health education topic for primary school

Make Learning Enjoyable with these Health Lessons for Kids

Explore different ways to teach kids health in the classroom or at home, that will keep them engaged and enthusiastic. Our health lesson plans range in topics designed for preschool kids to elementary and middle school students. We’ve designed these health lessons for kids to be time-efficient yet impactful and memorable. Whether you’re a teacher, other type of educator, parent or guardian, our lessons for kids will make learning enjoyable for both you and your students.

In these lessons, kids will learn fun ways to practice mindfulness and balance, how to eat well, ways to be active, or keep clean and hygienic—and without it feeling like another chore. Choose one of our health lesson plans below for a quick and easy learning activity for your child or children.

• 3-14 Years Old
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• Responsible Decision Making
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Exercise and Your Brain

All fats are not created equal, bad breath: what to do about it, backpack safety: that’s a thing, body composition, brain boost, breakfast power, breathe easy: asthma 101, create your own healthful snack, decreasing screen time, drive your bike keys to safe and healthy cycling, eye protection, fast food alert, food allergy awareness, gardening – growing goodness, get out and enjoy nature, get the facts: know your food label, gratefuls and grumbles: helping kids develop an attitude of gratitude, gratitude: overlooked blessings, grocery store virtual tour, guided imagery for younger children, guided imagery: create the state you want, hand-washing: a weapon against germs, healthy heart, how hungry am i, hungry for breakfast, it’s all in the breathing, it’s mealtime relax and enjoy, know what matters to you, learning mindfulness through movement, let’s talk maximizing the benefits of family mealtime, learning to calm fear, listen hear all about the ear, living a healthy life, love your lunch, marketing mania, mental remix, milk matters, more milk, please, smile bright tooth care, the power of meditation, wash hands for health, move it the importance of daily exercise for kids, myplate and yours too, noticing walk and reflection, oversweetened: the truth about sugary drinks, pedometer fitness fun, picky eating, portion distortion, power-up with snacks, quench your thirst the importance of water, safe and fun, in the sun, safe food is good food, self-esteem and body image activities for kids, skin: caring for the largest organ, smart snacking, splash why is it important to bathe, sports drinks and energy drinks, how to stay safe during physical activity, stress busters, stress no body needs it, stretch for your best, super sleep, the concussion conundrum, the dish on gluten, tobacco and e-cigarettes, vegetarian basics, water: making living things grow, what we can do to stress less, having a positive mindset, what’s my portion size.

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Ages & Stages

Teaching health education in school.

Many parents are keenly interested in the basic academic education of their youngsters—reading, writing, and arithmetic—but are not nearly as conscientious in finding out about the other learning that goes on in the classroom. A comprehensive health education pro­gram is an important part of the curriculum in most school districts. Starting in kindergarten and continuing through high school, it pro­vides an introduction to the human body and to factors that prevent illness and promote or damage health.

The middle years of childhood are extremely sensitive times for a number of health issues, especially when it comes to adopting health behavior that can have lifelong consequences. Your youngster might be exposed to a variety of health themes in school: nutrition, disease prevention, physical growth and development, reproduction, mental health, drug and alcohol abuse prevention, consumer health, and safety (cross­ing streets, riding bikes, first aid, the Heimlich maneuver). The goal of this ed­ucation is not only to increase your child's health knowledge and to create positive attitudes toward his own well-being but also to promote healthy be­havior. By going beyond simply increasing knowledge, schools are asking for more involvement on the part of students than in many other subject areas. Children are being taught life skills, not merely academic skills.

It is easy to underestimate the importance of this health education for your child. Before long he will be approaching puberty and adolescence and facing many choices about his behavior that, if he chooses inappropriately, could im­pair his health and even lead to his death. These choices revolve around alco­hol, tobacco, and other drug use; sexual behavior (abstinence, prevention of pregnancy and sexually transmitted diseases); driving; risk-taking behavior; and stress management. Most experts concur that education about issues like alcohol abuse is most effective if it begins at least two years before the behav­ior is likely to start. This means that children seven and eight years old are not too young to learn about the dangers of tobacco, alcohol, and other drugs, and that sexuality education also needs to be part of the experience of elementary-school-age children. At the same time, positive health behavior can also be learned during the middle years of childhood. Your child's well-being as an adult can be influenced by the lifelong exercise and nutrition habits that he adopts now.

Health education programs are most effective if parents are involved. Par­ents can complement and reinforce what children are learning in school dur­ing conversations and activities at home. The schools can provide basic information about implementing healthy decisions—for instance, how and why to say no to alcohol use. But you should be a co-educator, particularly in those areas where family values are especially important—for example, sexu­ality, AIDS prevention, and tobacco, alcohol, and other drug use.

Many parents feel ill-equipped to talk to their child about puberty, repro­duction, sex, and sexually transmitted diseases. But you need to recognize just how important your role is. With sexual topics—as well as with many other ar­eas of health—you can build on the general information taught at school and, in a dialogue with your youngster, put it into a moral context. Remember, you are the expert on your child, your family, and your family's values.

Education seminars and education support groups for parents on issues of health and parenting may be part of the health promotion program at your school. If they are not offered, you should encourage their development. Many parents find it valuable to discuss mutual problems and share solutions with other parents. Although some parents have difficulty attending evening meet­ings, school districts are finding other ways to reach out to parents—for in­stance, through educational TV broadcasts with call-in capacities, Saturday morning breakfast meetings, and activities for parents and children together, or­ganized to promote good health (a walk/run, a dance, a heart-healthy luncheon).

In addition to providing education at home on health matters, become an advocate in your school district for appropriate classroom education about puberty, reproduction, AIDS, alcohol and other substance abuse, and other relevant issues. The content of health education programs is often decided at the community level, so make your voice heard.

As important as the content of a health curriculum may be, other factors are powerful in shaping your child's attitudes toward his well-being. Examine whether other aspects of the school day reinforce what your youngster is be­ing taught in the classroom. For example, is the school cafeteria serving low-fat meals that support the good nutritional decisions encouraged by you and the teachers? Is there a strong physical education program that emphasizes the value of fitness and offers each child thirty minutes of vigorous activity at least three times a week? Does the school district support staff-wellness programs so that teachers can be actively involved in maintaining their own health and thus be more excited about conveying health information to their students?

In addition to school and home, your pediatrician is another health educator for you and your child. Since your child's doctor knows your family, he or she can provide clear, personalized health information and advice. For in­stance, the pediatrician can talk with your child about the child's personal growth patterns during puberty, relate them to the size and shape of other family members, and answer questions specific to your youngster's own de­velopmental sequence and rate.

For most school-related health concerns, your pediatrician can provide you with specific advice and tailored guidance. You and your pediatrician may also consult with the school staff on how to deal most effectively with school time management of your child's health problem.

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The Characteristics of Effective Health Education Curricula

What Is Health Education?

A health education curriculum refers to those teaching strategies and learning experiences that provide students with opportunities to acquire the attitudes, knowledge, and skills necessary for making health enhancing decisions, achieving health literacy, adopting health-enhancing behaviors, and promoting the health of others. 1 A health education curriculum is the primary means through which schools deliver health education and should include the following:

• A set of intended learning outcomes or objectives that directly relate to students’ acquisition of health related knowledge, attitudes, and skills

• A planned progression of developmentally appropriate lessons or learning experiences that lead to achieving health objectives

• Continuity between lessons or learning experiences that clearly reinforce the adoption and maintenance of specific health-enhancing behaviors

• Content or materials that correspond with the sequence of learning events and help teachers and students meet the learning objectives

• Assessment strategies to determine if students have achieved the desired learning

The curriculum clarifies the health content that is important and what students should be able to do as a result of participating in health education learning experiences.

For more information about health education, visit the Centers for Disease Control and Prevention’s (CDC’s) latest webpage at  https://www.cdc.gov/healthyyouth/health-education/index.htm.

What Does Research Say About Effective Health Education?

Health education curricula reflect the growing body of research that shows the importance of curricula that

• Emphasize functional health information (i.e., essential knowledge),

• Shape personal values and beliefs to support healthy behaviors,

• Shape group norms valuing healthy lifestyles, and

• Develop essential skills needed to adopt, practice, and maintain health-enhancing behaviors. 2–15

Studies also demonstrate that less effective health education curricula often overemphasize teaching scientific facts to increase student knowledge. 2–15 Reviews of effective programs and curricula and input from health education experts have identified 15 Characteristics of an Effective Health Education Curriculum. 2–15 More information about the 15 characteristics can be found at  https://www.cdc.gov/healthyschools/sher/characteristics/index.htm .

How Can Teachers Use the 15 Characteristics of Effective Health Education Curricula in Their Practice?

Some school districts purchase commercially available health education curricula that have been evaluated to show positive impacts on student health outcomes. Often, these evaluated health education curricula support several of the 15 characteristics (e.g., use of theory, culturally inclusive teaching strategies) found to contribute to the effectiveness on student outcomes. Other school districts use locally developed health education curricula that may rely on individual health teachers to create unit and lesson plans. Regardless of the curriculum type, understanding and applying the 15 characteristics is one of the core principles in selecting, developing, and delivering effective health education programs. Teachers who purposely apply and incorporate the Characteristics into all health education unit or lesson plans, learning activities, and assessments may help increase students’ likelihood of adopting and maintaining healthy behaviors. 

The 15 Characteristics of an Effective Health Education Curriculum focus on different aspects of health education curriculum development and implementation. To learn practical strategies about how teachers can apply the 15 characteristics in their daily practice, click on each of the characteristics listed below. Examples of how to support each characteristic are provided at K–2, 3–5, 6–8, and 9–12 grade level spans.

To view in PDF format, please click here .

Directions: Click on the grade-level icon below for examples of how to support the characteristics in a lesson.

To view Characteristics in PDF format, please click on the Characteristic below.

Characteristics Introduction :  The Characteristics of Effective Health Education Curricula

Characteristic 1 : Focuses on clear health goals and related behavioral outcomes

Characteristic 2 : Provides functional health knowledge that is basic, accurate, and directly contributes to health-promoting decisions and behaviors

Characteristic 3 : Focuses on reinforcing protective factors and increasing perceptions of personal risk and harmfulness of engaging in specific unhealthy practices and behaviors  

Characteristic 4 : Addresses personal values, attitudes, and beliefs

Characteristic 5 : Uses strategies designed to engage students

Characteristic 6 : Addresses social pressures and influences

Characteristic 7 : Builds personal competence, social competence, and self-efficacy by addressing skills

Characteristic 8 : Provides opportunities to reinforce skills and positive health behaviors

Characteristic 9 : Addresses individual and group norms that support health-enhancing behaviors

Characteristic 10 : Provides age-appropriate and developmentally appropriate information, learning strategies, teaching  methods, and materials

Characteristic 11 : Incorporates learning strategies, teaching methods, and materials that are culturally inclusive

Characteristic 12 : Provides opportunities to make positive connections with influential others

Characteristic 13 : Includes teacher information and plans for professional development and training that enhance  effectiveness of instruction and student learning

Characteristic 14 : Provides adequate time for instruction and learning

Characteristic 15 : Is research based and theory driven

1. Centers for Disease Control and Prevention. Health Education Curriculum Analysis Tool, 2021, Atlanta, GA: CDC; 2021.

2. Botvin GJ, Botvin EM, Ruchlin H. School-Based Approaches to Drug Abuse Prevention: Evidence for Effectiveness and Suggestions for Determining Cost-Effectiveness. In: Bukoski WJ, editor. Cost-Benefit/Cost-Effectiveness Research of Drug Abuse Prevention: Implications for Programming and Policy. NIDA Research Monograph, Washington, DC: U.S. Department of Health and Human Services, 1998;176:59–82.

3. Contento I, Balch GI, Bronner YL. Nutrition education for school-aged children. Journal of Nutrition Education 1995;27(6):298–311.

4. Eisen M, Pallitto C, Bradner C, Bolshun N. Teen Risk-Taking: Promising Prevention Programs and Approaches. Washington, DC: Urban Institute; 2000.

