Health-promoting schools

Health-Promoting SchoolsEvidence for a Holistic Approach to Promoting Healthand Improving Health Literacy

Albert Lee

Centre for Health Education and Health Promotion, Faculty of Medicine, The Chinese University of

Hong Kong, Shatin, Hong Kong

Abstract Chronic diseases are now the major causes of death and disability world-wide, and non-communicable diseases (NCD) account for the majorityof the global health burden. About half of premature deaths are relatedto health-risking behaviours that are often established during youth andextend to adulthood. While these diseases might not be curable, they arepreventable. Prevention is possible when sustained actions are directed atindividuals and families, as well as at the broader social, economic andcultural determinants of NCD. A ‘life-course’ approach to promoting healthybehaviour should begin early in life. The aim of this article is to discussthe impact of the ‘health-promoting school’ (HPS) on improvements inyouth health.

HPS can be described as a holistic, whole-school approach in which a broadhealth education curriculum is supported by the environment and ethos of theschool. HPS moves beyond individual behavioural change to consider organi-zational and policy change such as improving the physical and social environ-ment of the school, as well as its curricula and teaching and learningmethods. Apositive culture for health would facilitate higher levels of health literacy byhelping individuals tackle the determinants of health better as they build thepersonal, cognitive and social skills for maintaining good health. There is rea-sonable evidence to demonstrate that the whole-school approach using the HPSframework is effective in improving health, ranging from physical activities andhealthy eating to emotional health. Schools adopting the HPS framework havedemonstrated changes in culture and organizational practice to become moreconducive to health improvement. These schools were reported to have betterschool health policies, higher degrees of community participation, and a morehygienic environment than non-HPS schools, and students in these schools hada more positive health behaviour profile.

Health promotion and disease prevention is essential to reduce thehealthcare burden of children and adolescents. HPS would help to combatthe global burden of childhood obesity by promoting healthy eating behav-iours and encouraging higher levels of physical activity. There are gaps inservice provision for children and adolescents from both the health andeducation perspective; the HPS framework has the potential to develop amechanism of closer integration with the primary healthcare system,making youth health services more school based and student centred.

CURRENT OPINIONAppl Health Econ Health Policy 2009; 7 (1): 11-17

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A new model of interconnection between HPS and different components ofprimary healthcare can be evolved to make services for disease preventionand health promotion more student friendly.

Chronic diseases are now the major causes ofdeath and disability worldwide, with 35 milliondeaths (of a total 58 million deaths) due to chronicor non-communicable diseases (NCD) in 2005.[1]

A number of risk factors, including high choles-terol, hypertension, obesity, and cigarette and alco-hol use, are responsible for the majority of thechronic-disease burden. One study[2] has concludedthat high lipid levels, smoking, hypertension, dia-betes mellitus, abdominal obesity, psychosocialfactors, insufficient consumption of fruits andvegetables, excess alcohol use and lack of regularphysical activity accounted for most of the risks ofmyocardial infarction worldwide in both sexes, atall ages, and in all regions. Evidence has suggestedthat disease prevention is possible by minimizingexposure to potential risk factors with sustainedactions directed at both individuals and families, aswell as at the broader social, economic and culturaldeterminants of NCD.[3] In many urbanized areas,health-risking behaviours that contribute to theleading causes of mortality and morbidity later onin life (e.g. cardiovascular disease, cerebrovasculardisease and malignant neoplasm) are often estab-lished during youth and extend to adulthood.Public health interventions to modify these riskbehaviours have the potential to reduce prematuredeath by 47% and increase global life-expectancyby 9.3 years.[1,4]

In Australia, the health of young people conti-nues to deteriorate: youth depression has tripledin the past 30 years, and about 30% of teenagersexperience mental health issues before the ageof 18 years.[5,6] Thirty percent of Australianteenagers drink alcohol regularly, 16% smokeregularly, and 50% of those aged <18 years havetried cannabis.[5,6] In the US, surveillance ofyouth risk-taking behaviour has also shown anincrease in youth health-risking behaviours.[7]

Surveys in Hong Kong in 1999 and 2003 revealedthat a substantially high proportion of youngpeople did not have healthy eating habits, did not

partake in regular exercise and were emotionallydisturbed.[8,9]

Most of the health-risking behaviours adoptedby children and adolescents will have greatestimpact on their health later in life, but this impacthas been underestimated by society. A ‘life-course’ approach to promoting healthy behav-iours should begin early in life. One way totarget health improvement in young people isthrough the ‘health-promoting school’ (HPS)framework. This article discusses the impact ofHPS on the improvement of youth health.

