The Global Partnership for Education’s (GPE) Knowledge and Innovation Exchange (KIX) thematic funding supports global and regional initiatives that use knowledge exchange, evidence and innovation to help developing countries solve critical educational challenges. A GPE discussion paper,Improving teaching and learning. A knowledge and innovation exchange (KIX) discussion paper was published in July 2019. The purpose of this paper is to describe the current landscape in improving teaching and learning and spark discussion and debate around potential areas for GPE/KIX investment. The "describes the challenges facing developing country to improve learning levels and reviews existing efforts to address those challenges through global goods. It identifies remaining knowledge and innovation gaps and offers a set of areas in which GPE could invest.
"focus on teachers and their work,and on three important sets of challenges that affect them:
1.The quality of support to teacher development. This includes weak content and pedagogical knowledge and classroom skills (including instructional practices) among teachers, often because of low quality of pre-and in-service teacher training. This is related to inadequate standards and accreditation for teachers and a lack of ongoing support and coaching from head teachers and other administrative leaders.
2.Teaching methods and learning materials.This includes a lack of textbooks and other learning materials;language issues, particularly around mother-tongue teaching; and teaching that is not aligned with children’s current level of understanding.
3.Systems for recruiting, managing and engaging teachers.This includes attracting and retaining the most qualified individuals to the teaching profession, deploying teachers to areas of the country with the greatest need, reducing unauthorized teacher absences and maximizing instructional time, and engaging teachers in policy dialogue and reform.
The GPE paper reviews several global and regional initiatives currently underway from UNESCO, GPE and other organizations that aim to improve the quality of teaching. A notable item in that list is the Breadth of Learning Opportunities initiative led by the Brookings Institution and Education International that includes physical health and emotional/social well-being.
The paper concludes by identifying five areas for investment. These include "sharing what works" to (a) improve data on teachers and teaching, enhance teacher recruitment, selection & retention, (c) improving accountability, incentives & rewards, (d) scaling up high quality teaching in early childhood and primary grades (e) enabling school and system level factors that support teaching (f) aligning budgets, planning and workforce changes to increase the number of teachers and transparency. 
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The written submission from the committee responsible for monitoring the achievement of SD Goal #4 (Education) to the UN High Level Political Forum in July 2019 cause concern for those seeking to ensure that the educational objectives described in Target 4.7 of the Goal include attention to health and life skills education as per the 2015 Incheon Declaration which includes health and life skills as essential parts of a high quality education (See below). Most of the SDG committee's submission does a good job of calling for more investments in equity/access and in describing how Goal #4 (education) is connected to other goals such as #10 (inequalities), #5 (gender), #8 (employment), #16 (peace, good government), #13 (climate action) and the role of education sector in coordination (#17), Notably, Goal #3 (health), #6 (water, sanitation) and #2 (hunger) are missing from this discussion. The exclusion of these goals from the submission needs further explanation given that the theme of the HLPF was "Empowering people and ensuring inclusiveness and equality".

The submission from the SDG committee does not directly address the content/learning objectives that should be part of Target 4.7 but it does refer to the Brussels Declaration (see below) which was published subsequent to a series of UNESCO-led consultation in December 2018. It is disappointing to note that the work done by FRESH Partners in adding the concepts of health and life skills to the Incheon Declaration continues to be ignored or misunderstood. We are not opposed to adding new elements to the definition of quality student learning content but surely it is easy to understand that sexuality education is part of health education and at least equal in importance to physical education. And surely life skills, a key concept in most curricula around the world deserve more attention. 
     
These two documents underscore the importance of the work of the FRESH Working Group on Health Literacy, Life Skills and Social Inclusion which is building the case and demonstrating how Health, Personal & Social Development (HPSD) education is already a core subject in most countries and should be considered and monitored by the SDG committee monitoring progress in Goal #4 and Target 4.7.

