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

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 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...

(An item from the ISHN Member information service)   Most of the discussion and debates about curriculum design in health-personal-social development education has revolved around teaching knowledge (facts) and/or skills. In fact, the design and delivery of HPSD education is far more sophisticated than these two elements. They include attitudes, health beliefs/self-efficacy, normative beliefs, functional knowledge, behavioural intentions, perceptions of risk and more. An article in Issue #3, 2015 of Global Health Promotion reminds us yet another element, multiple intelligences (MI). The concept of MI recognizes that students learn in a variety of ways, through verbal, logical, spatial, bodily, interpersonal, naturalistic and existentialist intelligences. The article reports on a Nigeria study where a programme of drug education based on the Multiple Intelligences Teaching Approach (MITA) was developed. "An experimental group was taught using this programme while a control group was taught using the same programme but developed based on the Traditional Teaching Approach. Pupils taught with the MITA acquired more drug refusal skills than those taught with the Traditional Teaching Approach." Note: The ISHN description of HPSD education can be found here.  Read more>>

(An item from the ISHN Member information service)  With debates about the purposes of schooling now underway in several countries such as England, the US and others, we note that several blogs are adding useful commentaries suggesting that a holistic education, aimed at developing the whole child, are also adding to those debates. Watch these pages for ongoing reporting of the education reform paper in England and the renewal of the Education Act in the US. Both countries are deciding whether health education will be part of their core subjects. Read more>>

(An item from the ISHN Member information service)  School-focused research on the impact of normative beliefs on youth tobacco, alcohol and drug use has led to extensive discussions about "normative education" which focuses on transmitting beliefs about normative behaviours (eg most people do not smoke). Two articles in Issue #5, 2015 of Environment & Behavior report that even manipulated information about normative behaviours can have a positive impact on behaviours. Although both articles refer to studies of adult behaviours (use of cars for commuting and the use of bottled water), the results were the same. The participants in the two intervention groups did choose the healthier option. Read more>>

(An item from the ISHN Member information service)  With UNESCO and other UN agencies in the midst of developing indicators for student learning outputs as part of the new 2015-2030 Social Development Goals, our attention has turned to sources of advice about high quality HPSD education and curricula. Here are some good sources.
The association representing Personal-Social-Health-Economic Education (PSHE) in the UK provides an excellent summary in a blog posting on the characteristics of effective health and social development curricula. The list includes " some common elements of good practice, summarised here and available in greater detail in our ‘Case study key findings document’:

• A discrete, developmental and responsive PSHE education programme at the centre of the school curriculum, providing  opportunities to teach concepts, knowledge, language, strategies and skills that enrich the wider curriculum.
  
• PSHE education managed by an experienced, central co-ordinator with a genuine passion for the subject in their school. This co-ordinator should be supported by a ‘whole school’ commitment to PSHE education, and be part of a single data-driven system under which pupil personal development and pastoral care are provided.
  
• A senior leadership committed to monitoring the quality of PSHE teaching with the same rigour and expectations as other subjects. This also helps to ensure that any PSHE lessons observed during an Ofsted inspection can contribute positively to the overall judgment.
  
• Active involvement from members of the senior leadership team in teaching PSHE. Senior leadership team members’ involvement  - for example through heads of years teaching certain modules -  raises the profile and status of the subject with staff and pupils.
  
• PSHE education built around clear learning objectives and expected learning outcomes. Robust teacher, pupil and peer assessment allows schools to demonstrate pupils’ immediate learning from a single lesson and their progress over time. Schools should gather data to focus, evaluate and evidence the impact of the school’s PSHE provision. This ‘data rich’ environment also provides a strong evidence base for Ofsted inspections.
  
• PSHE education treated with the same regard as other subjects on the school’s curriculum. PSHE should be given appropriate curriculum time and a developmental scheme of work, have lessons observed and ensure that pupils’ work and progression is subject to scrutiny.
  