1. Health Improvement for Young People:the Health-Promoting School (HPS)

Effective health-improvement education givesindividuals or groups easier access to health in-formation and facilitates their understanding ofhealth-improvement concepts.[10] Different set-tings offer good opportunities to gain access toindividuals and groups. The WHO[11] defines a‘setting’ as having physical boundaries, a range ofpeople with defined roles, and an organization.Green et al.[12] expanded this definition to includethe arenas of sustained interaction, with pre-existing structures, policies, characteristics, insti-tutional values, and both formal and informalsocial sanctions on behaviours. ‘Healthy-setting’approaches such as HPS can address the deter-minants of health, particularly the social, culturaland political aspects, and can assist organizationsand institutions in creating a culture for healthimprovement.

A positive health culture would facilitate ahigher level of health literacy, helping individualsto build the personal, cognitive and social skillsthat determine their ability to gain access to,understand and use information to promote andmaintain good health.[10] School is an importantsetting in helping students to achieve healthliteracy.[13] Programme experiences and research

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ª 2009 Adis Data Information BV. All rights reserved. Appl Health Econ Health Policy 2009; 7 (1)

findings worldwide suggest that adolescents needaccurate information about their health anddevelopment; life skills in order to avoid risk-taking behaviours; counselling services; accept-able and affordable health services; and a safeand supportive environment.[14]

2. What is an HPS?

Health action is complex and the HealthAction Model (HAM), initially developed byProf. Keith Tones in the early 1970s, has pro-vided a theoretical base for the emerging specia-list professional practice of health education.[15]

The HAM identifies major psychological, socialand environmental influences on individualsadopting and sustaining health- or illness-relatedactions and consists of two major components:

1. the systems contributing to behavioural inten-tion that can be traditionally associated withhealth education;

2. the factors determining the likelihood of thatbehaviour intention being translated into prac-tice, which would be seen as health promotion.

The concept of HPS was first identified inthe early 1980s and has been advocated as an effec-tive approach to promote health in schools, ad-dressing the complexity of health action.[15-18] Itembodies a holistic, whole-school approach, inwhich a broad health education curriculum issupported by the environment and ethos of theschool.[16] It moves beyond individual behaviouralchange to consider organizational structure changesuch as improving the physical and social environ-ment of the school, as well as its curricula, teachingand learning methods.[11,17] It also enables thedevelopment of school policies conducive tohealth,[18] and provision of school health servicesbeyond routine screening.[16,18] This new approachto school health helps equip students with know-ledge and skills by shifting health into a moredynamic and political domain so that the deter-minants of health can be well addressed.[13]

The HPS concept can therefore help to ensuresustained positive changes and encourage schoolsto address the intertwined social, educational,psychological and health needs of school chil-

dren.[19] School communities can be regarded asmicrocosms of the larger community. Life-longlearning about health should begin at school.Health promotion and education efforts shouldtherefore be centred in and around schools, be-cause most children attend schools and schoolsalso constitute the ‘workplace’ for a substantialproportion of the population. Schools can pro-vide opportunities for children to develop andpractise skills to support a healthy lifestyle. It hasbeen suggested that well developed school health-promotion programmes are more effective thanthe traditional information-giving approach atencouraging children to adopt health-enhancingbehaviours and reduce behaviours that willcompromise their health.[20]

3. Effectiveness of HPS: Global Perspective

Recent evidence suggests that the way inwhich a school is led and managed, the experi-ences of students in participation and how theyare treated by teachers, and how schools engagethe local community build many protectivefactors for health and reduce health-risking behav-iours.[21-23] The school health-promotion program-mes shown to be effective in changing healthbehaviours were more likely to be complex,multi-factorial and innovative in many domains(curriculum, school environment and commu-nity), and to have a long duration.[21] Extensiveevidence has been gathered about what schoolsactually do in health promotion using the HPSframework.[24-26] In European countries, healthy-school award schemes are very popular as struc-tured frameworks acting as systems for themonitoring and recognition of achievements inimplementation of HPS.[27] Moon et al.[28] haveshown positive award-related changes in terms ofchildren’s health behaviours, and that the schoolsreceiving awards have greater health-promotingculture and organization. Audit-type evidencehas provided schools and the health and educa-tion authorities with comprehensive evidencethat can assist schools and authorities to con-centrate on any gaps and affirm quality work inschools.[28-31]

