The Importance of Health Education in Schools: Reflections, Representation and Recommendations

Abstract

The development of health literacy skills yields numerous benefits, including reduced premature mortality, better engagement with preventative health services (e.g., immunisations and screening) and medication compliance. Schools are an ideal setting to promote health education. The Personal, Social, Health, and Economic curriculum is essential in equipping children for adulthood, addressing health, relationships, and well-being. In recent years, commendable emphasis has been placed on mental health, healthy relationships, substance use, healthy weight, and physical activity. However, education concerning physical health, including immunisation, within the context of health literacy has not been prioritised. This Viewpoint piece examines several contemporary issues within the realm of health education, including contributions from those with lived experience, and proposes recommendations to complement broader health improvement models.

1. Review

1.1. Introduction

The school setting offers a powerful opportunity to influence health behaviours early in life, laying the foundation for a lifetime of well-being. Across the globe, health education has increasingly become recognised as a core component of public health strategy, with a growing body of evidence supporting its effectiveness when delivered within the school environment.

Health education in schools plays a crucial role in shaping lifelong behaviours, attitudes, and health outcomes among children and adolescents. The World Health Organisation (WHO) recognises health-promoting schools as a central platform for improving youth well-being, reducing health inequalities, and strengthening health literacy. With growing concerns around rising rates of obesity, mental health challenges, infectious disease transmission, and health misinformation, structured school-based health education has become increasingly important. Despite this widespread recognition, consistent international implementation remains uneven, and significant challenges persist in integrating health education systematically within national curricula.

1.2. Defining Health Education and Health Literacy

Health education refers to any combination of learning experiences designed to help individuals and communities improve their health by increasing knowledge or influencing attitudes [1]. A key objective of health education in schools is the development of health literacy—the ability to access, understand, appraise, and apply health information to make informed decisions [2]. Health literacy is strongly associated with improved health behaviours, enhanced communication with healthcare providers, reduced hospitalisations, and better disease self-management [3].

1.3. Impact

A robust body of evidence supports the effectiveness of school-based health education programmes. Langford et al. [4], in a Cochrane systematic review, found that Health Promoting Schools (HPS) models led to improvements in physical activity, diet, mental health, and reductions in tobacco and alcohol use. Interventions that engaged students, parents, and community partners and were reinforced by school policies achieved the most sustained impacts. Further support comes from the WHO Health Behaviour in School-aged Children (HBSC) study, which found that countries with structured health education programmes showed higher adolescent health literacy, better dietary habits, and reduced rates of risky behaviours [5]. Finally, a meta-analysis by Sharma [6] in 2006 similarly concluded that comprehensive school health programmes significantly improved health-related knowledge and behaviours among students.

These outcomes were more pronounced when educational programmes were supported by school policies and community partnerships, suggesting that isolated lessons alone are insufficient to create lasting change [1]. However, Lowry et al. [7]. argue that health education remains the “poor relation” in many school systems, under-prioritised, inconsistently delivered, and often detached from wider school values or culture. A number of important enablers and barriers have been identified that would enable school systems to reverse this.

A systematic review of school health policy measurement tools highlighted the critical importance of systemic factors in ensuring the successful implementation of health education. These include leadership support, adequate resources, and teacher engagement [8]. Programmes that align with these structural elements are more likely to be delivered effectively and with long-term impact. Sustainability is another major factor, as many interventions demonstrate short-term gains, but few persist beyond pilot phases unless they are integrated into the broader school culture. Herlitz et al. [9]. found that sustained outcomes are closely linked to the involvement of school leadership and community engagement. Additionally, the school environment itself contributes significantly to health outcomes. A synthesis commissioned by the National Institute for Health Research (United Kingdom) found that supportive environments—including physical facilities, demonstration of social norms, and inclusive policies—enhance the effectiveness of health education programmes [10]. This highlights the need for whole-school approaches that go beyond classroom delivery.

