmark combine physical activity with learning, encouraging pupils to see movement as a lifelong, enjoyable practice. Programs like daily group walks and “Walk of the Day” at Blåbjerg Children’s Universe, in Denmark, also create a culture of movement and wellbeing. In France, the Ecole Maternelle du Mas developed the “The Breakfast Activity”, focused on education to food and taste to strengthening and promoting the partnership with pupils’ families. In this school children (3 to 6 years old) were educated about food and taste, after the breakfasts were launched in the school on the Fridays before the school holidays and then implementation was carried out in two stages: during Taste Week, breakfast was offered with the help of the families, and every day a different culinary culture explored based on the families’ backgrounds and origins, and in the stage 2, in the day before each school holiday, breakfast was also organized. In Iceland, the Djúpavogsskóli project intitled “Implementing Health promoting school approach and integrating to Citta-slow approach”, with the primary goal of aligning it with the Citta-slow philosophy, focused the pilot project into three themes: Theme 1Nutrition and Physical Activity; Theme 2Mindfulness and Mental WellBeing; Theme 3Togetherness and Cooperation. The target group included students, staff, and the broader community, ensuring active participation from all stakeholders in creating a healthier and more supportive environment. The school’s engagement with the movement enhanced both staff and community interest in the project. The assessment results (checklists baseline) highlighted opportunities for strengthening the HPS approach further. Staff interest in the project has grown as positive outcomes have been achieved, with increasing participation from students and parents in initiatives like school gardens, mindfulness programs, and physical activity projects. Contribution 3. Promoting mental health and resilience across the lifespan Health Promoting Schools integrates mindfulness and mental wellbeing initiatives to build emotional regulation and resilience. Impact Strengthening mental health and coping strategies as well as personal and social competences, contribute to reduced risks of depression and anxiety in ageing populations. Examples of SHE4AHA Mindfulness practices at the Danish Vitaskolen Bohr helped students to develop tools to manage stress and maintain mental wellbeing throughout their lives. At the Fossvogsskóli, in Iceland, the “Leisure activities during recess, healthy morning snacks and health information to parents” project shows a lot of evidences in this group of contributions. The goals were to foster a healthier, more supportive school
School for Health in Europe for Active and Healthy Ageing (SHE4AHA) Policy and Implementation Recommendations 27 environment that prioritizes the physical, mental, and social wellbeing of students. The primary goals included reducing instances of bullying, enhancing student wellbeing, and promoting healthier nutritional habits through increased consumption of fresh fruits and vegetables. Additionally, the project sought to provide staff and parents with the tools and knowledge necessary to support students’ wellbeing effectively, while creating a framework that ensures the long-term sustainability of these efforts. More examples emerged from the Portuguese context. One of them is the Monsenhor Elísio Araújo Basic School project “Healthy cell phone-free breaks” 20 , where students created board games, traditional games and dances to liven up breaks between classes and socialize with classmates in a healthy way without using cell phones. Concerns about excessive cell phone excessive use were also evident at the same school in the project "Breaks away from social media and impact on mental health" 21 , in which students decided to spend more time cycling with friends in their free time outside of school, instead of using video games or online social media. Another Portuguese project regarding cell phone excessive use was implemented at the Basic and Secondary School Vieira de Araújo based in a whole class approach, entitled “Raise Your Head: Danger of Excessive Use of New Technologies 11th Grade” 22 , where students from the 11th grade encourage schools’ colleagues to think critically on this topic. Contribution 4. Developing action competence in all individuals towards ownership of health and wellbeing Health Promoting Schools actively involve pupils in health decisions, fostering a sense of ownership and empowerment in maintaining their health and wellbeing. Impact Encouraging individuals to take responsibility for their health as they age, improves quality of life and reducing healthcare dependency. Examples of SHE4AHA In Denmark, tools like the Brain Break Wheel show good results to enable pupils to make health-related choices, and building confidence in managing