Effectiveness of Health-Promoting Schools 13


There is a comprehensive body of literatureshowing that schools have a major role to play inaddressing the obesity/overweight issue. Adultswho experienced school-based physical activity intheir youth are significantly more active in adultlife than those who did not.[32] Use of the HPSframework to address the issue of physical activ-ity has been shown to be more effective thanthe curriculum-based approach.[33] School is aneffective setting in which to promote healthyeating because over one-third of a student’s dailyenergy intake is consumed in the school environ-ment.[34] An integrated settings-based approachwith an interconnected framework such as HPSappears to work best.[21]

Adoption of an HPS framework using a long-term, whole-school approach rather than ad hocprojects to build the self-esteem of students andimprove the school social environment can buildprotective factors and minimize risk factors.[35-37]

Evidence from a number of studies has demon-strated the effectiveness of schools in addressingmental health issues, and the effectiveness of iden-tifying policies and priorities for doing so andcommitting to them in an ongoing way.[21,22,38]

4. Outcomes Data from the HPSMovement in Hong Kong

The Centre for Health Education and HealthPromotion of the Chinese University of HongKong (CHEP) launched the Hong Kong HealthySchool Award (HKHSA) in 2001, building on theconcept of HPS to create better health for stu-dents and to support them in improving thequality of their lives.[39] It was modelled on theWHO Western Pacific Regional Office HPS fra-mework covering six key areas (health policy,physical environment, social environment, com-munity relationships, personal health skills andhealth services), which was designed to assistschools in strategically addressing particularhealth issues.[25,28] Each key area has a number ofcomponents and a respective set of indicatorsbased on extensive literature and documentaryreviews that have been adapted to ensure rele-vance in the Asia-Pacific context.[26,27,40-43]

The CHEP designed a rating system to enableschools to fulfil the criteria for accreditation todifferent levels of the award (bronze, silver andgold), as suggested by theWHO.[25,28,39] The ratingsystems and indicators are directed at improvinghealth promotion actions and outcomes that havebeen validated by a group of HPS experts fromdifferent parts of the world during their field visitsto schools in Hong Kong.[26,27,43,44] A study wasconducted to test the hypothesis that students fromschools that had comprehensively embraced theHPS concept as indicated by the HKHSA hadbetter health outcomes than students from schoolsthat only partially followed the HPS concept.[45]

Those schools with awards clearly demonstratedgreater reductions in health-risking behaviours(including anti-social behaviours) and greater im-provements in emotional well-being than schoolswithout awards.[45] The proportion of primary andsecondary students eating crisps and chocolate‘four times or more over the last week’ droppedsignificantly among students in schools with theaward (-7.4% for primary students [p= 0.015],-6% for secondary students [p= 0.025]), and theproportion of primary students having streetsnacks ‘four times in a week’ dropped signifi-cantly from 21.1% to 12.2% (p< 0.001) in primaryschools with the award, while those schoolswithout awards showed an increase from 15.6%to 24.1%.[46]

The study also demonstrated a significant in-crease in life satisfaction score: 1.55 (p = 0.008)and 1.26 (p = 0.018) for primary and secondarystudents from schools with awards, respec-tively.[45] The proportion of primary studentsexhibiting self-harm behaviours significantlydecreased from 15.9% to 9.9% (p = 0.01) inschools with awards but increased in schoolswithout awards (4.6% to 8.9%), and the propor-tion of secondary students feeling hopeless andsad significantly decreased from 32% to 22.9%(p = 0.01) in schools with awards but increasedslightly in those without awards.[45] The propor-tion of primary students involved in physicalfights decreased significantly (-5.4%; p= 0.024)in schools with awards, while an increasingtrend was observed in schools without awards(8.7%).[45]