Despite the demonstrated benefits of school-based health education, several challenges hinder its consistent implementation. These include competing curriculum demands, limited teacher training, and varying levels of policy support. A scoping review by Chilten et al. [11]. noted that single-topic programmes, such as those focusing only on smoking cessation or physical activity, are less effective than integrated approaches.

1.4. Impact on Academic Achievement

Contrary to concerns that health education may detract from academic goals, research indicates that healthy students perform better academically. A review by the U.S. Centers for Disease Control and Prevention (2014) found that physical activity, nutrition education, and emotional well-being interventions in schools improved concentration, memory, and academic outcomes [12]. Additionally, schools that embedded health into their ethos reported fewer behavioural problems, improved attendance, and greater student engagement [10].

1.5. International Approaches and Variations

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Finland

Finland exemplifies the integration of health education as a statutory and examinable subject. Health education is embedded in the national curriculum, with dedicated lessons taught by trained professionals. Students are assessed through both coursework and national examinations, ensuring that health literacy is prioritised alongside academic achievement [13].

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Australia

Australia’s “Health and Physical Education” curriculum combines health literacy with physical development and personal safety. The curriculum addresses issues such as sexual health, nutrition, mental well-being, and digital safety. The Australian model emphasises inquiry-based learning, student voice, and local contextual adaptation (ACARA, 2021) [14].

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United Kingdom

In England, Personal, Social, Health and Economic (PSHE) education has been made compulsory in primary and secondary schools, covering physical and mental health, relationships, and sex education. However, health literacy is not assessed formally, and implementation varies significantly between schools. Teachers often lack specific training, and time allocation is inconsistent [7].

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United States

In the U.S., health education is state-dependent, with considerable variation in content, teacher qualifications, and delivery. The Centers for Disease Control and Prevention (CDC) offers national guidelines, but uptake is uneven. Some states mandate comprehensive health education; others provide minimal instruction. A 2019 report by the CDC noted that fewer than half of U.S. high schools provided comprehensive instruction on key sexual health topics [15].

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Low- and Middle-Income Countries (LMICs)

In LMICs, health education is often constrained by limited resources, overcrowded curricula, and lack of trained personnel. However, initiatives such as the “Focusing Resources on Effective School Health” (FRESH) framework developed by UNESCO, UNICEF, WHO, and the World Bank have made strides in integrating health and nutrition interventions into education systems. School-based deworming programmes, menstrual hygiene management, and HIV prevention campaigns have demonstrated positive outcomes in countries like Kenya, Bangladesh, and India [16]. The challenges of effective implementation of school-based health education globally are highlighted in

Table 1. Challenges to implementation of school-based health education globally.

Challenge	Summary
Curriculum overload	Competing academic priorities often marginalise health education, especially in exam-focused systems.
Teacher training	Many educators feel ill-equipped to teach sensitive topics such as mental health, sexuality, and substance abuse.
Lack of standardisation	Without national guidelines, schools may inconsistently interpret what constitutes adequate health education.
Cultural sensitivity	Different cultures’ interpretation of health needs can conflict with current evidence-based policy decisions.
Assessment gaps	The lack of formal evaluation mechanisms makes it difficult to monitor outcomes or ensure accountability.

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1.6. Whole-School and Community Approaches

Research increasingly supports a “whole-school” approach, where health education is reinforced through policies, practices, and partnerships. The WHO’s Health Promoting Schools model is a key example, emphasising coordinated curriculum delivery, supportive school environments, and family/community involvement (WHO, 1998) [17].

Herlitz et al. [9] argue that sustained school health interventions require leadership support, integration into school culture, and ongoing professional development. Programmes embedded in wider community strategies are more likely to address structural determinants of health and ensure equitable access to information and resources. Examples include peer-led education to foster engagement, school-based health centres to provide preventive services, and collaboration with local health authorities to align messaging. A significant challenge is providing the resources, both financial and human, needed to deliver health interventions across communities and schools. There can be tension between funding for health and funding for education, with both services aiming to provide preventative care but not always able to share resources effectively.

