Prof. Dr. Johannes Keogh

Health promoting schools in New Zealand

This research describes the evolution of two schools in Auckland Region of New Zealand, becoming Health Promoting Schools.

Dr. Keogh and Mrs. Grace Benson


Manukau Institute of Technology
Mrs. Grace Benson
Mrs. Evelyn Hikuroa
Mrs. Elizabeth Farrell

Project Leader
Dr. Louise Rummel

Hochschule Fulda
Prof. Dr. Johannes Keogh

Dr. Louise Rummel, Mrs. Helen Scott
and Mrs. Grace Benson

Introducing Health-Promoting School (HPS) was first proposed by the WHO in the early 1980’s (Deschenes, Martin & Hill 2003 p.387). Whether this concept was successful or not is still unclear, as few HPS programmes were evaluated and the results subsequently published. Some of the research findings indicated that the results are “inconclusive as to how to operationalize the global nature of these approaches” (Deschenes, Martin & Hill 2003 p.387). Much has been written on the outcomes of the HPS approach but very little on the actual structures required for developing and sustaining the concept of a health-promoting school.

There is still a considerable amount of debate about the exact nature of Health Promoting Schools, as can be deducted from the available literature (Cushman, 2008; Rowling, 2005; Turenen, Tossavainen, Jakonen & Vertio, 2006). The World Health Organisation (WHO) originally gave an encompassing definition of HPS, which read: ”a Health Promoting School is one in which all members of the school community work together to provide pupils with integrated and positive experiences and structures, which promote and protect their health. This includes both the formal and informal curriculum on health, the creation of a safe and healthy school environment, the provision of appropriate health services and the involvement of the family and wider community in efforts to promote health (WHO, 1996:2, Cushman, 2008:232). A later version of the definition simply read: “A health promoting school is one that constantly strengthens its capacity as a healthy setting for living, learning and working” (WHO, 2010).

Health Promoting schools in New Zealand
Grant (2006) indicated that the philosophy of Health Promoting Schools in New Zealand is embedded in the Treaty of Waitangi. It is also based on a holistic approach, thus including all 4 aspects of health, namely the physical, social, emotional and spiritual aspects.

Implementing HPS in New Zealand was no easy process. It was well known that different countries used different approaches to Health Promoting Schools as well as different educational theories underpinning the concept (Grant, 2006; Cushman, 2008).

The so called “Fruit in Schools Project (FIS)” was introduced to encourage children to eat more fruit, while simultaneously making a contribution to the New Zealand Government’s cancer control strategy. The programme was introduced in 2 parts, namely during the first phase, schools were encouraged to take a Health Promoting School approach, supporting healthy eating, smoking cessation, physical activity and sun protection. During the second phase, children from high need primary schools (the decile 1-4 schools) were given fruit at school for a period of three years (

In October 2009, the New Zealand government confirmed that the FIS-programme was going to continue, even though it will in future be embedded in the HPS programme, and not overseen by the District Health Boards (DHB’s)(

Cushman (2008) described the New Zealand Government’s approach to implementing the concept of HPS. The framework used contained 3 distinct but interwoven processes. These were:

  1. The curriculum,
  2. The school organisation and ethos, as well as
  3. The links with parents and health providers (Cushman, 2008:234).

The decile rating was developed in New Zealand. It is therefore necessary to explain this system in order to improve the readability of the report.

The rating can be seen as an indicator measuring the extent to which schools draw pupils from low socio-economic communities. The indicator refers to Census data for households with school-aged children. A decile therefore is based upon a 10% grouping of the number of children within a specific geographical area, considering their socio-economic background in the calculation process (New Zealand Ministry of Education, 2010).

The aim of this study is to provide a descriptive case study on two Health-Promoting Schools (HPS) that have reached the Kauri level of the Tipu Ka Rea model. This case study will provide insight into the developmental stages of the Tipu Ka Rea model, the required infrastructure, and potential sustainability of two schools that have used the HPS model.

Ethical considerations:
Ethical approval for the research was obtained from the Manukau Institute of Technology Ethics Committee.

The study was conducted in 2 schools, namely a Decile 1 school and a Decile 4 School.

The Main findings can be summarised as follows:

  1. The facilitators indicated that the support of the school principle was vital for the transition to a Health Promoting school.
  2. The staff had to be involved in the whole process.
  3. The principles informed new teachers about the programmes already during the interviews.
  4. A big success of the programme was the improved parent attendance of PTA-Meetings (Whanau Evenings).
  5. The teachers indicated that they introduced sexual health content in their classes to prevent the high numbers of girls leaving school at 13 and having babies at 14. The success could not be evaluated.
  6. Several safety programmes (e.g. bike safety or traffic safety) were introduced.
  7. There was also a feeling of despair in some areas. Material taught at school could not be put into practice due to the high rate of poverty in the area.
  8. The children were all very proud to participate in the programme, especially if they were selected into certain offices.
  9. The Board of Trustees member and the community worker were very excited about the multitude of projects that could be offered to the children, such as the “Healthier eating” project including evaluating sausages and hamburgers on their nutritional value.

The project was completed in November 2010, and the project members submitted a publication for consideration.


  • Cushman, P. (2008). Health promoting schools: a New Zealand perspective. Pastoral Care in Education, 26(4), 231-241. doi:10.1080/02643940802472163.
  • Deschesnes, M., Martin, C., & Hill, A.J. (2003). Comprehensive approaches to school health Promotion: how to achieve broader implementation? Health Promotion International, 18(4), 387-396.
  • Grant, S. (2006) Tipu Ka Rea, to grow, expand and multiply: An operational model for developing sustainable Health Promoting Schools in Aotearoa New Zealand.
  • Grant, S. (2004) The language of health-promoting schools in Aotearoa New Zealand. Education and Health, 22(4), 56-57.
  • New Zealand Ministry of Education. 2010. 2010, 14:25.
  • Rowling, L. (2005) Dissonance and debates encircling “health promoting schools”. Health Promotion Journal of Australia, 16(1), 55/57.
  • World Health Organization. (1996) Health Promoting Schools, Series 5. Regional Guidelines. A framework for action. Manilla: WHO.
  • WHO. (2010) What is a health promoting school?

Internet pages


Contact Person:

Prof. Dr. Johannes Keogh
Hochschule Fulda
Fachbereich Pflege und Gesundheit

Marquardt Str. 35
D-36039 Fulda