14 Lee


A cross-sectional study was also conducted byCHEP in 2004 using multi-stage random sam-pling among schools in Hong Kong involvedin the HKHSA scheme and those schools thatneither participated in the HKHSA scheme noradopted the HPS concept (non-HPS).[46] Stu-dents in the HKHSA category were found tohave statistically significantly better personalhygiene practice, knowledge on health and hy-giene, as well as access to health information,compared with non-HKHSA-school students.HKHSA schools were reported to have betterschool health policies, higher degrees of commu-nity participation and a more hygienic environ-ment. Students in schools that had adoptedthe HPS framework had a more positive health-behaviour profile than those in non-HPSschools.[46]

5. The Way Forward

Apart from early diagnosis and treatment ofdisease, an emphasis on health promotion anddisease prevention is essential to improve thehealth of children and adolescents and reducehealthcare burden. Schools employing the HPSapproach successfully improve the emotionalhealth of students, build important protective fac-tors for students’ health and well-being, minimizehealth-risking behaviours, and create an overallimproved social environment in the school.

Reducing childhood obesity is an example ofthe potential economic impact of HPS. In 2007,it was estimated that 22 million children aged<5 years globally were overweight.[47] The HPSframework has been shown to be effective in pro-moting physical activities and healthy eating inHong Kong and Western countries, which inturn could reduce the problem of childhoodobesity.[32-34,45,46] The lowest prevalence estimatesof hypertension and hyperinsulinaemia (at veryhigh risk of developing diabetes mellitus) in obeseEuropean children were found to be 21.8% and33.9%, respectively, and the lowest number of ob-ese children being affected would be 1.11 millionand 1.72million, respectively.[48] Hypertension anddiabetes constitute a major healthcare burden inboth developed and developing countries.

Gaps are always found in service provisionfor children and adolescents from both healthand education perspectives. Extensive review ofthe evidence has shown how a well developedprimary healthcare system that includes HPSwould reduce all causes of death, leading to betterhealth status, reduced hospitalization and costsavings despite disparities in socioeconomicconditions.[49,50] It is often difficult to reachyoung people with appropriate health services topromote health and prevent adverse healthoutcomes because of barriers to access as manyfactors (such as social, political and economicfactors) are beyond the control of individuals andthe healthcare sector.[51] Young people are bothless likely and less willing to overcome barriers toaccessing health services. Changes at the macrolevel for child and adolescent health, such asorganizational practices and policies, cannotchange individual health actions and behaviours.HPS would help to bring the services closer tochildren and adolescents. Linkage with the com-munity would help students to be familiar withthe variety of services available in the communityand to gain a better understanding of thoseservices. The teaching of health-emphasizing cri-tical thinking would help them to understand theissues of ‘why’, ‘when’, ‘where’, ‘what’ and ‘how’in relation to school health services. HPS shoulddevelop a mechanism of closer integration be-tween school and different components of pri-mary healthcare, with the primary healthcaresystem making the services for disease preven-tion and health promotion more accessible tostudents.[50,51]

Acknowledgements

Funding was provided by an unrestricted grant fromthe Hong Kong Government Quality Education Fund. Theauthor has no conflicts of interest that are directly relevant tothe content of this article.

References1. Strong K, Mathers C, Leeder S, et al. Preventing chronic

diseases: how many lives can we save? Lancet 2005; 366(9496): 1578-82



2. Yusulf S, Hawkens S, Ounpu S, et al., on behalf of theINTERHEART Study Investigators. Effects of potentialmodifiable risk factors associated with myocardial infarc-tion in 52 countries (the INTERHEART study): case-control study. Lancet 2004; 364 (9438): 937-52

3. Mant D. Principles of prevention. In: Jones R, Britten N,Culpepper L, et al. editors. Oxford textbook of primarymedical care. Oxford: Oxford University Press, 2004: 369-72

4. WHO. Primary health care: now more than ever. Geneva:WHO Report, 2008

5. Rowe L. This summer, start a small social revolution. AusFam Physician 2005; 34 (1-2): 11-2

6. Sawyer MG, Arney FM, Baghurst PA, et al. The mentalhealth of young people in Australia: child and adolescentcomponent of the National Survey of Mental Health andWell-being. Canberra (ACT): Commonwealth Departmentof Health and Aged Care, 2000

7. Eaton DK, Kann L, Kinchen S, et al. Youth risk behavioursurveillance: United States, 2005. J School Health 2006;76 (7): 353-72