1.7. Culturally Responsive Health Education

Effective health education must be culturally relevant and responsive to the diverse experiences of learners, with evidence suggesting the importance of tailoring messages to local norms, languages, and values. This includes addressing gender equity, indigenous knowledge, and religious sensitivities. Without culturally appropriate and inclusive strategies, health education may fail to resonate with students or effect lasting behavioural change [18].

Community partnerships have proven effective in contexts where public health messages face resistance. In Scotland (UK), cross-cultural community partnerships have been suggested to engage with different cultures [19]

1.8. Digital Health Literacy and Emerging Themes

With the proliferation of digital media, young people are increasingly accessing health information online. While this creates opportunities for engagement, it also poses risks of misinformation. Digital health literacy—skills to evaluate and apply online information—has become a critical domain of school health education [20]. Pilot programmes in Canada and Germany have shown that integrating digital literacy into health curricula enhances students’ critical thinking, discernment, and self-efficacy. Topics include the safe use of digital health tools, understanding algorithmic bias in health apps and mental health impacts of social media.

1.9. Review Summary

The evidence is consistent: structured, well-delivered health education in schools yields significant benefits in health behaviours, academic achievement, and societal well-being. While international models offer valuable insights, local adaptation and political will remain crucial for successful implementation. As schools navigate a post-pandemic world marked by rising health disparities and digital transformation, integrating health education into core curricula is not only timely—it is essential.

However, for this potential to be realised, programmes must be sustainably implemented, culturally relevant, and supported at multiple levels of the education system. Ongoing research, combined with policy advocacy and community involvement, will be essential to creating resilient, health-literate future generations. As authors involved in health services research, education, public health, and with lived experience, we highlight the current challenges using a quasi-case-study approach based on our experiences in the English health and education system.

2. Representation

In the United Kingdom, health areas are governed by Integrated Care Boards, groups of health and social care professionals and also public representatives across acute, community and local government. The following points arose from discussions between members of this healthcare community in Leicester and surrounding areas and reflect the viewpoints of a range of healthcare professionals and members of the public. A review of the literature has been performed, but not a systematic one, as the primary aim was to promote discussion and reflection on this topic rather than provide a specific evidence base.

2.1. Empowering Children and Young People to Improve Their Future Healthcare: An English Perspective

Children in England are being let down by the National Health Service (NHS), as the Darzi report [21] unequivocally outlines. Over the past 15 years, infant waiting times increased by 60%. In 2023, over 100,000 children waited in emergency departments (EDs) for longer than six hours. These statistics reflect system capacity and demand rather than necessity. While parents of acutely unwell children often wait too long to be seen, did these children actually need specialist care from the outset? A review of children and young people presentations to EDs during the pandemic [22] revealed a decline in attendances by 63.9%. Although delaying emergency care can pose risks for children, during the early stages of COVID-19, there was little evidence that this shift in health-seeking behaviour worsened outcomes [23]. Indeed, mortality in children fell in the United States compared to the previous year [24]. The dramatic fall in ED attendances can be partly attributed to an eventual reduction in circulating respiratory viruses [25]. However, the size of this reduction at the onset of the pandemic outweighs the impact of non-pharmaceutical interventions, indicating that human behaviour was a much greater factor in the numbers seeking emergency care. A further argument highlighting a potential difference between demand and need is the impact of deprivation on children’s A&E attendances. According to Edge Health data, the two most disadvantaged quintiles of children aged 0 to 17 account for nearly half of all paediatric A&E visits [26]. This disparity is not accounted for by the two most deprived quintiles having the most seriously unwell children.