5. Gottfredson DC. School-Based Crime Prevention. In: Sherman LW, Gottfredson D, MacKenzie D, Eck J, Reuter P, Bushway S, editors. Preventing Crime: What Works, What Doesn’t, What’s Promising. National Institute of Justice; 1998.

6. Kirby D. Emerging Answers: Research Findings on Programs to Reduce Teen Pregnancy. Washington, DC: National Campaign to Prevent Teen Pregnancy; 2001.

7. Kirby D, Coyle K, Alton F, Rolleri L, Robin L. Reducing Adolescent Sexual Risk: A Theoretical Guide for Developing and Adapting Curriculum-Based Programs. Scotts Valley, CA: ETR Associates; 2011.

8. Lohrmann DK, Wooley SF. Comprehensive School Health Education. In: Marx E, Wooley S, Northrop D, editors. Health Is Academic: A Guide to Coordinated School Health Programs. New York: Teachers College Press; 1998:43–45.

9. Lytle L, Achterberg C. Changing the diet of America’s children: what works and why? Journal of Nutrition Education 1995;27(5):250–60.

10. Nation M, Crusto C, Wandersman A, Kumpfer KL, Seybolt D, Morrissey-Kane, E, Davino K. What works: principles of effective prevention programs. American Psychologist 2003;58(6/7):449–456.

11. Stone EJ, McKenzie TL, Welk GJ, Booth ML. Effects of physical activity interventions in youth. Review and synthesis. American Journal of Preventive Medicine 1998;15(4):298–315.

12. Sussman, S. Risk factors for and prevention of tobacco use. Review. Pediatric Blood and Cancer 2005;44:614–619.

13. Tobler NS, Stratton HH. Effectiveness of school-based drug prevention programs: a meta-analysis of the research. Journal of Primary Prevention 1997;18(1):71–128.

14. U.S. Department of Health and Human Services. Preventing Tobacco Use Among Young People–An Update: A Report of the Surgeon General. Atlanta (GA): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2011: 6-22–6-45.

15. Weed SE, Ericksen I. A Model for Influencing Adolescent Sexual Behavior. Salt Lake City, UT: Institute for Research and Evaluation; 2005. Unpublished manuscript.

Acknowledgements

The Society for Public Health Education (SOPHE) extends its appreciation to the authors and the following individuals for their subject-matter expertise. The document does not necessarily represent the official views of these individuals or their respective organizations.

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Introduction to The Characteristics of an Effective Health Education Curriculum

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Health Education

(15 reviews)

College of the Canyons

Copyright Year: 2018

Publisher: College of the Canyons

Language: English

Formats Available

Conditions of use.

Learn more about reviews.

Reviewed by Uma Hingorani, Affiliate Professor, Metropolitan State University of Denver on 10/12/23

There is a Table of Contents, but an index and glossary of terms would both be helpful to find information quickly. read more

Comprehensiveness rating: 4 see less

There is a Table of Contents, but an index and glossary of terms would both be helpful to find information quickly.

Content Accuracy rating: 4

The information is well organized and accurate. Some updates are needed, such as reference to latest edition of The Diagnostic and Statistical Manual of Mental Disorders (DSM), including online tools to track menstrual cycle and Roe vs. Wade overturned stance on abortion in U.S., using more current CDC Fact sheets, including psychodelic mushrooms under drugs of abuse and impacet of legalization of marijuana on abuse potention, and including e-cigarettes, JUUL, and other modern cigarette types. Some minor typographical and spelling errors were noted ('spermacides').

Relevance/Longevity rating: 4

Updating sections to include modern aspects would be helpful.

Clarity rating: 5

The language is clear and conducive to an undergraduate level college audience.

Consistency rating: 5

The book flows well and uses consistent terminology throughout the chapters.

Modularity rating: 5

The text is divided into subsections, making it manageable to read and understand.

Organization/Structure/Flow rating: 4

The book is well organized and flows well.

Interface rating: 4

Use of more diagrams would be helpful. The diagrams and charts used emphasize the textbook reading.

Grammatical Errors rating: 4

Some minor typographical (bullets points not aligned in e-copy) and spelling errors were noted ('spermacides').

Cultural Relevance rating: 4

Culturally and racially sensitive.

This is a well-written, well-organized textbook which provides a good overview of health. Including the WHO definition of health and wellness would be beneficial as well as using more references to college-age students to engage this audience. In addition, updating sections to modern times would be helpful. Nonetheless, it is a straightforward and helpful textbook to use for a general health class elective.

Reviewed by Anna Smyth, Adjunct Faculty, Salt Lake Community College on 4/18/21

Health is a broad subject, and this book has done a nice job of categorizing and explaining some of the most important aspects. The book does not have a glossary or index but provides references at the end of each chapter for further exploration. read more

Health is a broad subject, and this book has done a nice job of categorizing and explaining some of the most important aspects. The book does not have a glossary or index but provides references at the end of each chapter for further exploration.

The data and information presented in the book appears to be accurate but some statistics are over 10 years old. Students would benefit from an updated edition. The information about sensitive topics such as violence in relationships, sexual health, etc. are handled skillfully without bias.

The text is written in a way that it would be relatively easy to update. Some of the topics, legal marriage for example, are changing due to legislation across the country, but the book speaks generally enough about these topics to capture this reality. The reader can pursue the references included at the end of each chapter to find more specific time-sensitive data around such topics.

Clarity rating: 4

The book is very clear in its use of language. This is a particularly appealing element if you have students whose native language isn't English. A moderate proficiency in English will make this book accessible--easy to read and understand. One missing piece of context noted: Section 5.6 seems to refer to a chart, ie "in the lower left corner" but no chart is included.

Consistency rating: 4

The text is consistent in the way the framework has been structured and the terminology is relatively consistent throughout, however there are some occasional verb tense inconsistencies, for example in Chapters 6 and 8 the voice alternates between speaking directly to the reader (you) and in third-person.

Modularity rating: 4

It would be as easy to pull a few excerpts from the book as assigned reading as it would be to review the entire text throughout a semester. There could be more of a contextual introduction to each chapter that may help provide a useful modular framework.

As the text is a presentation of a variety of interrelated topics rather than information that must be presented in a particular sequence for full and proper understanding, the organization seemed appropriate and sufficient. As Maslow's heirarchy is presented, there is an argument for using the order from that framework or the order of the six dimensions of health presented in Chapter 1, but the content therein, aside from Chapter 1, is not determined by the sequence so the current organization is sufficient.

I saw no significant interface issues, however the text could benefit from more illustrative images throughout to support learning and such images could help with minimizing any confusion as well as retention of the information presented. An example of such is Figures 14 and 15 on page 152 and Figure 4 in Chapter 9.

In my review, I noticed very few grammatical or spelling errors.

Cultural Relevance rating: 3

Some of the sections could be updated with more inclusive language, such as the section on fertility and conception. Language such as "pregnant people" rather than "pregnant women" or "birthing person" rather than "pregnant mother" is more inclusive of the transgender community. The text generally tends to reference nationwide statistics without detail or context regarding specific demographics. This could be a valuable addition as illustrated in Chapter 1 that health can be substantially influenced by things such as race and ethnicity, culturally sensitive healthcare, sexual identity and orientation, etc. which are topics included later in the text. Expounding upon some of these critical aspects of health and determinants of health would add value and represent a more comprehensive perspective of health in the US.

This book is a solid resource with lots of useful information to use in health-related course curricula.

Reviewed by Garvita Thareja, Assistant Professor, Metropolitan State University of Denver on 3/16/21, updated 4/22/21

It had covered most of the major topics in health and wellness. However, there are some foundational topics like dimensions or health (they touched these, but need more depth), theories for behavior change that should be added , being foundational... read more

It had covered most of the major topics in health and wellness. However, there are some foundational topics like dimensions or health (they touched these, but need more depth), theories for behavior change that should be added , being foundational in nature. Then again, some concepts are just added there and may not be needed at this level as it adds to confusion than contribution. We don't need that deeper biology part as its a health topic and not anatomy/physiology.

Content Accuracy rating: 5

Its very accurate book. I would re structure some aspects and add some examples at few places, but overall, its up the mark with accuracy.

Relevance/Longevity rating: 3

Content needs an update. For example if its a weight management, then we need to add information about various apps and calorie tracking resources. If its a drug and abuse, I would add an activity that really engages students about how taking shots can affect their cognition and possibly put them in DUI. This text has too much theoretical concepts but less of applied part or case studies.

The information is clear and use simple languages. Not big jargons or difficult terms.

Yes, its consistent with the topics and headings and sub headings. Its just too much information actually VS field work, examples and real applications.

yes, its divided into various parts and sub parts. Easy to navigate and clear layout. I would just add that piece where if we click on a sub topic from table of contents, it takes us to that page automatically instead of scrolling around.

Organization/Structure/Flow rating: 5

Yes, very clear and logical flow.

Interface rating: 5

Its easy to navigate. I would add a little more images as it gets monotonous reading it. WIth a topic like health, lot more colors and contrasts and images can be added.

Grammatical Errors rating: 5

I did not find one.

Cultural Relevance rating: 5

Not offensive. But I would actually add more of culture and diversity when it comes to health. Why are some cultures "Healthy"? or "why is disparity between genders with access to healthcare across the globe/developing nations"?

It is an interesting book. I liked reading it and refreshing some of the topics. I would just add some case studies and activities to make it more interactive instead of passive reading. May be we can have a supplemental lab with it? Its not a perfect book as it covers upper and lower division topics. But definitely, some components can be used as they are well written.

Reviewed by Sara Pappa, Assistant Professor, Marymount University on 2/24/21

The textbook is a comprehensive compilation of personal (individual) health topics, which are clearly defined and described. It would be appropriate for a Personal Health or Introduction to Health/Health Behavior course. It has a table of... read more

The textbook is a comprehensive compilation of personal (individual) health topics, which are clearly defined and described. It would be appropriate for a Personal Health or Introduction to Health/Health Behavior course. It has a table of contents, but not an index or glossary. It does not highlight key terms. There is a reference list at the end of each chapter--this could be expanded to include helpful links. Chapters do not have introductions or summaries.

The content is accurate and relatively unbiased. It includes current public health topics such as the leading causes of death, social determinants of health and health disparities. I might suggest changing the name of Chapter 12 to Chronic Diseases.

Each chapter is made up of many sections, or short descriptions of the topics. This helps with the organization of the content. There are not a lot of case studies, examples, graphics or anecdotal information to enhance the learning process. The material is somewhat dry the way it is presented (not very engaging).

The textbook is written in clear language and at an appropriate reading level for college students.

The chapters are organized in a consistent manner.

The textbook could easily be broken down into smaller units or sections as well as followed in a different order as indicated by a course or instructor. The short sections, as well as the chapter and section/sub-section numbering systems, make it easy to follow.

The textbook is organized in a clear manner, with chapter and section titles that make it easy to follow.

The textbook is easy to read and navigate.

The textbook is well written with few grammatical errors.

The textbook does include some references to culturally competent content. It would be improved with the addition of specific examples, including data and research, about cultural differences and how these affect health.

Reviewed by Sarah Maness, Assistant Professor, Public Health, College of Charleston on 1/27/21

Covers a wide variety of health promotion topics, primarily at the individual level. Lacks a section on social relationships and health. Only covers romantic relationships and in ways that are culturally dated (section on Married and Non-Marrieds). read more

Comprehensiveness rating: 3 see less

Covers a wide variety of health promotion topics, primarily at the individual level. Lacks a section on social relationships and health. Only covers romantic relationships and in ways that are culturally dated (section on Married and Non-Marrieds).

Content Accuracy rating: 1

I would not feel comfortable using this text in my class based on issues with accuracy. Section 1.7 about Determinants of Health mentions Healthy People 2020 however does not describe the Healthy People Social Determinants of Health Framework when talking about Social Determinants of Health and includes different factors. Citations are very dated, 2008 or earlier when this edition came out in 2018. Healthy People 2030 is now out so next version should update to that as well. Bias encountered in the chapter about relationships and communication. Only covers romantic relationships and is written with from a heteronomative perspective that also centers marriage and is stigmatizing to those who are not married. ("Marriage is very popular..because it does offer many rewards that unmarried people don't enjoy." "There are known benefits to being married an in a long-term relationship rather than being single, divorced or cohabiting). Also refers to attempts to legalize same sex marriage in this chapter, which has been legal for years now. References are not formatted in AMA or APA style which is standard for the field. Wikipedia is used as a reference in Chapter 2. Chapter 6 discusses "options" for unplanned pregnancy (including taking care of yourself, talking to a counselor, quitting smoking) and does not mention abortion as an option. HPV vaccination recommendations need to be updated.

