Excerpt from Health-promoting schools: a resource for developing indicators, (2006) Schools for Health Europe, Amsterdam
Christine Hekkink, Goof Buijs & Zeina Dafesh Research on the regional implementation of health-promoting schools in the Netherlands pp 172-180
Regional public health services play a key role in developing the national health promoting schools strategy in the Netherlands. The Netherlands currently (2006) has 36 regional public health service divisions. Each regional public health
service division has a department of youth health care and a department of health promotion that facilitate the development and implementation of health promotion programmes. For the youth target group (4–18 years), there is parti -
cular emphasis on school-based programmes. The regional public health service divisions play a role in coordinating school
health policy in their region, preferably in close collaboration with other regional organizations that are supporting schools in health and care. The regional public health service divisions offer support to schools to help implement school health
policy. However, it is not known how these regional public health service divisions work to support health promotion in schools, hence the current project. This study used a questionnaire on health-promoting schools. This will serve as a
monitor for the Ministry of Health, Welfare and Sport and national institutions in the Netherlands to achieve a current view of how the regional public health service divisions contribute to health promotion in schools. The scan could be
carried out every four years, to monitor progress at the regional level in relation to health promotion in schools. Main Findings. Most regional public health service divisions (78%) have embedded support for schools in their departments of health promotion as well as youth health care. More than half the regional public health service divisions have established a project group within their organization focusing on health promotion in schools. Most of the public health service divisions (91%) offered extra training for their employees in health promotion in schools. Further, the public health service divisions have different functions (for example, an epidemiologist and school doctor) working in health promotion in schools. Approximately 40% of the regional public health service divisions define their strategy according to a demand-oriented approach and support schools in a structural way. Moreover, 70% of the public health service divisions make use of systematic research data and incorporate integrated activities in relation to health promotion in schools. Only 44% of the public health service divisions
have an annual action plan (including hours, budget and activities) for health promotion in schools. Further, only 38% of the public health service divisions systematically evaluate their approach in relation to health promotion in schools. The five health issues to which the public health service divisions had paid the most attention during the past year in primary schools were: obesity, healthy nutrition, sports and physical exercise, dental care and bullying. The public health service divisions paid most attention to the following five health issues in secondary schools: sexuality and relationships, smoking, alcohol, drugs and obesity. Local public health policy and demands from schools have the most influence on the choices public health service divisions make on the health issues addressed in schools.

Excerpt of a Case Study from Better schools through health: learning from practice Third European Conference on Health Promoting Schools, held in Vilnius, Lithuania, 15–17 June 2009
Geert Bruinen EFFECTIVE AND EFFICIENT HEALTH PROMOTION IN SCHOOLS; THE ROTTERDAM EXPERIENCE
A year and a half ago the Public Health Service Rotterdam-Rijnmond changed its approach to health promotion in schools. Instead of determining from within what the schools were offered the Public Health Service became ‘needs led’ and responded to schools’ demands. Since making this change almost 20% of all Rotterdam schools (in total almost 300, both primary and secondary schools), embrace the healthy school method. Until now it has been the common practice of regional public health services in the Netherlands to offer standard health promotion interventions to schools. The Rotterdam Health Service used the same strategy; the workers would visit schools which were reporting health issues which needed to be tackled and the workers would directly offer solutions and interventions. The health workers ‘owned’ the interventions. The response of the school management was often negative in response to this kind of intervention citing lack of time as a reason to reject it. Alternatively, if they were willing to spend time on the issue, they would want it done immediately and gave responsibility to an individual committed member of staff who would deal with it in their lessons. Many health promotion workers entered the schools and each with their particular expertise and partners were satisfied when health promotion was being done. But…
So in Rotterdam in January 2008 we changed our way of working and, with the support of the Netherlands Institute for Health Promotion NIGZ, we started working with the Healthy School Method. Most important was the change towards working co-operatively with schools as partners. We communicate openly about the health issues in their school, make it clear
that the responsibility for the work is theirs but offer support to equip them to tackle the problems. Management became the main point of contact with schools with support to help them understand the ‘health status’ of their pupils and help them to work with the healthy school method to promote healthy change.

Excerpt of a Case Study from Better schools through health: learning from practice Third European Conference on Health Promoting Schools, held in Vilnius, Lithuania, 15–17 June 2009
Vivian Bos, Nicole Boot IMPROVING THE WHOLE SCHOOL APPROACH IN THE NETHERLANDS pp 59-61
Interest in whole school health promotion is on the rise in the Netherlands. However, health promotion is not a prescribed part of the school curriculum. Schools are quite autonomous in organising their curriculum and of course, the main goals of a school are mastering skills in language and mathematics. Yet, many schools do organise ad hoc activities that promote the health of children such as a school fruit, regulations for use of alcohol at school parties and education about safe sex.
In the Netherlands regional health services have a legal obligation to help children with health problems. Schools install multi-disciplinary pupil care teams focusing on support for pupils, teachers and parents around the issue of behavioural problems.
Prevention work is not part of these obligations. Many local, regional and national organisations see schools as ideal settings for health promotion. Co-ordination of health promotion support has been lacking so health promotion agencies competed for the access to schools. Schools experienced an overload of initiatives and were unable to make an informed choice between everything offered to them.
The Ministry of Health and Welfare in the Netherlands established the coordination of Health Promoting Schools at the RIVM Centre for Healthy Living in 2007. The Centre of Healthy Living collaborates with 9 national health promotion institutes focusing
respectively on healthy eating, smoking prevention, stress prevention, prevention of alcohol and drugs abuse, sexual health and health-enhancing physical activities. Additionally, for the coordination of Health Promoting Schools, the Centre of Healthy
Living works together with 10 (out of 29) regional health services. In 2008 the Centre of Healthy Living researched how much the specific components of the whole school approach were being implemented. These components are: 1. Determining health needs of the school 2. Setting health promotion priorities 3. Assessing the important and changeable determinants 4. Compiling the school health plan 5. Realising the school health plan 6. School-based evaluation
The results showed that three quarters of regional public health institutes in the Netherlands do support schools with health promotion activities by using variants of the whole school approach. Most regional public health institutes and schools experienced the whole school approach as too intensive and adjusted the approach according to available local resources and the immediate needs of schools. The number of schools that are supported by regional public health institutes is still limited and most schools that are assisted are still in the early phases of becoming ‘a healthy school’.
The findings mentioned above were supported by a recent regional study, both qualitative and quantitative, into the implementation of whole-school health promotion (Schoolbeat-approach) among schools for secondary education. The study
was undertaken in the South of the Netherlands and indicated that the Schoolbeatapproach, for systematic school health promotion is only partially implemented. Reasons given for this were high workload and lack of health promotion as part of the
school quality measures. Nonetheless, teachers and school management felt a shared responsibility for the health and well-being of students, although schools want and need more guidance.