8. Lee A, Tsang KK, Healthy Schools Research SupportGroup. Youth risk behaviour in a Chinese Population: aterritory wide youth risk behavioural surveillance in HongKong. Public Health 2004; 118 (2): 88-95

9. Lee A, Lee N, Tsang CKK, et al. Youth risk behavioursurvey, Hong Kong (2003/04). J Primary Care HealthPromot 2005; Spec. iss.: 1-47

10. Nutbeam D. Health literacy as a public health goal:a challenge for contemporary health education and com-munication strategies into the 21st century. HealthPromot Int 2000; 15 (3): 259-67

11. WHO. Healthy settings: regional guidelines for the devel-opment of healthy workplaces. Manila: WHO RegionalOffice for the Western Pacific, 1999

12. Green LW, Poland B, Rootman I. The settings approach tohealth promotion. In: Poland B, Green LW, Rootman I,editors. Setting for health promotion: linking theory andpractice. Thousands Oaks (CA): Sage, 2000

13. St Leger LH. Schools health literacy and public: possibilitiesand challenges. Health Promot Int 2001; 16 (2): 197-205

14. WHO. Programming for adolescent health and develop-ment: report of aWHO/UNFPA/UNICEF study group onprogramming for adolescent health [WHO technical reportseries, 886]. Geneva: WHO, 1999

15. Tones BK. Affective education and health. In: Cowley J,David K, Williams T, editors. Health education in schools.London: Harper and Row University Press, 1990: 300-21

16. NutbeamD. The health promoting school: organisation andpolicy development in Welsh secondary schools. HealthEduc 1987; 46: 109-15

17. Parsons C, Stears D, Thomas C. The health promotingschool in Europe: conceptualising and evaluating thechange. Health Educ J 1996; 55: 311-21

18. Lee A. Helping schools to promote healthy educationalenvironments as new initiatives for school based manage-ment: the Hong Kong Healthy Schools Award Scheme.Promot Educ 2002; Suppl. 1: 29-32

19. Lee A, Lee SH, Tsang KK, et al. A comprehensive ‘‘healthyschools programme’’ to promote school health: theHong Kong experience in joining the efforts of health and

education Sectors. J Epidemiol Community Health 2003;57:174-7

20. Hawkins JD, Catalano RF. Broadening the vision of edu-cation: schools as health promoting environment. J SchoolHealth 1990; 60: 178-81

21. Stewart-Brown S. What is the evidence on school healthpromotion in improving school health or preventingdisease and specifically what is the effectiveness ofthe health promoting schools approach? Copenhagen:WHO, 2006

22. Patton G, Bond L, Carlin J, et al. Promoting social inclusionin schools: a group-randomized trial on student health riskbehaviour and well-being. Am J Public Health 2006; 96 (9):1582-7

23. Blum R, McNeely C, Rinehart P. Improving the odds: theuntapped power of schools to improve the health ofteens. Center for Adolescent Health and Development,Minneapolis (MN): University of Minnesota, 2002

24. Marshall B, Sheehan M, Northfield J, et al. School-basedhealth promotion across Australia. J School Health 2000;70 (6): 251-2

25. Lee A, St Leger L, Moon AS. Evaluating health promotionin schools meeting the needs for education and healthprofessionals: a case study of developing appropriateindicators and data collection methods in Hong Kong.Promot Educ 2005; 20 (2): 177-86

26. Rogers E, Moon AV, Mullee MA, et al. Developing the‘‘health-promoting school’’: a national survey of healthyschool awards. Public Health 1998; 112: 37-40

27. Aldinger C, Zhang XW, Liu LQ, et al. Strategies forimplementing health promoting schools in a provincein China. Promot Educ 2008; 15 (1): 24-9

28. Moon AM, Mullee MA, Rogers L, et al. Helping schools tobecome health-promoting environments: an evaluation ofthe Wessex Healthy Schools Award. Health Promot Int1999; 14: 111-22

29. Lee A, Cheng F, St Leger L. Evaluating health promotingschools in Hong Kong: the development of a framework.Health Promot Int 2005; 20 (2): 177-86

30. Lee A, Cheng F, St Leger L, Hong Kong Healthy SchoolTeam. The status of health promoting schools in HongKong and implications for further development. HealthPromot Int 2007; 22 (4): 316-26

