HOW SCHOOL SYSTEMS

CAN IMPROVE HEALTH

AND WELL-BEING

Background
TOPIC BRIEF
Physical activity
Schools play a key role in providing safe, nurturing learning
environments that provide the foundation for learners to
grow, learn and become healthy, educated and engaged
citizens.

What is a health-promoting school?

Health-promoting schools (HPS) are schools with
strengthened capacity to be healthy settings for living, Why is physical activity important
learning and working. HPS reflect a whole-school approach,
comprising healthy school policies, curricula, environments,
for health and well-being?
communities and health services. A comprehensive school An active lifestyle promotes physical and mental health, leading to better
health programme aims to make every school a health- overall health and well-being. The many benefits of physical activity
promoting school, which can be achieved by building
include improved cardiovascular health, stronger bones and muscles,
health-promoting education systems. A health-promoting
education system is one that, through intentional, planned healthy weight maintenance, better sleep, increased self-esteem and
actions, institutionalizes health promotion in all its functions, confidence and fewer symptoms of anxiety and depression. Active
i.e. governance of the educational process and its content, children are more likely to become active adults, and the benefits of
resource allocation, educators’ professional development, physical activity continue throughout life, reducing the risk of developing
information systems and performance management.
chronic health conditions such as heart disease, stroke, cancer, high
blood pressure, type 2 diabetes, osteoporosis and obesity.
What is new?
Although the concept of HPS was introduced by WHO many
Why is physical activity important
decades ago, the aspiration of fully embedded, sustainable for education and learning?
HPS within educational systems is yet to be achieved; few
countries have implemented HPS at scale. To fulfil the Regular physical activity may contribute to addressing the global learning
vision of “making every school a health-promoting school”, crisis, as it is associated with better brain health, which includes cognitive
United Nations agencies collaborated on developing global development, classroom behaviour (e.g., time spent on tasks) and
standards for HPS and systems, implementation guidance academic performance. It has also been linked to a reduction in bullying,
and case studies from low- and middle-income countries.
These evidence-informed resources are intended to be used pro-social behaviour and better school engagement and attendance.
by national education, health and associated sectors to Physical activity outdoors has been linked to lower visual impairment
strengthen their school health programmes in order to build (myopia), which may facilitate better learning.
health-promoting education systems.
Why are schools ideally placed to What are the current gaps?
improve physical activity? Most learners do not have enough physical activity, as,
worldwide, only one in five adolescents achieves the
Schools can provide equitable access to opportunities for
recommended level of physical activity (at least 60 min/day at
structured and incidental physical activity. This should include
moderate-to-vigorous intensity). Physical activity can be affected
mandated-quality physical education and general physical
by conflict, emergencies and crises and has further decreased
activity opportunities (including active play, walking and cycling
during the COVID-19 pandemic. The multiple barriers to physical
for transport, active lessons and sport). By listening to children
activity include poor access to safe spaces, cost of facilities
and adolescents and involving them in planning, organizing
and equipment, weather conditions, lack of mandated active
and delivering physical activity initiatives, schools can maximize
play and recreation time, competing academic demands and
their participation, enjoyment and skill development, while
societal/ cultural norms that discourage certain demographic
catering for learners’ diverse needs, abilities and interests,
groups, like girls, from participating in physical activity.
as well as ensuring gender-equitable access. Schools can
expose learners to a wide variety of physical activity options A systems approach can help address these gaps by integrating
and contexts, from active travel, to sport, to fundamental and aligning multiple elements, with the goal of amplifying
movement skill development, to active play and active lessons, benefits for education, health and well-being.
each potentially conferring unique benefits.
Physical activity is a good example of the importance of a
systems approach. Numerous determinants of physical activity
can be addressed by the education sector (in formal and
informal curricula) working with other sectors, such as transport
(e.g., safe transport to school, walking school bus) and urban
design (e.g., sport and play facilities, safety). Bringing such
elements together to promote physical activity sustainably is
the essence of an HPS and systems approach.
This brief explores how policies, curricula, environments and
services can be better designed and integrated to support
physical activity.