their wellbeing. In Portugal, a good example of a participatory and action-oriented project with positive results in the development of student action competence was the class-based project “It's in DATING that everything BEGINS... and only YOU can decide when it ENDS!” 23 . With the goal of preventing dating violence, a 7th grade class acted organizing a 20 Healthy Cell Phone-Free Breaks: https://www.youtube.com/watch?v=eqRPgZyqZdM 21 Breaks away from social media and impact on mental health: https://www.youtube.com/watch?v=vdjwBS_mb6E&t=9 22 Raise Your Head: Danger of Excessive Use of New Technologies 11th Grade: https://www.canva.com/design/DAFk5Gexx_s/C3J3x_FzitOhj4Jp6VHIuA/watch?utm_content=DAFk5Gex x_s&utm_campaign=designshare&utm_medium=link&utm_source=publishsharelink 23 Padlet of the It's in DATING that everything BEGINS Project: https://padlet.com/manuelasousa9/nonamoro-que-tudo-come-a-e-s-tu-podes-decidir-quando-acaba-rvgmidssg8b11r4l
School for Health in Europe for Active and Healthy Ageing (SHE4AHA) Policy and Implementation Recommendations 28 workshop for older students and repeated it with their parents. The workshop included the presentation of the theme by the students with two communications, “Don’t confuse love with abuse” and “Stop dating violence”, a shadow theatre, which they wrote and dramatized: “Step onto the stage against dating violence: close the door against dating violence”; a little musical moment; a debate with experts moderated by students; and the final signing of a contract drawn up by those present, which described the behaviours that everyone committed to adopting in the future in order to prevent or report dating violence. Contribution 5. Supporting lifelong learning and cognitive health Health Promoting Schools cultivate critical thinking, adaptability, and a love for learning through innovative teaching methods and movement-based education. Impact Encourages continuous learning and intellectual stimulation, reducing the risk of cognitive decline as individuals age. Examples of SHE4AHA Combining learning with movement in “Learning through Movement” at Blåbjerg Children’s Universe, in Denmark, school enhanced cognitive engagement and retention, preparing individuals for lifelong adaptability. At the Monsenhor Elísio Araújo Basic School in Portugal, the school projects integrated into the SHE4AHA project, with the aim of motivating students to learn natural sciences, develop critical thinking, and love for learning and environmental sustainability, show a large body of evidence on the importance of including health promotion throughout the teaching of the subjects. The following projects developed in this context can be consulted online: "Biodiversity is art" 24 ; "Scientific Illustration" 25 ; "Investigative Activity in the 8th grade of the Natural Sciences subject" 26 ; "Study Visit to the Cávado Estuary" 27 . These students also participated with their research projects in the Science Fair at the Vila Verde Municipal House of Knowledge. More evidences to support lifelong learning and cognitive health were found in the project "Feet in the Sand and in the Sea: Knowledge, Health, Leisure and Wellbeing" 28 developed at the Basic and Secondary School Vieira de Araújo, in Portugal, in which the school's 12th grade students did fieldwork on the beach with their teachers, participated 24 E-book of the Biodiversity is Art Project: https://issuu.com/felgueirasaragao/docs/biodiversidade_arte2 25 Padlet of the Project Scientific Illustration: https://padlet.com/eugeniaaragao/erasmus-languageslearning-zaa4z5arj6sd1h9t 26 Padlet of the Investigative Activity in the 8th grade of the Natural Sciences subject: https://padlet.com/lgbtqformacaoa22/atividade-investigativa-ci-ncias-naturais-8-ano-s1flvcmsxdsd4wsz 27 Padlet of the Study Visit to the Cávado Estuary: https://padlet.com/lgbtqformacaoa22/visita-de-estudog19fmk976hv7qlzi 28 Feet in the Sand and in the Sea: https://view.genially.com/6479a59d932cbb0012a04c37/presentationwatery-presentation
School for Health in Europe for Active and Healthy Ageing (SHE4AHA) Policy and Implementation Recommendations 29 in a lecture on sustainability, surfed, went hiking and walking on the beach, identified different species of fauna and flora, collected trash on the beach to indirectly educate other people and had lunch and dinner outdoors in a happy social gathering. Contribution 6. Strengthening Social Inclusion and Intergenerational Solidarity Health Promoting Schools promote social wellbeing through initiatives fostering community, cooperation, and trust, strengthening interpersonal skills and inclusiveness. Impact Reduces loneliness and social isolation across life stages, a critical issue for older populations. Examples of SHE4AHA Shared reading programs and group walks at Blåbjerg Children’s Universe in Denmark encourage inter-age group collaboration and mutual support, modeling intergenerational