Promising Paths: Health Promoting Higher Education - Reflections, Challenges & Future Frontiers

www.healthyuniversities.ac.uk
Promising Paths
Health Promoting Universities &
Colleges: Reflections, Challenges
and Future Frontiers
Mark Dooris
Professor in Health & Sustainability
Director, Healthy & Sustainable Settings Unit
University of Central Lancashire
PhotoCredit,DavidNiblack,imagebase.net

Background, Context & Vision
Theory & Practice: What, Why & How?
Reflections: UCLan & UK Experience
Challenges, Lessons Learned
Opportunities & Future Frontiers

Background: Health Promoting Higher Education Journey
A
1986 • Ottawa Charter for Health Promotion
1994/5 • First HPU Initiatives – Lancaster & UCLan, UK
1995 • German HPU Network
1996-8 • International HPU Conference [UK] & WHO Book
2003 • 1st International HPU Congress & Chilean HPU Network
2005 • 2nd International HPU Congress/Edmonton HPU Charter
2006 • English HPU Network & Spanish HPU Network
2007 • Ibero-American HPU Network
2009 • Swiss HPU Network & Austrian HPU Network
2013 • UK Healthy Universities Network
2015 • WHO: Health in All Policies and Cross-Sector Action
• This Conference!

Higher Education: The Context
Universities play an increasingly
important role in society:
2012: 32% of adults entered higher
education – up from 18% in 1999
2030: 414.2 million university students,
up 314% from 99.4 million in 2000
But…what are universities for?
UNESCO http://data.uis.unesco.org/
http://www.universityworldnews.com/article.php?story=20120831155341147
©MarkDooris
“We should be preparing students
for the work of the world, not just
the world of work.”
Porritt, 2012

Health Promoting Higher Education: The Vision

“A Healthy University aspires to
create a learning environment
and organisational culture that
enhances the health, wellbeing
and sustainability of its
community and enables people
to achieve their full potential.”

A co-benefits ‘win-win’ approach to education and health
Mutually
Beneficial
‘Win-Win’
Relationship
Education,
Learning &
Widening
Participation
Health,
Wellbeing,
Empowerment
& Social Justice
Hammond, 2002
Education is good for health…
Education and learning are positively associated with physical
and mental health and wellbeing – widening participation in
education will reduce inequalities, challenge prejudices and
empower people to keep on learning.

Beyond this, universities can do even more for health…
Wellbeing of students, staff & community.
‘Generator’ of health, justice and sustainability in society –
corporate responsibility and shaping.
Health can do more for universities:
Enhance core business.

The Healthy Settings Approach: Background
Health Promoting Universities – one application of the
healthy settings approach:
“Health is created and lived by
people within the settings of their
everyday life; where they learn,
work, play and love. Health is
created…by ensuring that the
society one lives in creates
conditions that allow the
attainment of health by all its
members.”
WHO, Ottawa Charter for Health Promotion, 1986

“The ‘settings approach’ became the starting point for WHO’s lead health
promotion programmes…shifting the focus from the deficit model of
disease to the health potentials inherent in the social and institutional
settings of everyday life.”
Kickbusch, 1996
©MarkDooris
The Healthy Settings Approach: What?

The healthy settings approach involves:
focus on structure and agency – place and people
understanding of a setting as context which directly and
indirectly impacts wellbeing
commitment to integrating health within the culture, ethos
structures and routine life of settings.

Salutogenic
Ecological
Systemic
Whole System Change
Adapted from: Dooris, 2005
©MarkDooris

Universities are large and complex organisations that do not have
health as their main raîson d’être.
Advocate in terms of ‘core business’, appreciating distinctiveness
of a university as a setting:
 a centre of learning and development
 a focus for cross-disciplinary creativity and innovation
 a business, concerned with performance and productivity
 a partner and player within local/national/global communities
 a setting in which students undergo a major life transition
 a context that ‘future shapes’ students – values, ideals, priorities.
Abercrombie, Gatrell & Thomas, 1998 (in Tsouros et al, 1998)
The Healthy Settings Approach: Application

Health Promoting Higher Education: Why?
“Health is created and lived by
people within the settings of their
everyday life; where they learn,
work, play and love.”
WHO, 1986
Higher Education Institutions
[HEIs] are an important and
influential setting.