2
WhatMaking
areevery
health-promoting schools
school a health-promoting and systems?
school: implementation guidance

The eight global standards are a system of interconnected elements (Fig. 1) comprising governance structures (primarily standards
1–4), community partnerships (standard 4) and school operations (primarily standards 5–8). A systems approach ensures that policies,
mechanisms and resources for health and well-being are sustainably promoted in all aspects of school life. This involves cross-sectoral
collaboration, participatory processes, models of distributed leadership, capacity-building and effective monitoring and evaluation.
Fig. 1. System of global standards for health-promoting schools
Fig 1. The eight global standards for health-promoting schools and systems

6. School social–
emotional
environment
1. Government 2. School policies 3. School 4. School and
policies and resources governance community 8. School
5. School
and resources and leadership partnerships health
curriculum
services
7. School
physical
environment

As in this topic brief, the global standards are designed to be used by various stakeholders involved in identifying, planning, funding,
implementing, monitoring and evaluating any whole-school approach (even if the term HPS is not used) at local, subnational, national
As inglobal
and the global standards,
levels, primary and secondary schooling and public andLike
the implementation theeducational
private global standards, this implementation
institutions.
guidance uses the term “HPS” generically, to guidance is based on two evidence reviews (31, 32),
include other whole-school approaches, such a series of case studies from eight low- and middle-
as comprehensive school health and education, income countries (36) and consultations with a
Activating synergies in health interventions
éducation pour la santé, école en santé, estrategia or global external advisory group and a wider group
entorno escuela saludable and escuela para la salud. of stakeholders.
What is the relation between physical activity, substance
use and behavioural outcomes?
Some school physical activity interventions that also target substance use
have been shown to reduce use of alcohol, marijuana and tobacco among
adolescents.
Participation in sport has been linked to pro-social behaviour (teamwork,
loyalty) among adolescents, restricts the time available for unstructured
activities and may lead to greater civic engagement in the community, each
of which can contribute to well-being.

What is the relation between physical activity and mental

health?
Regular physical activity of at least moderate-to-vigorous intensity is
associated with fewer depressive symptoms and better emotional well-being
in children and adolescents. Participation in physical activity can improve
sleep and self-esteem, create a sense of achievement and engagement
and provide opportunities for social interaction, all of which support healthy
physical and socio-emotional development.

3
How can we strengthen physical activity using a
health-promoting schools and systems approach?
The following are examples of actions, activities or initiatives that can be conducted to strengthen physical
activity using an HPS and systems approach. The list is not exhaustive; actions will depend on the context
(e.g., social, cultural, country-specific), vary by the level of schooling (e.g., primary, secondary) and are
ideally generated through engagement with all stakeholders (e.g., teachers, learners, community, caregivers,
government, private sector and civil society organizations), based on local data. Solutions that target multiple
aspects of education, health and well-being are encouraged as cost–effective ways of amplifying benefits.

•
1 Government policies
and resources
Develop national policies and guidelines for HPS and physical activity in EXAMPLES OF
schools, with a focus on inclusivity (e.g., girls and young women, learners
with varying abilities and special needs), and provide a variety of physical
activity opportunities (play, games, sport, safe active travel), ensuring
ACTIONS, FRAMED
alignment with the ministry of education in all relevant sectors (e.g., health,
infrastructure). Develop safety standards for school environments (e.g., sun WITHIN THE GLOBAL
safety, safe play equipment, zero tolerance of harassment) and regulate

•
greater access to school sports and play facilities outside school hours.
Allocate a budget and human resources for physical activity, including
STANDARDS FOR
specialized physical education teachers, purchase and maintenance of
sports and play facilities and equipment, professional development and HPS AND SYSTEMS
active before- and after-school programmes.
• Ensure good-quality physical education, defined according to
its frequency and inclusivity (e.g., older girls, with consideration
of individual experiences of menstruation and the variety of
programming), and encourage a minimum of weekly physical activity
and active learning a part of the national comprehensive health and
nutrition curriculum.
• Build partnerships to promote active travel to and from school, including