• Clear learning objectives which differentiate PSHE education where it is ‘blended’ with other subjects.  Some secondary schools ‘blend’ PSHE education, citizenship and RE whilst others separate them out as discrete timetabled subjects. Regardless of the model there should be clear learning objectives and outcomes for each element.
  
• Scope for flexibility and creativity to change the direction of lessons in response to pupil need.  This flexibility should take place within a wider framework ensuring that pupils would return to the planned learning at a later date.
  
• Recognition by schools that PSHE education helps to develop transferable skills that support academic success and success in life beyond school.  Schools should recognise PSHE education’s role in developing interpersonal skills such as listening, questioning, team-working and risk identification and its impact on pupils’ academic achievement, behaviour and success beyond school, including employability.
  
• A single ‘unifying framework’ or philosophy that focuses the entire school’s curriculum, making it clear to staff how the content and pedagogy of PSHE education contributes to this ethos.
  
• External visitors used within the context of a planned PSHE programme. Carefully selected external visitors can be used to enrich learning, provide expert input and act as role models with pre and post learning  offered through the regular planned PSHE programme.
  
• Active involvement of governing bodies. As part of their scrutiny of the curriculum, governing bodies should be provided with reports of pupils’ progress in PSHE and intended developments in the subject. Strong links with the student council should also be encouraged.

The Center for Disease Control & Prevention in the USA also provides excellent advice in their review of several Characteristics of an Effective Health Education Curriculum:

1. Focuses on clear health goals and related behavioral outcomes
2. Is research-based and theory-driven.
   
3. Addresses individual values, attitudes, and beliefs
4. Addresses individual and group norms that support health-enhancing behaviors
5. Focuses on reinforcing protective factors and increasing perceptions of personal risk and harmfulness of engaging in specific unhealthy practices and behaviors.
6. Addresses social pressures and influences.
7. Builds personal competence, social competence, and self efficacy by addressing skills
8. Provides functional health knowledge that is basic, accurate, and directly contributes to health-promoting decisions and behaviors
9. Uses strategies designed to personalize information and engage students.
10. Provides age-appropriate and developmentally-appropriate information, learning strategies, teaching methods, and materials
11. Incorporates learning strategies, teaching methods, and materials that are culturally inclusive.
12. Provides adequate time for instruction and learning.
13. Provides opportunities to reinforce skills and positive health behaviors
14. Provides opportunities to make positive connections with influential others
15. Includes teacher information and plans for professional development and training that enhance effectiveness of instruction and student learning.

The Glossary Term on Health Personal and Social Development Education being developed by the International School Health Network on its Wikipedia style web site has listed these important student learning outputs as part of its description of effective health and social development education.
There are several types of learning objectives that can be achieved in effective HPSD curricula and programs. These include:

• Focusing on functional or practical knowledge rather than simply presenting facts about health/social issues (eg too much detail on how STI are transmitted and not on enough on the fact that a person can have an STI and still look healthy)
• Developing and practicing general social, decision-making, life, media and decision-making/reasoning skills as well as practice and rehearsals in skills for specific situations (such as refusing alcohol)
• Promoting specific, practical age-appropriate behaviours (e.g. how to discuss/negotiate/refuse sex with partner) and providing specific pre-planned situational options (e.g. having a back-up drive home from parties) that can be sustained by the students rather than general and unrealistic calls for abstinence, alarmist messages contrary to prevailing social norms (alcohol is bad for you in communities where most adults drink)
• Addressing social pressures and influences through media literacy education, instruction about puberty, relationships with peers and peer pressure, how to communicate with parents and other adults
• Influencing normative beliefs, perceptions and attitudes through deconstructing mis-perceptions and providing factual information and investigation of collective behaviours of their peers/fellow students
• Personalizing information and risks about health and social problems and behaviours through inquiry-based learning, reflective journalling, role plays and other activities
• Developing behavioural intentions or personalized action plans through class discussions, buddy-based projects, external presentations
  
• Increasing self-awareness and awareness of the values and expectations of their parents, schools and communities
• Developing stronger empathy with others and greater social responsibility for promoting the health and welfare of others
  
• Learning how to access and use health services by visiting physicians offices, health clinics
  

Health literacy is a newer concept in health promotion that has not yet been applied extensively to school health education. We have always been trapped into developing health education by health topics (rather than generic skills or even basic skills/knowledge as in HL) so we do not have an evidence-based, experience-tested set of student learning outputs for all topics that can be developed in context relevant sets as a realistic, minimal output for schools.