Health Promoting Schools –
whole education spectrum.
Enhanced achievement,
performance & productivity
Impact on wider population health.

Higher Education Institutions have
served as settings for delivery of
projects on specific issues.
Shift from single topic focus – ‘health
promotion in the setting’ – to develop
holistic/strategic ‘whole system’
perspective.
Little research evidence on Health
Promoting Higher Education; however,
this is promising and it is possible to
draw on learning from other settings.
©MarkDooris

Embedding a ‘whole system’ commitment to
health into university structures/processes results
in positive outcomes for students, staff and the
organisation as a whole. (Newton, 2014)
Effective programmes are “likely to be
complex, multifactorial and involve activity in
more than one domain.” (Stewart-Brown, 2006: 17)
“While it is not possible to state with certainty that multi-
component, whole-settings approaches are more successful
in college and university settings than one-off activities, the
evidence points in this direction.” (Warwick et al, 2008: 27)

Health Promoting Higher Education: How?
Source:AdaptedfromDoorisetal,2010

students
lecturers
caterers & venue
operators
wider
community
families
support services
…connecting between people
Source:adaptedfromDooris,2005

sexual health
alcohol & substance
use/misuse
physical activity
advertising &
sponsorship
mental
wellbeing
food and diet
…connecting between issues

formal
curriculum
inter-personal
relationships
student finance
transport
infrastructure
students’
union
campus design
…connecting between components of the system

academic
development
finance &
investment
campus
development
local plan
food &
procurement
sustainability &
carbon reduction
…connecting between policies

A Whole System Approach
https://www.youtube.com/watch?feature=player_embedded&v=1200TPhLJTc

UCLan: Healthy University Initiative
www.uclan.ac.uk/hu

UCLan: Healthy University Action Plan
Theme 1: Healthy, Safe & Sustainable Food
Theme 2: Mental Wellbeing
Theme 3: Relationships & Sexual Health
Theme 4: Smoking, Alcohol & Drugs
Theme 5: Sport & Physical Activity
Theme 6: Development/Communication
www.uclan.ac.uk/hu
 Objectives: KPIs / timescales / leads
 Links to other themes
 Links to other university policies/plans
 Links to national and local strategies
…and contribute to policy/strategy consultations

UCLan: Mental Wellbeing –
A Whole University Approach
www.uclan.ac.uk/hu

UCLan: Sport and Physical Activity –
Ackn:SkyRide
www.uclan.ac.uk/hu

UCLan: Healthy and Sustainable Food –
www.uclan.ac.uk/hu

UK Healthy Universities Network
Established in 2006 with 8 universities
It now has representation from:
 73 UK HEIs
 12 non-UK HEIs
 27 other stakeholder organisations
Bi-annual face-to-face network meetings
& thematic learning workshops.
E-Newsletters, email/online networking.
©MarkDooris

UK Healthy Universities Network:
Website
Since 2010 launch:
19,000 visitors
145 countries
upwards trend

UK Healthy Universities Network:
Toolkit
www.healthyuniversities.ac.uk/toolkit

UK Healthy Universities
Network: Self Review Tool
Leadership & Governance
Service Provision
Facilities & Environment
Communication, Information
& Marketing
Academic, Personal, Social &
Professional Development
Health Promoting Higher Education:
Tools, Frameworks & Declarations
www.healthyuniversities.ac.uk/toolkit

Mental/
Emotional
Wellbeing
Physical
Activity
Healthy&
Sustainable
Food
SubstanceUse
&Misuse
Personal&
SexualHealth
&Relationships
Sustainable
Environment
Governance,
Leadership &
Management
Criteria
A1
Criteria
B1
Criteria
C1
Criteria
D1
Criteria
E1
Criteria
F1
Facilities, Environment,
& Service Provision
Criteria
A2
Criteria
B2
Criteria
C2
Criteria
D2
Criteria
E2
Criteria
F2
Community &
Communication
Criteria
A3
Criteria
B3
Criteria
C3
Criteria
D3
Criteria
E3
Criteria
F3
Academic, Personal,
Social & Professional
Development
Criteria
A4
Criteria
B4
Criteria
C4
Criteria
D4
Criteria
E4
Criteria
F4

