Comprehensive School Health Programs

Why Should Schools Address Student Health?

Major health problems among our children directly impact schools and student learning. Academic achievement, student self-esteem, and well-being are inextricably intertwined; responsibility for the emotional, intellectual, physical and social health of children is that of the whole community and all of its institutions. After the home, the school is often best positioned to serve as the community’s center for meeting the needs of the whole child (National Parent Teacher Association, 1992). Schools are being asked to address the health needs of children at a time when fundamental transformations of schooling structures and outcome expectations are also being demanded (Children’s Defense Fund, 1992; Carnegie Council on Adolescent Development, 1989). A restructured school alone cannot satisfactorily address the multidimensional concerns of children and youth. To address the developmental needs of children and families in a comprehensive and preventive manner, schools and communities must coordinate services. The American Academy of Pediatrics recommends that existing health-service providers join schools in coordinating school program components to improve the health and education outcomes of children. A service integration perspective which recognizes the central role schools play in the lives of children should therefore guide efforts to establish an empowering, healthy climate for them and their families within the community at large (Oomes & Herendeen, 1989).


What are Comprehensive School Health Programs?

Comprehensive school health programs (CSHP) are that part of school reform that seek to reduce or eliminate health-related barriers to student academic and personal success. CSHP are designed to reinforce health-promoting behaviors in students and to provide the skills students need to avoid negative health practices. (Carnegie Council on Adolescent Development, 1989; National Commission on Children, 1991).

Comprehensive school health programs are developed to mitigate six risk-behaviors which, nationally, are causing premature mortality and morbidity among our youth. (US Department of Health and Human Services, 1991). These negative behaviors impact health and the resulting capacity for both personal and academic success during adolescence and adulthood. The six high priority risk-behaviors are:

  • behaviors that result in unintentional and intentional injuries,
    tobacco use,
  • alcohol and other drug use,
  • sexual behavior,
  • dietary behavior, and
  • physical inactivity.
What are the Components of a Comprehensive School Health Program?

Because these high priority risk-behaviors arise from the interactions of persons and circumstances within and outside the student’s school experience, it is important to enlist persons, agencies, and organizations (inside and outside of the school) to address these behaviors. For this reason, comprehensive school health programs address health needs within the context of the student’s living conditions and local community. CSHP’s include eight interdependent components:

  • health education;
  • health services (on-site and/or school-linked);
  • school environment;
  • physical education and physical activity;
  • counseling, psychological, and social services;
  • food service program;
  • worksite health promotion for staff; and
  • integration of community resources. (Kolbe, & Allensworth, 1987)

These components provide additional opportunities, supports, and services that many of today’s students need to be successful. To be sure, “students who are hungry, sick, troubled, or depressed cannot function well in the classroom, no matter how good the school” (Carnegie Council on Adolescent Development, 1989).

Although the components listed above are present in many schools, few schools have developed a comprehensive, seamless web of care frequently termed a “full-service” school (Dryfoos, 1994). “Full-service” schools develop multi-faceted comprehensive programs that build knowledge, attitudes, and skills which promote health and reinforce the behaviors that prevent future problems. With administrative leadership (Davis & Allensworth, 1994; Resnicow & Allensworth, 1996), comprehensive school health programs are reflective of high level resource development designed to enable academic and personal success.


What is the difference between comprehensive school health programs and comprehensive school health education?

Comprehensive school health programs include health education but in addition, cultivate those components described above that provide services and additional support specific to individual student need. Comprehensive school health education is a planned, sequential curriculum of experiences presented by qualified professionals to promote the development of health knowledge, health-related skills, and positive attitudes toward health and well-being for students in preschool through grade 12.

Comprehensive school health education is but one facet of the eight component comprehensive school health program. Offered as a discrete course and embedded in a science, life skills, physical education, or language arts offering, a comprehensive health education curriculum seeks to address the six risk-behaviors identified earlier.

A highly regarded publication, National Health Education Standards: Achieving Health Literacy, (American Cancer Society, 1995) is a collaborative and definitive document which details what students should know and be able to do as a result of the area of health. This document also describes the supports that need to be in place for students to achieve these standards.

Does Health Instruction Make a Difference?

Two large nationwide longitudinal studies demonstrate the effectiveness of comprehensive school health education:

  • School Health Education Evaluation (Connell, Turner, & Mason, 1985);
  • Evaluation of Comprehensive Health Education in American Public Schools (Metropolitan Life Foundation, 1988);

It has been demonstrated that the provision of yearly comprehensive school health instruction can increase students’ awareness and practice of healthy behaviors (Metropolitan Life Foundation, 1988; Public Health Service, 1990; Pigg, 1989). The most complete evaluation of school health education was the School Health Education Evaluation (SHEE) study conducted in the early 1980s (Connell, Turner, & Mason, 1985). SHEE involved more than 30,000 fourth through seventh graders in over 1,000 classrooms from 20 states. Among its findings was the observation that at least 50 classroom hours of instruction were needed before students demonstrated significant changes in health attitudes and behaviors. It is generally recommended that students receive 50 classroom hours of instruction per year in health (English & Sancho, 1990).

