As a result of societal changes and the Widening Participation agenda, students are not necessarily the privileged people that they once may have been.
Student experience and student performance are key drivers in the higher education sector and health is an important enabling factor in both.
As large institutional settings where students and staff spend a lot of time, HEIs offer the opportunity to develop life skills and health awareness among an increasingly diverse population.
This Guidance Package offers…
…an approach to enhancing student experience and performance by addressing health-related issues.
…practical advice on how to apply a whole university approach to student health within your institution.
…a collection of case studies offering illustrative examples activities undertaken by a number of different institutions from a variety of entry points.
Find out if your institution already has a Healthy University working group and join it. If not, explore if there is an appetite to establish one.
Start to build your business case by demonstrating the links between student health and wellbeing and core agendas such as recruitment and retention
Map any current activities which already take place that address student health issues. These may not be lead by the most obvious departments or teams such as student services but may be based in sports, libraries, facilities management etc.
Speak to your students union’ about the work they are doing to address health-related issues with students and find out how you can work with and build upon existing practice.
Key Concepts and Terms
Health is defined as ‘…a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity’ (WHO, 1948, p. 1).
Seen holistically, health is about the ability of individuals and communities to fulfil their potential.
A Healthy University promotes the health of students and can be described as one which aspires to create a learning environment and organisational culture that enhances the health, wellbeing and sustainability of its community, and enables people to reach their full potential.
Health promotion is defined as ‘…enabling people to increase control over, and to improve, their health. To reach a state of complete physical, mental and social wellbeing, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment’(WHO, 1986, p. 1).
A Healthy University is a setting for health promotion:
‘Health is created and lived by people within the settings of their everyday life; where they learn, work, play and love. Health is created by caring for oneself and others, by being able to take decisions and have control over one’s life circumstances, and by ensuring that the society one lives in creates conditions that allow the attainment of health by all its members’ (WHO, 1986, p. 3).
Health inequality is defined as ‘…differences in health status or in the distribution of health determinants between different population groups’ (WHO, n.d.)
Health Promotion aims to reduce health inequalities where they are unfair and avoidable.
The traditional discourse around health inequalities may seem incongruous with the student population particularly where local health services do not view students as a priority population. The socio-economic make-up of students will vary from institution to institution and generally students are less likely to come from groups of society with the greatest health inequalities.
‘Universities’ work to widen participation… has nonetheless seen the proportion of young people living in the most disadvantaged areas who enter higher education increase by around 30 per cent over the past five years, and by 50 per cent over the past 15 years’ (UUK, 2010, p. 3).
Students are not necessarily the privileged people that they once may have been as a result of societal changes and the Widening Participation agenda (DfES, 2003). Reducing health inequalities within the student body means understanding the demographic status of students e.g. gender, sexuality, religion, ethnicity, domicile, age, disability, care leaver status. Environmental factors may also be important such as type of accommodation, year of study and course as well as social factors and skills such as emotional intelligence, self confidence and independent living skills.
What is the ‘student experience’?
The term student experience is widely used but quite difficult to define. It links to the business and marketing aims of the university and is a means by which a Higher Education Institution (HEI) attempts to quantify the totality of the value added to life by attending that institution. As such it may include satisfaction with course, the social elements of university life, support and professional services, facilities, accommodation, vocational and CV building opportunities, geographical location and much more.
The main tool that institutions use to measure the student experience is the National Student Survey (NSS) commissioned by HEFCE, supported by the National Union of Students (NUS) and administered annually by Ipsos MORI. The NSS is a national initiative, conducted annually since 2005. The survey runs across all publicly funded HEIs in England, Wales, Northern Ireland, and participating HEIs in Scotland. The survey asks final year undergraduates and students in their final year of a course leading to undergraduate credits or qualifications to provide feedback on their courses in a nationally recognised format. There are 22 questions, relating to the following aspects of the student learning experience:
- Teaching on my Course
- Assessment and Feedback
- Academic Support
- Organisation and Management
- Learning Resources
- Personal Development
- Overall Satisfaction
Students are also given the opportunity to write in positive and/or negative comments on their student learning experience as a whole at their university/college.
The results from the main 22 questions are made available for prospective students and their advisors on the Unistats website to help them make informed choices of what and where to study.