31. Lee A, Cheng F, Yuen H, et al. Achieving good standard ofhealth promoting schools: preliminary analysis after oneyear implementation of Hong Kong Healthy SchoolsAward Scheme. Public Health 2007; 121: 752-60

32. Dobbins M, Lockett D, Michel T, et al. The effectiveness ofschool-based intervention in promoting physical activityand fitness among children and youth: a systematic review.Ottawa (ON): Ministry of Health, 2001

33. Bell A, Swinburn B. What are the key food groups to targetfor preventing obesity and improving nutrition in schools?Eur J Clin Nutr 2004; 58: 258-63

34. Timperio A, Salmon J, Ball K. Evidence-based strategies topromote physical activity among children, adolescents andyoung adults: review and update. J Sci Med Sport 2004;7 (1): 20-9

35. St. Leger L. Protocols and guidelines for health promotingschools. Promotion Educ 2005; 12: 3-4

16 Lee


36. Wells J, Barlow J, Stewart-Brown S. A systematic review ofuniversal approaches to mental health promotion inschools. Health Educ J 2003; 103 (4): 197-220

37. Browne G, Gafni A, Roberts J, et al. Effective/efficientmental health programs for school age children: a synthesisof reviews. Soc Sci Med 2004; 58: 1367-84

38. Weare KC. Promoting mental, emotional and social health:a whole school approach. London: Routledge, 2000

39. WHO Regional Office for the Western Pacific. Health-promoting schools, series 5: regional guidelines. Develop-ment of health-promoting schools: a framework for action.Manila: WHO/WPRO, 1996

40. Centers forDisease Control and Prevention,National Center forEnvironmental Health, Division of Environmental Hazardsand Health Effects. Environmental public health indicatorsproject. Atlanta (GA): CDC, NCEH, EHHE, 2002: 2-3

41. Pattenden J. First workshop on practice of evaluation of thehealth promoting school: models, experiences and per-spectives; 1998 Nov 19-22. Bern/Thun: ENHPS, 1998:39-41 [online]. Available from URL: http://www.schoolsforhealth.eu/upload/pubs/FirstWorkshoponpracticeofevaluationoftheHPS.pdf [Accessed 2009 Mar 19]

42. Piette D, Roberts C, Prevost M, et al. Tracking downENHPS successes for sustainable development and dis-semination: the EVA2 project [Final Report]. 2002; 24[online]. Available fromURL: http://www.schoolsforhealth.eu/upload/pubs/TrackingdownENHPSsuccessesforsustainabledevelopmentanddissemination.pdf [Accessed 2009 Mar 19]

43. St Leger LH. Developing indicators to enhance schoolhealth. Health Educ Res 2000; 15 (6): 719-28

44. Tones K, Tilford S. Health education: effectiveness,efficiency and equality. London: Chapman & Hall, 2001

45. Lee A, Cheng F, Fung Y, et al. Can health promotingschools contribute to the better health and well beingof young people: Hong Kong experience? J EpidemiolCommunity Health 2006; 60: 530-6

46. Lee A, Wong MCS, Cheng F, et al. Can the concept ofhealth promoting schools help to improve students’ healthknowledge and practices to combat the challenge of com-municable diseases: case study in Hong Kong? BMC PublicHealth 2008; 8: 42

47. WHO. Childhood overweight and obesity [online]. Avail-able from URL: http://www.who.int/dietphysicalactivity/childhood/en/index.html [Accessed 2009 Mar 19]

48. Lobstein T, Jackson-Leach R. Estimated burden of paedia-tric obesity and co-morbidities in Europe: part 2. Numbersof children with indicators of obesity-related diseases. Int JPed Obes 2006; 1: 33-41

49. Starfield B, Shi L, Macinko J. Contribution of primarycare to health systems and health. Milbank Q 2005; 83 (3):457-502

50. Lee A, Kiyu A, Milman HM, et al. Improving health andbuilding human capital through an effective primary caresystem. J Urban Health 2007; 84 Suppl. 1: 75-85

51. Friedrich M. Twenty-five years of school-based health cen-ters. JAMA 1999; 281: 781-2

Correspondence: Prof. Albert Lee, Centre for HealthEducation and Health Promotion, Faculty of Medicine, TheChinese University of Hong Kong, 4th Floor, Lek YuenHealth Centre, Shatin, N.T., Hong Kong.E-mail: [email protected]



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Health-promoting schools