German Network of Health
Promoting Universities
10 Quality Criteria
www.gesundheitsfoerdernde-hochschulen.de/E_GF_HS_international/E1_GNHPU.html

Project-ism
Politeness
Playing it safe
Power relations
Playing the game
Positioning
Pathologisation
Parochialism
Challenges: The 8 Ps

Challenges: The 8 Ps - Project-ism
Health
Promoting
University

Challenges: The 8 Ps - Politeness

Challenges: The 8 Ps – Playing it Safe
©MarkDooris
www.dailykos.com

Challenges: The 8 Ps – Power Relations

Challenges: The 8 Ps – Playing the Game

Challenges: The 8 Ps – Positioning

Challenges: The 8 Ps – Pathologisation

Reflections:
Lessons Learned and Principles for Practice
Adapted from Poland & Dooris, 2010

Opportunities and Future Frontiers
Health Promoting Higher Education

Opportunities and Future Frontiers:
1. Working Across Sectors Post-2015
Cross-Sector Action for Health and Health Equity
Health in All Policies
Post-2015 Development Agenda

1. Working Across Sectors Post-2015: Implications – Internal
Health in All Policies and cross-sectoral working

Health Promoting Higher Education model influences and
becomes embedded in universities’ planning and policy
processes

Health becoming a core criterion in all decision-making


Potential for universities to harness and channel their
contribution through ensuring healthy lives and wellbeing for
all, providing inclusive and equitable education and lifelong
learning opportunities, and playing their part in building
inclusive, sustainable, resilient and just societies.
Global Focus on
Cross-Sectoral Action
Post-2015 Sustainable
Development Goals
1. Working Across Sectors Post-2015: Implications – External
www.un.org/sustainabledevelopment/

1. Working Across Sectors Post-2015: Implications – External
Waage et al, 2015

2. Connecting Health and Sustainability
Healthy
Universities
Sustainable
Universities
Avoid perpetuating what Trevor Hancock has called a ‘multiple
silo’ approach, whereby communities and organisations get
overburdened with a multitude of related programmes
Healthy & Sustainable Universities
Orme and Dooris, 2010; Poland & Dooris, 2010

2. Connecting Health and Sustainability
CanadianPublicHealthAssociation,2015

References and Further Reading
Higher Education: Overview and Purpose
http://data.uis.unesco.org/
http://www.universityworldnews.com/article.php?story=20120831155341147
http://www.timeshighereducation.co.uk/176727.article
http://www.theguardian.com/education/2011/oct/10/higher-education-purpose
www.unesco.org/new/en/education/themes/strengthening-education-systems/higher-education/mission/
http://www.unesco.org/new/en/education/themes/strengthening-education-systems/higher-education/reform-and-innovation/
Canadian Public Health Association (2015) Global Change and Public Health: Addressing the Ecological Determinants of Public
Health. Ottawa: CPHA.
Doherty, S. & Dooris, M. (2006) The healthy settings approach: The growing interest within colleges and universities. Education and
Health 24 (3): 42-43.
Dooris, M. (2001) The ‘health promoting university’: A critical exploration of theory and practice. Health Education 101 (2): 51-60.
Dooris, M. (2004) Joining up settings for health: a valuable investment for strategic partnerships? Critical Public Health 14 (1): 49-61.
Dooris, M. (2005) Healthy settings: challenges to generating evidence of effectiveness. Health Promotion International 21 (1): 55-65.
Dooris, M (2013) Bridging the Silos: Towards Healthy and Sustainable Settings for the 21st Century. Health & Place 20: 39-50.
Dooris, M., Cawood, J., Doherty, S. & Powell, S. (2010) Healthy Universities: Concept, Model and Framework for Applying the
Healthy Settings Approach within Higher Education in England. Final Project Report – March 2010. Preston: UCLan / London:
RSPH.
Edmonton Charter for Health Promoting Universities http://www.gesundheitsfoerdernde-
hochschulen.de/Inhalte/E_Gefoe_HS_internat/2005_Edmonton_Charter_HPU.pdf
German Network of Health Promoting Universities (2010) Quality Criteria of Health Promoting Universities. Hannover: GNHPU
www.gesundheitsfoerdernde-hochschulen.de/E_GF_HS_international/E1_GNHPU.html
Hammond, C. (2002) Education and Health. Education Journal 65. pp. 26-27.
Kickbusch, I. (1996) Tribute to Aaron Antonovsky – ‘what creates health’? Health Promotion International 11(1), pp. 5–6.
Kickbusch I. (1997) Health-promoting environments: the next steps. Australian and New Zealand Journal of Public Health 21: 431-4
Newton, J. (2014) Can a University Be a ‘Healthy University’? An Analysis of the Concept and an Exploration of its
Operationalisation through Two Case Studies. Thesis submitted for PhD. London: London South Bank University.
Orme, J. & Dooris, M. (2010) Integrating health and sustainability: the higher education sector as a timely catalyst. Health Education
Research 25(3): 425-437.
Poland, B. & Dooris, M. (2010) A green and healthy future: a settings approach to building health, equity and sustainability. Critical
Public Health 20(3): 281-298.

