Healthy Settings in Universities: A Comprehensive Review and Analysis

This report delves into the concept of 'healthy settings,' originating from the WHO's 'Health for All' strategy, with a specific focus on universities. It begins by highlighting the benefits of a green and healthy future, emphasizing sustainability and its positive impact on public health, while also addressing the influence of globalization and consumer culture on environmental and social determinants of health. The report explores the evolution of healthcare approaches, driven by technology and environmental awareness, and underscores the importance of creating healthy and sustainable environments for future generations. The report explores the WHO's definition of health and its implications, including the organization's health promotion initiatives, such as the 'Making Every School a Health Promoting School' campaign. It discusses the concept of settings as contexts for health promotion and the historical development of sustainable settings, including the Ottawa and Jakarta Charters. Furthermore, it examines the social determinants of health, the role of setting-based approaches in addressing health inequities, and the application of these approaches within educational settings, particularly universities. The report concludes by exploring the theoretical underpinnings of healthy settings and the practical application of these theories within university environments. The report addresses how universities can address health inequities and promote overall wellbeing among students and staff through various programs and initiatives. The report uses the provided references to support the discussion.

Running Head: HEALTHY SETTINGS
HEALTH SETTINGS IN UNIVERSITIES
Name of the Student
Name of the University
Author’s Note

1HEALTHY SETTINGS
Introduction
‘Healthy settings’ is a movement that was started by the World Health Organization due
to the WHO strategy of Health for All in 1980. This report will highlight the benefits of a green
and healthy future, developing a healthy place specifically a healthy university, imaging and
mapping of settings that is needed for everyday life. It will also differentiate between health in a
setting and a healthy setting, the international perspective about healthy setting and the critical
reflection about the theory of healthy setting will be given including the new ventures this topic
has the potential to explore. A green and healthy future is sustainable and healthy in the longer
run because it is done for the benefit of all. Globalization is linked with consumer culture, which
is devastating for the environment because it is the reason for climate change, social
determinants, health inequality and issues in public health settings (Dooris, 2004). It will be
focusing on healthy settings in universities and how WHO has initiated their help and
corporation in the sustainability in universities and educational settings. In the last few years
there has been an innovation and change in the idea of healthcare approaches in society and
educational settings due to a number of factors such as new technology, awareness about
unhealthy environment, environmental degradation and increasing health complications. A
healthy future is more attractive to the consumers due to many advantages such a healthy
standard of living, public health facilities, sustainability, and better prospect for the future
(Dooris, 2009). The opportunities and the upcoming challenges are another aspect that needs to
be given importance because of the development and ongoing rise in this field. Every individual
has the right to live in a healthy and sustainable environment so that they can live in a positive
background without stressing about the future resources (Dooris, 2016). Healthy setting
approach is appreciative of the health determinants that are operated in the settings of the

2HEALTHY SETTINGS
everyday life. In our everyday life, a number of factors become relevant for our wellbeing so it
requires the imaging and mapping of setting, so the future responses can be beneficial for the
upcoming generation.
Fig. 1. A Healthy Setting approach (Doherty & Dooris, 2006).
The healthy setting approach has been acknowledged internationally because it is
applicable and well known by many international organization. As it is a strategy by WHO, it is
well known all around the world and has been taken as a positive outcome. Contemporary
promotions of health consist of several social interventions that are slotted into intentional
changing of efforts in the contexts that are pre-existing (Poland, Green & Rootman, 2000). Many
conceptual frameworks and principles have been used by researchers and health workers to
include research, policy and practice. Seven conceptual frameworks of theoretical perspectives
were proposed such as the Ottawa Charter, salutogenesis, a socio-ecological approach (which is

