National Health Education Standards: A Framework for Promoting Health Literacy
The National Health Education Standards (NHES) serve as a crucial framework for establishing, promoting, and supporting health-enhancing behaviors among students from pre-Kindergarten through grade 12. These standards provide guidance for teachers, administrators, and policymakers in designing or selecting curricula, allocating instructional resources, and assessing student achievement and progress.
The Importance of Health Education
The Elementary and Secondary Education Act, as amended by the Every Student Succeeds Act of 2015 (ESSA), recognizes the significance of physical education and health education by including them as part of a “well-rounded” education for all students. These subjects have demonstrated positive associations with academic growth and achievement, attention and concentration, and the development of lifetime healthy habits.
Historical Context and Development
Recognizing the need for national standards in various K-12 subject areas, the first National Health Education Standards were released in 1995, followed by a second edition in 2007. In 2022, a third edition, titled "National Health Education Standards: Model Guidance for Curriculum and Instruction," was developed under the guidance of the National Consensus for School Health Education.
The development of the new standards involved the creation of three groups: the Management, Development, and Expert Review Groups. These groups followed an iterative process that included the development of three drafts of the standards, with each draft undergoing review by all three groups.
The National Health Education Standards 3rd Edition is an initiative of the National Consensus for School Health Education (NCSHE). The National Consensus is a collaborative that was created to address the need to update health education standards for schools. It was important for key organizations to work together on this task.
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Funding for the National Consensus has been provided by the Foundation for the Advancement of Health Education. No government funds were used in development or production of this work. The National Consensus for School Health Education includes the Management Group, the Development Group, and the Expert Review Group. The Standards Writing Group which is responsible for writing the standards is comprised of members from the Development Group. A health scientist from the Centers for Disease Control and Prevention’s (CDC) Division of Adolescent and School Health serves as a technical advisor to the project and is an ex-officio member of the Expert Review Group.
The first draft of the proposed National Health Education Standards 3rd Edition was initially reviewed by the project’s Development Group and Expert Review Group. The second version of the proposed standards was nationally reviewed by over 500 school health education stakeholders including members of the Development Group, the Expert Review Group, school health education professionals from CDC, as well as health educators who are members of the five national professional organizations involved in the National Consensus for School Health Education and the Foundation for the Advancement of Health Education which is not a membership organization.
Key Components of the NHES
The NHES are written expectations for what students should know and be able to do by grades 2, 5, 8, and 12 to promote personal, family, and community health. The third edition includes eight standards with aligned performance expectations, reflecting, updating, and refining previous versions of the standards and performance indicators for health education.
The eight proposed standards and performance expectations reflect, update, and refine previous versions of the standards and performance indicators for health education. The eight standards and performance expectations are written for use by preK-12 teachers, local school and state directors of health education, curriculum developers, and health education teacher preparation faculty. The standards and performance expectations reflect the functional health knowledge, beliefs, and skills necessary for students to adopt and maintain healthy behaviors, achieve health literacy, and enhance health and academic outcomes. The standards are intended to guide the development of health education curricula, instruction, and assessment for preK-12 students. The performance expectations are designed to progressively challenge students at appropriate age and development levels.
These standards and performance expectations are designed for use by preK-12 teachers, local school and state directors of health education, curriculum developers, and health education teacher preparation faculty. They reflect the functional health knowledge, beliefs, and skills necessary for students to adopt and maintain healthy behaviors, achieve health literacy, and enhance health and academic outcomes.
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The Eight National Health Education Standards
The eight standards and their rationales are outlined below:
- Obtain health information: The acquisition and application of functional health information provides a foundation for promoting health and well-being. This standard includes essential concepts based on established theories and models of health behavior and health promotion. only on risk factors, but also on protective factors that can support health and wellness. societal, and environmental contexts.
- Identifying the influences that affect health: Health and well-being are affected by many, diverse influences within individual, interpersonal, community, societal, and environmental contexts. This standard focuses on identifying and evaluating internal and external factors influencing health practices and behaviors. Influences on health and well-being may include but are not limited to: personal values and beliefs, perceived and social norms, family, peers, schools, communities, culture, media and technology, policies, and the environment. This standard recognizes that the factors affecting health behaviors and outcomes, such as social determinants of health, are complex and impact people and communities differently. It also supports the individual’s ability to identify and use skills to recognize the types of influences, analyze the role of influences across a variety of wellness dimensions, and manage influences on health and well-being in digital and in-person settings.
