Research into health promotion in schools to combat cancer

Cancer is now the leading cause of death in France, yet 40% of cancers could be prevented each year (1). Health promotion is therefore essential, particularly among young people. The health of children and adolescents is now at the heart of many public policies, spanning educational, social, and health issues. While early determinants of health are well identified, their impact on the reproduction of inequalities and on long-term individual trajectories calls for a paradigm shift: it is no longer just a question of treating or remedying, but of acting upstream, in living environments and from an early age. Among these environments, schools occupy a strategic position (2). It is universal, structural and continuous, providing an ideal space for developing behaviours, environments and skills conducive to good health. Therefore, health promotion in schools is not a peripheral objective, but a key lever for building a more equitable society that pays more attention to the well-being of its young people, thereby reducing the incidence of cancer in adulthood.

We now know that childhood and adolescence are crucial periods for establishing long-term health and for the onset of cancer. During these periods, factors such as diet, physical activity, mental health, addiction, abuse, environmental exposure and social inequalities can profoundly influence individuals’ biological, psychological and social development (3). From an early age, children from disadvantaged backgrounds are at increased risk of exposure to cancer risk factors: overweight, tooth decay, excessive sugar consumption, early initiation of smoking or alcohol consumption (3). A child of a manual worker is three times more likely than a child of a manager to be overweight, and nearly four times more likely to have at least one decayed tooth (4). Despite the overall and continuous decline in the consumption of psychoactive substances among minors since 2018 (5), certain behaviours remain a cause for concern: in 2022, 15% of 17-year-olds still smoked daily and more than a third had already experienced heavy episodic drinking (6). Excessive screen use is also a concern: in 2016, 66% of 11–17-year-olds exceeded the recommended limits, with effects on physical inactivity (6), sleep and mental health. These inequalities become entrenched and consolidated, manifesting themselves in adulthood as chronic diseases, psychiatric disorders or poor educational outcomes (7). These findings bolster a clear framework for action: if we want to influence the public health of tomorrow, we must invest in prevention and education about healthy lifestyles today — in the early years of life and in the most formative areas of young people’s daily lives, foremost among which is school.

Bearing this in mind, the ‘health-promoting school’ approach aligns with the Ottawa Charter and integrated health policies (8). It encompasses health education, a supportive school environment, and the commitment of the educational community. This approach is based on the idea of co-construction between the medical, educational and social spheres, recognizing that health is everyone’s responsibility. In France, this approach is a key focus of the National Health Strategy and has been incorporated into various public policy frameworks, such as the National Public Health Plan and the Interministerial Strategy for Mobilization Against Addictive Behaviours (2023–2027). It is also reflected in the Ten-Year Strategy for Combating Cancer (9) and the Roadmap for Mental Health, and has been championed by the Ministry of National Education since 2020. However, implementation still faces several challenges: regional inequalities, institutional compartmentalization, insufficient training for professionals, and a lack of shared indicators. It is precisely with this in mind that the Health Promoting School (HPS) (10) offers a comprehensive and participatory approach, based on the development of psychosocial skills and incorporating sustainable actions on school climate, sleep, physical activity, use of digital technology and mental health. This model fosters ownership of health issues and contributes to reducing inequalities in the long term.

To this end, the National Cancer Institute (INCa) organized an international French-language scientific conference in Paris on November 30 and December 1, 2023, in collaboration with leading institutions and scientific figures in the field. Entitled ‘Research in Health Promotion in Schools: The Latest in Research and Innovation’, the conference brought together over 300 researchers and professionals from nine countries. The conference provided an opportunity to review research on health promotion in schools, share innovative approaches and identify research prospects for the coming years. This editorial summarizes the ideas and perspectives that emerged during the conference, and introduces the contributions included in this special issue.

One of the key contributions of the work presented at this conference is the reminder that health promotion can no longer be conceived without a rigorous scientific background. In this regard, public health research — particularly, interventional research — is essential. For example, real-life studies have shown that validated psychosocial skills development programmes have a positive impact on psychoactive substance use, at-risk behaviours, mental health, school climate and educational achievement. The French Ministry of Education contributes to this by implementing empathy courses, which have been evaluated by Santé publique France. In the coming years, assessing the implementation of these programmes in different school contexts will be a priority. Similarly, researching the effect of environments (school premises, digital marketing and familial social norms) on health behaviours opens up prospects for structural action that is less focused on individual responsibility and more focused on transforming living contexts.

Therefore, promoting the health of young people is a shared responsibility. This requires interdepartmental coordination, commitment from local authorities, support for grassroots organizations, family involvement, and the active engagement of children and adolescents (11). A cultural shift is also required: moving away from a moralistic view of health and promoting a capacity-building approach (11), which empowers young people to take control of their choices and, consequently, their health. This requires changes in practices, sustained political will, and increased investment in research, training, and evaluation. The school environment provides an ideal setting in which to translate this shared responsibility into concrete health promotion actions.

This issue explores the integration of health promotion into school settings in relation to public policies, educational practices, and the current issues surrounding the prevention and reduction of social inequalities in health. It highlights recent research findings and the conditions necessary for the effective implementation and the levers to sustain the actions promoting student well-being. Building on the discussions that emerged from the conference, this issue brings together 11 articles and two commentaries focusing on three key areas: (1) the theoretical, ethical and conceptual foundations of health promotion in school settings; (2) factors contributing to health and achievement inequalities; (3) strategies for implementing, disseminating and sustaining interventions.

The first series of articles explores systemic approaches and the implementation of structured interventions. It focuses on initiatives implemented in school settings (Rostan et al.) and the conditions necessary to foster a comprehensive approach to health in schools (Guevel et al.). Other studies focus on social and territorial inequalities, highlighting the legal and structural challenges associated with protecting minors (Pitel et al., Minary et al.), as well as the specific obstacles to health promotion in vocational education (Le Corre).

Several contributions address the determinants of well-being and health literacy, analyzing factors that influence health education, with a particular focus on nutrition (Herr et al.), self-efficacy and life satisfaction (Salque et al.), and initiatives aimed at improving the school environment (Vandoorne et al. and Desmoriaux et al.).

Finally, this issue highlights the sustainability of innovative schemes by analyzing the durability of initiatives that promote physical activity (Laberge et al.), the implementation of an anxiety prevention programme in schools (Lane et al.), the transferability of a smoking prevention intervention among vocational high school students (Cousson-Gélie et al.), and a pragmatic model proposal to overcome the challenges of health promotion in schools (Valter et al.).

This special issue, at the crossroads between theoretical reflection and practical applications, is aimed at researchers, decision makers, education professionals, and anyone involved in promoting health in schools, offering rich and diverse perspectives on current and future issues in the field.

The INCa, the Directorate General for Health, the Directorate General for School Education, and the Interministerial Mission for the Fight Against Drugs and Addictive Behaviours, invite you to browse this unique publication on health promotion research in schools. By doing so, you will be contributing to the dissemination of the latest scientific knowledge for tomorrow’s progress.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.