How is CSHP Implemented?

Although moving a school and community toward the development and successful implementation of a comprehensive school health program is a substantial challenge, numerous resource materials are available to assist program planners. Step by Step to Comprehensive School Health: The Program Planning Guide (Kane, 1993) provides an easy to follow blueprint of the contents and processes important in the development of a quality CSHP. In addition, Step by Step offers self-assessment instruments, sample scope and sequence suggestions, and a listing of organizations which advocate for CSHP.

Of particular note is the upcoming publication of a concise description of comprehensive school health programming entitled: Health is Academic: A Guide to Coordinated School Health Programs. Slated for publication in early 1997 by Teacher’s College Press (New York, NY), the development of this compendium has been guided by the Educational Development Center (EDC) and has evolved with input from over 70 national organizations with expertise in student health and academic achievement.

There is a growing national movement to support the development of collaborative agreements by which health and human services are delivered to both children and parents in a school-based or school-linked setting. (Midwest Regional Center for Drug Free School and Communities, 1995). Local school districts and surrounding communities have organized to form councils that direct further planning for the positive acquisition of desired student outcomes. Although the school may be the site for programs to promote student health and prevent disease, it is important to note that these programs are not the sole responsibility of the schools but of the entire community.

Once a council is formed it brings together school and community representatives to identify additional federal, state, private, and public agencies and organizations that already provide services and resources which address student health concerns (American Academy of Pediatrics, 1993). The scope and purposes of this council may differ from community to community, but work to:

  • assess the health status of children and their families;
  • identify community health issues for children and families;
  • develop a shared vision for the health of children and families;
  • identify resource overlap and deficiencies;
  • develop policy recommendations to the board of education which support CSHP; and
  • promote the need and secure support for CSHP.

Comprehensive school health programming is a valuable tool in the quest for high academic achievement for all students. CSHP enables the health related needs of students to be met more consistently; it allows students to enjoy an enhanced capacity to attend to developmentally appropriate issues; and fosters heightened academic success (Carnegie Council on Adolescent Development, 1996). The cultivation of a community focus on student success through positive health behaviors will result in schools becoming more familiar to parents, community agencies and citizens. Schools will therefore reap the rewards of enhanced parent and community support, and students will benefit from more efficient use of school and community resources.


Related Articles
  • Benson, P., Galbraith, J., & Espeland, P. (1995). What kids need to succeed: Proven practical ways to raise good kids. Minneapolis, MN: Free Spirit.
  • Comprehensive Health Education Foundation. (1995). Renewing the partnership: The mainline church in support of public education. Seattle, WA: Author
    Fetro, J. (1992). Personal and social skills: Understanding and integrating competencies across health content. Santa Cruz, CA: ETR Associates.
  • Gallup Organization. (1994). Values and opinions of comprehensive school health education in US public schools: Adolescents, parents, and school district administrators. Atlanta, GA: American Cancer Society.
  • Joint Committee of the Association for the Advancement of Health Education and American School Health Association. (1992). Health instruction responsibilities and competencies for elementary (K-6) classroom teachers. Journal of School Health, 62(2), 76-77.
  • Joint Committee on Health Education Terminology. (1990). Report of the 1990 Joint Committee on Health Education Terminology. Reston, VA: Association for the Advancement of Health Education.
  • Kerr, D., Allensworth, D., & Gayle, J. (1991). School-based HIV prevention program: A multidisciplinary approach. Kent, OH: American School Health Association.
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  • U.S. Department of Health and Human Services Offices of Inspector General. (1993). School-based health centers and managed care: Examples of coordination. Item number 05-92-00681. Washington, DC: Author


  • American Academy of Pediatrics. (1993). School health: Policy and practice. Elk Grove Village, IL: Author
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  • Carnegie Council on Adolescent Development. (1996). Great transitions: Preparing adolescents for a new century. Washington, DC: Carnegie Corporation.
  • Children’s Defense Fund. (1992). The state of America’s children: 1992. Washington, DC: Author.
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  • Dryfoos, J. (1994) Full service schools: A revolution in health and social services for children, youth, and families. San Francisco, CA: Jossey-Bass.
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  • Kolbe, L., & Allensworth, D. (1987). The comprehensive school health program: Exploring an expanded concept. In P. Cortese & K. Middleton (Eds.), The comprehensive school health challenge. Volume one. Promoting health through education (pp.55-80). Santa Cruz, CA: ETR Associates.
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Copyright 1999 National Middle School Association. Used on NCMLE web site with permission of NMSA.