Comprehensive School Health

Comprehensive school health is an internationally recognized approach to supporting improvements in students’ educational outcomes while addressing school health in a planned, integrated and holistic way.

What is Comprehensive School Health?

Comprehensive school health is an internationally recognized approach to supporting improvements in students’ educational outcomes while addressing school health in a planned, integrated and holistic way.

This whole-school model builds capacity to incorporate well-being as an essential aspect of student achievement. Actions address four distinct but inter-related components that comprise a comprehensive school health approach:

  • social and physical environment
  • teaching and learning
  • policy
  • partnerships and services.

When actions in all four components are harmonized, students are supported to realize their full potential as learners – and as healthy, productive members of society.

Why Do We Need Comprehensive School Health?

Health and education are interdependent: healthy students are better learners, and better-educated individuals are healthier. Research has shown that comprehensive school health is an effective way to enhance that linkage, improving both health1 and educational outcomes2 and encouraging healthy behaviours that last a lifetime.

In the classroom, comprehensive school health facilitates improved academic achievement and can lead to fewer behavioural problems3. In the broader school environment, it helps students develop the skills they need to be physically and emotionally healthy for life.

Comprehensive School Health:

  • Recognizes that healthy students learn better and achieve more
  • Understands that schools can directly influence students’ health and behaviours
  • Encourages healthy lifestyle choices, and promotes students’ health and wellbeing
  • Incorporates health into all aspects of school and learning
  • Links health and education issues and systems
  • Needs the participation and support of families and the community at large

Comprehensive School Health in Canada

Effective, sustainable progress in comprehensive school health depends on a common vision, shared responsibilities and harmonized actions among health, education and other sectors. The challenge is to coordinate these efforts so that partners pool resources and develop action plans together, with, and in support of schools.

In Canada, the Pan-Canadian Joint Consortium for School Health models, supports, and encourages the partnerships between health and education that are essential to comprehensive school health.

Different Terminology, Same Ideas

The term comprehensive school health is widely used in Canada. In other jurisdictions, the approach may be known as health promoting school and its components may be expressed in different ways. However, the underlying concepts are the same; they are all based on the World Health Organization’s Ottawa Charter for Health Promotion (1986).


1 Stewart-Brown, S. (2006). What is the evidence on school health promotion in improving health or preventing disease and, specifically, what is the effectiveness of the health promoting schools approach? Copenhagen, WHO Regional Office for Europe (Health Evidence Network report;, accessed 16 Sep. 2008).

2 Murray, N.D., Low, B.J., Hollis, C., Cross, A. Davis, S. (2007). Coordinated school health programs and academic achievement: a systematic review of the literature. Journal of School Health, 77 (9), 589-599.


Systems Capacity and Change

Key Organizational Capacities for Sustaining Comprehensive Approaches to Health Promoting Schools

In recent years, school health proponents, program planners, and policy-makers have recognized the need for a more systematic and policy-oriented approach to comprehensive school health.

Although there is little definitive research on effective implementation of a comprehensive integrated school health program, there is considerable evidence supporting the effectiveness of action in specific issue areas. Using a comprehensive approach has the potential to significantly expand on these successes. However, this approach is also complex and difficult to implement and sustain in a meaningful way.

Success rests on sharing a common vision and goals and developing school programs that address the common determinants of health and academic outcomes. Lawrence St. Leger and Don Nutbeam suggest an increasing coincidence of school-related outcomes, school-based intervention, and inputs such as curriculum, professional development, policy, and organizational practicies that affect both the education and health outcomes of students. They provide a map that is useful for joint school health planning and implementation, one where there can be agreement on the actions to take and the reasons for these actions.

To sustain implementation of comprehensive approaches, many countries and state/provinces are focusing on policy, coordination, and strengthening the organizational capacities of school, public health and other systems to institutionalize internal and external relationships, responsibilities, and accountabilities for school health promotion. The following key capacities have been identified from a review of several national school health policies, a World Health Organization guide, reviews of literature on interagency coordination, and interview with key informants in several countries.

Key Capacities

Coordinated policies on school health, health issues and the elements of school health promotion are sometimes played out in local or provincial/territorial interagency agreements that may include financing, administration and organization. These explicit, comprehensive policy and managerial supports for inter-ministry, interagency and inter-disciplinary coordination and cooperation should include procedures in policy-making, program planning, and budget preparation to align responses to health and social issues undertaken through and with the school systems. As well, an overarching policy should favour inter-sectoral approaches and it should be reflected in guidance and directives to school, public health, police, social service and other local authorities and agencies.

Mechanisms for coordination and cooperation, both formal and informal, help to manage the implementation process, avoid confusion, and capitalize on synergistic action. Mechanisms may include joint committees, job descriptions, written policy statements, joint in-service programs, joint planning, shared budget allocations, joint vision development and consensus building.