Relevance/Longevity rating: 2

All topics are relevant but the supporting statistics are outdated by more than a decade in many places. Years are not included in many statistics, nor in the citation at the end of the chapter.

Clarity rating: 3

The sections read as rather disjointed. Chapters could be more aligned and have improved flow for the reader to understand how concepts are related. For example, going right into theoretical models of behavior change in Chapter 1 is early and advanced for an introductory text.

Consistency rating: 2

In the Introduction it states the book is about health, health education, and health promotion. Since health promotion is broader than health education, and fits the topics of the book, it is not clear why this is not the title instead. This book could be useful for an introduction to health promotion class but instructors may overlook it because of the name. Some chapters contain no in text citations despite stating facts, while others contain many. Reference lists and in text citations are formatted differently in different chapters.

Almost too modular, not clear how some sections relate and there is not a lot of detail in many subsections.

Organization/Structure/Flow rating: 3

The sections within each chapter often seem disjointed and do not include enough detail in each section.

Interface rating: 3

In many chapters, only weblinks are provided as citations. If the link is broken, there is no title, author, journal or year for reference. Figures included without citations (ex: Social Readjustment Rating Scale).

Grammatical Errors rating: 3

Did not notice overt grammatical errors.

Includes examples and text of people of multiple races and ethnicities. Is not inclusive based on sexual orientation and in terms of the way it discusses marriage and relationships.

The cover does not appropriately capture what the book includes. It could be more representative of health than just a sports field/physical activity. Health is multi-dimensional and includes in addition to physical - mental, emotional, spiritual, occupational aspects, which the book acknowledges in the text. Hair and clothing style of people on cover also look outdated.

Reviewed by Corrie Whitmore, Assistant Professor, University of Alaska Anchorage on 11/11/20, updated 1/10/21

This book was developed for a Health 100 class. It covers a wide variety of personally relevant health topics, with segments defining health, discussing "your bodies response to stress," describing threats to environmental health, and offering a... read more

Comprehensiveness rating: 5 see less

This book was developed for a Health 100 class. It covers a wide variety of personally relevant health topics, with segments defining health, discussing "your bodies response to stress," describing threats to environmental health, and offering a guide to "understanding your health care choices," which includes both nationally relevant and California-specific information. The index is detailed and specific. There is no glossary.

This textbook would be appropriate for a lower division personal health course. Some components would be useful in an introductory public health course, such as the "Introduction to Health," "Infectious Diseases and Sexually Transmitted Infections," and "Health Care Choices" secgments.

The text is not appropriate for a "Fundamentals of Health Education" or "Health Promotion" course aimed at future Health Educators.

Book provides accurate information with clear references to unbiased sources (such as the CDC for rates of diseases).

Content is releveant and timely.

The book is appropriately accessible for lower division students, with clear definitions of relevant vocabulary.

Good internal consistency.

The segmentation of the book into 14 topical sections, each with subsections, makes it easy to assign appropriate chunks of reading and/or draw pieces from this text for use in other courses, such as an introductory public health course.

Well-organized.

Easy to navigate.

Easy to read.

Good discussion of health disparities, acknowledges cultural components in health. Is not insensitive or offensive.

Reviewed by Audrey McCrary-Quarles, Associate Professor, South Carolina State University on 8/17/20

The Health Education book covered all the components usually found in other basic health books. It can be utilized as an Open Textbook for students taking the introduction to health or the basic health course, such as HED 151 - Personal and... read more

The Health Education book covered all the components usually found in other basic health books. It can be utilized as an Open Textbook for students taking the introduction to health or the basic health course, such as HED 151 - Personal and Community Health.

The author could use a picture that exhibits diversity on the cover.

Some of the data is just a little outdated but can be updated very easily with an article or current chart.

Clarity is okay.

Consistency is good!

Should be an easy read for students.

Organization and flow are great!

Text can use some more pictures and charts, especially in Chapter 1.

Did not notice any grammar errors in scanning over the book.

The cover should be a picture that depicts diversity as well as showing more diversity throughout the book.

Overall, the book serves its purpose. It is good!

Reviewed by Vanessa Newman, Adjunct Faculty, Rogue Community College on 7/22/20

The textbook successfully covers a wide array of health education topics. The chapters on "Relationships & Love" and "Health Care Choices" were excellent additions to what you find in many health books. Overall, I would have liked to have seen... read more

The textbook successfully covers a wide array of health education topics. The chapters on "Relationships & Love" and "Health Care Choices" were excellent additions to what you find in many health books. Overall, I would have liked to have seen more case studies, illustrations, examples, and quick quizzes to reinforce the content presented and to reach students with different learning styles. Many of the sub-topics could be even more robust with the addition of information on auto-immune disorders for example or a section on health education professionals like personal trainers and health coaches or information on what to do if you suspect a food-borne illness and how to access help.

The contributors have done a great job of presenting accurate information but it is now outdated in many sections and chapters which is what happens in textbooks generally. The language and presentation of material appears unbiased. The addition of more graphics and examples that cross demographics, cultures, and races would be a welcome addition. I found no factual errors but did question the notion that gluten-free diets can assist with anemia and wondered if research about the resilience gene in children might be referenced.

The research presented is all 2015 or before with an emphasis on 2008 information. Sections about marijuana and cannabis, infertility, social disorder, and smoking need refreshing. It would be helpful to have information about genetic testing (23 and me and Live Wello) added, functional fitness addressed, and infectious disease content brought up to date. So much has happened affecting people's health has transpired since 2015 that it is time for updating. Also, more information in sections like how baby birth weight can predict chronic disease development and mindfulness as a practice for improved quality of life.

Content is presented in clear, concise and appropriate language. Every once in a while there is a sentence structure issue or a word ordering that is clarified by a re-read. There is not an emphasis on jargon or overuse of idioms in my opinion. All terminology was defined or given reference as to where to locate additional information. Again the use of diagrams, illustrations, more examples would also improve clarity and accessibility for some. I did not recall seeing information on how many calories are in a gram of protein, carbohydrate and fat presented. And relevance affects clarity. For example, including language about portal of entry and exit in the infectious disease section.

Having a quick quiz at the end of every chapter would have added consistency. Also standardized formatting for charts and graphics would improve the textbook overall as well. The chapters, sections and headings all appear consistently presented. There was nothing presented that was jarring or appeared out of context. References looked similar and were all summarized at the end of each chapter.

Modularity was this textbook's strength. Large chunks of information were broken down into manageable sections and sub-sections and the white space was appreciated. Because of this, the information did not seem overwhelming or "too much too fast." Students can take breaks and not lose track of where they were or forget critical information. Again, more examples, quizzes or case studies could also improve modularity and add an interest factor. The table of contents was thorough.

Time was taken to decide which chapters and topics should be presented in which order. The flow was organic, natural and later sections built on previous information. The structure of the textbook made sense and usually my questions about a topic or subject were answered within the same page. I had no complaints about organization and could find sections easily based on the table of contents.

No interface issues for me, but I was reading on a personal computer and perhaps on a tablet or phone there would be.

The paragraph spacing was not what I would have chosen. There were some inconsistencies. There are contractions like isn't which I prefer not to see in textbooks because it is too casual a style for me. Many instances of punctuation coming after quotations, but this may have been a style choice. The font seemed appropriate but more bolding or color would keep the reader's attention. There are spelling errors on the food chart on p. 236. Some issues with singular vs. plural. For example on P. 64 "nightmares" needs to be plural. A few places where punctuation is missing.

The text is not culturally insensitive, but without additional examples, graphics, and diverse charts it becomes a bit bland. The reference to a handgun on p. 56 was uncomfortable for me. Under weight management, there could be more information presented on how different cultures appreciate varying body types and have different food rituals and discussion on how not to "fat shame" others. Some examples of cultural influences could be presented in the infectious disease section like how practices for burying the dead can lead to disease and how food preparation affects disease management.

I thought it was comprehensive and well organized. If it were not for relevance issues, I would choose to use this book in our general health class.

Reviewed by Robert West, EMS Program Director, North Shore Community College on 6/7/20

Health education is an enormous subject area but this text does an excellent job covering the most important topics. The comprehensive nature of it topic coverage does come at the cost of not being comprehensive within any single topic- this book... read more

Health education is an enormous subject area but this text does an excellent job covering the most important topics. The comprehensive nature of it topic coverage does come at the cost of not being comprehensive within any single topic- this book is an overview that provides an excellent framework for further study and exploration.

Topics within Health Education are inherently subject to bias- religious, cultural and generational perspectives often influence the scientific and open-minded exploration of issues in topics like sexuality, nutrition, and relationships. This book clearly strives to support perspectives with research and did not shy away from topics like abortion and gender roles.

The greatest weakness of this text is that it often feels outdated. Health information is dynamic and no text can always be current, but there are sections that are clearly too old to be considered useful unto themselves. Examples: The narcotic abuse epidemic is absent. This is a major issue in substance abuse and the text primarily looks at heroin abuse without examining the larger issue of prescription narcotic gateways to abuse, or even other narcotics of abuse. The use of PrEP for reducing HIV transmission has been available since 2012 but is not mentioned. The section covering sexual orientation and gender identity cites the 1993 Janus Report for its source of statistics. There is no publication date listed in the text- the latest citation that I noticed was 2015 but most come well before 2010, making the text a decade old in a field that changes rapidly.

The text is well-written and easy to comprehend.

Consistency rating: 3

The Acknowledgements page at the front of the book states that it was "compiled by..." and this speaks to the way the text appears. There is no consistency is the writing of the book. Some chapters are broken down into Sections, brief (often only a paragraph long) collections of sentences that seem to address a behavioral objective that we do not see. Other chapters are written like a standard text and then some appear in a question-and-answer format. None of these are inherently problematic, but the changing style may trouble some readers.

Chapters and chapter sections are clearly delineated.

Chapters are well organized- there is no logical order into which one must teach the various issues of health. The readings of this text could easily be sequenced as desired by the instructor.

The interface is clean and simple. There are few images/illustrations- they would be a welcome addition.

The text is well-written and contains no grammatical/spelling errors that I noticed.

Overall the text seems fair and cites studies to provide evidence of its claims, though some sections simply feel less than open-minded. In the discussion of marriage vs. cohabitation (does anyone use that word anymore?), the text lists advantages of being married that include less likely to commit crimes and less addiction. Statistically, perhaps, but is there a causal relationship? A single paragraph addressing "spiritual health" states: The spiritual dimension plays a great role in motivating people’s achievement in all aspects of life. Some people, yes, but it's not a global truth. Race is never addressed as a topic within the text, though it is commonly listed when a risk factor of disease, health care disparity, etc.

If updated, this would be a superb book. As it stands, it provides an excellent framework for a college course in General Health from which the instructor, or students, could be directed to contemporary writings on these issues. An instructor could readily assign chapter readings and then short research projects that would that could be shared with the class as a whole to assure present day relevance.

Reviewed by Kathy Garganta, Adjunct Professor, Bristol Community College on 5/26/20

The textbook covers a variety of topics in a choppy sequence jumping from three chapters on sexuality and sexual health to substance abuse then onto nutrition. The book was limited in depth and many areas needed additional explanation. There are... read more

The textbook covers a variety of topics in a choppy sequence jumping from three chapters on sexuality and sexual health to substance abuse then onto nutrition. The book was limited in depth and many areas needed additional explanation. There are many lists that did not have the background explanations to support the lists. Several areas were lacking details and were not at college level.

Content Accuracy rating: 3

The text was generally accurate, but lacked backup documentations. Several phrases or statements appeared subjective without the supportive documentation that could lead to misinterpretation. For example, page 107, Section 6.6, Sexual Frequency is covered in one paragraph. In it a statement, “although satisfaction is lower in women,” is delivered with no backup explanation. On page 149, section 7.11, Sexually Transmitted Infections begins with a list of twenty different infections without clarity of an opening explanation.

