# Reforming schools into health promoting schools: perspective based on expert consensus from a European multistakeholder consultation

## TL;DR

Experts propose integrating health promotion into schools using a holistic approach, including exposomics tools to improve children's wellbeing.

## Contribution

The study introduces the use of the human exposome and observatory infrastructures in schools to address children's health and non-genetic risk factors.

## Key findings

- Experts identified systemic limitations in funding and sustainability of health education programs.
- The human exposome and exposomics tools were proposed to integrate multiple health risk factors in schools.
- Observatory infrastructures could systematically monitor children's health and non-genetic risk factors.

## Abstract

Every school on this planet should aim to become a healthy school. This is the motto of the WHO/UNICEF health promoting school strategic agenda (HPS). To address gaps and needs of children’s health and educational inequalities in schools, a qualitative study was set up to synthesize experts’ views and insights on school health programs and the HPS strategy in Europe. This multi-stakeholder consultation took place during an international children’s health workshop in Cyprus (October 2024). Data was collected through focus group interviews with ~ 30 experts engaged in a multistakeholder consultation between academics, governmental officials, teacher liaisons, and health professionals, including WHO experts and NGOs. The consultation identified the following themes: systemic limitations in funding and sustainability of health education/promotion programs, enhanced curriculum needs for health literacy, limitations in school physical environment, rise in behavioral risk factors among children and adolescents, and growing mental health needs. A consensus was reached regarding the prerequisites and recommendations towards improving both health and educational outcomes for children; the implementation of holistic methodological frameworks, such as that of the human exposome and its exposomics tools were collectively proposed to better deploy the HPS recommendations in the school community.

Conclusion: By adopting a holistic, multi-sectoral approach for schools and their communities (parents, teachers, authorities, the public) that embeds the exposomics tools and methodologies, future societies would ensure that educational institutions not only serve as centers for academic learning, but also as environments that nurture the physical, mental, and social wellbeing of students.
What is Known:• The importance of schools and their communities, as settings to efficiently implement health education and promotion programs for children (4–19 years of age).What is New:• The utility of the human exposome in integrating multiple children’s risk factors and health services that overall impact growth and development.• Observatory infrastructures in schools would allow for the systematic monitoring and integration of children’s health and of their multiple non-genetic risk factors, feeding into the health promoting school strategy.

What is Known:

• The importance of schools and their communities, as settings to efficiently implement health education and promotion programs for children (4–19 years of age).

What is New:

• The utility of the human exposome in integrating multiple children’s risk factors and health services that overall impact growth and development.

• Observatory infrastructures in schools would allow for the systematic monitoring and integration of children’s health and of their multiple non-genetic risk factors, feeding into the health promoting school strategy.

The online version contains supplementary material available at 10.1007/s00431-025-06736-y.