solidarity. At the Monsenhor Elísio Araújo Basic School in Portugal, the projects "Gymnastics with grandparents" 29 , "Vegetable-garden with grandparents" 30 , involving respectively students and children in kindergarten in interaction with their grandparents, and student visits to the Day Centre for Older People to do activities with them, add some evidence that shows the important contribution of HPS to intergenerational solidarity. Contribution 7. Strengthening Community Cohesion Health Promoting Schools fosters a sense of community and shared responsibility, engaging schools, families, and the broader community in health-promoting efforts. Impact Creates inclusive, supportive environments that connect people across life stages, reducing age-related isolation. Examples of SHE4AHA Another Danish example is the Fanø School’s focus on TOGETHERNESS which strengthens relationships between pupils, teachers, and parents, establishing values of support and connection. Another example was found at the Basic and Secondary School Vieira de Araújo in Portugal, with the project “Ecoculture: Healthy and sustainable food" which involved the entire school and extended community in valuing the cultural and natural heritage of the region and advocating that a healthy lifestyle is fundamental for good mental health that promotes the general wellbeing and reduces the level of stress and anxiety. 29 Gymnastics with grandparents: https://www.youtube.com/watch?v=ciMxrIoAWb4&t=7s 30 Vegetable-garden with grandparents: https://www.youtube.com/watch?v=7KJeZGawPL4&t=4s
School for Health in Europe for Active and Healthy Ageing (SHE4AHA) Policy and Implementation Recommendations 30 The celebration of World Food Day with artisanal yogurt production 31 , a mycological walk 32 , a reading session in the school library about cultural heritage and a field trip to learn about sustainable tourism in the region were the actions carried out. With the same objective of strengthening community cohesion and quality of life, two 10th grade classes and one 11th grade class worked together on the project "We Propose!" 33 to identify problems in their community, propose solutions and initiate actions to resolve them. Thus, they presented proposals at the level of the environment and mobility, social solidarity, tourism and culture, quality of life, valorisation of local heritage, creation of a bank of volunteers at the school and valorisation of the regional market. Contribution 8. Addressing health inequities Health Promoting Schools provide targeted support for diverse pupil needs, including those from lower socio-economic and ethnic minority backgrounds, to promote equity in health education. Impact Reduces health disparities, ensuring that healthy practices and opportunities extend across the lifespan, especially for vulnerable populations. Examples of SHE4AHA Danish Vitaskolen Bohr addresses integration and inclusion through movement, mindfulness, and shared activities, ensuring all pupils develop essential skills for lifelong health. Contribution 9. Building policy alignment and sustainability Health Promoting Schools initiatives align with national and municipal policies on health promotion, education, and community development. Impact Demonstrates the long-term societal value of investing in preventive health initiatives, reinforcing the role of schools in fostering healthier future generations. Examples of SHE4AHA Danish Fanø School’s focus on creating systematic wellbeing structures showcases how schools can act as models for embedding health promotion into policies. 31 Ecoculture: Healthy and sustainable foodartisanal yogurt production: https://www.youtube.com/watch?v=5BcUgSiraBs 32 Ecoculture: Healthy and sustainable foodmycological walk: https://www.youtube.com/watch?v=s75WRiqPios 33 We Propose!: https://www.canva.com/design/DAFk5Mqtrnc/N4wIcccdEH4nvqSjj5y_A/watch?utm_content=DAFk5Mqtrnc&utm_campaign=designshare&utm_medium=link&utm_source=publishsha relink
School for Health in Europe for Active and Healthy Ageing (SHE4AHA) Policy and Implementation Recommendations 31 Another good example is the Healthy and Sustainable Food Project 34 of the Portuguese Gualtar Basic School developed with the objectives of promoting healthy and sustainable eating habits and lifestyles in the educational community and enhancing the acquisition of skills for young people to act as agents promoting health and wellbeing. Contribution 10. Advocating for health promotion as a school social HUB where individuals of all ages can gather for health, education, and recreation HPS can function as health promotion social HUB incubators which brings together people of all ages for health, education, and recreation having a wide-reaching and transformative impact on both individuals and the broader community health and wellbeing, are align with municipal and/ or national policies on health promotion. Impact