Table of Contents

HK J Paediatr (New Series)
Vol 21. No. 2, 2016

HK J Paediatr (New Series) 2016;21:134-135

Letter to the Editor

Healthy School Environment to Tackle Youth Mental Health Crisis

A Lee, V Keuing, A Lo, A Kwong

Dear Editor,

The recent outcry of suicide among students in Hong Kong with more than 20 incidents of students committing suicide in less than half a year since September 2015 has led to response of Education Bureau setting up a committee to study the reasons and make recommendations on appropriate preventive measures. During the Summit "Child Health and the Environment" speakers of the symposium on 'Nurturing Environment for Children' have highlighted the importance of boarder interpretation of environment including social, school and family environment highlighting the significance of healthy school environment for students to enjoy school life.1 There is already evidence locally and globally that the way the school is led and managed, the experiences students participate in shaping policies, how teachers treat students and how school engages local community and parents, build many protective factors for health and reduces health risk behaviours.2,3

The Centre for Health Education and Health Promotion, The Chinese University of Hong Kong (CHEP) launched the first territory-wide "Healthy Schools Award (HSA) Scheme" in 2001 modelled on the WHO Health Promoting School (HPS) framework covering six key areas (healthy school policies, physical and social environments, community link, action competencies on healthy living and school health care and promotion services) which is designed to assist schools in addressing health issues strategically. Students attending schools reaching the HPS standard with HSA were found to have better life satisfaction and emotional status, and reported better health and academic performance.3 The Quality Education Fund commissioned CHEP to establish the Thematic Network of HPS aiming to sustain the HPS movement in 2010.

CHEP has already established a system of creating a school profile for individual school based on the six key areas of HPS as mentioned with on-site inspection by a dedicated team and a system of surveillance of student health.4 Table 1 captures the improvement of certain components of different key areas among the 100 schools in the network at baseline (BA) and the performance of schools with HSA later on (QA).

Table 1 Changes in some elements of the Six Key Areas of Health Promoting School
  BA QA Difference
School's Social Environment
School involves students in policy making 18.3% (Pri) 63.6% (Pri) ↑45.3% (Pri)
Establishment of an inclusive environment of value and mutual respect 51.0% 92.1% ↑41.1%
Healthy School Policies
Prevention of Dependent or Indulgent Behaviour (since 2013/14) 25.0% 96.0% ↑71.0%
An Active School (since 2013/14) 29.2% 100.0% ↑70.8%
Action Competencies for Healthy Living      
School actively organises health education and health-promoting activities for the community 54.8% (Pri) 100% (Pri) ↑45.2% (Pri)
  43.9% (Sec) 93.8% (Sec) ↑49.9% (Sec)
Health Content Areas in Action Competencies for Healthy Living (Secondary School)
Prevention and Management of Disease 25.6 80.0 ↑54.4
Smoking, Alcoholism, Drug Use and Abuse 46.2 73.3 ↑27.1
Consumer Health 30.8 80.0 ↑49.2
School's Physical Environment
Provision of a suitable physical environment to enhance learning 53.0% 92.1% ↑39.1%
Provision of a safe environment 19.0% 52.6% ↑33.6%
Community Links
School encourages parents' active participation in review of Healthy School Policies 36.0% 94.7% ↑58.7%
School encourages community members or groups to participate in review of Healthy School Policies 26.0% 81.6% ↑55.6%
School Health Care and Promotion Service (Secondary School)
School encourages students to have health screening at least once a year 42.5% 81.3% ↑38.8%

Figure 1 shows the pattern of emotional health of students over years among 1,204 primary four (P4) and 678 secondary three (S3) students of 17 primary schools and 5 secondary schools when they first joined the network in 2010. P4 and S3 students were chosen to examine the changes for the cumulative impact of HPS at this mid-point of schooling. K6 scale is being used to assess emotional disturbance.5 Proportion of students with scores above 13 dropped from 23% to 10% among primary students and from 24.9% to 17.6% among secondary schools. The self-harm behaviours also dropped. However in terms of seeking help when they felt sad or hopeless does not show any increase and remains low, 27.1% to 24% among primary students and from 29.7% to 28.2% among secondary students.

Figure 1 Pattern of emotional health of students in Health Promoting Schools.

Model of HPS has the potential to enhance the school management conducive for health and soothing students' emotion. Schools would consider using the HPS framework as preventive measure for mental health problems particularly motivating students to seek help with emotional disturbance.

There is no conflict of interest.

A Lee*
V Keuing
A Lo
A Kwong
Centre for Health Education and Health Promotion,
JC School of Public Health and Primary Care,
Faculty of Medicine,
The Chinese University of Hong Kong, Hong Kong

*Correspondence to: Prof. A Lee


1. Chan CW, Wong LHL. Overview of Summit on Child Health and the Environment 2014. HK J Paediatr(new series) 2015;20:95-104.

2. Stewart-Brown S. What is the evidence on school health promotion in improving school health or preventing disease and specifically what is the effectiveness of the health promoting schools approach?. Copenhagen: World Health Organization, 2006.

3. Lee A, Cheng FF, Fung Y, St Leger L. Can Health Promoting Schools contribute to the better health and well being of young people: Hong Kong experience? J Epidemiol Community Health 2006;60:530-6.

4. Lee A, Cheng FF, St Leger L. Evaluating health promoting schools in Hong Kong: the development of a framework. Health Promot Int 2005;20:177-86.

5. Kessler RC, Green JG, Gruber MJ, et al. Screening for serious mental illness in the general population with the K6 screening scale: results from the WHO World Mental Health (WMH) survey initiative. Int J Methods Psychiatr Res 2010;19 Suppl 1:4-22.


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