Relevance/Longevity rating: 5

The textbook was written in 2018 and is still current today. Because of the changing nature of health, it will need updating.

The text was basic and often used lists without additional explanations. Many sections were too brief leaving the reader confused. Page 210 contained an example of a diet list. The list for 4 healthy diet approaches was followed by confusing numbering.

The structural set up of headings and subheadings were consistent, but occasionally spacing was off.

The use of headings and subheadings were helpful. The table of contents clear and easy to follow. Often the sub headings were very short and needed additional information to validate their statements. As an OER text, sections could be assigned as resources to courses outside of health.

The topics were arranged with an unusual flow. Having three chapters on sexuality before nutrition changed the flow and weight of importance.

The text is free of significant interface issues. The chapter headings in the table of contents allows for easy navigation. The use of charts, color displays, photos would have assisted in explaining the topics. The chapter’s would benefit with a more engaging approach. Introspective questions or activities would help to relate material to students lives.

The text contains no significant grammatical errors. However, spacing and formatting needed consistency. For example, on page 86, five definitions all begin with the same exact phrase, throwing off the reader’s flow. On pages 285-86 the formatting/spacing is off.

The text should make greater use of photos/drawings that are reflective of a variety of gender, races, and backgrounds.

Grateful to the author for contributing to OER resources.

Reviewed by Sonia Tinsley, Assistant Professor/Division Chair, Allied Health, Louisiana College on 4/28/20

Covers a variety of health topics that are typical to a personal and community health course. However, the information is very brief. read more

Covers a variety of health topics that are typical to a personal and community health course. However, the information is very brief.

Content is accurate. However, some chapters tend to be limited with reference information.

Some chapters include a limited number of statistics and references but could be updated.

Information is basic and easy to follow.

Terminology used is consistent throughout the text.

The information can be divided into modules to use throughout the course.

Topics are organized and easy to follow.

There were not any features in the text that seemed to be distracting or confusing.

There were no glaring grammatical errors.

The text was very basic and seemed to be written for a variety of races, ethnicities, and backgrounds.

Would have been helpful to have more self-appraisals for readers to complete and make information personable.

Reviewed by Jeannie Mayjor, Part-time faculty in the Health and Human Performance Dept., Linn-Benton Community College on 1/15/20

I think this book does a great job of making the material presented easy to understand. Many similar textbooks are more advanced due to more challenging word/term choices, but this book would work well for anyone taking an intro level class in... read more

I think this book does a great job of making the material presented easy to understand. Many similar textbooks are more advanced due to more challenging word/term choices, but this book would work well for anyone taking an intro level class in health.

The book doesn't cover any of the topics in an in-depth manner. Since it's an intro-level textbook, there aren't many complicated ideas to present where accuracy could be a problem. I think some areas, like nutrition, are missing more up to date info, but that could be remedied by incorporating more recent articles and info from various health journals.

Since this text provides an easy to understand overview of health, it would be easy to update. There are no cutting edge or controversial views expressed in the book, so it does have longevity, but again, there will be a need to present more up to date info to supplement the general understanding that the students will have after reading this text. I like the section on sexual health/identity/orientation in the Sexuality chapter. One more chapter that I appreciate is the chapter on psychology: the most common mental health disorders that college-aged students encounter is important and the section on resilience in both the psychology chapter and the stress management chapter are greatly needed.

The book is very clear and understandable. After having taught a health class every term for the past twenty years, I think the way this book is written would appeal to most students.

I did not catch any inconsistencies in this text. Topics discussed in early chapters might come up in later chapters at times, but the info presented the second time around is consistent with earlier explanations of ideas and terms.

Larger type on chapter headings would help improve the ability to divide the book into smaller reading sections, it's easy to miss the start of a new chapter when scrolling through the text. Once you are in a chapter, the subheadings are helpful in dividing the chapter into smaller reading sections. I wish the chapter on cardiovascular diseases (coronary heart disease and stroke) was limited to those two diseases, without including a section on cancer. I think the topic of cancer deserves its own chapter.

The text is well organized and chapters flow into each other in logical ways. There are enough chapters to spread this out over a ten or 15 week term/semester. The chapters are short enough that you could easily assign one and a half chapters or two chapters for one week's worth of classes.

I would have liked to see more photos, although there are plenty of graphs, and I enjoyed the interactive quiz called The Big 5 Personality Test, I would have liked to see more. Some of the links listed in resources are no longer working, and one link in the Fitness chapter is not working, (Adding Physical Activity to Your Life) and I had been looking forward to exploring the topic in more depth. The MyPlate.gov website has been significantly changed, around the time that this book was published, so some of the links to that site no longer work.

I usually notice grammatical and spelling errors, as well as missing words, but I did not encounter anything obviously wrong in my reading.

The text could use more cultural references. I would have liked to see more acknowledgement of cultural differences and references to the health of people from other cultures, especially as it relates to changes they may encounter once a person from another country moves here.

Great overview of the various topics covered in a 100 or 200 level college health class. I will use sections of this book to help simplify some of the topics that my students find challenging, for instance, the fitness and heart health chapters/sections. Due to the inclusion of many of the mental health disorders that our students encounter, I will fit in some of the sections in the psychology chapter. I look forward to implementing some of the material in this text into my health classes.

Reviewed by Jessica Coughlin, Assistant Professor , Eastern Oregon University on 1/6/20

This textbook includes very similar topics to most of the college level health education books that are available today. While the book includes many of the main points related to each topic, it does not go into too much depth. However, this... read more

This textbook includes very similar topics to most of the college level health education books that are available today. While the book includes many of the main points related to each topic, it does not go into too much depth. However, this limitation can be solved by supplementing the book with scholarly articles. Based on the number of chapters and the amount of information, I think this book would be beneficial for a 10 week or 16 week term.

The book cites quality sources, however it would be helpful to include in-text citations since the references are only at the end of the chapters and it is difficult to know where the information is coming from. This is especially important for time sensitive information such as statistics. Also, some information seems to be directly from the sources, but it is not cited.

The information is mostly up to date, however as stated before, including in-text citations would help readers have a better idea of the relevance of the material. Also, there are limited references for each chapter.

The material is delivered in a clear and concise way. Adequate context is provided for terms and concepts.

The format of the text-book is consistent as is the type of delivery for the information.

The text includes a good amount of headings and sub-headings, which makes it easy to break the information down into smaller reading sections.

The book has a good flow to it. Each section within the chapters is well-organized and provides a logical progression.

The book is free of any significant interface issues, however there are some small issues such as spacing and formatting errors. Additionally, some small changes such as larger title pages for each chapter would be helpful as well as more graphics and pictures.

I did not notice a significant number of grammatical errors.

The text is not culturally insensitive or offensive. Like most textbooks, it could provide more examples that navigate the relationship between health and different backgrounds.

I would use this textbook, along with other supplemental materials for my course. It reviews the main topics I currently cover in my course and has less limitations than many overly-priced books.

Reviewed by Kathleen Smyth, Professor of Kinesiology and Health, College of Marin on 4/17/19

This textbook covers the myriad of required topics for an Introductory Health Course. The table of contents includes all of the topics I cover in my classes. No textbook is perfect and this book is no different but one should not rely on textbooks... read more

This textbook covers the myriad of required topics for an Introductory Health Course. The table of contents includes all of the topics I cover in my classes. No textbook is perfect and this book is no different but one should not rely on textbooks only anyway. This free textbook is an excellent launching point for any contemporary health education course.

One of the greatest challenges in teaching health is to be unbiased given so many factors affect our health like politics, economics, zip code etc. The textbook does a fine job of explaining the role of government. For example: generic drugs and the abortion debate. Any areas in question can be used by the instructor to create a discussion with the students for better/different alternatives or ideas.

Health is very dynamic so the textbook will need to be updated on a regular basis.

This is an easy to read text. The majority of college students will have no issues with the terminology.

For a textbook that is not professionally published I found the terminology and framework sufficient for my needs. Anything missing can easily be added by the instructor and used as a discussion or research assignment for the students.

Maybe the best feature of the text is the modularity. Each section of the table of contents is hyperlinked so one could easily pick and choose the topics assigned to the students.

The organization follows the same logical fashion as all of the top rated professionally published Health Education textbooks.

There are a couple formatting issues but nothing that affects clarity in my opinion. I think because this is free I have lower expectations vs a professionally published textbook and I am ok with this.

I did not notice any obvious grammatical errors.

The text is not culturally insensitive or offensive but it could include in-depth analysis of health status in relation to one's race, culture and zip code. As I mentioned previously this is a topic that can easily be supplemented by the professor.

This free textbook meets all the requirements for an introductory health course. It leaves room for me to do my job to engage my students in more detail by discussing controversial topics while giving them the opportunity to be critical thinkers. I appreciate all of your efforts on this project.

Reviewed by Amanda Blaisdell, Assistant Professor, Longwood University on 4/11/19

It gives a lot of information, but it isn't very "in-depth." Admittedly, it would be a challenge to be very in-depth with one book that covers so many topics. This book certainly lacks sufficient images/pictures. The amount of information varies... read more

It gives a lot of information, but it isn't very "in-depth." Admittedly, it would be a challenge to be very in-depth with one book that covers so many topics. This book certainly lacks sufficient images/pictures. The amount of information varies by topic. For some reason, some topics (that don't seem as important in relation to other priority issues) have much more text and information, while other topics lack in comprehensive quality to a large extent. Types of intimate partner violence is incredibly insufficient. There are LOTS of ways that people are abusive, those 5 bullets are not enough. There are lots of incomplete sections. It seems like most sub-topics are hand-selected.

There are biases in the information. For example, mental health is described with an emphasis on college-aged students. Why? Mental health issues affect everyone. This makes it seem like a college student problem. Another example, on page. 57 a strategy to cope with stress is to "give in once in a while." What are we promoting here? I have taught health education and stress management for years. There is a better way to phrase the point they are getting to.

It seems like it is up-to-date as of right now, but health facts are only good for five years.

Sometimes more jargon is necessary. Too much relying on cultural metaphor.

Not all facts have footnotes so that the reader can find the source of the information. Why do some have a reference footnote but other facts do not? How can we dig deeper and fact-check? The reference sections are hyperlinks, which come and go. Why are the references lacking any actual APA, MLA, or other format? APA would be appropriate. Students emulate what they find in textbooks. Some seem to be in some formal form, but others are not and the formatting is not correct.

Yes, very much so.

Some topics fit in multiple categories, so there should be some in-document link to information.

Some sections have a space between paragraphs... some do not.. it is not consistent or visually appealing (Example, p. 23). Figure 1 on page 51 seems to have highlighting and blurriness on the image. Look on p. 122, what is that symbol before the "Copper IUD"? WHy does it say it twice? Is there a heading that wasn't bold? What is going on?

I don't know if you call this "grammar" per-se, but formatting is not consistent. For example, on p. 55 there is no consistency in capitalization of first words in bullet points. That just seems sloppy and unprofessional.

Don't refer to sexual arousal as being "turned on," as that is a cultural metaphor. Some language needs to be technical because this book is supposed to provide information. There is lots of evidence of attempts at cultural competence, but it doesn't provide enough of that. There are lots of lifestyles that are OK even if they don't fit our Western model.

To be honest, it seems like portions of this book are plagiarized. Is this a rough draft?

Table of Contents

• Chapter 1: Introduction to Health
• Chapter 2: Psychological Health
• Chapter 3: Stress Management
• Chapter 4: Relationships and Communication
• Chapter 5: Gender and Sexuality
• Chapter 6: Sexual Health
• Chapter 7: Infectious diseases and Sexually Transmitted Infections (STI's)
• Chapter 8: Substance Use and Abuse
• Chapter 9: Basic Nutrition and Healthy Eating
• Chapter 10: Weight Management
• Chapter 11: Physical Fitness
• Chapter 12: Cardiovascular Disease, Diabetes, and Cancer
• Chapter 13: Environmental Health
• Chapter 14: Health Care Choices

Ancillary Material

About the book.