The 2015 Incheon Declaration included this wording: "Quality education fosters creativity and knowledge, and ensures the acquisition of the foundational skills of literacy and numeracy as well as analytical, problem-solving and other high-level cognitive, interpersonal and social skills. It also develops the skills, values and attitudes that enable citizens to lead healthy and fulfilled lives, make informed decisions, and respond to local and global challenges through education for sustainable development (ESD) and global citizenship education (GCED)." as well as this reference tolife skills "We further commit to ensuring that all youth and adults, especially girls and women, achieve relevant and recognized functional literacy and numeracy proficiency levels and acquire life skills, and that they are provided with adult learning, education and training opportunities. We are also committed to strengthening science, technology and innovation.". These statements define the content for a holistic, high quality education that meets the needs of the whole child.    .

The 2018 Brussels Declaration defines the content of a high quality education. Health and Life Skills education are absent from the statement, ignoring the foundation provided by Incheon Declaration but adding pieces such as sexuality education and physical education.  "we commit to supporting lifelong learning opportunities for all to ensure necessary competencies for personal development, decent work and sustainable development, with attention to climate change, adaptation and mitigation. Additionally, education institutions must provide children, youth and adult learners with the competences to be active citizens in democratic and sustainable societies. This includes efforts to promote education for sustainable development and sustainable lifestyles, democracy and human rights, gender equality, age-appropriate comprehensive sexuality education, physical education and sports, education in native language, peace and non-violence, global citizenship and active participation, appreciation for cultural diversity, multilingualism, intercultural dialogue, solidarity and more peaceful, tolerant and inclusive societies. This requires attention to pedagogy, curricula, teaching and learning materials, assessments, initial teacher training and continuous professional development, inter alia.

A special issue of the Journal of Adolescent Health in July 2019 contains several cost-benefit estimates of investing in health, education, productivity and safety in low & middle income countries. "The papers in this supplement present an important milestone in addressing this challenge, helping the international development field to move forward by focusing on the question of investing at scale for a few key components of the adolescent health agenda that are especially relevant for low- and middle-income contexts. All the empirical papers assess the effectiveness of implementing a specific set of interventions nationally at scale for their prioritized outcome of interest—health, education, productivity, safety—for a sustained period through 2030. The analyses confirm that the resulting benefits in all cases are substantial, both for the adolescents and for the economic and social progress of their nations. Four of the five empirical papers also model the costs of these interventions, and three papers further extend their analysis to calculate benefit-to-cost ratios (BCRs) of such investments. The BCRs range from 5.8 to 12.6, indicating a compelling case for national and global decision-makers to prioritize investing in adolescents."  ....

• "Sweeney et al. [10] make the case for investments to improve outcomes in adolescent sexual and reproductive health, the health of adolescent mothers and their newborn children, and adolescent relevant communicable and noncommunicable diseases. They examine investments in intervention-specific costs, program costs, and health systems costs for 40 low- and middle-income countries. For the 66 adolescent health interventions modeled through 2030, they estimate 7.0 million deaths and 1.5 million serious disabilities averted at the average cost of $4.5 per capita each year. They also estimate BCRs of 12.6 for low-income, 9.9 for lower middle-income, and 6.4 for upper middle-income countries.  
• Rassmusen et al. model the effects of a set of identified interventions on child marriage (life skills, community mobilization, and cash transfers) and education (availability and proximity of schools, teacher quality, and cash incentives) for 31 low- and middle-income countries [11]. They find that the interventions result in an 8% reduction in marriage rates for 15-17 year olds by 2050, an increase of 19.3% in school attendance and completion, and 22.7% increase in productivity by 2030. The average BCR for these interventions is 7.4.
• Wils et al. [12] find that in 44 low- and middle-income countries, school dropout among preadolescents is now very rare. Rather, dropout is mainly an adolescent effect—especially between ages 14-19 years and particularly for girls. Their analysis shows that at the cost of $10.5 per capita per annum, nine identified interventions can be sustained through 2030, increasing secondary completion rates by 25% and doubling the quality of secondary schooling as measured by the learning index.
• On a continuum to this analysis, Sheehan and Shi [13] estimate the economic returns to both the quantity and quality of education for adolescents in the context of the actual employment patterns in 72 low- and middle-income countries. They find that with sustained investment through 2030, the economic benefits of better education for adolescent cohorts lead to an increase in Gross Domestic Product (GDP) of 40% overall and 50% in low-income countries.
• Noting that in 75 low- and middle-income countries, death rates by road accidents are disproportionately high and the leading cause of death for adolescents, Symons et al. [14] provide an assessment of interventions to reduce these deaths and injuries for adolescents. Modeling of their preferred interventions results in 1 million deaths and 3 million serious injuries averted, at a cost of $1.2 per capita and a BCR of 7.6   