The results are also made available to participating universities, colleges and students’ unions to use to facilitate best practice and to enhance the student learning experience.
What is ‘student performance’?
Performance is also a complex term but one more closely aligned to the academic mission. Broadly performance may be measured by academic attainment, attendance, and value added – by comparing entry grades to leaving grades to measure distance travelled.
Student health is an important factor in both student experience and student performance but this is an under-researched area which is difficult to quantify.
‘Student learning is at the core of the higher education academic mission. Health Promotion serves this mission by supporting students and creating healthy learning environments.’ (American College Health Association, 2005, p. 1)
Wider Context and Evidence Base
In 2004 Choosing Health, the national public health policy, described the importance of investing in student health and wellbeing in higher education. Starting university was highlighted as one of the key points and opportunities to positively influence health.
‘There will be natural points for people to review their health and develop their personal health guide:
…starting work or entering further/higher education’ (DH, 2004, p.114)
In 2006 a report on the successes of Choosing Health, Health Challenge England was published. It set out a strategic plan for delivery for the next two years and pointed to the importance of the setting for the health of the individual and the responsibility of all sectors for promoting health:
‘Lifestyles in the 21st century present new challenges for health that will affect our whole life. Health challenges stem from choices we make in the way we travel, the food we buy, the way we use our leisure, and in the way we interact with others – in particular as we grow and develop through life. Health Challenge England is about recognising the shared responsibility we all have to make the changes that will help improve our health.’ (DH, 2006, p.2)
Linking university activity with PCTs, local authorities and local strategic partnerships
National targets provide key drivers for student health promotion. For example the National NHS Chlamydia screening target aims to reach 30% of 16-24 year olds and a university provides a key opportunity for mass screening within that age group, linking national and institutional priorities.
Mapping student health needs to local health targets is also helpful to see how local and institutional targets can be aligned. For example Local Area Agreements (LAAs) were three-year action plans for achieving better outcomes, developed by councils with their partners in local strategic partnerships (LSPs). LAAs for 2008-11 were agreed with central government for all 150 first-tier local authority areas in England. Each one has been negotiated with the relevant regional Government Office, and includes a mix of national and local priorities and targets, relevant to the area. Choosing to align Healthy University work with these targets ated the opportunity for more effective joined up working. The principle of aligning Healthy University activity with local and national priorities is a strong one and links with structures that replace LAAs in the future will be important.
Why should universities promote the health of their students?
- As institutions concerned with quality and excellence, higher education institutions (HEIs) can invest in the health of their staff and students. In doing this, they invest in the overall health of the organisation.
- As large institutional settings where students and staff spend a lot of time, HEIs offer the opportunity to develop life skills and health awareness among an increasingly diverse population. They can also build health into their organisational culture, creating supportive working and living environments.
- As creative centres of learning, research, innovation and development, universities and colleges offer the opportunity to:
- educate and influence the next generation of decision-makers and managers
- build a multi-disciplinary understanding of public health within and across subject areas
- advocate for health at regional, national and international levels.
- As major local and regional institutions, universities and colleges can contribute to the health and well being of the wider population, and can mediate for healthy public policy.
Source: Healthy Settings Unit, UCLan
Things to consider:
- How is the accountability for ‘Student Experience’ and ‘Performance’ structured with HEIs?
- Building the business case. Demonstrating the links between student health and wellbeing and core agendas (e.g. recruitment; student experience; retention; performance; progression).
- What is the value of having a policy and procedures on student health and wellbeing?
- Identifying, engaging and developing ownership of key services.
- A settings based approach to an HEI – academic schools, campuses, residences, libraries etc.
- Ensuring consistency between the university and students’ union. (See Consultation and Partnerships section for more details).
Using the themes from the Ottawa Charter as a structure for whole system thinking a number of goals can be developed that are appropriate and relevant to the student experience as summarised on the right:
Build Healthy Public Policy
- Student health as a consideration in all university policies.
- Does the institution have a student health promotion policy / strategy?
- How do general policies apply to students e.g. alcohol, stress, smoking, bullying, equality and diversity.
- Student-specific policies – Student death policy, behaviour/code of conduct, management of infectious diseases, risk management.