3
improving urban planning (such as slowing traffic near schools), safe
neighbourhoods and public transport.
School
governance

2 School policies and leadership

and resources • Create school committees to oversee and
advocate for a physical activity policy and
• Communicate and endorse school policies and standards (e.g., for programming with school health and well-
health and well-being, physical activity, sitting time and screen time, being focal points. Involve teachers, school
sun safety, sexual harassment) in all local languages to learners, staff, health staff, student representatives, parents
parents, carers and the wider community. and carers in decision-making to promote
HPS, active learning and physical activity.
• Employ physical education teacher(s) and support continued
professional development (e.g., HPS, physical skills development, • Regularly evaluate the effectiveness of
inclusive, high-quality physical education and active learning methods) physical activity initiatives, active learning and
for school staff. the delivery of high-quality physical education
in a sensitive, non-comparative context
• Provide access to wellness programmes to improve school staff health
(e.g., by ensuring enjoyment, participation,
and well-being.
especially of girls and other marginalized
• Consider whether school uniform policy or clothing standards groups of learners, health and well-being, as
are amenable for physical activity, as well as being affordable and well as zero tolerance of harassment).
accessible and/or subsidized, e.g., sports bras for girls.
• Provide active before- and after-school
• Support active travel to and from school (e.g., walking, school bus, programmes and field trips, ensuring safety
“buddies”, bicycle storage, changing rooms, pedestrian crossings). of girls and assuring families of this.

4
4 School and community partnerships
• Engage with local community groups and events (e.g., sports, yoga, mindfulness activities, skills
development, outdoor activities, carnivals) and share use of community active recreation and play
facilities, while ensuring the safety for female users.
• Provide parents and carers with practical guidance on achieving the recommended daily levels of
physical activity and limiting competing activities such as recreational screen time (e.g., set limits for
screen time, provide information on safe active travel).
• Involve families in sports days and in homework designed to increase participation in physical activity,
especially of older girls.

5 School
curriculum

L
• Structure high-quality physical education
lessons with inclusivity and peer-led
learning in mind (e.g., activities in small
7 School
physical
environment
groups, team sports, non-competitive
activities, avoid elimination games). • Ensure access to clean, safe, gender-inclusive
• Integrate physical activity and active washrooms and changing rooms.
learning into other parts of the curriculum • Ensure access to clean, safe, shady spaces that
(e.g., registration runs, nutrition and home are conducive to being outdoors and being
economics, data collection on jumping physically active.
heights or running times in mathematics
• Ensure access to supervised recreation and play
classes, mapping active journeys to school
equipment and facilities that are age-appropriate
in geography).
and meet safety standards.
• Incorporate high-intensity physical activity
• Ensure that clean drinking-water is free and
“bursts” (classroom active breaks) into
widely accessible in all recreation areas.
lesson time to avoid prolonged sitting.
• Implement programmes to develop
fundamental movement and coordination
skills of learners in elementary school.

6 School
social– 8 School
health
services
emotional
environment • Facilitate access to health services as
appropriate (e.g., for concerns about growth
• Provide diverse physical activity programmes and physical health).
(e.g., gardening, running club, ball skills, • Ensure that learners and their families
orienteering, strength training, dance, yoga) understand the process and referral pathways
and a respectful, inclusive environment for for accessing health services, whether at
diversely sized bodies, older girls and learners school or in the community (e.g., pathways
with special needs and different abilities. to access affordable health services for
• Set up “buddy groups” and peer-led physical vulnerable people with limited resources).
activity opportunities.

