Start Date:  June 2010   End Date:  Dec 2011   Status: Completed

Research indicates that UK young people have among the worst health in Europe and there are marked inequalities in health across the social scale with considerable implications for later health problems and economic costs. The effects of curriculum based interventions on health, where most efforts have been focused, show mixed results. Another approach has been to change the school environment (SE) to promote health. This approach treats schools as settings which can influence health by aiming to change the physical, social or cultural environment within schools. The school environment approach has been influenced by the World Health Organisation (WHO) framework for 'Healthy Promoting Schools', which addresses school 'ethos' (values and priorities), family/community involvement and curriculum.
There are significant gaps in the evidence concerning the effectiveness and other key issues of SE interventions. This study addresses these gaps by examining the effects of school environment interventions and of school-level influences on the health and well-being of students, staff, parents and the local community, and how this can inform the development and implementation of future interventions.


  • RQ1: What theories are used to inform school environment interventions or explain school-level health influences? What testable hypotheses are suggested?
  • RQ2: What are the effects on student health/inequalities of school environment interventions addressing organisation/management; teaching/pastoral care/discipline; and the physical environment? What are the costs?
  • RQ3: How feasible/acceptable and context dependent are such interventions?
  • RQ4: What are the effects on student health/inequalities of school-level measures of organisation/management; teaching/pastoral care/discipline; and the physical environment?
  • RQ5: Through what processes might such influences occur?


Systematic review and stakeholder consultation in two stages:

  • Stage 1:  mapping references concerning how the school environment affects health and consulted stakeholders to identify stage 2 priorities.
  • Stage 2:  In-depth reviews and syntheses of evidence corresponding to each RQ.

Main Findings

See Reports

  • Bonell C, Jamal F, Harden A, Wells H, Parry W, Fletcher A, et al. (2013) Systematic review of the effects of schools and school environment interventions on health: evidence mapping and synthesis. Public Health Res 2013;1(1).
  • Bonell C, Wells H, Harden A, Jamal F, Fletcher A, Thomas J, Campbell R, Petticrew M, Whitehead M, Murphy S, Moore L. (2013) The effects on student health of interventions modifying the school environment: systematic review. Journal of Epidemiology and Community Health. doi:10.1136/jech-2012-202247
  • Bonell, C., Parry, W., Wells, H., Jamal, F., Fletcher, A., Harden, A., Thomas, J., Campbell, R., Petticrew, M., Murphy, S., Whitehead, M., & Moore, L. (2012) The effects of the school environment on student health: a systematic review of multi-level studies. Health & Place.
  • Bonell C, Harden A, Wells H, Jamal F, Fletcher A, Petticrew M, Thomas J, Whitehead M, Campbell R, Murphy S, Moore L. (2011) Protocol for a systematic review of the effects of schools and school-environment interventions on health: evidence mapping and syntheses. BMC Public Health 11:453

Contact us

Project led by LSHTM

IHHD Project Lead: Professor Angela Harden

Project Team: Professor Angela Harden (co -PI) (UEL), Dr Chris Bonell (co-PI) (Oxford), Dr James Thomas (Co-investigator) (IOE), Prof Mark Petticrew (Co-investigator) (LSHTM), Prof Margaret Whitehead (Co-investigator) (University of Liverpool), Prof Rona Campbell (Co-investigator) (University of Bristol), Prof Laurence Moore (Co-investigator) (University of Cardiff), Dr Simon Murphy (Co-investigator) (University of Cardiff), Dr Adam Fletcher (Co-investigator) (University of Cardiff), Ian Shemilt (Health Economist) (University of East Anglia), Val Hamilton (Information Scientist), Farah Jamal (Research Fellow) (UEL), Helene Wells (Research Fellow) (LSHTM)

Funder: National Institute for Health Research (Public Health Research Programme)

Project Partners: LSHTM, IHHD, IOE, Oxford, University of Bristol, University of Cardiff, University of Liverpool

For more information, contact: Angela Harden

Angela Harden

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