Readers will learn about the nature of health, health education, health promotion and related concepts. This will help to understand the social, psychological and physical components of health.

About the Contributors

Contribute to this page.

Health Education in Schools

The AAFP supports the inclusion of health education in the curriculum of grades K through 12 and continued health education in the community through adult education programs. 

Students at all levels should be provided opportunities to:

• Obtain accurate information on health, illness, and illness prevention.
• Obtain accurate information on health topics most relevant to the student population, such as substance abuse, sexual abuse, intimate partner violence, suicide, safety, nutrition, obesity, eating disorders, sexual activity, teenage pregnancy, sexually transmitted infections, mental health, family violence, risk-taking behavior, coping with peer pressure and stress.
• Gain understanding of growth and development from conception through adulthood. 
• Gain an understanding of family health history and its impact on health risk, and learn how individual health behavior is related to health status.
• Discuss personal attitudes, values and beliefs relating to health. Discuss the processes through which social values are acquired and the ways in which they can affect health.
• Develop critical thinking and decision-making skills in terms of health and sickness evaluation.
• Develop an awareness of the limitations of medicines and medical science in their personal care.
• Develop skills to recognize physical, emotional, or social stressors and how to effectively communicate those concerns. 
• Become interested in assuming responsibility for personal health.
• Develop a personal life-long health life style plan, including areas of healthy eating, exercise, social relationships, and avoidance of risky behaviors.
• Develop a sense of social responsibility and participate in promotion of health education to peers, family and community.

Well-designed health education programs, can help to improve the environmental and lifestyle factors that lead to improved population health.  (1980) (January 2022 COD)

Copyright © 2024 American Academy of Family Physicians. All Rights Reserved.

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Health Literacy and Health Education in Schools: Collaboration for Action

M. elaine auld.

Society for Public Health Education

Marin P. Allen

National Institutes of Health (ret.)

Cicily Hampton

University of North Carolina at Charlotte

J. Henry Montes

American Public Health Association

Cherylee Sherry

Minnesota Department of Health

Angela D. Mickalide

American College of Preventive Medicine

Robert A. Logan

U.S. National Library of Medicine and University of Missouri-Columbia

Wilma Alvarado-Little

New York State Department of Health

July 20, 2020

Introduction

This NAM Perspectives paper provides an overview of health education in schools and challenges encountered in enacting evidence-based health education; timely policy-related opportunities for strengthening school health education curricula, including incorporation of essential health literacy concepts and skills; and case studies demonstrating the successful integration of school health education and health literacy in chronic disease management. The authors of this manuscript conclude with a call to action to identify upstream, systems-level changes that will strengthen the integration of both health literacy and school health education to improve the health of future generations. The COVID-19 epidemic [ 10 ] dramatically demonstrates the need for children, as well as adults, to develop new and specific health knowledge and behaviors and calls for increased integration of health education with schools and communities.

Enhancing the education and health of school-age children is a critical issue for the continued well-being of our nation. The 2004 Institute of Medicine (IOM, now the National Academies of Sciences, Engineering, and Medicine [NASEM]) report, Health Literacy: A Prescription to End Confusion [ 27 ] noted the education system as one major pathway for improving health literacy by integrating health knowledge and skills into the existing curricula of kindergarten through 12th grade classes. The NASEM Roundtable on Health Literacy has held multiple workshops and forums to “inform, inspire, and activate a wide variety of stakeholders to support the development, implementation, and sharing of evidence-based health literacy practices and policies” [ 37 ]. This paper strives to present current evidence and examples of how the collaboration between health education and health literacy disciplines can strengthen K–12 education, promote improved health, and foster dialogue among school officials, public health officials, teachers, parents, students, and other stakeholders.

This discussion also expands on a previous NAM Perspectives paper, which identified commonalities and differences in the fields of health education, health literacy, and health communication and called for collaboration across the disciplines to “engage learners in both formal and informal health educational settings across the life span” [ 1 ]. To improve overall health literacy, i.e., “the capacity of individuals to obtain, process, and understand basic health information and services needed to make appropriate health decisions” [ 42 ], it is important to start with youth, when life-long health habits are first being formed.

Another recent NAM Perspectives paper proposed the expansion of the definition of health literacy to include broader contextual factors, including issues that impact K–12 health education efforts like state rather than federal control of education priorities and administration, and subsequent state- or local-level laws that impact specific school policies and practices [ 39 ]. In addition to addressing individual needs and abilities, socio-ecological factors can impact a student’s health. For example, the Centers for Disease Control and Prevention (CDC) uses a four-level social-ecological model to describe “the complex interplay” of (1) individuals (biological and personal history factors), (2) relationships (close peers, family members), (3) community (settings such as neighborhoods, schools, after-school locations), and (4) societal factors (cultural norms, policies related to health and education, or inequalities between groups in societies) that put one at risk or prevent him/her from experiencing negative health outcomes [ 11 ]. Also worth examining are protective factors that help children and adolescents avoid behaviors that place them at risk for adverse health and educational outcomes (e.g., self-efficacy, self-esteem, parental support, adult mentors, and youth programs) [ 21 , 59 ].

Recognizing the influence of this larger social context on learning and health can help catalyze both individual and community-based solutions. For example, students with chronic illnesses such as asthma, which can affect their school attendance, can be educated about the impact of air quality or housing (e.g., mold, mites) in exacerbating their condition. Students in varied locations and at a range of ages continue, often with the guidance of adults, to take health-related social action. Various local, national, and international examples illustrate high schoolers taking social action related to health issues such as tobacco, gun safety, and climate change [ 18 , 21 , 57 ].

By employing a broad approach to K–12 education (i.e., using combined principles of health education and health literacy), the authors of this manuscript foresee a template for the integration of skills and abilities needed by both school health professionals and children and parents to increase health knowledge for a lifetime of improved health [ 1 , 29 , 31 ].

The right measurements to evaluate success and areas that need improvement must be clearly identified because in all matters related to health education and health literacy, it is vital to document the linkages between informed decisions and actions. Often, individuals are presumed to be making informed decisions when actually broader socio-ecological factors are predominant behavioral influences (e.g., an individual who is overweight but has never learned about food label-ling and lives in a community where there are no safe places to be physically active).

Health Education in Schools

Standardized and broadly adopted strategies for how health education is implemented in schools—and by whom and on what schedule—is a continuing challenge. Although the principles of health literacy are inherently important to any instruction in schools and in community settings, the most effective way to incorporate those principles in existing and differing systems becomes a key to successful health education for children and young people.

The concept of incorporating health education into the formal education system dates to the Renaissance. However, it did not emerge in the United States until several centuries later [ 26 ]. In the early 19th century, Horace Mann advocated for school-based health instruction, while William Alcott also underscored the contributions of health services and the school environment to children’s health and well-being [ 17 ]. Public health pioneer Lemuel Shattuck wrote in 1850 that “every child should be taught early in life, that to preserve his own life and his own health and the lives of others, is one of the most important and abiding duties” [ 43 ]. During this same time, Harvard University and other higher education institutions with teacher preparation programs began including hygiene (health) education in their curricula.

Despite such early historical recognition, in the mid-1960s, the School Health Education Study documented serious disarray in the organization and administration of school health education programs [ 45 ]. A renewed call to action, several decades later, introduced the concepts of comprehensive school health programs and school health education [ 26 ].

From 1998 through 2014, the CDC and other organizations began using the term “coordinated school health programs” to encompass eight components affecting children’s health in schools, including nutrition, health services, and health instruction. Unfortunately, the term was not broadly embraced by the educational sector, and in 2014, CDC and ASCD (formerly the Association for Supervision and Curriculum Development) unveiled the Whole School, Whole Community, Whole Child (WSCC) framework [ 36 ]. This framework has ten components, including health education, which aims to ensure that each student is healthy, safe, engaged, supported, and challenged. Among the foundational tenets of the framework is ensuring that every student enters school healthy and, while there, learns about and practices a healthy lifestyle.

At its core, health education is defined as “any combination of planned learning experiences using evidence based practices and/or sound theories that provide the opportunity to acquire knowledge, attitudes, and skills needed to adopt and maintain healthy behaviors” [ 3 ]. Included are a variety of physical, social, emotional, and other components focused on reducing health-risk behaviors and promoting healthy decision making. Health education curricula emphasize a skills-based approach to help students practice and advocate for their health needs, as well as the needs of their families and their communities. These skills help children and adolescents find and evaluate health information needed for making informed health decisions and ultimately provide the foundation of how to advocate for their own well-being throughout their lives.

In the last 40 years, many studies have documented the relationship between student health and academic outcomes [ 29 , 40 , 41 ]. Health-related problems can diminish a student’s motivation and ability to learn [ 4 ]. Complications with vision, hearing, asthma, occurrences of teen pregnancy, aggression and violence, lack of physical activity, and low cognitive and emotional ability can reduce academic success [ 4 ].

To date, there have been no long-term sequential studies of the impact of K–12 health education curricula on health literacy or health outcomes. However, research shows that students who participate in health education curricula in combination with other interventions as part of the coordinated school health model (i.e., physical activity, improved nutrition, and/or family engagement) have reduced rates of obesity and/or improved health-promoting behaviors [ 25 , 30 , 34 ]. In addition, school health education has been shown to prevent tobacco and alcohol use and prevent dating aggression and violence. Teaching social and emotional skills improves academic behaviors of students, increases motivation to do well in school, enhances performance on achievement tests and grades, and improves high school graduation rates.

As with other content areas, it is up to the state and/or local government to determine what should be taught, under the 10th Amendment to the US Constitution [ 48 ]. However, both public and private organizations have produced seminal documents to help guide states and local governments in selecting health education curricula. First published in 1995 and updated in 2004, the National Health Education Standards (NHES) framework comprises eight health education foundations for what students in kindergarten through 12th grade should know and be able to do to promote personal, family, and community health (see Table 1 ) [ 12 ]. The NHES framework serves as a reference for school administrators, teachers, and others addressing health literacy in developing or selecting curricula, allotting instructional resources, and assessing student achievement and progress. The NHES framework contains written expectations for what students should know and be able to do by grades 2, 5, 8, and 12 to promote personal, family, and community health.

SOURCE: Centers for Disease Control and Prevention. 2020. National Health Education Standards. Available at: National Health Education Standards Website. https://www.cdc.gov/healthyschools/sher/standards/index.htm (accessed June 19, 2020).

The Coordinated Approach to Child Health (CATCH) model, which was first developed in the late 1980s with funds by the National Heart, Lung, and Blood Institute, serves to implement the NHES framework and was the largest school-based health promotion study ever conducted in the United States. CATCH has 25 years of continuous research and development of its programs [ 24 ] and aligns with the WSCC framework. Individualized programs like the CATCH model develop programming based on the NHES framework at the local level, so that local control still exists, but the mix and depth of topics can vary based on need and composition of the community.

Based on reviews of effective programs and curricula and experts in the field of health education, CDC recommends that today’s state-of-the-art health education curricula emphasize four core elements: “Teaching functional health information (essential knowledge); shaping personal values and beliefs that support healthy behaviors; shaping group norms that value a healthy lifestyle; and developing the essential health skills necessary to adopt, practice, and maintain health enhancing behavior” [ 13 ]. In addition to the 15 characteristics presented in Box 1 , the CDC website has more detailed explanations and examples of how the statements could be put into practice in the classroom. For example, a curriculum that “builds personal competence, social competence, and self-efficacy by addressing skills” would be expected to guide students through a series of developmental steps that discuss the importance of the skill, its relevance, and relationship to other learned skills; present steps for developing the skill; model the skill; practice and rehearse the skill using real-life scenarios; and provide feedback and reinforcement.

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.

SOURCE: Centers for Disease Control and Prevention. 2020. Characteristics of an Effective Health Education Curriculum. Available at: https://www.cdc.gov/healthyschools/sher/characteristics/index.htm (accessed June 19, 2020.)

In addition, CDC has developed a Health Education Curriculum Analysis Tool [ 14 ] to help schools conduct an analysis of health education curricula based on the NHES framework and the Characteristics of an Effective Health Education Curriculum.