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based on structure and agency with the help of sociological theories), whole system change,
organizational development, Dooris’s framework and systems thinking. The approach of healthy
settings in universities has a holistic approach to health, includes the whole university’s
requirements and facilities with the organizational culture and wellbeing of the youth (Scriven
and Hodgins, 2011).
Discussion
World Health Organization (WHO) defines health as a state of complete mental, social
and physical wellbeing and not only the absence of disease or infirmity. This definition was
coined in the year of 1946 as identified in the preamble of WHO constitution. The implication
and relevance of health is essential because it affects the wellbeing of the entire global
population. The implications of health is the ‘ability to adapt and self-manage’ in the aspect of
positive wellbeing and sustainability in the long run. The relevance of health is the wellbeing of
an individual in every parameters that helps them live a physically, socially and emotionally
positive environment. A good health includes a balanced diet, intervention of physical activities
and the recommended amount of sleep, which increases the chances of improving our health.
WHO has been promoting health because it is their major objective as an organization
that is known internationally, and is useful for several health interventions for the vulnerable
groups. A new health promotion has been started by WHO that focuses on health promotions in
schools. The name of the health initiative is “Making Every School a Health Promoting School”
and it will be developed through the promotion of Global Standards for Health Promoting
schools and it will serve more than 2.3 billion school age children that includes contributing to
WHO’s 13th General Programme of Work. This also aims towards achieving the target of ‘1
billion lives made easier’ by 2023 (Poland, Dooris & Haluza-Delay, 2011).

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A setting is a scenario, manner or position that is set and the working or the framework is
implemented with the help of the particular setting. Sometimes the time, place and the
circumstances are set for something to develop or occur. “Health is created and lived by people
within the settings of their everyday life; where they learn, work, play, and love” as written in
The Ottawa Charter (1986) (World Health Organisation, 1986).
Fig 2. The Ottawa Charter (Dooris, 2012).
The health setting is an approach that is based on health promotions and influencing more
acts of healthy living, and the Healthy Cities Programme is the best initiative for a successful
Healthy Settings programme. The concept of sustainability has been prevailing from a long time
and it has been a part of history in local, national and international levels. This concept emerged
through the idea of growing awareness because of several ecological crisis in the 20thy century.

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The roots of this concept is influenced by the longue duree approach that means ‘long term’, it
aims on events that happened over a long period of time, which is affected by the relation of
people and the world (Orme & Dooris, 2010). Global Health 2020 focuses on enhancing
costumer experiences, altering patient demographics, implementing new care models and
advanced technology that promises value based care (Poland, Krupa, and McCall, 2010).. Health
promotions have taken place in Ottawa and Jakarta by WHO, the 4th international conference on
health promotion known as New Players for a New Era is an ongoing health promotion in the
21st century. From 21 to 25 July in 1997, a meeting took place in Jakarta that was a critical
moment for the international strategies for global health. WHO’s member states made a
commitment to implement strategies for Health for All and the primary healthcare principles
after the declaration of Alma-Ata. In Ottawa, Canada, the first international conference on health
promotion took place 11 years back, this started the proclamation of Health Promotion for
Ottawa Charter (Dooris et al., 2018). These health promotions have been a guiding light for
implementing health strategies all around the world, it has its relevance and meaning for a health
promotion’s key strategies. Several milestones in health promotions have occurred due to the
corporation of WHO and the Geneva conference in 1954 opened many doorways for health
strategies all across the globe. It revolved around the armed violence and sustainable
development, it highlighted the role of the civil society in reducing the violence caused due to
social unrest, crime and war. The declaration was accepted in 2006 and it is followed by 113
states all around the world. The Geneva statement is strong and political, that focuses on the
impact of armed violence in the developmental context (Kickbusch, 2003). This was one of the
advances in the field of health promotion because it was aiming towards realizing the cost behind
armed violence, assessing the risks and vulnerability, prevention and reduction of violence

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through programs and promote practices and best lessons. The social determinants of health are
influenced by many aspects such as the birthplace, growth, lifestyle and other activities of an
individual. The health inequities of social determinants are the structural process and conditions
that distributed unequally in the society, the VicHealth framework is distributed in 3 sections of
influences and entry points known as the socioeconomic, political and cultural context, daily
living conditions and personal health related factors. The public health has been reviewed in a
number of settings that identified many approaches being used in these settings such as
community or neighbourhood, educational, healthcare, workplace or prisons. In the community
setting the health inequities were addressed with the help of local people to promote or volunteer
for the group. Volunteers have delivered parenting and child developmental support to mothers
through programmes in homes or communities and this improved the health of children in the
nutritional and cognitive aspect including the mother’s mental health. Several locality based
obesity prevention programmes were initiated in Australia but evaluation will give the correct
result about it being affective to health inequities (Whitelaw et al., 2011). The 9th Global
Conference took place in Shanghai, China, which committed to announce their political choices
for health. It focused on the link between wellbeing and health and the United Nations 2030
Agenda for sustainable development and its goals. The policies protects people from health risks,
health inequities and provides access to healthcare centres. The event in Shanghai marked the
30th year of the first global conference, which was held in Canada, Ottawa and the landmark of
Ottawa Charter for health promotion began. Setting based approaches have been beneficial for
health promotion as it has been evident a number of times according to the literature that is
found. The setting approach is used for addressing the social determinants of health and one of
the setting based health promotion is the educational setting. Health settings in universities have

