In This Article Expand or collapse the "in this article" section School Health Programs in the Pacific Region

  • Introduction
  • General Overviews
  • Evolving School Health Models
  • Science of Adolescence and Early Childhood Development
  • Building a Comprehensive, Integrative, and Coordinated School Health Program (CICSH)

Public Health School Health Programs in the Pacific Region
Albert Lee
  • LAST REVIEWED: 12 October 2022
  • LAST MODIFIED: 22 February 2018
  • DOI: 10.1093/obo/9780199756797-0173


How should a school health program be constituted? There are widely debated existing infrastructures, resources, and cultures, depending on geographic location, morbidity, and mortality patterns of children and adolescents in the area. Some developing countries might rely on schools as the setting to provide different types of services for children and adolescents, not to mention health-care services, while parents living in well-developed countries have access to a variety of health services, making school health programs redundant. In the past, school health programs have played an important role in preventing communicable diseases by offering immunization and hygiene education. The emergence of “new” communicable diseases (the unexpected outbreak of severe acute respiratory syndrome [SARS] in 2003 with more than 1,800 patients in over a dozen countries worldwide within two months, or the large outbreak of Ebola in West Africa in 2014) has posed new public health challenges in prevention of communicable diseases. The SARS experience let us know that communicable diseases threatened not only developing countries but also developed parts of the world, as reflected by the clustering of SARS in Hong Kong and Toronto. The dictum of public health practice, “prevention better than cure,” applies particularly to school health. It is especially true for infectious diseases, as treatment strategies are diverse and experimental at the time of outbreak. In 2011, the United Nations adopted the “Declaration of the High-Level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases (NCD).” The key action was to reduce risk factors and create health-promoting environments. With fasting-growing economies and the rapid pace of urbanization, we are exposing our young generations to a high-risk society, with increasing ecological and socioeconomic risks and individualization, and also risking mental health problems in our adolescents. In 2007, the WHO published a “Mental Health Global Action Program” and a “Movement for Global Mental Health.” School health programs need to be redefined to tackle the “triple health burdens”: communicable disease, NCD, and mental health.

General Overviews

This article will review the school health models developed in the late 1990s and analyze how school health promotion programs, especially the health promoting school (HPS) model, have shaped school health development in different parts of the world. How does the HPS model serve the requirements of school health? Findings from expert forums, such as Investing in Young Children Globally 2017 and Blum and Dick 2013, are relevant here. Maintaining a healthy and hygienic environment is one effective public health measure for combatting infectious disease, and Lee, et al. 2003 points out the important role of schools to step up public health measures, as observed during the severe acute respiratory syndrome (SARS) outbreak in Hong Kong. Lee, et al. 2008 reports that the concept of HPS would improve students’ health knowledge and practices in combating communicable diseases. Hong Kong was declared free of SARS on 23 June 2003 within months after the outbreak, while Liberia was first declared free of Ebola transmission in May 2015 (over a year after the outbreak started). However, the virus has been reintroduced twice since then; World Health Organization 2016 declared the end of the outbreak. Lee and Abdullah 2003 discusses how Hong Kong’s “setting approach” and “community development model” in school settings contributed to controlling infectious diseases. Bay, et al. 2017 argues that multidisciplinary approaches to incorporating education and health viewpoints should facilitate primary risk reduction for noncommunicable diseases (NCDs) in school settings. Eley, et al. 2004 investigates the genetic and biological factors that interact with family and school environments to mollify the risk of mental disorders. Insel and Wang 2010 calls for a rethinking of mental disorders as disorders of brain circuits likely to be caused by developmental processes shaped by a complex interplay of genetics and experience. The MindMatters approach in Wyn, et al. 2000 illustrates how mental health promotion would reduce psychiatric morbidity.

  • Bay, J. L., R. Hipkins, K. Siddiqi, et al. 2017. School-based primary NCD risk reduction: Education and public health perspectives. Health Promotion International 32:369–379.

    Highlighted the shortfalls of traditional strategies, which focused on secondary prevention to address NCD risks, and the importance of primary prevention strategies focusing on children and adolescents for long-term sustainable behavioral change.

  • Blum, R., and B. Dick. 2013. Strengthening global programs and policies for youth based on the emerging science. Journal of Adolescent Health 52:S1–S3.