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A research review reported in the July 2019 issue of the Journal of Adolescence found that "Greater density of same race/ethnic peers led to better mental health for all youth" and that ".No overall mental health advantage in schools with increased diversity was found."A range of mental health outcomes were assessed (e.g., internalizing behaviors, psychotic symptoms) in order to broadly capture the relationship between school context on mental health and psychological wellbeing. Methods: A search across six databases from 1990 to 2018 resulted in 13 articles from three countries (United States, United Kingdom, and the Netherlands) that met inclusion criteria following a two step review of titles/abstracts and full-text."  Read more....

An article in the July 2019 issue of Pediatrics examined associations between adolescent connectedness and multiple health-related outcomes in adulthood. "We used weighted data from Waves I and IV of the National Longitudinal Study of Adolescent to Adult Health (n = 14 800). Linear and logistic models were used to examine associations between family and school connectedness in adolescence and self-reported health risk behaviors and experiences in adulthood, including emotional distress, suicidal thoughts and attempts, physical violence victimization and perpetration, intimate partner physical and sexual violence victimization, multiple sex partners, condom use, sexually transmitted infection (STI) diagnosis, prescription drug misuse, and other illicit drug use.In multivariable analyses, school connectedness in adolescence had independent protective associations in adulthood, reducing emotional distress and odds of suicidal ideation, physical violence victimization and perpetration, multiple sex partners, STI diagnosis, prescription drug misuse, and other illicit drug use. Similarly, family connectedness had protective effects for emotional distress, all violence indicators, including intimate partner violence, multiple sex partners, STI diagnosis, and both substance use indicators. Compared to individuals with low scores for each type of connectedness, having high levels of both school and family connectedness was associated with 48% to 66% lower odds of health risk behaviors and experiences in adulthood, depending on the outcome.  Read more......

Social inclusion is an often stated goal for education, health and social development programs. But how can we measure progress towards this challenging goals in educational systems that have a mandate to certify students for further studies and ultimately, social placement? An article in Volume 96 of the International Journal of Educational Research "presents the results of a descriptive survey study developed with the objective of identifying the level of inclusion (LI) of elementary schools in Catalonia (Spain) and classifying them according to the consolidation level of their inclusive practices in six dimensions: school organization, inclusive school climate, classroom organization, educational support, community involvement and lifelong learning. Conclusions form a starting point to generate changes in future educational policies of Catalonia based on evidences, that could influence international trends."  Read more...

The art & science of student assessment is often an overlooked element of Health, Personal & Social Development education. Generally, we compete with the traditional demand for students marks in academic subjects with a call for more holistic assessment practices but we rarely examine what we are suggesting students learn beyond the basic facts (literacy) of health. Issue #31, 2019 of ASCD Express gives us some insights as it covers the debate within education about moving to student evaluation without grades and marks. The articles in this issue suggest that "High-quality feedback should describe work against criteria students themselves understand and suggest attainable next steps at the appropriate level of challenge, points and averages mask what students actually know and are able to do, a straightforward reporting system gives students the information to take ownership of learning by measuring their performance relative to defined standards and making mastery, not points, the reward for your students...."  Read more...

The unique challenges related to building teams of teachers (and others) to improve programs and school practices has been discussed in educational research but less in health and social development. There is very little planning time in the teacher's work day, the regular working environment (the classroom) is isolated from other adults, teacher backgrounds are often derived solely from their previous experiences as students and their relatively low professional status makes other prone and willing to "fix the teachers" as their primary strategy.This is why the July 2019 issue of Educational Leadership should be of interest to school health & development advocates. The issue examines the barriers to teacher teams, "collective efficacy" as a driving concept, ensuring that team meetings work for teachers and treating teachers like professionals. Read more..... 

