Two approaches to school health promotion--a focus on health-related behaviours and general competencies. An ecological study of 25 Swedish municipalities.

The school is an important potential health-promoting setting for children and adolescents. Two main perspectives on school health promotion have been identified, one addressing health-related behaviours, the other stressing the development of general competencies. From a policy perspective, it is important to establish whether these two approaches are complementary or competing. This question was analysed by examining school administrations in 25 municipalities in Stockholm County, Sweden. An attempt was made to relate level of activity in line with each approach to general adolescent health outcomes. Data related to the two approaches were collected through the administration of a questionnaire. Outcome variables, measured as fraction of students qualified for upper secondary school, fraction of students with high alcohol intake, and fraction of 15-18 year olds suspected of crime, were measured on the basis of registry data. To control for structural patterns, socio-economic, demographic and system characteristics were gathered from public statistics. Spearman rank correlation coefficients were computed. Clusters of determinants assignable to each of the two approaches--promotion of health-related behaviours and supporting the development of student competencies--were identified. The two approaches were found to be negatively correlated. Thus, the perspective focusing on promotion of student health-related behaviours and the one emphasizing general development of student competencies seem to be competing rather than complementary. If this result is confirmed by other studies, it will have important policy implications.