3.8.9 United States

The approach implemented in the United States by the Centers for Disease Control and Prevention comprises seven long-term, integrated strategies to promote school health programmes. About half the strategies focus on programme implementation; the rest focus on research to assess and improve the impact of programmes. The strategies are described below:

· Create an operating unit at the national level employing staff experienced in implementing and conducting research on school health programmes. These staff are responsible for implementing the following strategies.

· Carry out health surveillance to define programme objectives, including the identification of priority health outcomes among young people, health behaviour that influences those outcomes, knowledge, attitudes, and skills that affect behaviour, and school policies and programmes to improve specific knowledge, attitudes, skills, and behaviour.

· Provide support for states, so that they can help local schools implement effective programmes. Resources are provided for the establishment of senior policy positions in the state departments of education and health to help local school districts improve and integrate the elements of school health programmes. This strategy provides each state the capacity and flexibility to determine and pursue its own unique interests, needs, and actions. In this fashion, collaboration between the education and health sectors becomes possible because the necessary resources are made available.

· Support and encourage national organizations in helping local schools implement effective programmes. Financial and technical support is accordingly provided to about 25 national nongovernmental education, health, and social service organizations, many of which have working affiliates at the state or local level.

· Convene relevant groups to help plan and implement strategies collaboratively. Representatives are periodically convened from: each state department of education, health, and social services; nongovernmental organizations; federal agencies; organizations representing higher education; and philanthropic organizations.

· Conduct research to assess programme effectiveness, including research to develop and evaluate promising interventions; research to assess the impact of efforts to help schools implement interventions; and evaluations to assess the impact of states’ efforts to help schools implement school health programmes.

· Synthesize the results of research and programme activities to enhance their applicability to the improvement of programme effectiveness. For this strategy, research registries and meta-analysis databases have been instituted to compile and synthesize the results of research conducted to reduce each of several critical risk behaviours (e.g. tobacco use, unsafe sexual behaviour), identify school health programmes that have shown evidence of effectiveness in reducing specific risk behaviour, and develop research-based guidelines for reducing risk behaviour through school health programmes.