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Health Promoting University

Thomas Hartmann, Ute Sonntag

(last update 28 February 2015)

Since the World Health Organization’s (WHO) Ottawa Charter of 1986, the Settings Approach has been considered a core strategy in health promotion, while networking has become the central principle of action. In light of this, many setting-related networks of health promotion have been established on international and national levels (federal government, federal states, municipalities). In addition to regions, towns, schools and hospitals, the WHO officially declared universities and other institutions of higher education (for brevity in the rest of this text, the term ‘universities’ should be taken to include all higher-education institutions) to be a setting for health promotion as part of its Healthy Cities Project in 1997. The first international conference on Health Promoting Universities took place as early as 1996 in Lancaster (United Kingdom). This was followed by Edmonton/AB (Canada) in 2005, when the Edmonton Charter was agreed, Ciudad Juárez (Mexico) in 2007, Pamplona (Spain) in 2009 and Kelowna/BC (Canada) in 2015.

In Germany it was the universities in Lower Saxony in the Forschungsverbund Gesundheitswissenschaften Niedersachsen (Lower Saxony Health-Science Research Community) which started popularizing the concept of health promotion at universities in the first half of the 1990s. Building on this and in view of the interest coming from other states, the nationwide working group Arbeitskreis Gesundheitsfördernde Hochschulen (AGH) was established in 1995. Since then it has been co-ordinated by the Landesvereinigung für Gesundheit & Akademie für Sozialmedizin Niedersachsen e.V. (Association for Health Promotion and Academy for Social Medicine Lower Saxony, LVG & AFS). There is no ‘membership’ in the AGH in the strict sense; low-threshold participation is possible at any time. Currently more than 400 individuals from different status groups and hierarchical levels from more than 100 universities and institutions affiliated with universities are linked via a mailing list. The stated goal of the AGH is to introduce universities to the ten quality criteria of a health promoting university (see Table 1) and to explain them, as well as to suggest ideas as to how they can be implemented, based on a mutual exchange of experiences of all network participants.


A Health Promoting University follows the so-called settings approach.


A Health Promoting University is based on the concept of salutogenesis and focuses on conditions and resources necessary for health.


A Health Promoting University integrates the concept of health promotion into university policy (for example: mission statements, guiding principles for leadership, agreements regarding targets, service agreements, or other agreements).


A Health Promoting University integrates health promotion in a cross-cutting manner to guide all its internal processes and decisions as well as education and research.


A Health Promoting University employs a university-wide supervisory committee, which is responsible for developing health promoting structures and processes in all relevant areas of the university.


A Health Promoting University manages information in a transparent fashion. It uses the results of regularly conducted health reports to formulate goals and measures, which are derived from understandable, transparent, and accessible information and data. Health promoting measures undergo quality assurance evaluation during and after their implementation.


A Health Promoting University carries out health promoting measures, which are aligned with both behavioural and structural aspects that are organised following a participatory approach.


A Health Promoting University is committed to the principle of sustainability. Health promotion that operates in this way functions from a global perspective and is capable of accounting equally for social, ecological, economic, and cultural aspects.


A Health Promoting University integrates gender and cultural mainstreaming as well as the equitable treatment of humans with non-communicable diseases and disabilities. Such integration is an essential component of health promotion.


A Health Promoting University is connected to other universities as well as to the regions and communities that surround it.

Table. 1. Quality criteria for a health promoting university.
The quality criteria with explanations were developed in a two-year discussion process and were agreed at the anniversary event ‘10-Year Anniversary of the Working Group: Health Promoting Universities’ at the University of Bielefeld on 10 June 2005. Source:
http://www.gesundheitsfoerdernde-hochschulen.de/Inhalte/E_Gefoe_HS_internat/ AGH_INFO_QUALITY_CRITERIA_HPU_LOGO_ENG.pdf.

A comprehensive internet presence (www.gesundheitsfoerdernde-hochschulen.de), regular working-group meetings, expert conventions and national as well as international activities in association with different universities and stakeholders have led to a constant expansion of the network and its tasks. Germany does not yet have an up-to-date quantitative stock-take of the measures, projects and processes for the organizational development of a health promoting university. Universities generally follow the general social discourse about lifestyle questions such as protecting non-smokers and preventing alcoholism, as well as an expansion of sporting activities along with services to help with a balanced diet. On the level of organizational development, it means the establishment of occupational health management, which currently caters to the non-academic staff. A health management plan for students, with its own approaches and personnel resources, is under discussion. In addition, some of the universities, following general social trends, have made a particular commitment to sustainability and/or to being family friendly.

The more than 300 institutions of higher education in Germany currently have approx. 2.7 million students and 600,000 non-academic and academic staff (destatis.de 2014/15). Generally speaking, universities are subject to the 16 different state university laws. Since the end of 2014, the federal government has had a greater say in universities once again because of a change to the Basic Law (something that had been abolished in principle in 2007 as a result of a reform of the federal system and the freezing of the Framework Act for Higher Education). The two most important types of higher-education institutions are represented by the more than 100 universities (‘Universitäten’) and 200 universities of applied sciences (‘Fachhochschulen’), although the size of the institutions, their subject-specific and personnel composition, and their traditions vary greatly. The proportion of students among the people working, teaching, learning and doing research in the higher-education setting is generally more than 80%, while the non-academic and academic staff each make up around 10%.

