The link between pupil health and wellbeing and

The link between pupil health and wellbeing and attainment – Why does it matter? Claire Robson Children, Young People and Families team Public Health England

The link between pupil health and wellbeing and attainment • What does the data tell us about the health and wellbeing of school age children? • What does the evidence tell us specifically about the link between pupil health and wellbeing and attainment? • What are the implications for practice? 2 Link between health & wellbeing and attainment

Life course approach 3 Link between health & wellbeing and attainment

Early Years

Why is this important? Approx. 80% of brain development takes place by the age of 33 Up to 20% of women develop a mental health problem during pregnancy or within a year of giving birth. This can lead to disordered early attachment with long term consequences for mother and baby 1 £ 23 bn per year: the costs of failing to deal adequately with perinatal mental health problems and child maltreatment 5 5 Link between health & wellbeing and attainment Around 1 in 10 (9. 1%) of children are obese at age 4/5 years 2 27% of children have tooth decay at age 5 years 4 7% of children around five years of age have speech, language and communication needs (SLCN)6

6 Physical activity among young children Health Survey for England 2012 Around one in ten children aged 2 -4 years meet the government recommendation* for physical activity (boys 9%, girls 10%) *At least 180 minutes (3 hours) of physical activity on all seven days in the last week Link between health & wellbeing and attainment

Primary school-age

8 Physical activity among children Health Survey for England 2012 Around two in ten children aged 5 -15 years meet the government recommendations* for physical activity (boys 21%, girls 16%) *Child recommendations for physical activity in CMO report 2011 – one hour moderate activity per day HSE reports at least 60 minutes of moderate to vigorous activity on all seven days in the last week Link between health & wellbeing and attainment

9 Physical inactivity among children Health Survey for England 2012 Around four in ten children aged 5 -15 years are physically inactive* (boys 39%, girls 45%) *Fewer than 30 minutes of moderate to vigorous activity on each day or 60 minutes or more on fewer than seven days in the last week Link between health & wellbeing and attainment

10 Prevalence of obesity among children National Child Measurement Programme 2014/15 Around one in ten children in Reception is obese (boys 9. 5%, girls 8. 7%) Around one in five children in Year 6 is obese (boys 20. 7%, girls 17. 4%) Child obesity: BMI ≥ 95 th centile of the UK 90 growth reference Link between health & wellbeing and attainment

11 Prevalence of overweight and obesity Children aged 2 -10 and 11 -15 years; Health Survey for England 2012 -2014 Child overweight BMI between ≥ 85 th centile and <95 th centile, child obesity BMI ≥ 95 th centile of the UK 90 growth reference. Link between health & wellbeing and attainment

12 Link between health & wellbeing and attainment

13 Oral health – not just teeth • Almost a third (27. 9%) of 5 year olds have tooth decay with 3 or 4 teeth affected (PHE 2012) • Hospital admissions for 0 - 4 yr olds were 9, 585 • Hospital admissions for 5 – 9 yr olds were 26, 356 • Stark inequalities exist with some of the most vulnerable, disadvantaged and socially excluded facing significant oral health problems - 44% of variation explained by deprivation Impact of poor oral health: • Pain • School absence/school readiness • Treatment Ø fear and anxiety Ø time off school and work. • Cost across all ages – £ 3. 4 billion NHS Link between health & wellbeing and attainment

Secondary school age

15 We are seeing a mixed picture… There are 7. 4 million adolescents aged 10 -19 living in the UK, accounting for 12% of the population and forming part of 4. 8 million UK households 1 • The under-18 conception rate is at its lowest level since 1969, but remains twice that of 16 other European countries 2 • Smoking, Drinking, Drugs survey shows declining trends in substance use overall in under 163 • Since 2000 the trend has been one of stabilisation and decline across all the main drugs from heroin to cannabis 3 1 - Hagell, Coleman and Brooks 2013 2 - Public Health England’s written response to the Health Education Select Committee inquiry into PSHE, July 2014 3 – Smoking, Drinking and Drugs Survey 2013 Link between health & wellbeing and attainment

16 • • • Overall, 26% of young people feel low at least once a week Increases with age Gender differences • • Overall, 22% of young people said they had selfharmed In comparison with other studies, self-harm increasing over the past decade Health Behaviour of School Age Children Survey England, 2014 Link between health & wellbeing and attainment

Life Satisfaction 15 year olds who report high life satisfaction by gender, 2002 - 2014 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 73% 65% 81% 67% 69% 74% 55% Boys Girls 2002 2006 17 Link between health & wellbeing and attainment 2010 2014

Feeling Low by Age, Gender and Country Link between health & wellbeing and attainment

Cyber-bullying Young people who reported being cyber-bullied in the past two months 35% 30% 25% 20% 31% 15% 28% 10% 16% 5% 10% 16% 12% 0% 11 year olds Base: All respondents in 2014 13 year olds 19 Link between health & wellbeing and attainment 15 year olds Boys Girls