Provides access to HP and empowers individuals to make informed decisions, reducing health disparities by providing equitable access to resources for underserved groups, and fosters intergenerational connections, reducing loneliness and isolation, especially among seniors and youth. Furthermore, promotes mental health by providing a safe, supportive space for socializing, group activities, and peer support, and encourages inclusion and community belonging, key protective factors for mental wellbeing. Examples of SHE4AHA During the SHE4AHA project, Monsenhor Elíseo Araújo Basic School in Portugal rethought itself as a HPS and established itself as an embryo of a social HUB for health promotion in the school and local community, involving the Municipal Council, the Health Centre and specialists from several universities in a process of integrating several projects already existing at the school and creating others. This reorganization of health promotion at school led to the creation of the following action networks 35 : 1) "Manual Network”, where people of all ages can learn to cook and do more manual work and crafts to promote mental health and wellbeing, with participants choosing to make keychains, dream catchers and spirit killers, painting, sculpture, photography and crochet with science; 2) "Interactive Network”, where students investigate problems with the help of experts and then explain to people of all ages how society and politics work so that these people can intervene and give new ideas, with the students carrying out investigative work and debating ideas in Forum Theatre, to end with the dissemination of their work at the annual municipal Science and Technology Fair; 3) "Sports Network”, which includes all school sports activities provided by the school, in collaboration with the community, and which include: mountain biking, swimming, badminton, athletics, canoeing, gymnastics with grandparents and work in the healthy vegetable garden at the school; 4) “Volunteer Network", where participants can choose 34 Healthy and Sustainable Food Project: https://padlet.com/martakrus/alimenta-o-saud-vel-esustentabilidade-8lssv670htba9njw 35 https://view.genially.com/648dc5abaf5ef000138c71ff/guide-lacos-vivos
School for Health in Europe for Active and Healthy Ageing (SHE4AHA) Policy and Implementation Recommendations 32 to volunteer in catteries, kennels, nursing homes, orphanages, plant trees, collect garbage from oceans and forests, among others, such as holding a charity Christmas and visiting the Senior Citizens Day Center; 5) "Healthy Breaks Network" which includes people interested in livening up recess by creating board games and traditional games; organizing dances, promoting craft activities at school (crochet, embroidery, cooking...) or group cycling activities; 6) "Teachers' Health and Wellbeing Network" brings together people interested in sharing crafts, books and movies from their youth to liven up school breaks, promoting the adults’ wellbeing and serve as inspiration for students; 7) "Health and Leisure Network with Heritage", organized by the Bernardino Machado Basic School in collaboration, to value the sustainability of local heritage and health and environmental sustainability through guided physical exercise practices. 3.2. Top ten evidence-based recommendations to use the pixie Health Promotion School Guide and SHE material to create or maintain HPS Throughout the implementation of the SHE4AHA project, as already explained, keyprofessionals at the pilot schools of Denmark, France, Iceland, Portugal and Slovenia, the SHE4AHA attended the SHE4AHA teacher training to integrate health-promoting strategies into the school curriculum. The SHE Material and the “Your Guide to Becoming a Health Promoting School” by the SHE4AHA team (Schulz et al., 2025) were critically analysed and implemented in all schools. Evidences collected brought out the Top ten evidence-based recommendations to use the pixie Health Promotion School Guide and SHE material to create or maintain HPS listed in Figure 1. Figure 19. Top ten evidence-based recommendations to use Your Guide to Becoming a Health Promoting School and the SHE material 1. Establish a clear vision and goals for health promotion 2. Form a health-promoting steering group 3. Prioritize Active Pupil Involvement 4. Integrate health promotion into daily routines 5. Provide professional development for teachers and non-teaching staff 6. Create accessible tools and resources 7. Foster parental involvement and support 8. Embed health promotion into school policies and leadership priorities 9. Monitor progress and share results 10. Foster collaboration and knowledge sharing