Poland, B., Dooris, M. & Haluza-Delay, R. (2011) Securing ‘supportive environments’ for health in the face of ecosystem collapse:
meeting the triple threat with a sociology of creative transformation. Health Promotion International 26 (Supplement 2): ii202-ii215.
Poland, B., Green, L. & Rootman, I. (2000) Settings for Health Promotion: Linking Theory and Practice. London: Sage.
Poland, B., Krupa, G. And McCall, D. (2010) Settings for health promotion: an analytic framework to guide intervention design and
implementation. Health Promotion Practice 10(4): 505-16.
Robinson, J. (2012) Regenerative Sustainability: From Damage Control to Improving the Environment.
http://news.ubc.ca/2012/01/03/regenerative-sustainability-from-damage-control-to-improving-the-environment/
Robinson, J. and Cole, R. (2014) Theoretical underpinnings of regenerative sustainability, Building Research & Information, DOI:
10.1080/09613218.2014.979082
Simon Fraser University (2013) A Healthy Campus Community at SFU
https://www.youtube.com/watch?v=1200TPhLJTc&feature=player_embedded
Stewart-Brown, S. (2006). What is the evidence on school health promotion in improving health or preventing disease and,
specifically, what is the effectiveness of the health promoting schools approach? Copenhagen: WHO Regional Office for Europe.
(Health Evidence Network Report http://www.who.dk/Document/E88185.pdf
Tsouros, A., Dowding, G., Thompson, J. & Dooris, M. (Eds.) (1998) Health Promoting Universities: Concept, Experience &
Framework for Action. Copenhagen: WHO Regional Office for Europe. www.euro.who.int/__data/assets/pdf_file/0012/101640/E60163.pdf
UK Healthy Universities Network www.healthyuniversities.ac.uk
UK Healthy Universities Network Toolkit and Self Review Tool www.healthyuniversities.ac.uk/toolkit
United Nations 2015 is the Time for Global Action www.un.org/sustainabledevelopment/
University of Central Lancashire Healthy & Sustainable Settings Unit www.uclan.ac.uk/hssu
University of Central Lancashire Healthy University www.uclan.ac.uk/hu
Waage, J. et al (2015) Governing the UN Sustainable Development Goals: interactions, infrastructures, and institutions. Lancet
http://dx.doi.org/10.1016/S2214-109X(15)70112-9.
Warwick, I., Statham, J. and Aggleton, P. (2008) Healthy and Health Promoting Colleges – Identifying an Evidence Base. London:
Thomas Corum Research Unit, University of London.
World Health Organization (1986) Ottawa Charter for Health Promotion. Geneva: WHO.
World Health Organization (2013) Helsinki Statement on Health in All Policies. Geneva: WHO.
http://apps.who.int/iris/bitstream/10665/112636/1/9789241506908_eng.pdf?ua=1
World Health Organization (2014) HiAP Framework for Country Action. Geneva: WHO.
http://apps.who.int/iris/bitstream/10665/112636/1/9789241506908_eng.pdf?ua=1
World Health Organization (2015) HiAP Training Manual. Geneva: WHO. http://www.who.int/social_determinants/publications/health-
policies-manual/en/

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