Physical Activity Young people physically active for 1 hour a day 30% Overall 19% meet physical activity guidelines 25% 20% Boys 15% Girls 10% 5% 0% 11 13 15 20 Link between health & wellbeing and attainment • 22% of boys • 15% of girls

Physical Activity 21 Link between health & wellbeing and attainment

Eating Breakfast Young people who eat breakfast every day, by age and gender 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 83% Boys 74% 71% 50% 11 year olds Girls 65% 13 year olds 22 Link between health & wellbeing and attainment 49% 15 year olds

Energy Drinks Figure 3. 14: Young people who report drinking energy drinks at least five times a week 12% 10% 8% 6% 10% 4% 8% 6% 2% Boys 9% Girls 5% 3% 0% 11 years 13 years 15 years Base: All respondents in 2014 Approx 20% of boys and 12% girls across 13 & 15 year olds drink energy drinks 2 -3 times a week 23 Link between health & wellbeing and attainment

Sleep & Concentration Young people who report having at least 8. 5 hours sleep on school nights 100% 90% 80% 70% 60% 50% 93% Boys 93% 40% Girls 74% 73% 30% 48% 20% 46% 10% 0% 11 years old Nearly three quarters (73%) of young people reported having at least 8. 5 hours sleep on school nights 13 years old 15 years old Link between health & wellbeing and attainment However this decreased significantly by age

Sleep & Concentration Young people who don’t have enough sleep to concentrate, by age and gender • Overall, 22% of young people cannot concentrate at school due to lack of sleep • Increases with age • Gender differences 50% 40% 30% 20% 10% 0% 13%11% 25% 19% 43% 29% 11 year olds 13 year olds 15 year olds Link between health & wellbeing and attainment Boys Girls

What does the evidence tell us about the link between health and wellbeing and attainment?

Evidence – key messages 1. Overall pupils with better health and wellbeing are likely to achieve better academically 2. Effective social and emotional competencies are associated with greater health and wellbeing, and better achievement 3. The culture, ethos and environment of a school influences the health and wellbeing of pupils and their readiness to learn 4. A positive association exists between academic attainment and physical activity levels of pupils. 27 Link between health & wellbeing and attainment

“Promoting physical and mental health in schools creates a virtuous circle reinforcing children’s attainment and achievement that in turn improves their wellbeing, enabling children to thrive and achieve their full potential. ” Brooks, F. 2013. Chapter 7 : Life stage: School Years. In Chief Medical Officer's annual report 2012: Our Children Deserve Better: Prevention Pays health and wellbeing 28 Link between health & wellbeing and attainment

Pupils with better health and wellbeing are likely to achieve better academically • multi-level studies suggest that schools where students do better academically than might be expected from their social profile also do better in terms of health (Bonell C et al. 2013 Systematic review of the effects of schools and school environment interventions on health: evidence mapping and synthesis. Public Health Res 2013; 1. www. journalslibrary. nihr. ac. uk/__data/assets/ pdf_file/0016/71161/Full. Report-phr 01010. pdf) • experimental studies suggest that programmes to promote students’ broader wellbeing and development also benefit their academic learning (Murray N et al 2007 Coordinated school health programs and academic achievement: a systematic review of the literature. J Sch Health 2007; 77: 589 -600). • meta-analyses of experimental studies suggest that social and emotional skills and mental health programmes in schools both boost attainment (Durlak J et al 2011 The impact of enhancing students’ social and emotional learning: a meta-analysis of school-based universal interventions. Child Dev 2011; 82: 405 -32 and Farahmand F et al, 2011 School-based mental health and behavioral programs for lowincome, urban youth: a systematic and meta-analytic review. Clin Psychol 2011; 18: 372 -90. ) 29 Link between health & wellbeing and attainment

Social and emotional competencies 11% boost in achievement tests – linked to school programmes that improve pupils social and emotional learning (Durlak et al, 2011) Social and emotional competencies are a more significant determinant of attainment than IQ 30 Link between health & wellbeing and attainment (Dweck, 2012)

Social and emotional competencies A number of specific social and emotional competencies have positive impacts on academic achievement: RESILIENCE pupils who are confident about their learning, and who have a ‘growth mindset’ persist when faced with challenges pupils who can set goals, manage stress and organise their school work achieve higher grades pupils who use problem solving skills to overcome obstacles do better academically All can be included in structured, systematic teaching of social and emotional life skills 31 Link between health & wellbeing and attainment

School culture and ethos Protective assets: • Having a sense of belonging to school (Vienio et al 2007; Zeynep, 2010) • Having a teacher who is interested in you (Clea et al, 2002) • Positive relationships between pupils (Flook et al, 2005) • Level of engagement/active involvement in decision making (Jamal et al, 2013) • Personal Social Health and Economic Education (Ofsted, 2013) 32 Link between health & wellbeing and attainment

