Chapter Three in the revised open access edition of the Handbook of Salutogenesis discusses the concept as as a "Theory, as an Orientation and as the Sense of Coherence".  We hope that this interesting discussion does not lose the original focus of the concept as "In its most general meaning, salutogenesis refers to a salutogenic orientation, particularly in health promotion research and practice, focusing attention on the origins of health and assets for (positive) health, contra to the origins of disease and risk factors." We say this because in school health promotion, the tendency has been to address specific health and social problems (a medical, deficit approach) rather than addressing the needs and overall development of the whole child. Indeed, we see the  salutogenesis concept as a health sector version of the whole child approach. 
ISHN Comment: See the discussion of the whole child approach launched by ASCD and others in the early 2000s 

Schools for Health in Europe (SHE) has published a qualitative report on the barriers and facilitators to implementing a school health promotion approach in five countries. The barriers include:  Lack of understanding
about the approach, teachers having a limited focus on HP in their teaching, difficulties in the organization of the school, a lack of time from partners and limited support and involvement from government. The facilitators were the opposites of the barriers, including sufficient priority setting, support from teachers & principal, a focus on school as a healthy workplace, support from the community and support from government. The authors suggest that the implications/recommendations include:

• conducting a context-specific analysis of the barriers and facilitators in each country
• creating sufficient time and local support for schools
• improving regional and national coordination and knowledge exchange 
• creating a healthy workplace for school staff
• creating awareness that HP can be part of every lesson
• promoting the inclusion of HP as a basic element in teachers’ education 
•  promoting the explicit integration of HP as a core subject in the national curriculum 
• cooperating at a national level with a research institute and the education inspection body
• acting on the potential benefits of the Covid pandemic (increased concern for health) while addressing the problems created 

ISHN Comment. This extract from the larger study conducted by SHE researchers is a welcome addition to out growing understanding of implementation issues. Readers are encouraged to review our summary on better practices in implementing, maintaining, scaling up and sustaining (IMSS) approaches and programs. As well, we are pleased to note that the SHE recommendations are addressed in our global Fact-Finding Survey being conducted this Winter and Spring.
Read more about the SHE report ..... 

ISHN has gathered knowledge about Understanding Educators: Backgrounds, Beliefs, Work Lives & Concerns as part of better efforts to integrate health and social programs within education systems. Several articles in Volume 109, 2022 of Teaching and Teacher Education  provide much to add to our understanding. Teacher beliefs, concerns, working conditions, career patterns as well as different aspects of teacher education and development are discussed in the articles. If we are to work more effectively with teachers, we must better understand these things.
Go to the journal issue.

The WHO news release announcing the Geneva Charter on Well-being stated that "The 10th Global Conference on Health Promotion on 13-15 December 2021 marked the start of a global movement on the concept of well-being in societies. A focus on well-being encourages different sectors to work together to address global challenges and help people take control over their health and lives. " The WHO Director General noted that "“Health does not begin in a hospital or clinic. It begins in our homes and communities, with the food we eat and the water we drink, the air we breathe, in our schools and our workplaces,” We have to fundamentally change the way that leaders in politics, the private sector, and international institutions think about and value health, and to promote growth that is based on health and well-being for people and the planet, for countries in all income levels.” The Charter outlines the necessary elements of a ‘well-being society’ and what needs to be done in order to better prevent and respond to the multiple health and ecological crises we face globally. It identifies key action areas and offers instruments for implementation.The document encourages five key actions: 

• Design an equitable economy that serves human development within planetary boundaries;
• Create public policy for the common good;
• Achieve universal health coverage;
• Address the digital transformation to counteract harm and disempowerment and to strengthen the benefits; and
• Value and preserve the planet.

ISHN Comment: The adoption of the well-being concept by WHO is a good thing. The WHO interpretation of the concept is broad and gets beyond the physical and mental health of individuals. However, we worry about the vagueness of the term and how it is understood by many different sectors. The OECD interpretation defines well-being as a "better life" . UNESCO merges the WB concept with health and focuses on specific aspects of health and school programming in its strategy for health and well-being. The Centers for Disease Control & Prevention in the USA describes WB as a perception among people that  "their lives are going well" . The Oxford Dictionary defines WB as "the state of being comfortable, healthy, or happy" . Wikipedia links the WB concept to other vague concepts such as wellness, which reflects a growing connection among many defining WB as synonymous with individual mental health . Few definitions focus on the economic welfare. If we are to move further into the use of the well-being concept we shopuld work harder to define it is practical, policy and program terms that schools can use.