Linking health instruction inextricably with health services and other components of a comprehensive school health approach. There are a number of models of health education, particularly from sex education that has linked instruction with convenient, accessible services, or ensuring nutrition education goals are reflected in the school cafeteria are examples. The IVAC model developed in Denmark and used widely in Europe has flipped the instructional paradigm by using a student action learning framework as its basis rather than the traditional behavourist model.

(An item from the ISHN Member information service)  Several news stories and commentaries were noted this week about the need to review mandatory sex education and health education curricula. In the US, several former surgeon-generals have called for a renewal of sex education, the lack of attention from school districts is noted, a reduced teen pregnancy rate is reported, the US Congress considers making health education part of the core curriculum and Hawaii has dropped its abstinence only approach to sex ed. In the UK, an all party committee has recommended mandatory health education and sex education and a response is expected from the new government by the end of June 2015. Read more>>

(From Drug & Alcohol Findings UK)  A cogent analysis of the limitations of school-based drug education is discussed in a blog post from this multi-partner knowledge exchange organization in the UK. The article suggests that school-based instruction is, almost by definition, constrained by the social forces surrounding and enshrined in schools. When adults, whose normative beliefs and practices encourage alcohol use, try to impose a delay in access to this popular pastime in the adult world on adolescents, the results are predictably limited. The article suggests a possible divorce of the "educational" aspects (empowering youth to make decisions) from the preventive aspects. Or, at least, the article suggests, that the goals of drug education should be modified to more limited objectives (harm reduction) or different objectives more compatible with schooling (character building, preventing school dropouts etc). Here is a brief except: 
"School-based drug education was and for many remains the great hope for preventing unhealthy or illegal substance use. Across almost an entire age group it offers a way to divert the development of these forms of substance use before they or their precursors have taken root. Though promise is clear, the fulfilment is less so. Most disappointing for Europe and for the UK were results from the seven-nation EU-Dap European drug education trial and the English Blueprint trial. The former was the largest European drug education trial ever conducted and tested a sophisticated US-style social influence programme, yet the results were patchy – generally positive but modest and usually not statistically significant benefits relative to control schools. The multi-million pound Blueprint trial was the largest in Britain and featured advanced interactive teaching methods reinforced by parental and community-wide components. Its government funders expected the results to “trigger a fundamental assessment of the place of drug education” in UK drug policy. If it did, it would be to confirm that drug education in secondary schools makes little contribution to the prevention of problems related to drinking and illegal drug use, though the evidence in respect of smoking is stronger. By the end of the follow-up period, on none of the most relevant measures was there was any sign that Blueprint had retarded growth in substance use any more effectively than usual lessons in the non-Blueprint schools. What might lie behind such disappointments can be divided in to at least two possibly interrelated domains: contradictions in principle, shortfalls in practice. Among the first is the contradiction between the objectives of education and those of prevention: the former seeks to empower children to think for themselves and open up new horizons, the latter to channel thoughts, attitudes and actions in ways intended by programme developers and teachers. Then there are potential contradictions within prevention programmes themselves. Some aim to limit young people’s autonomy in their choice of friends and substances by extending autonomy in decision-making, to encourage conformity to non-drug use values by discouraging conformity to other young people, to develop team work and social solidarity without accepting that youngsters may express this by going along with their peers as well as deciding not to". Read more>>

