Embedding health and sustainability
It is important to integrate commitment to health within university strategic planning processes. This will then underpin core business performance and productivity. There are a number of ways in which this can be achieved including developing an over-arching health policy and using the technique of health impact assessment. Whichever approach a university adopts, the processes put in place will be monitored by a number of external agencies including the Quality Assurance Agency for England. In addition, universities have internal policy and planning processes which can be influenced using the health universities approach.
…an outline of the external and internal processes involved in policy and planning in the higher education sector
…examples of ways in which health can be integrated into policy and planning
…an explanation of health impact assessment as a tool to becoming a health university
…a discussion of how impact can be measured
Indentify key individuals within your university who develop university policies
Review the way in which health impact assessment could be a useful tool
Consider whether developing an overarching health policy is the best way of integrating health into policy and planning processes
Use the guidance materials already available to support policy themes such as work-related stress and reducing the risk of student suicide.
Healthy Universities is an important application of the settings approach, which has its roots in the Ottawa Charter and its assertion that ‘health is created and lived by people within the settings of their everyday life; where they learn, work, play and love’. The settings approach has already been used successfully in schools and further education settings to improve the health of children and young people.
A Healthy University aspires to create a learning environment and organisational culture that enhances the health, wellbeing and sustainability of its community, and enables people to achieve their full potential. Key to becoming a healthy university is an understanding of the whole system approach which recognises the interrelationships and interconnectedness of different elements of the university system, and emphasises the importance of the interactions between people, their behaviours and their environment. This holistic way of thinking does not separate health from other goals such as sustainable development (see Guidance Package on Connecting and Developing Synergy between Health and Sustainable Development Agendas). Details of the whole university approach can be found in the Guidance Package on Leading and Developing the Whole System Healthy Universities Approach.
In order to integrate this approach effectively into the ethos, culture, structures and processes of a university, the relevant systems and procedures need to be identified.
Universities work within national and institutional frameworks. There are a number of, procedures, reviews and audits which support strategic planning and policy development and implementation. If commitment to health and wellbeing is to be secured, it will be important to both engage with and influence these processes. In the University Context section, details are provided of the national framework within which universities work together with examples of institutional procedures that can be utilised to:
The importance of integrating a commitment to health within strategic planning processes and of building health-enhancing policy is widely acknowledged within health promotion and public health. This is evident within the Ottawa Charter with its emphasis on ‘Building Healthy Public Policy’, the recent European Union focus on Health in All Policies and the increasing interest in health impact assessment (see under Planning and Implementation). There is also a widespread acceptance that embedding health and wellbeing within organisations through the policy and planning processes is a key means of underpinning core business performance and productivity. Further information relating to the wider context and to making a case for Healthy Universities is provided in the Making the Case PowerPoint Presentation.
There are a number of national-level guidance materials that can support the Healthy Universities approach in relation to particular policy themes. These include:
The Quality Assurance Agency for Higher Education (QAA) looks at the standards of qualifications and the continuous improvement in the management of qualifications in colleges and universities. The main type of review process that takes place in England is the Institutional Audit. This audit is carried out by teams of academics who use their experience and knowledge to determine the level of confidence that they have in the way in which each university or college ensures that the appropriate level of academic standards and academic infrastructure are maintained. There are four elements of this academic infrastructure:
At the end of an Institutional Audit, the QAA publishes an HEI-specific report of their findings on their website. It also publishes an overview report which identifies emerging issues and good practice across universities.
Higher Education Funding Council – there are 130 universities and higher education colleges in England which are funded by the Higher Education Funding Council for England (HEFCE). HEFCE has four areas of activity:
HEFCE measures student experience through the National Student Survey, which takes place annually. The survey provides a student satisfaction score by institution and is influential in the strategic planning processes of universities and higher education colleges. HEFCE also monitors institutions links with business and the community through a Business and Community Interaction Survey, which measures the exchange of knowledge between higher education institutions and business and the community.
As HEFCE looks at learning, teaching and research, it also supports HEIs in workforce planning. It publishes a Workforce Framework, which identifies the key achievements and challenges for HEIs with particular reference to the conditions needed to maintain a healthy and sustainable workforce (see also Guidance Package on Leading and Implementing a Healthy Universities Approach to Enhance Staff Experience and Performance).