School for Health in Europe for Active and Healthy Ageing (SHE4AHA) Policy and Implementation Recommendations 33 Table 2 summarizes the reasons for proposing these recommendations, based on evidence from the projects developed in the pilot schools described in the previous section. Table 2. Reasons to recommend using Your Guide to Becoming a Health Promoting School and the SHE material Recommendation Why? 1. Establish a clear vision and goals for health promotion Use the SHE Guide to define a shared vision and specific, measurable goals for health promotion that reflect the needs of pupils, staff, and the broader school community. A clear purpose aligns stakeholders and ensures wellbeing becomes a core priority in the school's culture. 2. Form a health-promoting steering group Follow the SHE Guide’s advice to create a steering group consisting of teachers, leadership, parents, and pupils to drive and monitor HPS initiatives. A dedicated team ensures ongoing commitment, resource allocation, and accountability. 3. Prioritize active pupil involvement Use SHE materials to involve pupils in planning, decisionmaking, and evaluating health-promoting activities. Active participation enhances pupil ownership, motivation, and engagement in health initiatives. 4. Integrate health promotion into daily routines Follow the SHE Guide to embed health-promoting practices, such as movement breaks, mindfulness, and healthy habits, into the school’s daily timetable. Consistency creates lasting habits, supports readiness for learning, and fosters stability. 5. Provide professional development for teachers and non-teaching staff Use the SHE materials to organize training sessions and professional development opportunities for teachers and staff. Focus on health education, movement integration, and mindfulness practices. Equipping teachers and nonteaching staff with the knowledge and confidence to implement HPS practices is critical for success. 6. Create accessible tools and resources Develop and share practical tools, like playbooks, activity catalogs, and ready-to-use materials, to streamline implementation for teachers and staff. Simple, accessible resources reduce workload and encourage consistent use of health-promoting activities. 7. Foster parental involvement and support Use the SHE Guide’s strategies to communicate the purpose, benefits, and progress of HPS initiatives to parents and encourage their involvement. Parental engagement builds trust and ensures alignment between home and school environments. 8. Embed Health Promotion into School Policies and Leadership Priorities Use the SHE Guide to align HPS initiatives with school policies and leadership goals, ensuring wellbeing is a long-term strategic priority. Strong leadership commitment ensures continuity, resource allocation, and systemic change. 9. Monitor Progress and Share Results Use SHE materials to establish clear monitoring and evaluation frameworks to assess the impact of healthpromoting initiatives. Share progress with stakeholders to maintain momentum. Evidence of success builds trust, secures ongoing support, and informs necessary adjustments. 11.Foster Collaboration and Knowledge Sharing Use SHE materials to organize collaborative workshops, partnership meetings, and study visits with other schools to exchange ideas and best practices. Cross-school collaboration fosters creativity, innovation, and shared learning to strengthen HPS initiatives.
School for Health in Europe for Active and Healthy Ageing (SHE4AHA) Policy and Implementation Recommendations 40 5.Support cross-country implementation by: • Facilitating knowledge exchange by encouraging national coordinators to adopt SHE4AHA practices. • Organizing peer-learning activities, such as study visits or collaborative projects between countries. 6.Promote evidence-based advocacy by: • Using SHE4AHA results as evidence to advocate for integrating health promotion into national policies and curricula. • Highlighting the benefits of health-promoting schools for improving wellbeing, readiness to learn, and sustainability. 7.Monitor and evaluate impact by: • Developing indicators and tools to monitor the long-term implementation and outcomes of SHE4AHA practices within the network. • Collecting feedback and evidence from schools to continually refine and improve tools and strategies. 8.Engage policymakers and stakeholders by: • Sharing SHE4AHA results with European policymakers to demonstrate the importance of health promotion in schools. • Advocating for continued funding and policy support for health-promoting schools across Europe. 9.Leverage partnerships for sustainability by: • Collaborating with international organizations (e.g., WHO Europe, UNESCO) to mainstream SHE4AHA outcomes into broader health and education initiatives. • Forming partnerships with research institutions to develop further studies and tools based on SHE4AHA findings. 10.Highlight success stories for visibility by: • Using the SHE website, newsletters, and social media to share success stories from SHE4AHA pilot schools. • Showcase schools as role models for implementing sustainable health-promoting practices.