(From the ISHN Member information service) A blog post noted this week reports an another trend in education, another one that should catch the attention of advocates of health and personal/social development education because of the ongoing competition for time in over-crowded curricula. ASCD, a leading educational organizations notes the trend "Lessons involving STEAM -- science, technology, engineering, arts and math -- are catching on nationwide, including in schools in Florida, Ohio and Texas. The concept also has drawn support from businesses and government. Still, some say the effects of STEAM on student achievement remains unclear. " STEM education–that’s science, technology, engineering, and math–has gotten an increasing amount of buzz over the past few years. And now, there’s a twist on STEM: the addition of the arts, making it STEAM. Supporters say a more focused inclusion of the arts helps kids become creative, hands-on learners by sparking innovation. This fits with the calls for "21st Century Learning from business and other leaders, where innovation and creativity are increasingly valued as a business, enterprenurial skill. Read more>>

(Identified by ASCD SmartBrief)  A blog post identified by the ASCD Smart Brief service and published by Edutopia suggests that students should be taught to prepare their curricula vitae (which include personal and professional goals) rather then a simple resume (which simply lists assignments and accomplishments). This strategy for Career Education and Student Planning, one which the author calls preparing a "course for life", fits very well with health/personal/social development education, where effective teachers often use student journals and other reflection activities to help students learn more about themselves and their surroundings. As well, linking CV preparation with health journals and reflections is another way to achieve a better integration of health concerns within the core concerns of education systems. The author of the blog post discuses how difficult it can be for students to learn self-reflection techniques. But we all know that this process is essential if students are to develop personal behavioural and life plans. The article then outlines a five phases of preparing a CV, all of which are applicable to HPSD education as well as career education. Read more>> 

MPs in England have launched an inquiry into the future of PSHE and sex and relationships education (SRE) in schools. The Education Select Committee has called for evidence to help with its investigation, which will tackle a range of issues including whether PSHE should be a statutory subject. The cross-party inquiry comes after an Ofsted subject report last year judged that PSHE was not good enough in 40 per cent of the 50 schools it visited – primary and secondary. The report – Not Yet Good Enough – also found that half of secondaries needed to improve its SRE, while many teachers lacked training to tackle sensitive or controversial issues in both PSHE and SRE. Inspectors expressed concern about a lack of “high-quality, age-appropriate SRE” in more than a third of schools which they said could leave children vulnerable to “inappropriate sexual behaviours and sexual exploitation”. 
Read more>>

(From Drug & Alcohol Findings) The featured review brought together the findings of three reviews conducted for the Cochrane collaboration, each concerned with the effectiveness of ‘universal’ programmes aiming to prevent the development of drinking or drink-related problems in young people aged 18 or younger. As opposed to programmes for high-risk groups, universal programmes target large groups such as an entire age range, whether or not they are known to be specially prone to substance use or problems.The reviewed evidence supports the effectiveness of some but not all universal programmes for alcohol misuse prevention among young people. Given the variability in the results, particular attention should be paid to the content of programmes and the context in which they are delivered, including the setting, key personnel and target age. A programme may for example be effective where adolescent alcohol drinking is rare, but ineffective where it is the norm and reflects powerful social and cultural pressures to drink. Specifically in the school setting, some studies found no effects of preventive programmes, others statistically significant effects. Most commonly observed positive effects were for drunkenness and binge drinking, and it seems that certain generic psychosocial and developmental prevention programmes can be effective and could be considered as policy and practice options.

Main findings School-based programmes Of the 53 trials, 41 were conducted in North America. Relative to a standard curriculum, six of the 11 trials of alcohol-specific interventions found some statistically significant reductions in drinking. Another 39 studies tested more generic programmes. Of these, 14 found some statistically significant reductions in drink-related outcomes relative to a standard curriculum. Some apparently positive results may have been due to inadequate adjustment for ‘clustering’ effects (eg, of children in a class and of classes in schools), and in some studies results were confined to certain subgroups and/or some measures of drinking but not others. Most commonly, significant effects related to drunkenness and binge drinking. Impacts tended to last longer after generic than after alcohol-specific or other programmes. Overall, the evidence is more convincing for certain generic rather than alcohol-specific programmes. Among generic programmes, those based on psychosocial or developmental approaches (life skills in Life Skills Training; social skills and norms in Unplugged; behaviour norms and peer affiliation in the Good Behaviour Game) were most likely to report statistically significant effects over several years when compared to standard school curricula or other types of interventions.