5
How does a systems approach work in different contexts?

Polygon for physical activity of school-aged children, Croatia

Background: In Croatia, 14% of the main elementary schools and 83% of peripheral elementary schools
have either no or limited access to a gymnasium, making it difficult to achieve mandated physical
education requirements in all weather conditions.
Approach: Under the National Health Promotion Programme “Healthy Living” (2014–2015), the Croatian
Institute of Public Health, the Ministry of Health and the European Social Fund supplied schools that
did not have a gymnasium with mobile multi-purpose sports and play equipment adaptable for outdoor
and indoor use. Professional development support was provided to physical education and classroom
teachers in the form of a manual (including a video) produced in collaboration with the Ministry of
Science Education and Sport and the Education and Teacher Training Agency.
Results: Teachers in the 120 main elementary schools without gymnasia reported greater student
enjoyment of physical education and motivation to exercise with school equipment and their own
perceptions of having access to suitable equipment and conditions to teach physical education.
Teachers shared photographic documentation of how they innovatively used the equipment indoors
and outdoors. Students created a video presenting their impressions of the programme.
Messages: A systems intervention, led by Government agencies with multisectoral (education,
health) collaboration and investment in equipment and capacity-building, led to better
implementation of the national physical education curriculum.
Reference: Krtali´c S, Morovi´c ML, Kasumovi´c L, Spasovi´c V, Musli´c L, Milanovi´c SM. Applicability
and quality assessment of the set of equipment in the project “Polygon for physical activity of school-
aged children” in primary schools without gymnasia. Kinesiology. 2020;52(1):134–42 (https://hrcak.
srce.hr/ojs/index.php/kinesiology/article/view/9298).

Schools in motion, Costa Rica

Background: In 2018, the Ministry of Health collaborated with the National University of Costa Rica to
develop healthy environments to promote students’ physical activity. They addressed multiple levels,
including school policy, governance, curriculum and environment of the participating schools.
Approach: School policies to promote movement were followed by re-organization of school spaces
to encourage physical activity, facilitate high-quality physical education and promote acquisition of
motor skills. The intervention consisted of virtually coached movement sessions of 20–40 min once
or twice a week, supervised by an undergraduate teacher. The sessions were designed to promote
playfulness, enjoyment and improvement of basic motor skills (self-efficacy). Resources such as hula-
hoops, ropes, cones, gymnastics balls and frisbees were provided. Suspension of face-to-face lessons
in 2020 due to the COVID-10 pandemic resulted in a new initiative. A health and wellness page was
created on the social network Facebook to promote active lifestyles in and around the students’ home
environments. In June 2020, a graduation ceremony was conducted for the school “Concepción de
San Isidro de Heredia”, which completed 10 movement challenges. In May 2021, a dialogue was held,
called “Intervention in school children to promote physical activity in times of pandemic: Families in
movement and mobile active schools”.
Results: Participating students achieved greater self-efficacy and tended to enjoy physical activity more,
with higher participation levels. It was noted that parent or caregiver accompaniment is important at an
early age to reinforce the enjoyment of physical activity.
Messages: A coordinated approach across multiple levels of school systems led to increased
self-efficacy in physical activity. Flexibility in adapting the intervention to a virtual platform
enabled the benefits to continue even when schools were closed in 2020 due to the COVID-19
pandemic.
Reference: Escuelas en Movimiento Costa Rica [Schools in motion Costa Rica]. Washington DC:
International Life Sciences Institute; 2022 (https://ilsimesoamerica.org/proyectos-de-capacitacion/
escuelas-en-movimiento-costa-rica/).