In its role of facilitating good practice HEFCE supports carbon reduction to support HEI in reducing their carbon footprint and published a national-level Strategic Statement and Action Plan on Sustainable Development In Higher Education.
Each university will take its own approach as regards internal structures and procedures. However, some common themes can be identified:
The strategic direction of a university is led by the Board of Governors. This Board is responsible for determining the educational character and mission of the University, for oversight of its activities and for the efficient use of resources.
The Executive i.e. the Vice-Chancellor and the Directorate Team lead the policy implementation, organisation, operations, direction and management of the University. They usually focus on strategic direction, strategic planning, student experience, finance and capital programmes, human resource management, student and academic services; facilities management.
Executive commitment is crucial to the success of a Healthy University initiative and a case study of how this can be achieved is available.
Academic standards are normally reviewed by an Academic Board. The Academic Board advises the Vice-Chancellor on the University’s academic and other activities. In particular, it considers and advises on matters relating to awarding taught and research degrees. The Academic Board is normally responsible for overseeing general issues relating to research, scholarship, learning/teaching and course validation/delivery; and for considering and advising the Vice-Chancellor and Board of Governors on the development of academic and related activities and the resources needed to support them.
Courses delivered within the higher education setting will be led by a Course Team. The content of the course will normally be reviewed every four to five years. These reviews utilise the expertise of an external assessor and determine whether the course is fit for purpose and whether it meets benchmark statements for the discipline. In order to influence the content of courses and work towards integrating health within and across curricula, it will be important to establish when a course is to be reviewed. Normally universities and colleges plan course reviews one year in advance as part of their strategic planning process. Where the commitment sought involves curriculum development, and then it is vital to link with the Course Team early in the review process. There may also be opportunities to make minor amendments or changes to the course content during the period of validation. A good point of contact for schedules for course validations and minor changes or reviews is a central quality assurance department or section. Examples of these can be found at the web sites below:
There is no ‘one size fits all’ approach to the integrating health within a university’s planning and policy processes. In some universities, an overarching health policy may be the most effective and influential starting point. In others, it may be more appropriate to work towards integrating health into existing policies.
When considering whether to develop a single health policy, the following points may be useful.
| Advantages of Overarching Health Policy | Disadvantages of Overarching Health Policy |
| Supports the whole systems approach | Difficulties in understanding the whole system approach and its value |
| Internal and external partners are explicitly engaged in focusing on health | It may be easier to achieve meaningful engagement through working to embed health into existing policies |
| Facilitates sharing good practice | Getting buy in from all parts of the university and partners can be challenging |
| Facilitates efficient consultation and involvement with students, staff and partners | Collaborative working across the university and with external agencies can be challenging |
| Raises the profile of health and wellbeing issues | Evaluation can be complex |
| Involves a proactive process rather than reacting and responding to other people’s agendas | Can be complex to implement and therefore slow to have an impact |
| Reduces duplication that may be involved in working across multiple policies | Does not necessarily achieve the aim of integrating health within the broader planning and policy system |
Many universities have existing policies that deal with areas such as health and safety, equality and diversity and active travel. In order to integrate a commitment to health and wellbeing explicitly into these policies (or into wider planning decisions), a useful technique is to use health impact assessment (HIA) to identify the anticipated impact of each policy or proposed development on health and wellbeing. Once identified, this can be explicitly described together with any action plans needed to reduce any negative impacts. The commitment to health and wellbeing will then become apparent and transparent.
HIA is a practical approach used to judge the potential health effects of a policy, programme or project on a population. Recommendations are produced for decision makers and stakeholders, with the aim of maximising the proposal’s positive health effects and minimising its negative effects. Whilst there are limited examples of HIA being used by universities, it evidently offers a potentially valuable tool to measure the health impact of any policy or plan in much the same way as universities measure the impact on equality and diversity. The advantage in using this as a tool is that health becomes an explicit criterion and can be meaningfully integrated into all policies.