Go to the WHO Charter

An article in the January 2022 collection of BMC Public Health explores the value added by doing vaccinations in school sites. Other research has shown that school-based programs have a broader reach, better coverage, help to familiari8ze young people with health care services and can be linked directly with classroom instruction as well as individual education and school activities. This article explores the feasibility of school-base vaccinations in a small pilot study. "Vaccination rates for measles, mumps, and rubella (MMR) and diphtheria, tetanus, pertussis, and polio (Tdap-IPV) are not optimal among German adolescents. Education in combination with easy access to vaccination may be a promising approach to improve vaccination rates. The present paper describes a pilot study of a planned cluster randomized controlled trial (cRCT) in which we aim to improve MMR and Tdap-IPV vaccination rates together with knowledge and self-efficacy in a school setting." The findings of the pilot study indicated good feasibility. Of the total sample, 437 students (50.9%) brought their vaccination cards to school, 68 students received Tdap-IPV vaccinations, and 11 received MMR vaccinations. Out of six knowledge questions, on average, the students had more correct answers before and after the class and positive changes to self-efficacy .

ISHN Comment: Further comparative research on the impacts of school-based vaccinations during and after the Covid pandemic are urgently needed.

Read more in the article.    

An article in the BMC Public Health journal broadens the analysis of physical activity of adolescents in Australia. The article notes that "24-hour movement guidelines recommend a healthy balance of high levels of physical activity, low levels of sedentary behaviour and appropriate sleep duration each day." The methods of the study were "A repeated national cross-sectional survey of students in grades 8 to 11 (ages 12-17 years) was conducted in 2009-2010 (n=13,790), 2012-2013 (n=10,309) and 2018 (n=9,102). Students’ self-reported physical activity, screen time and sleep behaviours were assessed using validated instruments administered in schools via a web-based questionnaire".  The results were "In 2018, around one in four students (26%) did not meet any of the 24-hour movement guidelines, while only 2% of students met all three. Adherence to the sleep duration recommendation was highest (67%), with substantially smaller proportions of students meeting the physical activity (16%) and screen time (10%) recommendations. Differences in adherence by sex, grade level and socio-economic area were apparent. Students’ compliance with the screen time recommendation has declined over time, from 19% in 2009-2010 to 10% in 2018. However, there has been no significant change in the proportion meeting the physical activity (15% in 2009-2010 cf. 16% in 2018) and sleep duration (69% in 2009-2010 cf. 67% in 2018) recommendations. Compliance with all three guidelines has remained very low (<3%) across each survey round."

ISHN Comment: Although the broader analysis is useful to measure the overall daily PA among young people, the continuing focus on the quantity of PS rather than the quality is troubling. It has been refreshing to see the shift in PA sector back towards fundamental movement skills rather than counting minutes of activity during the school day. (This article continues that quantity-based thinking by suggesting more walking to school.) while more PA is always health promoting, schools should be focused more on knowledge, skills and attitudes that can be carried into life rather than counting steps or minutes. Further, much of the quantity-based thinking suggests light PA activities (such as walking to school), which actually do not mean the guideline of 60 minutes of moderate to vigorous activity. Measuring acquired skills is a better measure. What might be even better for schools to address is attitudes. Do school-based activities and PE classes actually increase or decrease student enjoyment of PA? 

Read more in the journal article.

Three articles in Issue 1, 2022 of the  Value in Health journal describe the newly developed standards for for Health economic evaluations. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 replaces the standards published in 2013.
Read more in the journal (subscription required)

The Covid pandemic has underlined the need to a public or societal concern for the health of others. Many in the USA, like other countries, consider health to be a personal responsibility, de-emphasizing the other side of the equation, whereby public authorities are able to provide supports in times of need, especially during health crises like Covid. An article in Issue #1, 2022 of Preventive Medicine documents the fragile state and erosion of public support for social safety nets during the pandemic, even as a new President assumed power.  "We surveyed a nationally representative cohort of 1222 U.S. adults in April 2020 and November 2020 to evaluate changes in public opinion about 11 social safety net policies and the role of government over the course of the pandemic. ....The share of respondents believing in a strong role of government also declined from 33% in April to 26% in November 2020".