What can we do to balance demand versus need? Unfortunately, communities hold considerable myths regarding simple illnesses, which makes caregiver education crucial. Fever phobia describes a phenomenon where concern about fever is disproportionate to its outcome [27]. According to earlier research, 20% of parents believe that their child’s fever could cause brain damage [28]. If this is the first time a child has had a fever, regardless of how ill their child actually is, the diverse information needs [29] of caregivers often means they seek help from an ED. Ensuring that all caregivers have the skills and knowledge to manage minor illnesses in their and others’ children, and delivering this education during their own childhood, represents a viable solution.

2.2. The Potential for Collaboration with Education

The Department for Education in the United Kingdom expects schools to take responsibility for tailoring Personal, Social, Health, and Economic (PSHE) and Sex and Relationships education to address the unique needs of their pupils [30,31]. Whilst this allows adaption of content based on local context, the absence of a standardised framework risks inconsistencies in the educational content, particularly concerning vital health topics like human papillomavirus (HPV) and the vaccine [32].

PSHE is not an assessed subject, nor are its objectives designed to develop health literacy skills. This contrasts with countries like Finland, where Health Literacy is a mandatory, formally assessed subject [13] leading to qualifications relevant for university admission. Teachers delivering Health Literacy lessons receive university-level training in the subject. Enhancing health literacy is a cost-effective strategy for tackling non-communicable diseases and addressing social determinates of health inequalities [33,34], and thus reducing demand on NHS services. There is an increasing demand and expectation that schools should fulfil parental responsibilities in educating children about PHSE matters. However, it is important to acknowledge that up to 42% of adults in the UK fail to understand basic health information. Strengthening health literacy skills in children and young people will yield benefits for future generations of parents.

2.3. Student Co-Production and Engagement

Young people can influence the curriculum and how important health topics are received by co-producing educational resources and participating in lesson design and delivery. Empowering students to contribute to their own learning materials stimulates engagement and delivers more relevant and relatable content. Classroom education can be supplemented by “whole-school” work and community education, such as student and public health campaigns. This approach enhances the effectiveness of health education while fostering a sense of ownership and responsibility amongst young people regarding their health. It helps them to recognise that preventative measures like vaccination contribute to a collective responsibility for public health.

2.4. Representative Example: Strengthening PSHE with HPV Education

Human papillomavirus (HPV) is a common virus linked to cervical, throat, anal, penile, vulvar, and vaginal cancers. Whilst a highly effective vaccine can protect against these cancers, many young people remain unaware of HPV’s prevalence, transmission, and associated risks. With average vaccination rates receding to approximately 50% among boys and girls [35], data reveals a stark departure from pre-pandemic uptake and pronounced disparities across geographic and demographic segments.

Unequal access to vaccination persists both locally and globally, with vaccination knowledge being a contributing factor resulting in reduced vaccination coverage. Despite the importance of sex education as a practical and spiritual aspect of Islamic education, it remains underdeveloped due to cultural sensitivities and taboos. Discussions are often restricted to topics like menstruation, predominantly for females, leaving out broader, essential areas of knowledge that align with both Islamic teachings and modern health education standards. This limited approach leaves a gap in providing holistic guidance to children about their health, relationships, and responsibilities. Addressing these challenges requires a thoughtful, culturally aware strategy from healthcare professionals that integrates practical knowledge, community support, and sensitivity to the diverse backgrounds of the families they serve.

Schools can address this gap by incorporating culturally and age-appropriate HPV education into the PSHE curriculum. This would help demystify the virus and encourage open conversations around ways young people can support their health.

In some Asian cultures it is shameful to talk about anything related to sex, and when it concerns parents and children it is even more sensitive and complex. To start conversations with school-aged children, the school needs to set up a group with an adult mentor. The mentor should have a topic ready for discussion to open conversations. This will need some prior work to set up at school, and children should lead this with the help of an adult of the same gender. [Student, 14 years old]

2.5. Engaging Parents Through Students

There are limited health resources for parents from ethnically diverse backgrounds and who are not fluent in English; it takes proactive information-seeking to access them, an obstacle to this being the fact that these resources are frequently only available via English-language websites. Parents play a key role in decision-making regarding adolescent vaccination. Their support is essential to improving vaccine uptake. Schools can encourage students to act as ambassadors, bringing home accurate, up-to-date information about HPV to help bridge the knowledge gap between generations. Collaborative initiatives promote family engagement and ensure that critical messages extend beyond the classroom.