An article in Volume 40, 2019 of the Annual Review of Public Health states that "Most of the clinical research conducted with the goal of improving health is not generalizable to nonresearch settings. In addition, scientists often fail to replicate each other's findings due, in part, to lack of attention to contextual factors accounting for their relative effectiveness or failure."   To address these problems, the authors "review the literature on assessment of external validity and summarize approaches to designing for generalizability. When investigators conduct systematic reviews, a critical need is often unmet: to evaluate the pragmatism and context of interventions, as well as their effectiveness. Researchers, editors, and grant reviewers can implement key changes in how they consider and report on external validity issues. For example, the recently published expanded CONSORT figure may aid scientists and potential program adopters in summarizing participation in and representativeness of a program across different settings, staff, and patients." They go on to highlight three key areas where “science as usual” is failing public health settings:

• Research is too seldom tested with realistic expectations of the staff resources and other organizational infrastructure of future adopters: The research staff training, time, and/or resources are often greater than what resource-constrained public health practice settings can muster. (We would also frame this issue as a failure to test programs with representative staff and delivery conditions, including the use of unrepresentative levels of supervision, feedback, and measurement.)
  
• Research is too seldom tested with representative participants. Participants are often less diverse than in the real world, in terms of both the spectrum of healthy and diseased individuals as well as the cultural, demographic, and health literacy differences that may influence program effectiveness.
  
• Research interventions are highly controlled and inflexible to local site adaptation

The authors suggest that the Pragmatic Explanatory Continuum Indicator Summary (PRECIS) tool (79) and the more recently revised and updated PRECIS-2 tool (accessible at http://www.precis-2.org) (56) have been developed to guide researchers to explicitly consider nine factors (originally 10) related to external validity when designing a study. .....other frameworks have informed both the design and the evaluation of research programs, such as the RE-AIM model (27, 31, 34). More recently, the PRISM framework (Figure 2a) has been developed, both mapping onto RE-AIM outcomes and addressing contextual factors more explicitly (23). PRISM identifies specific contextual aspects of the organization delivering the program, the intervention itself (and how it fits within the multilevel context), the patient/participant receiving the program, and how the external environment and factors related to sustainability and infrastructure influence the RE-AIM outcomes." Read more....

An July 2019 article in BMC Public Health underlines the need for greater clarity when we discuss scaling up programs as opposed to more effective ways to implement an effective program. "The implementation of interventions at-scale is required to maximise population health benefits. ‘Physical Activity 4 Everyone (PA4E1)’ was a multi-component school-based program targeting adolescents attending secondary schools in low socio-economic areas.An efficacy trial of the intervention demonstrated an increase in students’ mean minutes of moderate-to-vigorous physical activity (MVPA) per day and lower weight gain at low incremental cost.This study aims to assess the effectiveness and cost effectiveness of a multi-component implementation support intervention to improve implementation, at-scale, of the evidence based school physical activity (PA) practices of the PA4E1 program. Impact on student PA levels and adiposity will also be assessed, in addition to the cost of implementation." A cluster randomised controlled trial, utilising an effectiveness-implementation hybrid design, will be conducted in up to 76 secondary schools located in lower socio-economic areas across four health districts in New South Wales (NSW), Australia.Schools will be randomly allocated to a usual practice control arm or a multi-component implementation support intervention to embed the seven school PA practices of the PA4E1 program. The implementation support intervention incorporates seven strategies including executive support, in-School Champion, teacher training, resources, prompts, audit and feedback and access to an external Support Officer. The primary trial outcome will be the proportion of schools meeting at least four of the seven physical activity practices of the program, assessed via surveys with Head Physical Education teachers at 12 and 24-months. Secondary outcomes will be assessed via a nested evaluation of student PA and adiposity at 12-months (Grade 8 students) and 24 months (Grade 9 students) undertaken in 30 schools (15 per group)" . ISHN Commentary: This promises to be an excellent study but will it measure the effect and cost effect of an implementation strategy as opposed to different methods for scaling up the multi-intervention program to other schools or other regions? Read more....