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been going since a long time and it is a holistic understanding of health, and it creates an
environment keeping in check the priorities of the university (Newman et al., 2015). The
universities that promote health transforms the sustainability and health of the current and future
societies, while contributing to the welfare of the people, places and the global world. The
involve health into everyday operations, academic mandates and business practices. This activity
enhances the health awareness and health consciousness amongst the young generations, which
will be the flag bearers of the future generations. The campus culture has compassion, equity,
wellbeing and social justice that enhances the health of people. The idea of healthy and
supportive living is delivered to staffs, students and visitors as well. Health setting in educational
institutes serves the entire community and the society in future because educational programmes
are used (Dooris, 2006). The conceptual and theoretical underpinnings that converts the theory
settings into practice is a development because it enhances the role of health promotions. Seven
conceptual frameworks were designed for health promotions such as the Ottawa Charter, which
is a sociological approach. The healthy universities has few common theoretical perceptions that
have included the settings in a generalized manner. The collaboration with theory has been well-
developed at times, and some other theories gives value to the healthy setting research and
practices (Dooris, 2001). The argument that theorization is a key role to play in determining the
complications of settings, guidance, implementation and evaluation of programmes. Educational
settings have been helpful in addressing health inequities in universities because they cover a
broad population and they work effectively in modifying menus, changing the curriculums to
include health promotion and nutrition awareness, providing free meals to vulnerable
populations, reducing substance abuse, racism and increasing mental health awareness (Dooris,
Wills and Newton, 2014). Health promotion in universities also looks after the affected

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communities and finding pathways for community based support services. Health equity has
been addressed in universities and educational campuses, through providing free meals in UK
that has been a universal approach that can benefit all students and staffs all across the social
spectrum. The healthy setting in universities look like health promotional awareness programmes
and workshops that are approved by the concerned universities and their staffs (Doherty &
Dooris, 2006). The Healthy Universities program is an application for health promotion in the
educational setting and the involved universities including the stakeholders look after the
processing of the programme. The criteria is based on a number of factors such as benefits to
students, health awareness in the targeted population, eradicating public health issues and the
economic effect it can have on the people. Health equities in university setting is addressed with
the help of nutritional plan initiatives such as breakfast and meal programmes for the students.
The perspective of ecological model is reflecting the multidisciplinary influences and it is
determined by a complex interaction of organizational, environmental and personal factors. The
health inequities are addressed by the educational setting through universities that is eradicating
the socioeconomic, political and ecological factors affecting the public health (Dooris, Powell
and Farrier, 2019). These health promotions come with several opportunities and challenges,
which can be a future constraint. The university students and the faculties tend to be unhealthy
because they do not indulge into physical activities often except a few, this gives another
opportunity for the health promotions to target the educational settings. A wider understanding of
health is necessary to implement health policies and promotions because it gives a broad idea
about the criteria that has to be met. It includes several laws and rules that influences the type of
promotion that is being done in a university setting because many legislations have dietary intake
rules for different age groups (Doherty, Cawood, & Dooris, 2011). The common challenges

9HEALTHY SETTINGS
found in a university setting, is integrating the implementations into a corporate activity that
ensures a holistic approach to organizational development, implementing rules and regulations
for new policy areas such as stress, environment and drugs, which is a common issue in the
young generation, also funding such promotions are huge so they require several stakeholders
and government bodies. The health of the public and the earth is related to each other, this shows
that the health concerns of the public will affect the condition of the world. A setting based work
is dependent on an individual behaviour change found in a setting that helps in improving daily
living conditions or the socioeconomic aspect (Dooris, 2012).
Opportunities and Challenges
In order to foster the wellbeing of the university community, the Health Promoting
University (HPU) framework recommends universities to incorporate health into university
culture, procedures, and policy. Universities all over the planet have taken the stance, and an
action plan to direct universities into an HPU has been developed. Nevertheless, there is little
knowledge about how universities turn the theory into practice. This study examined how the
HPU system was applied by 54 universities from 25 countries around the world (Holt & Powell.,
2017)
Three thousand six hundred eighty-three students at a UK metropolitan university
were obtained for quantitative data. For the collection of data and simple descriptive statistics, a
60-question online student questionnaire focussing on seven main topically relevant fields was
used. The research recognised the need to seek alternative routes to engage students throughout
the academic year with effective health services. A prevalent need is highlighted by University
initiatives concerning healthy food options, cooking healthy and hydration. Risky behavior
involving alcohol, narcotics and tobacco use and sexual activities makes a powerful argument