There is no single agreed method for undertaking HIA, but as illustrated in Figure 1, there are normally 5 stages – screening, scoping, appraisal, reporting and monitoring:
Figure 1: Prospective Health Impact Assessment
Source: WHO
Useful guides to HIA, with examples of ‘real-life’ assessments and other resources, can be found at:
The way in which the whole system Healthy Universities approach is implemented depends upon whether there is a single overarching health policy or health and wellbeing are integrated into other policies. Whichever approach is deemed appropriate, it will be important to engage and consult with relevant groupings, services and agencies. A number of key internal and external partners can be identified, each with particular areas of influence:
| Key Internal Partner | Area of Influence |
| Academic staff | Curriculum development Research |
| Facilities management | Building design Estates Carbon footprint Catering Student accommodation |
| Human Resources | Stress management Mental health and wellbeing |
| Sports | Physical activity |
| Student Services | Mental health and wellbeing Student experience Counselling Finance |
| Students’ Union | Sports Alcohol policy Student hardship and debt Student experience |
| Sustainable Development | Travel plans Recycling Carbon footprint and carbon reduction Procurement |
| Key External Partner | Area of Influence |
| Primary Care Trusts (PCT) | Local health services e.g. chlamydia screening |
| Local authorities | Provision of sports facilities, support for parents with young children |
| GP practices | Local health services |
| Trades unions | Health and wellbeing of staff Health and safety |
| Public health networks | Local public health promotion activities Knowledge and skills development |
| Higher Education Academy (HEA) | Curriculum development. Skills development for academic staff |
| British Universities and Colleges Sport (BUCS) | Physical activity |
| Association of Managers and Heads of Student Services in Higher Education (AMOSSHE) | Services offered by student services within higher education institutions Healthy Universities Knowledge Community |
As highlighted in the Guidance Package on Leading and Developing the Whole System Healthy Universities Approach, one important governance mechanism for a whole system Healthy University initiative is a high-level steering group or management group. This will ideally be chaired by a senior manager, preferably at Directorate level, with representation from at least some of the key internal and external partners identified in the tables on the left.
This group will play a crucial role in leading the development, implementation, evaluation and monitoring of a health policy or of an action plan overseeing the effective integration of health in and across the university’s wider policy and planning process. Often, smaller, focused task and finish teams/groups are established to consider implementation of specific pieces of work, as illustrated by the example below:
Manchester Metropolitan University: Health Policy Group
Manchester Metropolitan University has an overarching Health and Wellbeing Policy led by the Health Policy Group and chaired by the Pro-Vice-Chancellor for Health. It is the role of this group to ensure that the values and ethos of the whole system approach are integrated into the university’s wider policies and procedures. It also ensures that policies and procedures are interconnected and that improvement to health and wellbeing is embedded in all areas of university activity. Specific policies around healthy eating, sustainable development, transport and mental health are implemented via small teams or working groups. In its early stages of development, mental health and wellbeing for students and staff was identified as a key issue. A small team with representation from organisational development, human resources, academic staff, technical staff, unions and Counselling Services developed a stress management policy and support tools for staff. This policy sits within the overall framework of the institutional health and wellbeing policy and will be further developed as a mental health and wellbeing policy for students and staff.
As discussed in the Evaluation Section of the main website, evaluation of the integration of health and wellbeing into the policy and planning process is an important means of evaluating the effectiveness and efficiency of the whole system Healthy Universities approach, thereby helping to enhance its credibility and legitimacy.
Evaluation is the systematic collection of data that will allow a judgement to be made about the value of a programme or intervention, allow reflection about what is happening and provide an assessment of whether you have achieved what you set out to do. Evaluation involves the systematic collection of information from a range of participants, making use of a variety of methods – and in health promotion, is often understood to comprise three types:
Source: WHO
More detailed guidance is available in the HIA Evaluation Cookbook WHO on the WHO website.
In designing an evaluation focused on policy and planning, it may be useful to consider the following questions:
During the evaluation of the process of integrating health and wellbeing into other university policies and processes the following should be considered:
When evaluating the impact of this integration, then the following should be considered:
Source: Taylor,L, Quigley, R. (2002) Health Impact Assessment. A Review of Reviews. London: Health Development Agency
Taylor, L. and Quigley, R. (2002) Health Impact Assessment. A Review of Reviews. London: Health Development Agency
World Health Organisation (WHO) (1986) Ottawa Charter for Health Promotion. Geneva, Switzerland: WHO.
World Health Organisation (WHO) (n.d.a) Health Impact Assessment [Internet accessed on 13 August 2014]
World Health Organisation (WHO) (n.d.b) Health Impact Assessment: use of evidence [Internet accessed on 13 August 2014]