    DOI: 10.1016/j.jadohealth.2012.11.004

    The findings of the expert forum have identified the linkage of policies and programs to current understanding of science. The findings identified three main ways in which science could influence policies and programs for prevention of NCDs as well as behavioral modifications that shape adolescent health outcomes.

  • Eley, T. C., K. Sugden, A. Corsico, et al. 2004. Gene-environment interaction analysis of serotonin system markers with adolescent depression. Molecular Psychiatry 9:908–915.

    DOI: 10.1038/

    A study of gene-environment interaction in adolescent depression. The findings reaffirmed that an important source of genetic heterogeneity is exposure to environmental risk.

  • Insel, T. R., and P. S. Wang. 2010. Rethinking mental illness. JAMA 303.19: 1970–1971.

    DOI: 10.1001/jama.2010.555

    The genetics of mental illnesses may really be the genetics of brain development, with different outcome possibilities depending on biological and environmental context. It is time to rethink mental disorders as disorders of brain circuits, likely to be caused by developmental processes shaped by a complex interplay of genetics and experience.

  • Investing in Young Children Globally. 2017. CONCEPT NOTE: Forum on Investing in Young Children Globally; An activity of the Board on Children, Youth, and Families and Board on Global Health at Institute of Medicine and National Research Council of the National Academy of Sciences. Washington, DC: National Academy of Medicine.

    Investing in Young Children Globally (iYCG) aims to identify and communicate best practices to translation science and evidence into programs and policies that improve the lives and potential of young children around the world.

  • Lee, A., and A. S. M. Abdullah. 2003. Severe acute respiratory syndrome: Challenge for public health practice in Hong Kong. Journal of Epidemiology and Community Health 57:655–658.

    DOI: 10.1136/jech.57.9.655

    The community needs to be strengthened and equipped with the health skills to promote better health and hygiene as well as create a supportive environment conducive to long-term health. This paper describes some of the public health initiatives in Hong Kong, such as the “setting approach” and “community development model” to help fight SARS.

  • Lee, A., F. Cheng, H. Yuen, M. Ho, and Healthy School Support Group. 2003. How would schools step up public health measures to control spread of SARS? Journal of Epidemiology and Community Health 57:945–949.

    DOI: 10.1136/jech.57.12.945

    In partnership with school principals, teachers, students, and parents, an educational video was produced with practical advice on preventive measures against SARS in the school context. A management flow chart was developed for schoolteachers to help the schools to triage students with possible SARS cases. The paper has also illustrated how schools could maintain a hygienic environment using the HPS guidelines.

  • Lee, A., M. C. S. Wong, F. Cheng, H. S. K. Yuen, V. M. W. Keung, and J. S. Y. Mok. 2008. Can the concept of health promoting schools help to improve students’ health knowledge and practices to combat the challenge of communicable diseases: Case study in Hong Kong? BMC Public Health 8.42.

    The study adopted multistage random sampling among schools with HPS awards reaching standards as HPS and among schools not involved in the award scheme or adopting the concept of HPS (non-HPS). Students in the award category were found to be significantly better in personal hygiene practice and knowledge on health and hygiene as well as having access to health information. Healthy School Award (HSA) schools were reported to have better school health policy, higher degrees of community participation, and more hygienic environments.

  • World Health Organization. 2016. Latest Ebola outbreak over in Liberia; West Africa is at zero, but new flare-ups are likely to occur.

    Liberia was first declared free of Ebola transmission in May 2015, but the virus was reintroduced twice after that. It was not until early January 2016 that the World Health Organization declared the end of the most recent outbreak of the Ebola virus disease in Liberia and that all known chains of transmission had been stopped in West Africa.

  • Wyn, J., H. Cahill, R. Holdsworth, L. Rowling, and S. Carson. 2000. MindMatters, a whole-school approach promoting mental health and wellbeing. Australian & New Zealand Journal of Psychiatry 34.4: 594–601.

    DOI: 10.1080/j.1440-1614.2000.00748.x

    This paper describes MindMatters, an innovative, national mental health promotion program that provides a framework for mental health promotion in Australian schools, hoping to facilitate exemplary practice in the promotion of whole-school approaches to mental health by developing mental health education resources, curriculum and professional development programs, and trial guidelines on mental health and suicide prevention. The professional development dimension for teachers of the program was found to be central to enhancing the role of schools in broad population mental health promotion.

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