Despite CDC’s extensive efforts during the past 40 years to help schools implement effective school health education and other components of the broader school health program, the integration of health education into schools has continued to fall short in most US states and cities. According to the CDC’s 2016 School Health Profiles report, the percentage of schools that required any health education instruction for students in any of grades 6 through 12 declined. For example, 8 in 10 US school districts only required teaching about violence prevention in elementary schools and violence prevention plus tobacco use prevention in middle schools, while instruction in only seven health topics was required in most high schools [ 6 ].

Although 8 of every 10 districts required schools to follow either national, state, or district health education standards, just over a third assessed attainment of health standards at the elementary level while only half did so at the middle and high school levels [ 6 ]. No Child Left Behind legislation, enacted in 2002, emphasized testing of core subjects, such as reading, science, and math, which resulted in marginalization of other subjects, including health education [ 22 , 31 ]. Academic subjects that are not considered “core” are at risk of being eliminated as public school principals and administrators struggle to meet adequate yearly progress for core subjects, now required to maintain federal funding.

In addition to the quality and quantity of health education taught in schools, there are numerous problems related to those considered qualified to provide instruction [ 5 , 7 ]. Many school and university administrators lack an understanding of the distinction between health education and physical education (PE) [ 9 , 16 , 19 ] and consider PE teachers to be qualified to teach health education. Yet the two disciplines differ regarding national standards, student learning outcomes, instructional content and methods, and student assessment [ 5 ]. Kolbe notes that making gains in school health education will require more interdisciplinary collaboration in higher education (e.g., those training the public health workforce, the education workforce, school nurses, pediatricians) [ 29 ]. Yet faculty who train various school health professionals usually work within one university college, focus on one school health component, and affiliate with one national professional organization. In addition, Kolbe notes that health education teachers in today’s workforce often lack support and resources for in-service professional development.

Promising Opportunities for Strengthening School Health Education

Comprehensive health education can increase health literacy, which has been estimated to cost the nation $1.6 to $3.6 trillion dollars annually [ 54 ]. The National Action Plan to Improve Health Literacy by the US Department of Health and Human Services (HHS) includes the goal to “Incorporate accurate, standards-based, and developmentally appropriate health and science information and curricula in childcare and education through the university level” [ 49 ].

HHS’s Healthy People Framework presents another significant opportunity for tracking health in education as well as health literacy. The Healthy People initiative launched officially in 1979 with the publication of Healthy People: The Surgeon General’s Report on Health Promotion and Disease Prevention [ 50 ]. This national effort establishes 10-year goals and objectives to improve the health and well-being of people in the United States. Since its inception, Healthy People has undertaken extensive efforts to collect data, assess progress, and engage multi-stakeholder feedback to set objectives for the next ten years. The Healthy People 2020 objectives were self-described as having “input from public health and prevention experts, a wide range of federal, state, and local government officials, a consortium of more than 2,000 organizations, and perhaps most importantly, the public” [ 51 ]. In addition to other childhood and adolescent objectives (e.g., nutrition, physical activity, vaccinations), Healthy People 2020 specified social determinants as a major topic for the first time. A leading health indicator for social determinants was “students graduating from high school within 4 years of starting 9th grade (AH-5.1)” [ 52 ]. The Secretary’s Advisory Committee report on the Healthy People 2030 objectives includes the goal to “eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being of all” [ 53 ]. The national objectives are expected to be released in summer 2020 and will help catalyze “leadership, key constituents, and the public across multiple sectors to take action and design policies that improve the health and well-being of all” [ 53 ].

In terms of supports in federal legislation, the Every Student Succeeds Act (ESSA) of 2015 recognized health education as a distinct discipline for the first time and designated it as a “well-rounded” education subject [ 2 , 22 ]. According to Department of Education guidelines, each state must submit a plan that includes four academic indicators that include proficiency in math, English, and English-language proficiency. High schools also must use their graduation rates as their fourth indicator, while elementary and middle schools may use another academic indicator. In addition, states must specify at least one nonacademic indicator to measure school quality or school success, such as health education. Under the law, federal funding also is available for in-service instruction for teachers in well-rounded education subjects such as health education. These two items open additional pathways for both identifying existing or added programs and having the capacity to collect data.

While several states have chosen access to physical education, physical fitness, or school climate as their nonacademic indicators of school success, the majority (36 states and the District of Columbia) have elected to use chronic absenteeism [ 2 ]. Given the underlying causal connection between student health and chronic absenteeism, absenteeism as an indicator represents a significant opportunity to raise awareness of chronic health conditions or other issues (e.g., student social/emotional concerns around bullying, school safety) that contribute to absenteeism. It also represents a significant opportunity for schools to work with stakeholders to prevent and manage such health conditions through school health education and other WSCC strategies to improve school health. Educators are more likely to support comprehensive health education if they are made aware of its immediate benefits related to student learning (e.g., less disruptive behavior, improved attention) and maintaining safe social and emotional school climates [ 31 ].

In an assessment of how states are addressing WSCC, Child Trends reported that health education is either encouraged or required for all grades in all states’ laws, with nutrition (40 states) and personal health (44 states) as the most prominent topics [ 15 ]. However, the depth and breadth of such instruction in schools is not known, nor if health education is being taught by qualified teachers. In 25 states, laws address or otherwise incorporate the NHES as part of the state health education curriculum.

The authors’ review of state 2017–2018 ESSA plans, analyzed by the organization Cairn, showed nine states that have specifically identified health education as one of its required well-rounded subjects (Florida, Georgia, Indiana, Louisiana, Maine, Maryland, Nevada, North Dakota, and Tennessee) [ 8 ]. Cairn recommends that most states include health education and physical education in state accountability systems, school report card indicators, school improvement plans, professional development plans, needs assessment tools, and/or prioritized funding under Title IV, Part A.

In 2019, representatives of the National Committee on the Future of School Health Education, sponsored by the Society for Public Health Education (SOPHE) and the American School Health Association (ASHA), published a dozen recommendations for strengthening school health education [ 5 , 31 , 55 ]. The recommendations addressed issues such as developing and adopting standardized measures of health literacy in children and including them in state accountability systems; changing policies, practices, and systems for quality school health education (e.g., establishing Director of School Health Education positions in all state and territory education agencies tasked with championing health education best practices, and holding schools accountable for improving student health and well-being); and strengthening certification, professional preparation, and ongoing professional development in health education for teachers at both the elementary and secondary levels. Recommendations also call for stronger alignment and coordination between the public health and education sectors. The committee is now moving ahead on prioritizing the recommendations and developing action steps to address them.

Integrating Youth Health Education and Health Literacy: Success Stories

Minnesota statewide model: integrating school health education and health literacy through broad partnership.

The Roundtable on Health Literacy held a workshop on health literacy and public health in 2014, with examples of how state health departments are addressing health literacy in their states [ 28 ]. One recent example of a strong collaboration between K–12 education and public health agencies is the Statewide Health Improvement Partnership (SHIP) within the Minnesota Department of Health’s Office of Statewide Health Initiative [ 35 ].

SHIP was created by a landmark 2008 Minnesota health reform law. The law was intended to improve the health of Minnesotans by reducing the risk factors that lead to chronic disease. The program funds grantees in all of the state’s 87 counties and 10 tribal nations to support the creation of locally driven policies, systems, and environmental changes to increase health equity, improve access to healthy foods, provide opportunities for physical activity, and ensure a tobacco-free environment [ 35 ]. Local public health agencies collaborate with partners including schools, childcare settings, workplaces, multiunit housing facilities, and health care centers through SHIP.

SHIP models the integration of (1) law, (2) policy, (3) goal setting, and (4) resource building and forging some 2,000 collaborative partnerships and measuring outcomes. SHIP sets a helpful example for others attempting to create synergies across the intersections of state government, health education, local communities, and private organizations. The principles of health literacy are within these collaborations.

Grantees throughout the state have received technical assistance and training to improve school nutrition and physical activity strategies (see Figure 1 ). SHIP grantees and their local school partner sites set goals and adopt best practices for physical education and physical activity inside and outside the classroom. They improve access to healthy food environments through locally sourced produce, lunchrooms with healthier food options, and school-based agriculture. In 2017, SHIP grantees partnered with 995 local schools and accounted for 622 policy, systems, and environmental changes.

SOURCE: Minnesota Department of Health, Office of Statewide Health Improvement Initiatives. 2012. Statewide Health Improvement Partnership Evaluation Data, Minnesota Department of Health Legislative Report 2017. Reported by SHIP grantees using the REDCap system. This data represents the activities and reach of partner sites active between September 24, 2016, and August 25, 2017.

Minnesota has also undertaken a broad approach to health literacy by educating stakeholders and decision makers (i.e., administrators, food service and other staff, students, community partners, and parents) about various health-related social and environmental issues to reduce students’ chronic disease risks.

SHIP grantees assist in either convening or organizing an established school health/wellness council that is required by USDA for each local education agency participating in the National School Lunch Program and/or School Breakfast Program [ 46 , 47 ]. A local school wellness policy is required to address the problem of childhood obesity by focusing on nutrition and physical activity. SHIP also requires schools to complete an assessment that aligns with the WSCC model and provides annual updates. Once the assessment is completed by a broad representation of stakeholders, SHIP grantees assist schools in prioritizing and working toward annual goals. The goal setting and assessment and goal-setting cycle is continuous.

The Bigger Picture: A Case Study of Community Integration of Health Education and Health Literacy

Improving the health literacy of young people not only influences their personal health behaviors but also can influence the health actions of their peers, their families, and their communities. According to the SEARCH for Diabetes in Youth study funded by the CDC and the National Institutes of Health’s National Institute of Diabetes, Digestive, and Kidney Diseases, from 2002 to 2012, the national rate of new diagnosed cases of Type 2 diabetes increased 4.8% [ 32 ]. Among youth ages 10–19, the rate of new diagnosed cases of Type 2 diabetes rose most sharply in Native Americans (8.9%) (although not generalizable to all Native American youth because of small sample size), compared to Asian Americans/Pacific Islanders (8.5%), non-Hispanic blacks (6.3%), Hispanics (3.1%), and non-Hispanic whites (0.6%).

Since 2011, Dean Schillinger, Professor of Medicine in Residence at the University of California San Francisco and Chief of the Diabetes Prevention and Control Program for the California Department of Public Health, has led a capacity-building effort to address Type 2 diabetes [ 23 , 28 , 44 ].

This initiative called The Bigger Picture (TBP) has mobilized collaborators to create resources by and for young adults focused on forestalling and, hopefully, reversing the distressing increase in pediatric Type 2 diabetes by exposing the environmental and social conditions that lead to its spread. Type 2 diabetes is increasingly affecting young people of color, and TBP is specifically developed by and directed to them.

TBP seeks to increase the number of well-informed young people who can participate in determining their own lifelong health behaviors and influencing those of their friends, families, communities, and their own children. The project aims to create a movement that changes the conversation about diabetes from blame- and-shame to the social drivers of the epidemic [ 23 ].

TPB is described by the team that created it as a “counter-marketing campaign using youth-created, spoken-word public services announcements to re-frame the epidemic as a socio-environmental phenomenon requiring communal action, civic engagement, and norm change” [ 44 ]. The research team provides a description of questionnaire responses to nine of the public service announcements in the context of campaign messages, film genre and accompanying youth value, participant understanding of film’s public health message, and the participant’s expression of the public health message. The investigators also correlate the responses with dimensions of health literacy such as conceptual foundations, functional health literacy, interactive health literacy, critical skills, and civic orientation.

One of the campaign partners, Youth Speaks, has created a toolkit to equip and empower students and communities to become change agents in their respective environments, raising their voices and joining the conversation about combating the spread of Type 2 diabetes [ 56 ].

In a discussion of qualitative evaluations of TBP and what low-income youth “see,” Schillinger et al. note that “TBP model is unique in how it nurtures and supports the talent, authenticity, and creativity of new health messengers: youth whose lived experience can be expressed in powerful ways” [ 44 ].