10HEALTHY SETTINGS
that sexual health and alcohol control in the university should not be avoided (Dooris et al.,
2018).
The social, political and economic environment in which humans live, understand,
function and devote their recreational time influences their health and well-being and the WHO
argues that environments such as workplaces, schools and health services offer realistic
possibilities in the implementation of comprehensive strategies and adequate health promotion
resources. The exposure to health-care promotion is driven by a salutogenic approach, which
focuses on how health and wellbeing are produced, rather than simply viewing these sites as
platforms for accessing communities and treatments.
Universities ultimately affect the wellbeing of their societies through their institutional
policies and practices, strategic planning, communication systems, judgment-making methods
and service layout and delivery, all affecting well-being and standard of living as large
organizations, which include learning, working, communicating and living. An emphasis on
healthy employees has been strongly correlated to efficiency and productivity and indicates that
universities must provide high-quality services to healthy and good empowered staff. While
facilities play a major role, there has been proof that social media sites influence a spectrum and
interconnected psycho-social factors such as ' psycho-social effects, ' ' collective efficiency ' and '
cultural standards ' which is essential to well-being. Strong community connections can also
promote cultural values that make a positive impact on health and wellbeing. The value of the
cultural shift cannot be overlooked in university education environments where students develop
in trust and mature through their interaction in these societies (Dooris et al., 2018).
Healthy University has expressly emphasised the importance of developing atmospheres
and situations that endorse and preserve the health, wellbeing and human prosperousness, and

11HEALTHY SETTINGS
drawn on entire system approaches and systems thinking. While notified by a fundamental
salutogenic orientation, the execution and study of healthy universities tended not to be explicitly
framed with respect to salutogenic concepts. Like many other fields, university education is
shown a rising focus on well-being, adaptability and coping–viewpoints not the same as
salutogenesis but that directly apply to them. Universities are intricate systems and it will be
crucial that salutogenic thought thought process to notify, research, political and practice at
several levels in order to guide future developments. Thus, salutogenesis is an assets approach
towards gratitude self-efficacy hardiness epathy and humour (Kickbusch et al., 2003).
Asset-based community development (ABCD) is potentially a viable way to support
people with long-term health issues but the fact that this strategy is missing is accepted. In order
to provide a better understanding of those strategies that how they function and where they
function, a practical approach was taken, a study and definition mapping exercise of ABCD
methods for improving health. In total, 29 documents were considered relevant and included in
the examination. The concrete synthesis and idea analysis helped to define ideas most often
correlated with ABCD, but did not find any papers based on LTCs and thus no proof of the fact
that it enhances health outcomes for individuals with LTCs. This Article provides a clearer
conceptual framework on the key ingredients necessary for ABCD activation, although there is
no clearer understanding of how to execute ABCD or analyse it.
Economically and socially disadvantaged groups face substantially higher long-term
health issues, with rising severity of long-term conditions (LTCs) and multimorbidity levels.
More tailored personality-management approaches have been requested for vulnerable
communities and support for people with LTCs in conventional primary care settings has proven
difficult to achieve. It is generally accepted that alternative ways of helping LTCs are important.

12HEALTHY SETTINGS
The Marmot review notes that addressing vulnerable peoples ' health needs and
addressing health disparities requires a greater focus on building and improving healthy and
productive communities. One key recommendation is to engage with third sector organisations
and community groups, to empower people and local communities to improve their quality of
life and wellness. Similarly, the role of Chronic Care model involves mobilising community
resources and forming productive alliances to meet the needs of patients with community
organisations. This has to do with evidence of a strong role for social media in health promotion,
which can have significant implications for health outcomes. A new study evaluating a treatment
that enabled access for patients with stage 3 chronic kidney disease to local community services
has shown significant health progress. It demonstrates the potential advantages of extending the
support for LTC individuals by highlighting support for access to community programs and
personal support systems.
Introduction of all these methods in the university health care techniques can help in
growing the rate of university health care approaches.
There is a long and complicated theoretical history of economic development, human
well-being and achieving a prosperous future. For example, the American conservationist
Gifford Pinchot, in his 1910 book The Battle for environmental, stressed that the current
generation has the right to use what it wants and everything it needs from the now available
natural resources to use what we need to keep our descendants not deprived.
This vocabulary strikingly anticipates the seminal work of the World Commission on
Environment and Development (WCED), which describes "sustainable development" as a
mechanism that "respects current needs without jeopardising future generations ' capacity to
respond to their own needs." However, it addresses needs instead of encouraging growth or