- Linking or aligning the university to with local / regional health policy e.g. Local Area Agreements.
Create Supportive Environments (physical and social)
- Living and working/studying conditions should be safe, stimulating, satisfying and enjoyable.
- Considering all settings within the student lifestyle – residences, academic schools, cafés, Students Union venues, bars, medical practices, the community that students live and socialise within, online settings, libraries, sports facilities etc.
- Assessment of the health impact of a rapidly changing environment is essential and must be followed by action to ensure positive benefit to the health of students.
Strengthen Community Actions
- Need to have a commitment to the process of empowering communities, supporting, encouraging ownership and control. Involvement students in setting priorities, making decision, planning strategies and implementing them is at the heart of the Healthy University process.
- Facilitating a sense of community offering opportunities for students to make a difference in their communities.
Develop Personal Skills
- Need to facilitate learning, learning skills to prepare people to cope with/respond to health issues.
- Need to provide information, education for health, and enhance life skills for people to exercise more control over their own health and over their environments, and to make choices conducive to health.
- Curriculum content.
Reorient Health Services
- Need to review, audit and monitor current health services. Ensuring that student needs are considered in internal services, student-focussed services and other local services.
- Need to respond to service user needs, health research, importance of developing appropriate, inclusive and accessible services.
Planning and Implementation
What does it mean to apply a ‘whole university approach’ to student health?
Putting a whole university approach into practice will include asset mapping and needs assessment, leadership, review and development of policy and procedures, training and development, service development, curriculum links, research, campaigns and events, projects, internal and external partnerships as well as monitoring and evaluation.
The process model in figure 1 is a helpful tool to visualise the links between the steps in the process and audit current structures within universities. For a more detailed explanation of this model see the Planning and Implementation section of the Guidance Package on Leading and Developing the Whole System Healthy Universities Approach.
Figure 1: Healthy Universities – Operational Planning, Implementation and Management
Source: Adapted from Doherty, S. and Dooris, M. (2006)
Senior level leadership is essential to support a whole university approach in order to:
- Establish governance arrangements that link into the university decision making structures.
- Ensure/encourage senior level membership of the Healthy University steering group.
- Ensure awareness of cross cutting nature of Healthy University work and work across the whole university.
Things to consider:
- Where does the work sit within your university?
- Who will lead the work?
- Who needs to be involved – internal and external partners?
- Needs assessment
- Staff training needs
- What resources are needed?
- What structures need to be created?
- How is the work monitored and evaluated?
- How are students themselves involved in the strategy, design and implementation of actions and monitoring and evaluation?
Consultation and Partnerships
In setting up, designing, delivering, monitoring and evaluating interventions, consultation with the following groups is essential:
Students and staff
A joined up approach to student health is likely include the following services within a university:
Student services, sports and lifestyle department, academic schools, libraries, catering services, estates, community involvement / volunteering, professional services, environment team, health and safety, accommodation services, security, careers.
There are a numbers of key partnerships which, although not strictly internal, do often involve co-located services: Students union, non-university owned student residences, student medical practices, chaplaincy team.
Key external partnerships will vary by locality but may include. NHS services, the private and voluntary sector, city / county councils, crime and drugs partnerships, police.
The wider community including health professionals.
Evaluation and Impact
It is important to ensure that evaluation and measuring impact are integral to policies, procedures and work programmes. It is also vital to consider how impact is to be measured – both drawing on existing data and through tailored evaluation.
One way of doing this is to capitalise on existing data to establish baseline information – an audit of current practices and outcomes is helpful as something to measure success against. Information that may be already available to universities could include:
- Information about who your students are – numbers of international students, mature, local and student from care leaving backgrounds. Ethnicity, gender and other features of the population are useful to measure the effectiveness of interventions for defined groups.
- Information from health services – e.g. numbers accessing Chlamydia screening/mental health support/alcohol advice. Do/could local services collect information relating to students e.g. late night hospital admissions?
- Research done by the academic community relating to student health.
- Research done by students themselves either through the student union or as part of their academic course.
- Statistics on retention, absence reporting, behavioural incidents.
- Student Satisfaction Survey.
- Statistics from organisations such as Public Health Observatories which can provide population data which can reflect the demographics of the student population.