School for Health in Europe for Active and Healthy Ageing (SHE4AHA) Policy and Implementation Recommendations 41 3.7. Actions and policies that can benefit from the SHE4AHA results The SHE4AHA results provide evidence-based practices and tools that can influence and strengthen actions and policies aimed at promoting health, wellbeing, and preventive education within schools and broader educational systems. The following key actions and policies can directly benefit: 1. National and regional education policies Benefit: Integrate HPS approaches into national and regional educational frameworks. Action: • Mandate the inclusion of health, wellbeing, movement, and mindfulness practices in school curricula. • Align policies with evidence-based tools like Brain Breaks, mindfulness sessions, and movement-based learning to improve learning outcomes. Impact: Improves pupils' readiness to learn, wellbeing, and engagement while reducing health inequalities. 2. Health and wellbeing policies Benefit: Support preventive health approaches within schools as part of national public health strategies. Action: • Promote HPS initiatives that address mental, physical, and social health (e.g., mindfulness, movement, community-building). • Encourage cross-sector collaboration between education, health, and local government sectors. Impact: Reduces long-term health burdens and fosters healthy habits from an early age. 3. Teacher training and professional development programs Benefit: Enhance teachers’ capacity to implement health-promotion strategies in daily teaching. Action: • Integrate SHE4AHA tools and results (e.g., Brain Break Wheels, wellbeing catalogs) into teacher education programs. • Provide ongoing professional development on implementing movement, mindfulness, and trust-building activities. Impact: Empowers teachers to deliver effective health-promoting practices that benefit pupils’ health and academic outcomes.
School for Health in Europe for Active and Healthy Ageing (SHE4AHA) Policy and Implementation Recommendations 42 4. School improvement plans Benefit: Use SHE4AHA results to prioritize pupil wellbeing as a key indicator of school success. Action: • Include specific wellbeing initiatives (e.g., shared reading, group walks, structured lesson starts) in annual school plans. • Create steering groups to oversee the implementation of health-promoting activities across school levels. Impact: Creates sustainable, school-wide approaches to fostering health and wellbeing. 5. Policies addressing mental health in schools Benefit: Utilize evidence from SHE4AHA to inform national and local strategies on mental health promotion. Action: • Introduce mindfulness and stress-reducing activities as part of the mental health curriculum. • Provide tools for early intervention and preventive measures to reduce stress and anxiety. Impact: Enhances pupils’ emotional regulation and resilience while reducing mental health challenges. 6. Inclusive education policies Benefit: Use health-promotion practices to create inclusive learning environments that support diverse pupil needs. Action: • Promote activities that foster trust, cooperation, and togetherness (e.g., shared walks, cross-grade collaborations). • Implement physical and mental activities to engage all pupils, including those with additional needs. Impact: Reduces isolation, builds community cohesion, and supports equity in education. 7. Physical activity and health promotion policies Benefit: Align school-based health initiatives with national physical activity and nutrition guidelines. Action: • Implement movement-based programs (e.g., Brain Breaks, “Learning through Movement”) across schools to increase daily physical activity. • Use tools like the Brain Break Wheel to integrate activity into academic lessons. Impact: Promotes healthy lifestyles, reduces sedentary behavior, and supports physical and cognitive development.
School for Health in Europe for Active and Healthy Ageing (SHE4AHA) Policy and Implementation Recommendations 43 8. Parental engagement and family policies Benefit: Encourage parental involvement in health-promotion initiatives as part of broader family policies. Action: • Use platforms like AULA to communicate health-promoting activities and progress. • Encourage collaboration between schools and families to align wellbeing efforts at school and home. Impact: Strengthens the school-home connection, ensuring a holistic approach to pupil wellbeing. 9. Community development policies Benefit: Use SHE4AHA results to align schools with local community health and development efforts. Action: • Promote partnerships with local organizations, businesses, and health services to support HPS practices. • Use schools as hubs for community events that promote health and wellbeing. Impact: Builds healthier, more resilient communities while extending the reach of school initiatives. 10. European and international education policies Benefit: Incorporate SHE4AHA findings into European Union and international frameworks on education and health. Action: • Use the results to advocate for HPS as a standard approach in education policies across Europe. • Share evidence-based tools and success stories to inspire cross-country implementation. Impact: Promotes consistency in health promotion across schools, fostering a healthier European school network. 4. Visions and challenges for future: International strategies for action To ensure the continuous impact of HPS and build on the results of SHE4AHA, the following international strategies for action outline a vision for future development while addressing key challenges:
School for Health in Europe for Active and Healthy Ageing (SHE4AHA) Policy and Implementation Recommendations 44 Vision 1. Integrating HPS into global education and health policies Strategy: Collaborate with international organizations (e.g., WHO, UNESCO, EU) to position HPS as a core component of educational and health systems globally. Action: • Advocate for HPS integration into global frameworks like the UN Sustainable Development Goals (SDG 3: Health and SDG 4: Quality Education). • Develop policy recommendations that align HPS with global health promotion strategies. Challenge: Achieving policy alignment across diverse cultural, political, and economic systems. Vision 2. Building cross-sector collaboration Strategy: Foster partnerships between education, health, and community sectors to implement sustainable HPS initiatives. Action: • Encourage multi-sectoral partnerships to fund, develop, and evaluate HPS programs. • Connect schools with health services, mental health professionals, and local organizations for shared initiatives. Challenge: Establishing effective coordination between multiple sectors with differing priorities and resources. Vision 3. Establishing long-term funding mechanisms Strategy: Develop sustainable funding frameworks at national and international levels to ensure HPS programs can scale and endure. Action: • Advocate for dedicated funding streams for health promotion within education budgets. • Engage with EU funding programs and international donors to support HPS expansion and capacity-building. Challenge: Overcoming financial constraints and ensuring funding continuity beyond short-term projects. Vision 4. Ensuring equitable access to health-promoting initiatives Strategy: Embed equity into HPS strategies to ensure inclusion of diverse, marginalized, or under-resourced communities. Action: • Develop adaptable tools and materials that address cultural, socio-economic, and linguistic diversity. • Promote HPS practices as a means to close health and education equity gaps. Challenge: Addressing disparities in resources and capacity between highand lowresource regions.
School for Health in Europe for Active and Healthy Ageing (SHE4AHA) Policy and Implementation Recommendations 45 Vision 5. Strengthening teacher and school leader capacity Strategy: Expand professional development programs to equip teachers and leaders with health-promotion skills. Action: • Integrate HPS principles into teacher education programs at national and international levels. • Offer train-the-trainer programs to build local capacity for sustainable HPS implementation. Challenge: Ensuring teachers have the time, training, and motivation to prioritize health promotion. Vision 6. Embedding monitoring and evaluation into HPS initiatives Strategy: Establish standardized frameworks for monitoring, evaluation, and research on HPS outcomes. Action: • Develop international indicators to assess the impact of health-promotion activities on pupil wellbeing and learning. • Share best practices and results through international knowledge-sharing platforms. Challenge: Ensuring consistency in data collection and evaluation across countries with varying capacities. Vision 7. Leveraging technology to expand reach Strategy: Use digital platforms to disseminate HPS tools, resources, and knowledge globally. Action: • Develop an accessible online repository for SHE materials, case studies, and HPS frameworks. • Leverage e-learning tools to provide professional development and peer collaboration across borders. Challenge: Addressing the digital divide and ensuring equitable access to technological resources. Vision 8. Promoting active pupil and community involvement Strategy: Foster meaningful involvement of pupils, parents, and local communities in HPS initiatives. Action: • Implement participatory approaches, where pupils and communities co-create health-promotion strategies. • Develop international networks for sharing pupil-led health promotion initiatives. Challenge: Balancing top-down policies with grassroots participation and ensuring meaningful engagement.
School for Health in Europe for Active and Healthy Ageing (SHE4AHA) Policy and Implementation Recommendations 46 Vision 9 Scaling successful practices internationally Strategy: Identify, document, and share successful HPS models to inspire and guide schools globally. Action: • Use platforms like SHE to showcase scalable solutions and tools developed through SHE4AHA. • Facilitate study visits, exchanges, and collaborative learning opportunities across schools and countries. Challenge: Ensuring scalability while adapting practices to local contexts and challenges. Vision 10. Advocating for health promotion as a global priority Strategy: Highlight the evidence-based impact of HPS on wellbeing, academic success, and long-term health outcomes. Action: • Advocate for HPS to be recognized as a global best practice for achieving healthier and more sustainable societies. • Use evidence from projects like SHE4AHA to influence international decisionmakers and policies. Challenge: Maintaining political will and demonstrating HPS as a cost-effective and essential strategy.
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