Health Promoting Schools

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Health Promoting Schools

• Neal Kaufman, M.D., M.P.H.
• Co-Director, UCLA Center for
• Healthier Children, Families and Communities
• (www.healthychild.ucla.edu)
• Professor of Pediatrics and Public Health
• UCLA Schools of Medicine Public Health
• Commissioner, First 5 LA
• (www.first5.org)
• National Conference of State Legislators
• August 19, 2005

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Health Promoting Schools

• Changing threats to health over the centuries
• Obesity/diabetes epidemic (Diabesity)
• Creating health promoting schools
• Informing policy decisions with data experience
• Suggestions for actions

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First Revolution in Health1850-1950

• Cities
• Unhealthy places to live
• Poor sanitation, unhealthy air, limited physical
  activity
• Death from communicable and water born diseases,
  injuries
• Solution Health Promoting Design
• Open space, good sanitation, safe food
  processing, cemeteries away from people, safer
  building conditions
• Lester Breslow M.D., M.P.H., UCLA School of
  Public Health

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Second Revolution in Health 1950- Now

• Deaths from cancer, heart disease, stroke,
  diabetes, injuries.
• Causes thought to be primarily biologic, not as
  much environmental/ behavioral
• Solutions Biomedical enterprise
• Hospitals, medical specialists, intensive care
  units, biomedical research, pharmaceuticals

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Third Revolution in HealthNow- ?

• Deaths from obesity/diabetes (diabesity), heart
  disease, stroke, cancer, injuries, violence,
  suicide.
• Falsely believed to be lifestyle diseases
  prevented primarily by enhanced personal
  responsibility.
• Really are lifestyle choices, colliding with
  genetics and toxic environment.
• Solution Healthy lifestyles facilitated by
  Health Promoting Design Quality Medical Care

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Obesity Trends Among U.S. AdultsBRFSS, 1990
(BMI 30, or 30 lbs overweight for 5 4
person)
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Obesity Trends Among U.S. AdultsBRFSS, 1995
(BMI 30, or 30 lbs overweight for 5 4
person)
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Obesity Trends Among U.S. AdultsBRFSS, 2000
(BMI 30, or 30 lbs overweight for 5 4
person)
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Diabesity Epidemic

• Lifestyle choices
• Colliding with genetics
• Toxic environment

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Diabesity epidemic

• Can be improved by
• Healthy lifestyles
• facilitated by
• Health Promoting Design
• Quality Medical Care

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Health Promoting Design

• Making the right thing to do
• the easy thing to do.
• Making the healthy choice
• the easy choice.

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How does this apply to children in schools?
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Factors affecting health in schools

• Nutrition
• Physical exercise
• Health education and curriculum
• Health services
• Psychosocial services
• Health promotion of teachers
• Healthy school environments
• Community interactions

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The Six Ss of Health Promoting Schools

• Siting
• Size
• Style
• Services
• Surroundings
• Sustainability

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Some Health Impacts of School Siting

• Direct toxic effects due to the presence of
  pollutants, allergens, mold, or bacteria.
• Walkability based on distance from home and
  community.
• Social isolation if not part of the
  communitycould lead to depression.

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Health Impacts of School Siting

• Stress related conditions for parents with
  increased commuting time.
• Transit time for children, with less time for
  studies or physical activities.
• Pollution due to increased traffic.

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Health Impacts of Size and Style

• Design and Structure (child development, learning
  environment)
• Aesthetic Quality (sense of worth, mood)
• Social environments (mental health, interpersonal
  connections)
• Indoor/Outdoor Environments (toxins, air quality,
  pollutants)
• Transportation and Connectivity (walkability,
  social cohesion)
• Interactions with Community (services and
  supports)

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The Importance of School Size

• A higher percentage of students, across all
  socio-economic levels, are successful when they
  are a part of smaller, more intimate learning
  communities small schools encourage teachers to
  innovate and students to participate, resulting
  in higher grades and test scores, improved
  attendance rates, and lowered drop-out rates.
• -- US Department of Education

New Schools for Older Neighborhoods, 2002
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Health Benefits of Smaller Schools

• Walking between school, home and the community
• Sense of self and belonging
• Sense of community
• Safety

Small schools offer what metal detectors and
guards cannot the safety and security of being
where you are known well by people who care for
you. -- NYC principal
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• We need to find ways to create small, supportive
  learning environments that give students a sense
  of connection.
• -- former US Secretary of
• Education Richard W. Riley

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School Services

• Provides the neighborhood with places for
  recreation and education during non-school hours.
• Provides community members with opportunities to
  teach and volunteer.
• Provides the community with a valuable asset.
• The benefits schools provide to communities.

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School Surroundings

• Easily accessible services and supports.
• Financial support for joint ventures.
• Community culture context for child
  development.
• Diversity of experiences and people.
• The benefits communities provide to the school.

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Schools in a Community Context

• The school is viewed as the cornerstone of the
  neighborhood. Other things may come and go, but
  the school stays. It symbolizes the
  neighborhood. You take out the school, and its
  the beginning of the decline of the neighborhood.
  Youve got to have a school to have a
  neighborhood.