13HEALTHY SETTINGS
serving consumer preferences as the defining feature of progress. WCED emphasises equity
concerns, in particular, the aim to reduce poverty in environments and communities where the
basic needs of people stay unfulfilled.
The goals of the universities project for health education are centered on the WHO health
policy for all, the Ottawa health promotion charter and the local Agenda 21 philosophy and
principles. The project's main objectives are: The principles of Health Development, Equity,
Sustainability and Solidarity represent, intersectional and interdisciplinary cooperation and
mechanisms of involvement and empowerment are pillars of the university that promotes health.
The design and construction of universities ' laws and practices is largely autonomous. As key
factors in strategy and policy changes, the university emphasizes health and sustainability.
Universities hire a number of academics, administrative staff, and administrators in a wide
variety of fields and are major industries. The University that promotes wellbeing tries to
establish opportunities for safe work and research and to incorporate best practices in workforce
policy. Higher education provides a variety of cultural and recreational activities, as well as
numerous services for staff, students and local people.

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Fig 3. Healthy setting in universities (Holt & Powell, 2017)
The university that promotes health supports diversity, flexibility and accessibility (in
terms of availability and costs) in the provision of services and facilities, ensuring that all staff
and students are able to meet their needs. The demographic profiles of their student, workers and
native populations have particular health issues. The university aims to identify the specific
medical needs of its individuals and provide a coordinated response of all primary health care
and social services inside and outside the university.
Universities offer formal training, but also provide opportunities to grow individually and
socially, often when students change their lives in a way that can influence all aspects of their
lives and adapt their values and opinions. The University, which promotes wellness, aims to
encourage students and employees to achieve their full capabilities in a controlled environment.
Universities run large fields with landscaped and built surroundings. The wellbeing-promoting
university aims at the creation and maintenance of healthy and productive physical environment
through its policies for buildings, land use, transport, waste treatment, purchases and energy.

15HEALTHY SETTINGS
Fig 4. Synergy of Healthy Setting (Newton, Dooris and Wills, 2016)
The main functions of universities are training and research analysis. As a center for the
gaining knowledge and development of curricula and research in all university faculties and
departments, it seeks to utilize its potential to contribute to health gains. In the local or regional
culture, the universities are a key contributor. The medical-promoting university seeks to
enhance its position as a wellness advocate in the region by developing relationships, serving as
a community resource, leading the way and using its strength as a health lobbyist.

16HEALTHY SETTINGS
Fig 5. A question of balance (Dooris, 2004)
All university representatives and their local communities are involved in the goals.
Nevertheless, interventions plans may be targeted at specific groups: student target groups, staff
or workers target groups, local communities or neighborhood targets.
Conclusion
To conclude this essay, the key points given above will be summarized and that is the
health promotional strategies used by WHO, several health initiatives taken by them to evolve
health promotions globally depending on the public health issues. The healthy settings in
universities have been found in many universities of UK such as Lancashire and Germany. The
university setting includes the administration, staff and students who take part in such initiatives,
it looks after several parameters of health because they keep evolving and researching about the

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changing health awareness all around the world. Many conceptual frameworks have been
designed for health promotions such as Ottawa Charter, salutogenesis, whole systems and socio-
ecological models that are being used for different promotions depending on the benefits of the
models. The approach of health settings in universities is essential for the social determinants of
health inequities such as socio-political and economic factors that are an obstruction in
promoting health in public settings. Sustainable development has been an important target for
people working in the healthcare industry because sustenance in the future affects a number of
factors for the future generation. The resources being used in a proper manner will ensure that
the young generation will be experiencing such facilities and this can only be enabled with the
help of healthy settings in universities.

18HEALTHY SETTINGS
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