The AGH is the largest networking association for health promoting universities in any single country worldwide. In spite of the administrative decision to install healthy universities as a part of the healthy cities unit in the WHO, the health promoting universities have never seen themselves as a sub-project of the Healthy Cities Project. Approaches to develop a concept for a ‘Regional Health University’, such as were proclaimed by the Organization for Economic Cooperation and Development (OECD) in 1977, provide a potential development model of health promoting universities as outlined in ‘Hochschulen für Gesundheit in regionaler Verantwortung’ (cf. Table 1). Its practical implementation has not yet occurred in Germany. Despite problems affecting all institutions (such as noise in educational facilities), there are still no further interfaces in the educational chain either. The national networking structure for the ‘Healthy Schools’ programme (Health Promotion and Schools) has already been discontinued. The healthy day-care institutions, which are not an official setting in the WHO sense, do not yet possess a national network (Health Promotion in Nursery Schools and Child Day-care Centres).

Analogies to other health promoting settings can best be made to (other) workplace settings, not least because of the comparable legal framework conditions of the Arbeitsschutzgesetz (Safety and Health at Work Act) and the preventive mission of the statutory health insurance (Gesetzliche Krankenkassen). The recommendations for action differ in their funding on the basis of SGB (Social Legislation Code) V sections 20/20a, where they are subdivided into individual measures, measures to promote health in the workplace, and measures in living environments (Setting Approach). In principle, all three funding threads in the statutory health fund system are open to applications from higher education institutions. So far it is primarily the introduction of health promotion in the workplace that has benefited in the context of health management in the workplace. These health-related approaches in organizational and quality development have found their way into university structures along with safety at work, which is increasingly leading to the employment of professional co-ordinators (Health Promotion and the Workplace). This development has been supported since the beginning of 2000 by, among other things, the introduction of two-stage study-degrees (Bachelor and Master) and a number of controlling measures (Bologna Process) (Training and Further Training in Health Promotion and Preventive Measures).

Students, who at 80 percent form the largest status group in the higher education setting, are generally considered a healthy population, despite various studies that have highlighted student health deficits. To what extent the introduction of the new course structures is having a negative impact on student health is the object of current research and debate, which is based on a university-specific health report (University Health Report). Universities have the potential to balance out unequal health opportunities caused by social factors (Social Inequality and Health). The educational opportunities of students from so-called educationally disadvantaged households can be supported by providing university health services. More than 50% in any year group in Germany now acquire the necessary qualifications to attend an institute of higher education, so that such attendance will become the norm in the future.
Health promoting universities have developed into an independent field of research and action in Germany. As a multifactor key setting they are also the living environment in which research, teaching and theory-to-practice transfer lead to scientific insights and provide major impetus to develop the setting approach further. The establishment of further health-science courses at universities leads to an increased emphasis on competence, both among lecturers and the students, which in turn leads to a demand for subjects, projects and final theses on health promoting universities. This potential for new insights could increase even more in the future through interactions with other settings, particularly those in the educational chain.

Faller G, Gesund lernen, lehren und forschen: Gesundheitsförderung an Hochschulen, in: Faller G (ed.): Lehrbuch Betriebliche Gesundheitsförderung, 2. Aufl., Hans Huber, Bern, 2012, 290-298
Gesetzliche Krankenversicherung Spitzenverband (ed.), Leitfaden Prävention, Handlungsfelder und Kriterien des GKV-Spitzenverbandes zur Umsetzung von §§ 20 und 20 a SGB V vom 21. Juni 2000 in der Fassung vom 10. Dezember 2014, Berlin 2014
Hartmann T / Seidl J, Gesundheitsförderung an Hochschulen, Veröffentlichungen zum Betrieblichen Gesundheitsmanagement der Techniker Krankenkasse. Hamburg: Techniker Krankenkasse (ed.), Band 20, 2. Aufl., 2014
Krämer A / Sonntag U / Steinke B / Meier S / Hildebrand C (ed.), Gesundheitsförderung im Setting Hochschule, Wissenschaftliche Instrumente, Praxisbeispiele und Perspektiven, Juventa, Weinheim/Munich 2007
Seibold C / Loss J / Nagel E, Gesunde Lebenswelt Hochschule - ein Praxishandbuch für den Weg zur Gesunden Hochschule, Veröffentlichungen zum Betrieblichen Gesundheitsmanagement der Techniker Krankenkasse, vol. 23, 2010
„Setting Gesundheitsfördernde Hochschulen“, Schwerpunktheft der „Prävention und Gesundheitsförderung“ with 16 specific articles, vol. 5 (3), 2010, 177-288
Tsouros A / Dowding G / Thompson et al (eds.), Health Promoting Universities - Concept, Experience and Framework for Action, WHO Regional Office for Europe, Copenhagen 1998;
World Health Organization - Regional Office for Europe, Health Promoting Universities Project: Criteria and Strategies for a new WHO European Network, WHO Copenhagen/Geneva 1997.

Internet addresses:
www.gesundheitsfoerdernde-hochschulen.de/ (website of the Arbeitskreis Gesundheitsfördernde Hochschulen)
www.hs-fulda.de/index.php?id=9248 (website Gesundheitsfördernde Hochschule Fulda)
www.uni-paderborn.de/universitaet/gesunde-hochschule/ (website Gesunde Hochschule Paderborn)
www.uhreport.de/ (website of the University Health Report)
www.uni-oldenburg.de/bssb/hochschulnetzwerk-suchtgesundheit/ (website of the HochschulNetzwerk SuchtGesundheit)

Links: Health Promotion in Nursery Schools and Child Day-care Centres, Setting Approach

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