School belonging Agree (belong) Neither Disagree 4. 4% 5. 5% 10. 6% Weekly alcohol 11. 6% consumption 13% 20 % Drunkenness at least twice 17% 20 % 29% Been bullied 3. 1% 4. 3% 10. 9% Physical 8. 8% Fighting (3 x 12 months) 11. 5% 18. 8% Feeling low 34. 4% 50. 1% Regular smoker 33 21. 1% Link between health & wellbeing and attainment

Teacher connectedness Agree Neither Disagree Regular smoker 4. 2% 5. 1% 10. 1% Weekly alcohol consumption 11. 2% 12. 1% 22 % Drunkenness 14. 9% at least twice 20 % 31% Been bullied 3. 8% 3. 6% 7. 4% Physical Fighting (3 x 12 months) 9. 8% 9. 3% 16. 9% Feeling low 22. 9% 29. 2% 39. 5% 34 Link between health & wellbeing and attainment

Positive health behaviour • Children who are aerobically fit have higher academic scores • Physical activity linked to improved classroom behaviour • Participation in extra-curricular activities also positively linked with attainment • Promising associations between diet and academic attainment 35 Link between health & wellbeing and attainment

PSHE and health behaviours Health and wellbeing covered well poorly Self-harmed 19. 2% 30. 3% Smoked on 6 or more days in last 30 days 6. 1% 8. 4% Drunk alcohol 6 or more times in last 5. 5% 30 days 9. 0% Drunkenness 4 or more times in last 1. 1% 30 days 3. 0% On a diet 17. 5% 22% Eat breakfast every day 59. 7% 52. 5% • Young people have more positive health behaviours if health and wellbeing was covered well in PSHE classes 36 Link between health & wellbeing and attainment

Family life – time spent together Figure 7. 8: Young people who reported eating evening meal/dinner at least 3 -4 times per week with their families, by age and gender 90% 80% 70% Figure 7. 9: Young people who reported to have a family sports activities at least Boys once a week, by age and gender 60% 50% 40% 80% 78% 79% 76% 30% 74% 75% 70% 20% Girls 60% 10% 50% 0% 11 years Base: all respondents in 2014 13 years 15 years 40% 30% 20% 60% Boys 50% 44% Girls 34% 10% 31% 22% 0% 11 years 13 years Base: All respondents in 2014 37 Link between health & wellbeing and attainment 15 years

Implications for practice

Implications for practice a whole school approach Actions relating to each of the following areas: • Teaching and learning specific time allocated within the school curriculum in order to help students develop the knowledge, attitudes and skills needed to support health and wellbeing. • Ethos and physical environment promoted through the ‘hidden’ or ‘informal’ curriculum, which encompasses the leadership practices, values and attitudes promoted within the school, as well as the physical environment and setting of the school. • Engagement with families and/or communities recognition of the importance of these other spheres of influence on children’s attitudes and behaviours in school. 39 Link between health & wellbeing and attainment

40 Link between health & wellbeing and attainment

Ofsted inspection process Grade descriptors for personal development, behaviour and welfare (p. 49 -51) Outstanding: • Pupils can explain accurately and confidently how to keep themselves healthy. They make informed choices about healthy eating, fitness and their emotional and mental well-being. They have an age-appropriate understanding of healthy relationships and are confident in staying safe from abuse and exploitation. • Pupils have an excellent understanding of how to stay safe online, the dangers of inappropriate use of mobile technology and social networking sites. • Pupils’ spiritual, moral, social and cultural development equips them to be thoughtful, caring and active citizens in school and in wider society Grade descriptors for the effectiveness of leadership and management includes the example: “The curriculum also contributes well to pupils’ behaviour and welfare, including their physical, mental and personal well-being, safety and spiritual, moral, social and cultural development. ” 41 Link between health & wellbeing and attainment

42 Link between health & wellbeing and attainment

Support from PHE – useful links The link between health and wellbeing and attainment – a briefing for head teachers, school governors and teachers https: //www. gov. uk/government/publications/the-linkbetween-pupil-health-and-wellbeing-and-attainment Promoting children and young people’s emotional health and wellbeing : a whole school approach - a practical framework for promoting the emotional health and wellbeing of all children within education settings – content written by Children and Young People’s Mental Health Coalition https: //www. gov. uk/government/publications/promoting-children-and-young-peoplesemotional-health-and-wellbeing What works in schools and colleges to increase levels of physical activity? https: //www. gov. uk/government/publications/what-works-in-schools-to-increase-physicalactivity-briefing Injury prevention – resources to support schools to promote safe and active travel published: Road injury prevention: resources to support schools to promote safe active travel www. chimat. org. uk/schoolhealth 43 Link between health & wellbeing and attainment

“Healthy children become healthy people who create better lives for themselves, their communities and their countries” UNICEF 44 Link between health & wellbeing and attainment

Claire Robson Children, Young People and Families team Public Health England claire. robson@phe. gov. uk Follow us on twitter@PHE_UK Gemma Mann Yorkshire & Humber Public Health England gemma. mann@phe. gov. uk Tel: 07773 156313 www. gov. uk/phe and @PHE_Yorks. Humber