The ‘settings’ approach to health and wellbeing promotion was initiated following the Ottawa Charter (WHO 1986) which, among other things, drew attention to the ways in which the everyday places, arenas, organisations and institutions dynamically interact with people’s health and wellbeing. The charter helped to shift the focus from individual behaviour regulation to social and societal forces related to wellbeing. The first international initiative within this framework was the WHO’s Healthy Cities network. Following this initiative, a number of networks, projects and interventions took place, such as Health Promoting schools, kindergartens, hospitals, workplaces, and even health-promoting prisons. Additionally, the settings approach has been used for diverse types of activities and communities, for example wellbeing promoting playgrounds, sports clubs, and virtual, online or web-based communities.
The settings approach does not simply imply an ‘evidence-based’, fixed intervention to be implemented in different arenas with a view to promoting health and wellbeing (e.g. Whitelaw et al, 2001; Simovska and McNamara, 2015). Rather, it refers to a generic approach to promotion of health and wellbeing underpinned by the principles linked to the socio-ecological concept of health and wellbeing, societal determinants, equity, and empowerment and emancipation. Thus, a ‘setting for health and wellbeing’ is defined as a ‘place or social context where people engage in daily activities and in which cultural, historical, environmental, organizational and personal dynamics interact to affect health and wellbeing’ (WHO, 1998; 19).
Applied to schools and daycare institutions the definition is as follows:
“[A] health promoting school is a school that has constant focus on providing children and young people with opportunities to live, learn and play” (WHO, 1991).
Such a definition aligns well with the Danish laws relating to both daycare institutions and schools. The law on daycare, leisure time and recreational activities for children and young people § 7 states that ‘children should be provided with physical, psychical and aesthetic environments which promote their wellbeing, health, development and learning’ (Danish Social, Children and Integration Ministry, 2013). Similarly, the law on primary and lower secondary school (Folkeskoleloven) (Danish Ministry of Education, 2013) positions health and wellbeing in the national curriculum as a mandatory topic to be integrated across the subjects, with its own syllabus and teacher guidelines. Moreover, the ongoing school reform emphasises the importance of school as a setting for the promotion of health and wellbeing of pupils; the reform demands 45 minutes of physical activity for the pupils over the course of the school day and introduces wellbeing promotion and monitoring among the pillars of the reform. Last but not least, the reform requires cross-disciplinary and inter-professional collaboration among teachers and pedagogues with a view to both improving the wellbeing and learning of children and young people and optimising transition from daycare to school settings.
Figure 1 represents a modified version of the model of the health-promoting school that has been developed and researched in Denmark over the last couple of decades (e.g. Jensen, 2002; Sørensen and Koch, 2009; Simovska et al, 2015). The original model is an integral part of the Danish national curriculum for health, sexuality and family education (Danish Ministry of Education, 2014).
The sections in Figure 1 feature a few dimensions that dynamically interact and are in constant movement. These include, but are not limited to:
Physical environment of the school: this dimension refers not only to the size of the rooms and outdoor facilities, good indoor climate, lighting, noise, hygiene, but also to the architecture, interior design, furniture and facilities.
School culture, i.e., the social order or the ethos of the school, points to the quality of relationships among the pupils and between pupils and teachers, and with the school leadership as well as to existing policies in terms of wellbeing, health, bullying, safety, inclusion and diversity, etc.
Links with families and local community: refers to the collaboration with parents, the municipality and other stakeholders, for example different associations, NGOs, sports clubs and private actors that can help extend the possibilities for playing, learning and development beyond school.
School leadership and the internal collaboration: refers to the leadership style, governing strategies and the professional collaboration between the teachers, nurses and other involved professional groups within the school.
Emergent curriculum: points to opportunities for enacting pedagogical strategies as well as for whole school development, which are not only concerned with the key subjects and test results, but also consider the links between wellbeing, learning, play and subjectification, that is, a curriculum that allows and provides guidance for ‘coming into the world’ of children and young people as unique beings in the face of plurality and difference (Biesta, 2014).