Better Health For All

I am a child. During the next 15 years I am likely to: Question my body image. Make my first independent decision about my diet and exercise. Witness or experience bullying. Have my first sexual experience. Be offered a cigarette. Be offered my first taste of alcohol. Make my first decision about drug use. So, asks the PSHE Association, ‘Who is going to teach the knowledge and skills I will need to manage these ‘first moments’ and stay healthy and safe? (1)

• By Marie Findlay, Policy Team, Royal Society for Public Health

Around 9% of teenagers in England are regular smokers by the age of 15 (2) and in the last month in the UK, more than half of 15-16 year-olds consumed five alcoholic drinks (3).  Teenage pregnancy rates are among the highest in Europe (4) while 31% of young men and 37% of young women aged 11-18 are overweight or obese  and only a minority do the recommended amount of physical activity (6).

Over half of mental health problems develop in teenage years (7). The significance of adolescence in forming behaviours that impact on health over a lifetime can hardly be overstated, and yet the health outcomes of young people in some of our communities are among the worst in the developed world (8).

RSPH Chief Executive Shirley Cramer, CBE, (left) joins children from Manningtree High School. They were the first graduates to be awarded the RSPH Level 2 Certificate for Youth Health Champions (YHC) by Duncan Selbie (centre), at a ceremony attended by Jane Davis (right of Ducan Selbie), YHC Coordinator at Manningtree High School. 

Schools are unique, being one of the only agencies that have regular contact with almost all children and young people during these formative years. It is therefore essential we utilise this opportunity to properly integrate health education in order to equip everyone with the knowledge, understanding and skills to navigate a complex world of choices and lead healthy, fulfilling lives.

Personal, Social, Health and Economic education (PSHE), highlighted by the Chief Medical Officer as a ‘bridge’ between education and public health (9), not only provides this opportunity but can also drive improvements in a range of Public Health Framework Outcome indicators (10).  Young people themselves are hungry to learn, with 86% of pupils feeling they need to be taught about PSHE topics in school.  Why, then, does PSHE remain a non-statutory part of our children’s education?

Perhaps the issue is masked by the fact that most schools deliver elements of PSHE in some form. But while curriculum requirements entail coverage of some components, quality of provision is hugely variable (12) and the 2012 Ofsted Report concluded that it was not yet good enough in a sizeable proportion of schools (13). This leaves many children and young people vulnerable with gaps in knowledge and skills spanning relationships, mental health and alcohol misuse (14).

Following the latest review, Elizabeth Truss, then Parliamentary Under Secretary of State for Education and Childcare, deemed a change of status unnecessary as ‘Teachers are best placed to understand the needs of their pupils and do not need additional central prescription’ (15). But teachers suffer from the lack of emphasis placed on a non-statutory PSHE. Many simply don’t want to teach it (16) and this is unsurprising when support from schools is variable.

Research has found that only 28% of secondary school teachers find it easy to be released for PSHE CPD training and only 21% find it is easy to get funding (17).  Teachers may also feel uncomfortable talking about sensitive and controversial issues without adequate training (18) resulting in topics such as sexuality, mental health and domestic violence being dropped.

Practical, innovative input from schools is vital to improving PSHE provision and evidence points towards an integrated approach (20).  In 2012, the Royal Society for Public Health (RSPH) hosted a workshop with stakeholders across health and education who stressed the need to move away from responding to deficits by combating bullying or teaching sex education and healthy eating as isolated issues. Good practice was seen not just as providing information to pupils but building confidence and resilience, including the ability to take measured risk and make active decisions, both of which are believed to be key determinants of individual health action (21). Schools that perform well put health and development at the heart of their curriculum and ethos (22).

One way to nurture these skills is through a peer-led approach. The Youth Health Champions initiative, piloted by North East Essex Primary Care Trust, trained students as facilitators of health education and to act as signposts for their peers. This has been developed by RSPH into a movement to engage young people in their own health journeys. In schools, Youth Health Champions consult with teachers on content and work with small groups during PSHE sessions with feedback indicating messages are ‘far more relevant and easy to understand when delivered by… their contemporaries’ (23).

Crucially, delivery can be approached by schools in partnership with public health authorities to target specific public health interventions in addition to meeting learning goals. The PSHE Association has, for example, supported Portsmouth City Council’s Health Improvement team to assess local public health priorities and adapt a programme of study to suit their needs – truly using the subject as a bridge between education and public health.

It is now time to strengthen this bridge with statutory underpinning. Caroline Lucas, whose bill to introduce statutory PSHE will be read in parliament for the second time in late February, has said: ‘as long as PSHE remains a non-statutory…subject…there will be virtually no coverage…in teacher training. In school, PSHE teachers are not given the curriculum time or training that they need – statutory status is key.’

We must get serious about empowering children and young people to manage their own health if we are to see changes in worrying health indicators. If we don’t do this in schools, where will we do it?

1) PSHE Association
2)  Cancer Research UK
3) RCN
4) FPH manifesto, ‘Start Well, Live Better’,
5) ‘Key Data on Adolescence for 2013’ published by the Association for Young People with the support of Public Health England
6) Chief Medical Officer’s Report, 2012
7)  RCN
8) RCN
9) Chief Medical Officer’s Report, 2012
10)  PSHE Association
11) Ofsted report on personal, social, health and economic education in English schools in 2012
12) Independent Review of the proposal to make Personal, Social, Health and Economic Education statutory, 2009
13) Ofsted 2012 report
14) Ofsted 2012 report
15) Draft Written Statement: links to a pdf
16) Kath Sanderson, ‘Health education in schools: strengths and weaknesses in relation to long-term behaviour development’, Perspectives in Public Health, DOI: 10.1177/1757913911430915
17) Formby et al, ‘ Personal, Social, Health and Economic (PSHE) Education: A mapping study of the prevalent models of delivery and their effectiveness’, January 2011
18) Ofsted report, 2012
19) Ofsted report, 2012
20) Formby et al, ‘ Personal, Social, Health and Economic (PSHE) Education: A mapping study of the prevalent models of delivery and their effectiveness’, January 2011
21) Kath Sanderson, ‘Health education in schools: strengths and weaknesses in relation to long-term behaviour development’, Perspectives in Public Health, DOI: 10.1177/1757913911430915
22) Lolc Menzies, ‘Charting a Health Literacy Journey – overview and outcomes from a Stakeholder Workshop’, Perspectives in Public Health, DOI: 10.1177/1757913911431041
23) Martin Page, ‘How to avoid ‘dad dancing’: a peer-led approach to the delivery of health education in secondary schools’, Perspectives in Public Health, DOI: 10.1177/1757913911430913