Children and parents should be helped to gain better understanding regarding HPV and its importance by professionals involved in providing the HPV vaccine (…) Schools should promote this to students/parents in assemblies through parent information workshops. It could also be promoted through faith settings like madrasa classes where school-aged children attend Islamic studies and workshops in community settings. [Zain’s mother]

2.6. Parental Viewpoint

Throughout children’s education, the presumption of parental healthcare decision-making predominates. This is a powerful enabler of the remote consent system allowing immunisation teams to vaccinate children in schools. Alongside this is the ability for older children, deemed Gillick Competence [36], to self-consent for their in-school vaccinations.

However, how do teenagers know that they can self-consent? How do they acquire and assimilate the knowledge required about vaccination risks and benefits to be sufficiently well-informed to be autonomous? It is currently impossible to prioritise this educational process within schools and many remain oblivious to the self-consent process, risking them missing out on their cancer-preventing HPV vaccination.

In the United Kingdom, on their 16th birthday, teenagers become responsible for their healthcare; simultaneously, parents lose access to their child’s medical records and, consequently, their ability to effectively advocate for them. Whilst some teenagers are confident, well-informed, and healthcare-literate, others are terrified of making a simple phone call.

Recently, my son needed his childhood vaccination record before heading off to university amid a measles outbreak. His red book was lost, and his NHS app showed only COVID-19 vaccinations, so this required interaction with his GP surgery. He couldn’t pluck up courage to phone them himself; it took two data-sharing consent emails, several phone calls and two weeks before he finally accessed his vaccination record through me. While I fully respect his autonomy and privacy in decision-making, I find myself more comfortable, as a parent, with the Gillick Competence model, evolving throughout childhood, than with the presumption of overnight healthcare independence at 16.

Including subjects such as “My Health” and “Navigating the NHS” in the educational curriculum will actively teach children about our NHS system, raising awareness about their health, maintaining wellness, preventative healthcare, and managing minor illnesses independently. Children need to understand their healthcare rights and be adequately prepared for the significant legal transition at age 16, enabling and empowering them to effectively access services and information so that they feel capable and confident to navigate the support around them.

3. Future Directions and Potential Policy Recommendations

To enhance the quality and impact of school-based health education, several key actions emerged from the discussions between healthcare professionals and the public. We acknowledge that these are limited by being the thoughts of a selected and focused group of individuals but highlight that they represent a diverse slice of the healthcare economy (including both professionals and the public). They are presented in this Viewpoint piece as a suggestion for further research and evaluation as opposed to evidence-based policy decisions

• National Policy Frameworks: Governments should develop and enforce minimum standards for health education content, delivery, and teacher training.
• Formal Assessment: Introduce summative and formative assessments to evaluate health literacy, especially in areas like digital competence and mental well-being.
• Teacher Training: Provide pre-service and in-service training programmes on evidence-based health education methods.
• Cultural Adaptation: Develop inclusive materials that reflect diverse cultural, linguistic, and religious contexts.
• Monitoring and Evaluation: Invest in longitudinal studies to measure outcomes, identify gaps, and scale successful models.
• Student Participation: Engage young people in curriculum co-design and peer-led initiatives to ensure relevance and ownership.

4. Conclusions

To ensure long-term success, health education must be embedded within national education frameworks and supported by clear policy guidelines. Improving and standardising health education, engaging students in lesson design and promoting communication between students and parents will enable schools to empower young people with the necessary knowledge to make informed health decisions. Noting that whole-school approaches that align health promotion with academic goals are more likely to succeed, this will contribute to reduced emergency department attendances, higher vaccine uptake, decreased stigma, and a healthier generation.