-- President of the National Association of
Elementary School Principals
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Health Impacts of SchoolServices and Surroundings

• Improved community capacity leads to improved
  well-being of those who live, work, learn and
  play there.
• Increased civic involvement improves individual
  and collective health.
• Increased neighborhood cohesiveness promotes
  self-esteem and improves psychosocial well-being.
• Increased access to open space facilities
  promotes physical activity, outdoor learning,
  overall well-being.
• Increased access to a array of services and
  supports improves a variety of child and family
  outcomes.

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A Solution Community-Centered Schools

• Small and located in walkable neighborhoods
• Function not only as places of education, but
  also gathering places for all members of the
  community
• House not only student and adult learning, but
  also recreational and cultural activitiesserving
  as an anchor tenant for the community
• Feature co-location and joint-use facilities
  reducing duplication of services and costs

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Community-Centered Schools

• Help meet leisure, recreation, and wellness needs
• Accessible to people of all ages
• Encourage parental involvement in school
  activities
• Contain shared public spaces accessible year round

-- National Clearinghouse for Educational
Facilities, 2003
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• Regrettably, in an era of planning marked by
  greater awareness and commitment to smart
  growthby overlooking health as a key impetus
  for good planning or smart growth, planners are
  clearly missing an opportunityto educate the
  public and to actively accomplish progressive
  planning goals

-- Marya Morris American Planning Association
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Health Impact AssessmentA methodology new to
the U.S.

• Structured, multidisciplinary process to
  prospectively evaluate and synthesize evidence
  about health impacts of policies, programs or
  projects.
• Used internationally to determine the impacts of
  a broad range of economic, political, social and
  environmental factors on the publics health.
• Helps mitigate negative health problems from the
  outset and creates healthier environments,
  especially for public places like schools.
• UCLA School of Public Health

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Examples of UCLA HIAs

• The Los Angeles City Living Wage Ordinance
• California after-school initiative (Prop 49)
• The 2002 Federal Farm Bill
• Sacramento Safe Routes to School
• Highway redevelopment in Tennessee
• Legislation to provide immunity from injury
  liability
• Obesity prevention strategies
• Public markets as engines of economic
  development
• not completed (as of August 2005)
• http//www.ph.ucla.edu/hs/health-impact

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Some policy options to help create health
promoting schools

• Provide incentives for school districts to
  cooperate with other institutions (such as
  churches, non-profits, private businesses) to
  jointly share facilities.
• Avoid building schools that are distant from the
  communities they serve work to ensure that 50
  of students can walk or bike to school.
• Work with smart growth advocates to determine
  optimal locations and designs for schools.
• Provide funding for Health Impact Assessments on
  new and renovated school plans and policies.

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Some options to help create health promoting
schools

• Repeal mandates to follow minimum acreage
  requirements for schools.
• Provide incentives to renovate existing schools
  rather than build new schools.
• Mandate communication between community planning
  agencies and school districts.
• Persuade school districts to submit construction
  and improvements plans to local governments for
  approval.

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Summary

• A double bottom line Appropriate school siting
  and design can improve student health and
  academic performance while enhancing community
  well-being.
• Health promoting schools address a range of
  student outcomes in the context of family and
  community.
• Utilize the six Ss of Health Promoting Schools
  Siting, Size, Style, Services, Surroundings and
  Sustainability.
• Health Impact Assessments help administrators and
  policy makers achieve student and community
  dreams.

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Contact information

• Neal Kaufman, M.D., M.P.H.
• nkaufman_at_mednet.ucla.edu
• UCLA Health Impact Assessment
• http//www.ph.ucla.edu/hs/health-impact

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Model Legislation Maine

• LD2552 (1998)
• Extensive long-term planning involved
• New emphasis on renovation
• Governs the State Board of Education in terms of
  school site selection
• Requires a complete analysis of existing building
  sites and proposed new building locations
• Requires the involvement of local community
  members and stakeholders in the process

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Model Legislation New Jersey

• Executive Order (2002)
• mandated the establishment of a Smart Growth
  Policy Council to ensure that school
  construction initiatives promote smart growth,
  open space, and revitalization of communities.
• Educational Facilities Construction Financing
  Act 1998
• School districts must file long-range facilities
  plans with local planning boards.

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Model Legislation Maryland

• Abolished minimum acreage requirements for
  schools
• Enacted smart growth legislation in 1997
• Avoid sprawl
• Revitalize existing facilities, neighborhoods,
  and communities.
• Eliminate funding bias towards new schools. Has
  designated that 80 of for capital projects go to
  existing schools.

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Model Legislation California

• 2001 school districts to notify local
  governments when explore sites
• districts and localities to meet to discuss
  future school sites.
• Safe Routes to Walking Program (1999)
• redirects the states federal transportation
  dollars to local governments.
• Colorado has recently passed a similar bill

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The Built Environment in the school Examples of
What We Know
The research has established that
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The Built Environment Examples (continued)
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UCLA Health Impact Assessment

• http//www.ph.ucla.edu/hs/health-impact