COVID-19: Health Crisis Affecting Children and their Families and a Need for Health Education and Health Literacy in K-12

In a recent op-ed, Rebecca Winthrop, co-director of the Center for Universal Education and Senior Fellow of Global and Economic Development of the Brookings Institution asked, “COVID-19 is a health crisis. So why is health education missing from school work?” [ 58 ] She notes that “helping sustain education amid crises in over 20 countries, I’ve learned that one of the first things you do, after finding creative ways to continue educational activities, is to incorporate life-saving health and safety messages.” Her call is impassioned for age-appropriate, immediately available resources on COVID-19 that can be easily incorporated into distance lesson plans for both children and families. Many organizations, such as Child Trends, are curating collections of such resources. Framing these materials using principles of health literacy and incorporating them into health education messages and resources may be an ideal model for incorporating new pathways for public health K–12 learning.

Call to Action for Collaboration

Strategic and dedicated efforts are needed to bridge health education and health literacy. These efforts would foster the expertise to provide students with the information needed to access and assess useful health information, and to develop the necessary skills for an emerging understanding of health.

Starting with students in school settings, learning to be health literate helps overcome the increased incidence of chronic diseases such as Type 2 diabetes, and imbues a sense of self-efficacy and empowerment through health education. It also sets the course for lifelong habits, skills, and decision making, which can also influence community health.

Pursuing institutional changes to reduce disparities and improve the health of future generations will require significant collaboration and quality improvement among leaders within health education and health literacy. Recommendations provided in previous reports such as IOM’s 1997 report, Schools and Health: Our Nation’s Investment [ 26 ]; the 2004 IOM report on Health Literacy [ 27 ]; and the 2010 National Action Plan to Improve Health Literacy [ 49 ] should be revisited. More recently, a November 2019 Health Literacy Roundtable Workshop (1) explored the necessity of developing health literacy skills in youth, (2) examined the research on developmentally appropriate health literacy milestones and transitions and measuring health literacy in youth, (3) described programs and policies that represent best practices for developing health literacy skills in youth, and (4) explored potential collaborations across disciplines for developing health literacy skills in youth [ 38 ]. With its resulting report, the information provided in the workshop should provide additional insights into collaborations needed to reduce institutional barriers to youth health literacy and empowerment.

At the national level, representatives from public sector health and education levels (e.g., HHS’s Office of Disease Prevention and Health Promotion, CDC, Department of Education) can collaborate with school-based nongovernmental organizations (e.g., SOPHE, ASCD, ASHA, National Association of State Boards of Education, School Superintendents Association, Council of Chief State School Officers, Society of State Leaders of Health and Physical Education) to provide data and lead reform efforts. Leaders of higher education (e.g., Association of American Colleges and Universities, Association of Schools and Programs of Public Health) can join with philanthropies and educational scholars to pursue curricular reforms and needed research to further health education and health literacy as an integral component of higher education.

Among the approaches needed are (1) careful incorporation of key principles of leadership within systems; (2) the training and evaluation of professionals; (3) finding and sharing replicable, effective examples of constructive efforts; and (4) including young people in the development of information and materials to ensure their accessibility, appeal, and utility. Uniting the wisdom, passion, commitment, and vision of the leaders in health literacy and health education, we can forge a path to a healthier generation.

Acknowledgments

The authors would like to express our gratitude to Melissa French and Alexis Wojtowicz for their support in the development of this paper.

Funding Statement

The views expressed in this paper are those of the authors and not necessarily of the authors’ organizations, the National Academy of Medicine (NAM), or the National Academies of Sciences, Engineering, and Medicine (the National Academies). The paper is intended to help inform and stimulate discussion. It is not a report of the NAM or the National Academies.

Conflict-of-Interest Disclosures: Wilma Alvarado-Little has no relevant financial or non-financial relationships to disclose. She contributed to this article based on her experience in the field of health literacy and cultural competency and the opinions and conclusions of the article do not represent the official position of the New York State Department of Health. Cherylee Sherry discloses that she works for the Minnesota Department of Health in the Office of Statewide Health Improvement Initiatives which oversees the Statewide Health Improvement Partnership Program funded by the State of Minnesota.

Contributor Information

M. Elaine Auld, Society for Public Health Education.

Marin P. Allen, National Institutes of Health (ret.)

Cicily Hampton, University of North Carolina at Charlotte.

J. Henry Montes, American Public Health Association.

Cherylee Sherry, Minnesota Department of Health.

Angela D. Mickalide, American College of Preventive Medicine.

Robert A. Logan, U.S. National Library of Medicine and University of Missouri-Columbia.

Wilma Alvarado-Little, New York State Department of Health.

Kim Parson, KPCG, LLC.

Teaching mental health topics in primary school

Is it ever too early to start talking to youth about the importance of mental health? I would argue not when discussions regarding mental health have grown in importance and are continuing to receive much-needed attention from the general public. Particularly in light of the global pandemic and prominent figures speaking out more, one can not underestimate the impact this has had on reshaping previously negative connotations. When one in six youth (6-17) in the US experience a mental health disorder each year, early education on the topic seems like a given. 

Working as a tutor over the summer, I had the opportunity to share my intense interest in learning about mental illness with a curious 4th grader. This was a daunting task for me. I struggled with where to even begin, what disorders to highlight, how much should I talk about this or that? What would be engaging and relevant to a nine-year-old? The pressure of making the first formal introduction to mental health to a child forced me to reflect on what I took away as most important. 

In school, topics relating to mental health are not typically introduced unless there is a concentrated effort made to do so. In my experience, mental health was only something that I discovered as a result of my interest in psychology while in middle school. While it may have been touched upon briefly in the form of self-care practices, it was never pushed to the extent of memorizing one’s timetables or learning to write a good thesis statement. This gap in education seems to create a barrier that continually perpetuates the difficulty of conversing openly about mental health and emotional issues. This lack of exposure to understanding mental health leaves teenagers and children without the tools to speak about mental and emotional health.

Mental illness, in particular, remains to be a generally unspoken topic for most youth which likely plays a part in shaping one’s attitudes towards it early on. Unless one has personal experience with mental illness, it is difficult to understand why some people act in a certain way.

In my efforts to create an effective lesson plan, I decided to go with what came most naturally and create an informational lecture-style presentation. I prepared slides of basic information and covered some of the mental disorders she had expressed interest in. As I was going through the slides, she remained engaged and was able to follow along. She understood the importance of mental health and even had her own self-care practices. As we covered some specific disorders, I asked why she was particularly interested in conditions such as dyslexia and schizophrenia.  Where had she heard of these before?

She went on to detail her experiences with strangers as well as instances of fear in these encounters. She expressed a great deal of confusion as to why people acted in this way but had no way to explain it. I approached this first by explaining the implications of the disorder and how it affects many aspects of a person’s day-to-day life. In other words, I focused on the person, not the condition.

Following the session, I quickly came to the conclusion that power points were not nearly as productive as simply having a conversation and listening. While presenting slides I felt as if I was talking to the student rather than with her. Unsurprisingly, the student was more interested in talking about their individual experiences and encounters. 

Knowing facts and information about mental health is important, but resonating with experience is valuable as a starting point for youth in destigmatizing negative views of mental illness. When there is an open space to express emotions about these encounters, it allows adults to address confusions and educate. There is also an important aspect of validating youth’s feelings so that similar conversations can continue to happen in the future. Frequent discussions promote improved emotional regulation from a younger age as well as develop coping abilities when faced with difficult situations. Schools should focus on starting conversations in the classroom about mental health and opening up the lines of communication. 

The way they talk about mental illness and interact with others can be greatly shaped by their perception of the topic as a whole. Acquiring the tools and language to discuss mental health is imperative to shaping how peers understand and interact with each other.  Mental illness can be a  heavy and complex topic, but introducing the concept of mental health and sharing individual experiences early in childhood will equip children to better understand themselves and their peers. And, by having these honest conversations, we can begin to destigmatize mental illness.

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Feature Story

Feature story

Invest in women and girls’ education and health rights to end aids in africa.

11 March 2024

Despite substantial declines in new HIV infections globally, the HIV/AIDS epidemic continues to d

Despite substantial declines in new HIV infections globally, the HIV/AIDS epidemic continues to disproportionately impact adolescent girls and young women in many countries, particularly in sub-Saharan Africa. In 2022, there were 3,100 new weekly infections among adolescent girls and young women aged 15-24 years.  In sub-Saharan Africa, adolescent girls and young women accounted for more than 77% of new infections among people aged 15-24 years in 2022.

That’s why Education Plus Initiative co-hosted with the Grand Duchy of Luxembourg a high-level side event on the margins of the 68 th Commission on the Status of Women (CSW68) to bring attention to the cost of inaction, calling for more consistent investment in education, health and economic rights of adolescent girls and young women in Africa. The CSW, which runs from 11- 22 March 2024, is the United Nations largest annual gathering on gender equality and women’s empowerment, with this year’s priority theme, Accelerating the achievement of gender equality and the empowerment of all women and girls by addressing poverty and strengthening institutions and financing with a gender perspective.

Speakers included four ministers from Luxembourg, Benin, Sierra Leone, and Uganda, senior government officials from Cameroon and South Africa, and heads of UN agencies who co-lead Education Plus, ATHENA network. Hannah Dolly Kargbo, a young activist from Freetown, Sierra Leone, and founder of the Girls Advocacy Development Network (GADNET), pre-recorded a video that showed her work with young people to advance rights.

The event, Education Plus investment cases for transformative results: leveraging girls completion of secondary education for gender equality and HIV prevention mobilized government, partners and key stakeholders towards accelerated actions and translate commitments to action for gender equality and HIV prevention in Africa.

The costs of inaction on the rates of HIV in adolescent girls and young women remain significant, not only counted in terms of the harmful impacts on girls’ lives but in how they undermine prospects for poverty eradication and the well-being and resilience of families, communities, societies and national economies.  For instance, the lack of educational and economic opportunities that result in women’s diminished labour force participation is estimated to cost the African region US$60 billion in economic losses every year. And yet Africa could gain US$500 billion per year through multi-sectoral investments in adolescents and youth, especially girls, by capitalizing on demographic windows of opportunity.

Education Plus calls for investment in the education and empowerment of adolescent girls and young women, and 15 champion countries are already committed to using education as a means to reduce high HIV rates.  Investments that guarantee education for all young people, violence-free school environments, provision of stigma-free health services, comprehensive sexuality education, access to sexual reproductive health and rights services and economic autonomy and empowerment are key to ending AIDS as a public health threat by 2030. When adolescent girls and young women complete secondary school, their risk of getting HIV is reduced significantly.

“We must take immediate action to change this situation, get girls back to school and ensure they complete secondary education. This requires commitments made by African member states to address gender inequalities, stigma and discrimination that fuels these infections fulfilled. There is progress in Africa, but it simply isn't fast enough. That's why we have this initiative - Education Plus”

Winnie Byanyima UN Under-Secretary General and UNAIDS Executive Director

“What I find extremely worrying is the surge in extreme conservative policies on sexual and reproductive health and rights. This is across the world but also in sub-Saharan Africa. We must avoid going back in time. We need to empower girls because it's the only way that we will have women empowered.”

Yuriko Backes Minister of Gender Equality and Diversity, Luxembourg

“We can make HIV a disease of the past, but we can't do it without listening to understanding and supporting young girls and women to take the lead. Now is the time to ensure that every girl lives a life free from violence with unhindered access to quality education, to sexual and reproductive health rights and services and with meaningful opportunities to lead a productive life.”

Catherine Russell UN Under-Secretary General and UNICEF Executive Director

"We know that investing in girls' education and health is an important lever. We can't build our country's development by leaving out 53% of our population"

Véronique Tognifodé Minister of Social Affairs and Microfinance, Republic of Benin

“Under the radical inclusion policy, we are bringing pregnant girls back to school, retain girls when they become pregnant. So, education and HIV go a long way! When they are educated and have an awareness of HIV, their well-being, and reproductive and sexual rights, they are more assertive when negotiating safer sex.”

Isata Mahoi Minister of Gender and Children’s Affairs, Sierra Leone

“Adolescent girls and young women's organizations are the least funded. Only less than 5% funding of gender equality goes to women's rights organizations, even less goes to young feminist-led organizations. We need to keep the ones who are most affected, most impacted leading the response. We're not here to ask for leadership but to offer leadership to co-lead alongside you.”