ISHN Comment: One of the poorly understood goals of an effective health & life skills education program is to promote a concern for the health of others. In the US, that specific goal has been part of the National Standards for Health Education for many years. Yet, progress towards that goal is rarely reported.  There are other societal underpinnings to health education that could be used in a comparison study. For example, in Africa, one could examine the impact of the "ubuntu" concept (which emphasizes the connection between individuals and the village. Or an indigenous perspective, one that views health as a set of relationships with the land and with our ancestors could be considered. Eastern world views, such as that which has emerged in Bhutan, which measures "happiness" in relation to economic and social progress should al;so be on the list.  This discussion should be a part of any review of the failure of health education in many jurisdictions to have an impact on the fundamental values which should guide our responses to health and other crises.

Go to the Preventive Medicine Journal article.

The 2019 National Profile of Local Health Departments (LHDs) prepared by the National Association of County and City Health Officials (NACCHO) in the US reported on several aspects of LHD practices. THe reported noted that:

• 98% of LHDs had partnerships with local school districts that only shared information, with the direction of exchange of information being about equal
  
• 71% of LHDs had partnerships with local school districts that included regularly scheduling meetings, have written agreements, or share personnel/resources with organization
  
• 35% of the LHD employees were assigned to community health (5,600 in total for all responding LHDs)
  
• 59% of LHD employees were assigned as health educators (7500 in total for all responding LHDs)
  
• 72% of lHDs provided support to schools and daycare centers
  
• 37% of lHDs provided  health services in schools   
  

ISHN Comments: Most analyses and monitoring of school health programming is done with a focus on school districts and the education system. This type of analysis of the rile of health ministries and local health departments requires more attention.

Click here for the full copy of the report

The Lancet has published a report on a large cross-sectional survey of school health monitoring in 17 provinces in China. The study used data from 2428 schools from 17 provinces in China in 2018. Data were collected using a questionnaire administered by the Ministry of Education through its monitoring system, and included infectious diseases (e.g., reporting system for student infectious diseases), non-communicable diseases (e.g., regular student health examinations), and school physical environments (e.g., monitoring of classroom light, microclimate and drinking water). "Findings: Overall, the coverage rate of full school health monitoring systems was 16·6%. The coverage rates of school health monitoring systems for infectious diseases, non-communicable diseases, and school physical environments were 71·2%, 68·5%, and 24·9%, respectively. Coverage was higher in schools from urban rather than rural areas, in schools from areas with greater wealth, and in senior secondary schools rather than junior secondary and primary schools. Overall, the coverage of school health services monitoring was higher in urban areas, in wealthier areas, and in senior secondary schools."

The monitoring of infectious diseases is likely higher than most other countries. "The proportion of schools with all infectious disease monitoring systems was 71·2%. Overall, infectious disease monitoring systems were established in more than 90·0% of schools. The exception was in the use of student enrolment inoculation cards, which were adopted by only 76·4% of schools. The use of enrolment inoculation cards requiring an inspection system varied by school type, being highest in primary schools (96·4%), followed by junior secondary schools (47·3%) and senior secondary schools (25·6%)." Further "Since the SARS outbreak in 2003, the Chinese government has invested heavily in infectious disease control and prevention, with demonstrated improvements in disease surveillance.
This may explain why we found few differences in the coverage of infectious disease prevention and monitoring systems between urban and rural locations, regional SES groups, and primary and secondary schools, which is consistent with the widespread implementation of school-based monitoring systems around infectious diseases. Among the components of infectious disease monitoring in schools, the one exception to high coverage was around a system to review student enrolment inoculation cards (a certificate inspection system) which was evident in only 76·4% of schools, well lower than for other components." .

ISHN Comments: This Chinese example of SH monitoring is likely among the best in the world and underlines the need to better surveillance policies and practices. The relative "problems" with tracking student vaccination rates would be likely be seen as a success in most other countries. The discussion of monitoring and reporting (See the ISHN and FRESH Partner (pp 38-39) summaries on Monitoring, Reporting, Evaluating & Improving) should be linked directly to improvement planning and policy-making. Countries could learn more from each other on implementing better MREI practices which have been underlined  by the recent Covid pandemic.

Read the Lancet article here