Family-based programmes All but one of the 12 trials were conducted in North America. Nine recorded statistically significant reductions in drinking, in some cases over longer as well as shorter term follow-ups. One study recorded apparently negative effects which may have arisen by chance or due to methodological issues. In another, though ineffective on its own, the family-based intervention was effective when combined with a school-based intervention. There is some evidence for the short to medium-term success of gender-specific interventions for daughters, typically involving their mothers. Some trials found impacts only among children already using substances at the start of the trial.

Multi-component programmes All but three of the 20 trials were conducted in the USA. Relative to comparison conditions, 12 trials reported statistically significant reductions in drinking lasting up to three years among children allocated to multi-component programmes. Six of the 20 trials found no statistically significant differences, and in another significant reductions were confined to children already drinking at the start of the trial. It was unclear whether in general adding further prevention components to an existing programme improved outcomes; reports on four trials indicated some possible benefits, but another three trials found no such indications.  Read More>>

(From Prevention Plus Wellness) Helping children, adolescents and young adults understand how health risk behaviors and health enhancing behaviors influence each other is critical to them making effective decisions for enhancing their whole health. In particular, youth need to know how substance abuse and health promoting habits affect each other to either enhance or interfere with their physical and mental health, perceived self-image, and achieving important life goals. In the past, health behaviors were viewed as being largely independent of each other. We now know that it is more common for youth to experience a number of co-existing unhealthy behaviors rather than a single behavior problem. These co-occurring behaviors influence each other both directly, as well as indirectly through common underlying risk and protective factors such as self-image and self-regulation skills. Effective prevention programs should therefore help young people identify how multiple areas of their lives interconnect to influence their future health, well-being and happiness. Below we provide some tips for teachers and parents on how to communicate with youth to help them make the connection between substance abuse and healthy behaviors. Read more>>

(An item from the ISHN Member information service) Knowing that there is often too much content to cover in a health/personal-social development curriculum, health advocates often suggest that other subjects be used to convey health messages. This is an attractive idea but a qualitative study from singapore, reported in Volume 31 of Teaching & Teacher Education, reports that implementing an integrated curriculum strategy may be difficult for teachers. The authors report that "In this qualitative study, we examined eleven Singapore teachers' conceptions of teaching and learning as related to their experiences implementing integrated curriculum. Interviews revealed that the teachers' conceptions of integration spanned the spectrum of ideas found in relevant literature. Further, although participants saw benefits to integration, including greater engagement of learners, they also spoke of significant obstacles to its implementation, such as teachers' own perceived lack of subject knowledge and a misalignment with the assessment system. The findings, while echoing previous studies conducted in various countries, highlight implementation difficulties in settings where high stake examinations and disciplinary-based curriculum prevail.". Read more>>

(An item from the ISHN Member information service)  Shape Up – a school-community approach to influencing the determinants of a healthy and balanced growing up (www.shapeupeurope.net) was a three-year project aimed at the development, implementation and assessment of an innovative approach to health promotion and health education concerning overweight and obesity in children and young people. The researchers report that ' Shape Up demonstrated that young people can be guided to successfully bring about health-promoting changes at the school and community level. For example, these chnages included healthier food consumption at school, new forms of physical activity, and increased interest, motivation and ability among children and young people to deal with health issues. More specifically, Shape Up has proven to be effective in initiating and bringing about health-promoting changes in the ecology of the school, including improvements at the school, parent, community/municipal and individual student levels. 

(An item from the ISHN Member information service)   This report evaluates the strengths and weaknesses of personal, social, health and economic (PSHE) education in primary and secondary schools in England. It is based on evidence from inspections of PSHE education carried out between January 2012 and July 2012 in 50 maintained schools and on evidence from an online survey of 178 young people conducted on behalf of Ofsted between October and November 2012. Read more>>