Schools in the Netherlands must comply with a minimum set of requirements relating to health promotion. All students must engage in a mandatory level of physical activity. A Social Safety Act, passed in 2015, also requires schools to be socially safe environments, which means they must develop policies to prevent violence including bullying. Schools are also obliged to provide education around sexuality and sex diversity, although they are flexible in determining how they do this. Beyond this, schools can implement the Healthy School Programme and other programmes like the ‘Jong Leren Eten’ or programmes to stimulate more physical activity. Still, they do so voluntarily. The Dutch report also mentions that schools have a mandatory obligation to pay attention to vulnerable groups and can apply for (temporary) subsidies for programmes, where needed.

Policies do not mention that health education and/or health literacy should be part of the curriculum or part of the educational goals. Therefore, there is a substantial difference between schools in how much attention there is to health education. While all stakeholders responding to the RSA survey and in the Schools4Health roundtable in the Netherlands felt that health education should get attention in every school, the reality is that health promotion in schools in the Netherlands is not mandatory. 64% of the 11 survey respondents in the Netherlands therefore believe there is insufficient attention for health promotion, while 27% indicated they do not know, and 9% felt there is adequate attention. 

Among the survey respondents, there was uncertainty about whether national policies recommend that schools have a written policy and/or action plan on the health and wellbeing of students and staff. 55% thought this was recommended while another 35% did not think or did not know if this was mentioned in national policies. Moreover, 73% of respondents said they were not familiar with or do not know of (mandatory) policies that specifically address the health and wellbeing of teachers and other staff working in schools.

Further links to health-related policies and with municipalities
The Netherlands also has a Prevention Agreement, which makes the link between living environments and health. The Prevention Agreement aims to reduce tobacco and harmful alcohol consumption, as well as overweight and obesity in the Netherlands, and strengthen levels of physical activity and mental health. In addition, the Dutch report highlights the GALA, Gezond en Actief Leven’s Akoord (Healthy and Active Life) agreement, initiated by the Ministry of Public Health, Wellbeing and Sport. It is an agreement between municipalities, municipal health services, health insurers and the Ministry of Public Health, Welfare and Sports to create the ability for cross-domain cooperation resulting in an integrated approach for prevention policies with common (mandatory) goals for 2040. It encourages these bodies to work together to create healthy living environments, through the Healthy School Programme in the Netherlands, amongst many others, and thereby also stimulates the uptake of this programme. 

Organisations such as JOGG (healthy youth healthy future) also receive subsidies from the Ministry of Health to encourage and work with municipalities to create healthy living environments, also in and around schools. Interestingly, almost half of the stakeholders involved in the Dutch Schools4Health survey did not know of national policies that address community links and the physical and social environment, reflecting that this is an area that could use more attention focus. 

About the Schools4Health mapping of health promoting school policies in the EU
This article is an extract of the Schools4Health ‘Report on policy and practice to strengthen the Health Promoting School approach across the EU’. A key objective of the Schools4Health project is to encourage and enable public authorities and other relevant actors to move from health promotion in schools, towards applying more holistic Health Promoting School approaches. This is supported through the initiative’s policy component, which seeks to raise awareness, mainstream and scale up Health Promoting School approaches among policymakers and practitioners, and to engage them in efforts to integrate this approach in their national/sub-national contexts. It means bringing together different stakeholders in policy and practice, across levels of governance and sectors, to optimise the contribution that schools can make to the health and wellbeing of students, staff, and the wider communities.

As a first step, the Schools4Health consortium focused on scoping the current policy landscape across different participating municipalities, regions and countries influencing or impacting school wellbeing. This was done by identifying and bringing together key actors in the respective partner countries to discuss the broader policy context around health promotion in schools, and identify what is required, from a policy perspective, to introduce or strengthen the implementation of the Health Promoting School model in school settings.

Visit the Schools4Health website to access all resources from the project https://schools4health.eu/