Assigned staffing and infrastructure, such as provincial/territorial and district school health coordinators, help to facilitate and support interdisciplinary coordination and cooperation in school health promotion. These staff assignments should include time for actively supporting voluntary cooperation and alignment of activities, programs, polices and practices. They should be based on explicit intergovernmental, inter-ministry, inter-agency and inter-disciplinary agreements and should ensure that the voices of youth, parents, professionals and volunteers are heard in the decision-making about policies and programs.

Continuous workforce development ensures ongoing development for teachers, administrators as well as public health professionals. It includes explicit and sustained programs and processes to develop ministry and local agency workforces, through studies of current professional practices, guidance and support for the development of university and college pre-service preparation programs, and development of guidelines, models and materials for sustained staff development programs.

Knowledge transfer and exchange within and across systems, includes mechanisms and processes to sharing evidence as well as local solutions and ideas for implementation, funding and evaluation with decision-makers and practitioners to describe lessons learned and promote promising practices. This would included evidence-based knowledge summaries published by a variety of sources, guidelines for policy, programs and practice from provincial, territorial and professional sources and tools and models that enable decision-makers and practitioners to reflect on their situation and their practice and to locate materials and models that can be adapted to their circumstance.

Collecting and sharing reliable data entails the regular and timely collection and communication of data on the health outcomes, social behaviours and related learning of children and youth, and their connectedness to parents, schools and the community. These data are for use in appropriate decision-making and indicators systems and can be gleaned from periodic surveys of local agency policies, programs, and system capacities without implying a supervisory role or identifying survey participants. It is also important to develop explicit and agreed upon procedures and processes to conduct regular scans of health, social, educational environments to identify emerging trends, plan responses, and suggest actions for policymakers and agencies.

Long-term planning and sustained funding are essential for sustainability. They ensure the continuance of programs that demonstrate effectiveness, based on regular evaluations that shed light on program process, context and outcomes. Financial resources are needed for staff, personnel training, infrastructure changes, coordination, intersectoral participation and dissemination to support continued implementation and school health promotion action and evaluation plans.


1 Lawrence St Leger and Don Nutbeam. 2000. A Model for Mapping Linkages Between Health and Education Agencies to Improve School Health. Journal of School Health. Feb;70(2):45-50.

2 Deschesnes M et al. 2003. Comprehensive approaches to school health promotion: how to achieve broader implementation? Health Promotion International. 18(4):387-396.

3 WHO, Rapid Assessment and Action Planning Process (RAAPP), A Method and Tools to Enable Ministries of Education and Health to Assess and Strengthen their Core Elements of Capacity to Promote Health Through Schools, n.d. See

The 4 Components of Comprehensive School Health

There are 4 separate but interconnected components that address comprehensive school health. When actions in all four components are harmonized, students are supported to realize their full potential as learners – and as healthy, productive members of society.

Teaching and Learning

Student-centered learning and teacher training through resources, activities, and provincial/territorial curriculum. Students gain age-appropriate knowledge and experiences, helping to build skills to improve their health, well-being, and learning outcomes.

Resources and activities should include school health policies and guidelines, culturally-relevant contexts, and school community assets.

Social and Physical Environment

The social environment is:

  • the quality of the relationships among and between staff and students in the school
  • the emotional well-being of students
  • influenced by relationships with families and the wider community
  • Supportive of the school community in making healthy choices by building competence, autonomy, and connectedness.

The school’s social environment supports the school community in making healthy choices by building competence, autonomy, and connectedness.

The physical environment is:

  • the buildings, grounds, play space, and equipment in and surrounding the school
  • basic amenities such as sanitation, air cleanliness, and healthy foods
  • spaces designed to promote student safety and connectedness and minimize injury
  • Safe, accessible, and supportive of healthy choices for all members of the school community.

The physical environment is safe and accessible and supports healthy choices for all members of the school community.

Partnerships and Services

Community – and school – based partnerships and services are essential links for student achievement and the health and well-being of everyone in the school community. They enhance the range of supports and opportunities for students, parents, educators, and others. Examples of partnerships and services are:

  • health and education sectors working together
  • community organizations supporting school activities, student safety, risk interventions, or curriculum
  • donations of product or labour from a company towards the creation of a school garden or lunch program
  • contracts with fruit and vegetable growers/distributors for school fundraising initiatives.


The management practices, decision-making processes, rules, procedures, policies, and guidelines at all levels that promote student wellness and achievement, and shape a respectful, welcoming, and caring school environment for all members of the school community.

Comprehensive School Health Core Documents
Provincial Comprehensive School Health Resources
If you would like help finding the resources you need, contact the Joint Consortium for School Health today!