- Access Valid and Reliable Health Information, Products, and Services: Access to valid and reliable health information, products, services, and other resources is essential to promoting health and well-being, and preventing, detecting, managing, and treating health issues and conditions. Access to valid and reliable information, products, services, and other resources promotes health and well-being in individual, interpersonal, community, societal, and environmental contexts. This standard focuses on identifying, accessing, and evaluating valid and reliable resources, including managing misinformation and disinformation, within digital and in-person settings. Media and technology play a significant and increasing role in the way individuals learn about and connect with ourselves, others, and the world.
- Using Interpersonal Communication Skills to Enhance Health: Effective communication promotes health and well-being in individual, interpersonal, community, societal, and environmental contexts. This standard focuses on expressive and receptive communication in digital and in-person settings. Combined with perspective-taking, communication skills help to recognize and strengthen interpersonal interactions, create and maintain relationships, express and interpret messages, and manage conflict.
- Using Decision-Making Skills to Enhance Health: Effective decision-making is needed to identify, adopt, and maintain health-promoting behaviors. This standard includes skills and steps integral to the process of effective decision-making to support health and well-being.
- Using Goal-Setting Skills to Enhance Health: Goal-setting is a process to support short- and long-term health and well-being goals. In addition to achieving a goal, a goal-setting process includes using practices, habits, and routines in daily life. This standard includes the processes needed to plan, reach, and reflect on health goals. Setting goals is a flexible process, and considers personal and social factors affecting health and well-being.
- Practicing Health-Enhancing Behaviors: Developing health practices and behaviors can promote health and well-being over the lifespan and reduce risk to self and others. Practicing health behaviors is critical to incorporating health-promoting habits and routines into all dimensions of wellness. Due to the increasing influence of technology, it is crucial to develop and apply practices and behaviors that support media balance and digital wellness.
- Advocating for Personal, Family, and Community Health: Advocacy skills are critical for promoting health and well-being within individual, interpersonal, community, societal, and environmental contexts. This standard helps learners develop and apply skills and strategies to increase agency and advocacy for self and others.
Impact and Implementation
States and local school districts across the country use the National Health Education Standards to develop or revise existing standards, frameworks, and curricula. HECAT results can help schools select or develop appropriate and effective health education curricula, enhance existing curricula, and improve the delivery of health education.
In Iowa, for example, the State Board of Education approved and adopted recommended physical education and health education standards on March 28, 2019. Iowa adopted the National Health Education Standards 2nd Edition and performance indicators as recommended Iowa Academic Standards for Health Education, which encompass the Health Literacy Standards of the 21st Century Skills.
Neither the recommended Iowa Academic Standards for Health Education nor the Health Literacy standards are or determine curriculum. Health education is required in kindergarten through 12th grade to teach from a multicultural, gender-fair approach with global perspectives incorporated at all levels in the education program. The education program requirements for human growth and development are written in law from kindergarten through 12th grade. Iowa Code 256.9(46)School districts shall incorporate age-appropriate and research-based materials into relevant curricula and shall reinforce the importance of preventive measures when reasonable with parents and students.School districts shall provide age-appropriate and research-based materials and a list of available community and internet-based resources to parents.
Collaboration and Support
The National Consensus for School Health Education builds on decades of collaboration among leading national health education organizations in the United States. The Consensus develops model guidance and other resources for educators interested in quality school health education within the framework of the Whole School, Whole Community, Whole Child model.
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Through the National Collaboration to Promote Health, Wellness, and Academic Success of School-Age Children, CDC Healthy Schools funds five national non-government organizations (NGOs) to complement and strengthen the work of state grantees. CDC Healthy Schools also funds the National Association of Chronic Disease Directors (NACDD) to provide technical assistance and professional development activities that will build the capacity of state health departments. This will equip school health and education leaders with greater knowledge, skills, and abilities to implement proven strategies that create healthier environments for students.
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