6
Resources

Health-promoting schools Physical activity

Making every school a Quality Physical Education (UNESCO)

health-promoting school:
QUALITY https://en.unesco.org/publications/
global standards and PHYSICAL
EDUCATION quality-physical-education-guidelines-
indicators
Guidelines for
policy-makers
https://www.who.int/publications/i/
Policy-Makers
Making every school a
health-promoting school
Global standards and indicators

item/9789240025059

International Benchmarks for Physical

Making every school a Education Systems (International Council
health-promoting school: of Sport Science and Physical Education)
Implementation guidance https://www.icsspe.org/system/files/
https://www.who.int/publications/i/ Final%20ICSP%20Benchmarks%20
Making every school a
health-promoting school item/9789240025073 ICSSPE%20Dec%202012.pdf
Implementation guidance

Global Recommendations on Physical

Activity for Health (WHO)
Making every school a
https://www.who.int/publications/i/
health-promoting school:
item/9789241599979
country case studies
https://www.who.int/publications/i/
Making every school a
health-promoting school item/9789240025431 PROMOTING PHYSICAL ACTIVITY
THROUGH SCHOOLS: a toolkit

Country case studies

Promoting physical activity through

Promoting Physical Activity through
SCHOOLS:
A TOOLKIT Schools: a toolkit (WHO)
In partnership with

WHO guidelines on school https://apps.who.int/iris/

health services handle/10665/350836
https://www.who.int/publications/i/
item/9789240029392

WHO guideline on
school health services
Promoting Physical Activity through
Science and Technology in
childhood Obesity Policy

Schools: policy brief (WHO)

PROMOTING PHYSICAL ACTIVITY
THROUGH SCHOOLS: POLICY BRIEF
https://apps.who.int/iris/
Introduction
Physical activity is good for hearts, bodies and minds. Regular physical
activity can improve physical fitness; improve heart, vascular and
metabolic health, and bone health; and reduce adiposity in children and
adolescents (1). Being active can also improve cognitive function, including
Global estimates
indicate that over
80% of young
handle/10665/354605
academic performance and mental health, and can reduce symptoms of people in school are
depression and anxiety (1). In contrast, too much sedentary behaviour not meeting the global
can be unhealthy; it increases the risk of obesity and poorer fitness and recommendations of 60
cardiometabolic health, and can affect sleep duration (2).
minutes of moderate-to-
Global estimates indicate that over 80% of young people in school are vigorous physical activity
not meeting the global recommendations of 60 minutes of moderate-to-
vigorous physical activity per day (see Box 1) (3). In most countries, girls
per day
are less active than boys, and levels of inactivity among girls have not
improved since 2001 (in fact, the gap between girls and boys is widening)
(3). In addition, the most socially disadvantaged groups in most countries,
such as girls and those living with chronic health conditions or disability,
are often the least active.

Policy Brief on Promoting Physical

Activity Among Adolescents (UNICEF)
https://gdc.unicef.org/resource/
policy-brief-promoting-physical-activity-
among-adolescents

Webinar: Promoting Physical Activity

in Schools (Save the Children)
https://healtheducationresources.
unesco.org/news/
webinar-promoting-physical-activity-schools

7
Acknowledgements
Development of this series of topic briefs was coordinated by Dr Faten Ben Abdelaziz, Dr Valentina
Baltag, Dr Mervat Nessiem and Ms Audrey Kettaneh at WHO; Mr. Yongfeng Liu and Ms Emilie
Sidaner at UNESCO; and Ms Deepika Sharma and Ms Joanna Lai at UNICEF.
The briefs were written by Professor Susan Sawyer, Centre for Adolescent Health, Murdoch
Children’s Research Institute, Royal Children’s Hospital, and University of Melbourne, Australia,
a WHO Collaborating Centre for Adolescent Health, in collaboration with Dr Monika Raniti. The
lead writers were Dr Monika Raniti (Mental health); Dr Natalie Evans (Nutrition and WASH);
Dr Dorothy Dumuid and Associate Professor Carol Maher (Physical activity); and Dr Wing See
Yuen and Associate Professor Amy Peacock (Substance use).
WHO acknowledges the valuable contributions of technical experts at WHO, UNESCO, UNICEF,
WFP and UNODC, including regional advisers and other academic experts who provided
feedback.
WHO gratefully acknowledges the financial support of the NORAD Fund.

How school systems can improve health and well-being. Topic brief: physical activity
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