Catherine Nyambura Programs Director, ATHENA Network

"It is now a policy that when constructing a school, you must have sanitary facilities separate for both girls and boys, and girls changing rooms and space. We also have intensified education, communication and advocacy on HIV/AIDS and opened schools to give information on sexual and reproductive health. We are working with girls who have dropped out of school to skill them."

Amongi Betty Ongom Minister for Gender, Labour and Social Development, Uganda

“Girls are unable to live up to their full potential because of barriers, but those barriers are dismantlable. Africa is not poor, but African women and girls are licking a spoon, a spoon they do not even own, so let's shift the discourse so that the resources also available in the countries are prioritized for investing in education, HIV prevention and investing in girls.”

Nyaradzayi Gumbonzvanda UN Assistant Secretary-General and UN Women Deputy Executive Director for Normative Support, UN System Coordination and Programme Results

Related: At the 68th Commission on Status of Women UNAIDS calls for action to achieve gender equality and end AIDS

Education Plus initiative

Guayaquil joins the worldwide group of cities committed to ending the HIV epidemic

15 March 2024

Asia Pacific women living with HIV build their power through Feminist School

08 March 2024

Community leadership driving progress to eliminate mother-to-child HIV transmission in Indonesia

07 March 2024

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The ministry of public health and the ministry of education and higher education in partnership with unicef launch the school medical screening program to connect public schools with primary health care centres.

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12 March 2024, Beirut –The Ministry of Public Health (MoPH) and the Ministry of Education and Higher Education (MEHE) in partnership with UNICEF, announced today the launch of the School Health Screening program to reach all children in public schools with an essential quality medical check-up.

The program, funded by the European Union, the German government through KfW Development Bank, France and the United States Governments, will be implemented between March and April 2024 and will ensure that 400,000 children across 1000 public schools across Lebanon are screened by a medical team from Primary Healthcare Centres (PHCs) including a doctor and a registered nurse. The team will examinate students for growth monitoring, their vaccines record and screen for various health conditions including eye, ear, cardiac, respiratory, skin, and others.

Minister of Education and Higher Education, Dr. Abbas Al-Halabi, said: “Health and education are the most important pillars in a society’s development. Public schools include students coming from the most vulnerable societies who are in need of health care. This programme will help screening Childrens’ general health, and early detect any health issues.  We call on having it implemented in all private schools as well, in cooperation with the Ministry of Public Health and we thank the taskforce teams at the Ministries of Health and Education, UNICEF, and all donors and stakeholders supporting this programme”.

The School Medical Screening program aims to reach children with preventive and promotive health, early diagnosis, and referral while using the school platform to create awareness on various topics among the next generation. The importance of this screening is its timely detection and referral of any child who needs medical support, and the interlinkage between public schools and PHCS for better follow-up and planned interventions, while enhancing access to essential health services not just for children but for the entire family. MEHE, MOPH and UNICEF are coordinating to ensure that all children across all public schools participate in the health screening.

Minister of Public Health, Dr. Firas Al-Abiad, said: “The program we are launching today meets the National Health Strategy objectives that the Ministry launched a year ago, which is based on placing primary care as a cornerstone. The joint work between the Ministries of Health and Education leads to creating a path to continue the service. It is essential to provide health care from an early age to avoid many diseases and complications”. he added: “We appreciate the support provided by our partners from the international community and we call on continuing the joint responsibility to support Lebanon bearing the heavy burdens that the country is unable to hold alone”.

“Children’s health and nutrition are key determinants of education outcomes and with increased poverty a majority of families in Lebanon cannot afford access to preventive healthcare,” said Edouard Beigbeder, UNICEF Representative in Lebanon. “Investing in the health, nutrition and well-being of students is as important as investing in education provision to achieve inclusive and equitable quality education. I want to thank the funding support of the European Union, the German government through KfW development bank, France and the United States Governments for supporting this initiative. Healthy, well-nourished children and adolescents learn better, and as adults they lead healthier and more productive lives”.

In Lebanon, School Health and medical screening has been taking place across public schools till 2017-18 in collaboration with the private sector, but this critical activity was stopped with the unfolding of the crisis. MoPH and MEHE are collaborating to re-initiate this important initiative with a system strengthening approach through close linkage and collaboration between PHCCs and Schools as they strongly believe in the importance of monitoring students health and anchoring the whole family and community to the PHCs.

The PHC Department at the MoPH, in collaboration with the MEHE, have mapped PHCCs to Schools and conducted capacity building of all selected PHCCs based on the protocol and reporting mechanism. The close collaboration of the MoPH and the MEHE is a great example of joint efforts in improving the Health and Education of children in Lebanon.

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UNICEF works in some of the world’s toughest places, to reach the world’s most disadvantaged children. Across 190 countries and territories, we work for every child, everywhere, to build a better world for everyone. For more information about UNICEF and its work for children visit www.unicef.org/lebanon/ .

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Blog The Education Hub

https://educationhub.blog.gov.uk/2024/03/04/school-funding-everything-you-need-to-know/

School funding: Everything you need to know

No school, child or local authority is the same and school funding needs to reflect that. That’s why sometimes it can seem complicated.

Here’s what you need to know about school funding.

How are schools funded?    

Most state-funded schools in England receive funding through two main funding pots which determines what the money can be spent on – revenue funding and capital funding.    

Schools can decide how they spend their revenue funding. It is used to pay for the day-to-day running costs of a school, such as teacher pay , support staff pay, energy bills, minor maintenance, and teaching materials.   

Capital funding is a separate pot of money used to pay for new school buildings and improvements to the school estate.  

How does government decide how much revenue funding each school gets?  

Each year, the government allocates money for all state-funded mainstream schools, including academies and council-run schools, using a formula that ensures funding is fair and reflects their pupils’ needs.  

This is called the National Funding Formula (NFF) which you can read more about here .   

This formula takes a variety of factors into account, such as the number of pupils a school has and how its location may affect the school’s running costs.  

T he funding system also protects schools against large decreases in per-pupil funding from one year to the next, giving schools stability to help their budget planning.   

Schools have the flexibility to decide how to use this funding. Most of the money is spent on paying staff, but it can also be used for other costs such as classroom materials and energy.  

Independent or private schools operate outside this system and raise their funding through fees.  

How much is spent on school funding?  

In autumn 2022 , we announced that in 2023-24, schools will get an extra £2 billion of revenue funding and the same again in 2024-25.   

And in July 2023, we announced further funding for the next two academic years to support that year's teachers' pay award - with over £480 million going into schools this academic year, and over £825 million for the next.

This is on top of the £1.5 billion increase schools were already set to receive in 2023-24, bringing the overall funding increase this year to £3.9 billion, compared to 2022-23.  

It means that total school revenue funding in England is £57.7 billion for 2023-24, rising to £59.6 billion for 2024-25.    

As a result, in 2024-25 schools will receive the highest ever in real terms per pupil, as measured by the GDP deflator measure of inflation – the routine measure of public spending.

According to the Organisation for Economic Co-operation and Development (OECD), in 2019-20 the UK was the highest spender in the G7 on schools and colleges delivering primary and secondary education as a share of GDP.  

The department’s published statistics on school funding over recent years provide data on funding for pupils aged 5-16. This coverage has been chosen both to capture core funding for schools and to ensure the series is as comparable over time as possible, despite changes to the specific grants allocated to schools over time.  

What does this money mean for my child’s school?  

The additional £2 billion will mean that a typical primary school with 200 pupils can expect to receive around an extra £35,000 in funding.    

A typical secondary school with 900 pupils would receive an additional £200,000.    

  Schools can choose how they spend the additional funding, for example, on staffing, classroom materials, or other running costs.   

Overall, funding for mainstream schools is increasing by around £310 per pupil this year – which is on top of the average £300 per pupil increase last year (2022-23). Additional funding for teachers’ pay is on top of this.  

In total, average per-pupil funding in schools for 2023-24 is £7,460.    

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Tags: primary school , primary schools , School funding , schools , Secondary School

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Matthew McConaughey and ASU are helping an Arizona school district. Here's how

Oscar Award-winning actor Matthew McConaughey is helping a Phoenix-area school district secure federal safety funding.

The celebrity's Greenlights Grant Initiative, which he founded with his wife, Camila Alves McConaughey, has partnered with Arizona State University to help Glendale Elementary School District submit five grant applications this year, with more in the works. The initiative assists school districts nationwide in locating and applying for federal safety and mental health grants.

If its applications are approved, Glendale Elementary School District could receive up to $600,000 for the next five years to build afterschool social and academic enrichment programming at five campuses: Challenger, Glendale American, Glendale Landmark, Glenn F. Burton and Harold W. Smith elementary schools. 

"It was one of those 'too good to be true' type of scenarios," Glendale Assistant Superintendent for Behavioral Health and School Safety Louis Laffitte Jr. said of the opportunity. "I think it's critical for us."

ASU partners with Glendale Elementary School District

Glendale serves about 10,000 students across 14 campuses, which include an online school and a preschool. The district has one staff grant writer who primarily works on state grants and those coming from the Arizona Department of Education, Laffitte said. Individual educators must otherwise find time to apply for grants that catch their interest.

Laffitte reached out to Greenlights Grant Initiative in November for support.

A team of three ASU students — Allison Miller, Elizabeth Brammer and Daniel Zimmerman — led the grant writing effort under the guidance of Sarah Lindstrom Johnson, a professor in ASU's T. Denny Sanford School of Social and Family Dynamics. Lindstrom Johnson is an experienced grant writer whose research focuses on school climate and safety. 

Arizona is unique, she said, because it has many rural districts that "tend to be smaller, more nimble, with less infrastructure." Grant writing is a time-consuming endeavor that can take more than 50 hours to complete, depending on the application. Not every district will apply for lack of time or know-how, she said. Some districts might not even know what grants are available or where to look.

"I thought I was addressing a really important gap in making sure the access to these funds — even access to the competition for these funds — is equitable," Lindstrom Johnson said. "One of the great resources that I have as a professor here is I have access to the students. I call it my 'student power.'"

Last semester, she taught a specialty course called "Narratives of School Shootings." When three of her students learned that she assisted schools with safety grant applications, they wanted to join the cause. Those students are now working on another grant for Glendale and one for an Arkansas district.

"When Camila and I launched the Greenlights Grant Initiative, Dr. Sarah Lindstrom from Arizona State University

Matthew McConaughey said in a statement that Lindstrom Johnson "was one of the first to raise her hand and lend her expertise, time and resources to help school districts in her state apply for school safety and mental health grants" when the Greenlights Grant Initiative launched.

"We are beyond grateful" to Lindstrom Johnson and her students, he said, "for stepping up and helping Glendale Elementary School District apply for federal funding to establish afterschool programs that will help their students excel and grow."

What is the Greenlights Grant Initiative?

Greenlights Grant Initiative started after the 2022 shooting at Robb Elementary School in Uvalde, Texas, which claimed the lives of 19 students and two teachers. Uvalde is Matthew McConaughey's hometown. His mother had once taught kindergarten at a local school just down the street from Robb Elementary.

The initiative taps into funding made possible by the Bipartisan Safer Communities Act , which President Joe Biden signed into law in 2022 in response to the Uvalde shooting. The law increased funding for crisis intervention and violence prevention programming. Sen. Kyrsten Sinema , I-Ariz., and Sen. Mark Kelly , D-Ariz., supported the bill and are on the initiative's bipartisan congressional advisory council .

"This partnership will give families peace of mind, allowing generations of Arizona students to grow and achieve their American Dream," said Sinema, the council's co-chair , in a statement about the ASU partnership.

The initiative provides support to any district. Its website sets alerts for grant deadlines, offers webinars on how to apply, and shares expert tutorials on the grant writing process. To date, it has equipped more than 1,500 schools with grantsmanship training.

Greenlights Grant Initiative stems from the McConougheys' just keep livin Foundation , which the couple established more than a decade ago to implement afterschool fitness and wellness programs at high schools with a large share of students from low-income households.

"We know how important afterschool programs are for the well-being of students. Our prescription is to prevent so we don't have to cure later in life. We're glad we can work with ASU to achieve this same goal," Matthew McConaughey said.

Reach the reporter at [email protected] .