In the UK, with over 160 HE providers, 2.28 million students from increasingly diverse backgrounds and more than 410,000 staff (Higher Education Statistics Agency, 2016), the higher education sector offers potential to promote health and wellbeing and contribute to UK Government agendas such as obesity, mental wellbeing, physical activity, climate change and environmental issues (Holt & Powell, 2017). Not only are universities large and complex settings within which people learn, work, interact and socialize: they are also service providers; stakeholders and partners within their local communities; contexts within which many students undergo significant life transition, developing independence and life-skills; and ‘future shapers’ that play a key role in clarifying students’ and staff’s values and priorities and building tomorrow’s citizens, workers and decision-makers (Dooris, Doherty, Cawood, & Powell, 2012). Investing in health and wellbeing in a university setting is therefore a win-win situation: healthy learners and healthy staff will increase levels of achievement, performance and productivity; and universities have the potential to make a significant contribution to long-term health improvement of the population.

The University of Central Lancashire (UCLan) is located in Preston in the North West of England and is committed to helping people from all walks of life to make the most of their potential. Having gained university status in 1992, it grew rapidly and now has around 30,000 students and 3,000 staff. In 1995, it became one of the first few universities in Europe to establish a Healthy University initiative. In doing so, it became part of the wider movement for health promoting settings. Following evaluation of a two-year pilot phase (Dooris, 2001), substantive funding for the Health Promoting University post was secured. More than two decades later, the initiative is thriving and successfully embedded in the University’s 2015–2020 Strategy, which highlights its commitment to achieving “a healthy university committed to the physical and mental wellbeing of its students and staff” and “transformational change of the Preston campus…underpinned by a commitment to environmental sustainability.”

UCLan’s Healthy University initiative aims:

• To integrate within the University’s culture, processes and structures a commitment to health and to developing its health promoting potential
• To promote the health and well-being of staff, students and the wider community

In addition to these aims, it has six objectives which continue form a broad ‘agenda for action’:

• To integrate a commitment to health within the University’s plans and policies
• To support the healthy personal and social development of students
• To develop the University as a supportive, empowering and healthy workplace
• To create health promoting and sustainable physical environments
• To increase understanding, knowledge and commitment to multi-disciplinary health promotion across all University schools and services
• To support the promotion of sustainable health within the wider community

Co-ordinated from within the Healthy & Sustainable Settings Unit in UCLan’s Faculty of Health and Wellbeing, the Healthy University works to a three year planning cycle overseen by a high-level steering group and reporting to the university’s Safety, Health and Environment Committee and Executive Team. The Healthy University seeks to apply a whole organization and whole system perspective to all of its work, involving and connecting relevant stakeholders and adopting a range of approaches and mechanisms.

The Ottawa Charter for Health Promotion (WHO, 1986) has often been used to provide a framework to ensure that work is viewed from a range of different perspectives (i.e. policy, environment, service provision, skills development, community action). More recently, the Okanagan Charter for Health Promoting Universities and Colleges (2015) has provided a vision and action framework for higher education settings.

Whilst the Healthy University approach necessitates forging connections between different health topics, it can also be used as a means of ensuring that whole system thinking is applied to particular issues of concern. Food is one such issue that can usefully serve to illustrate this, as has been explored by Doherty, Cawood, and Dooris (2011).

Illustrative focus: health, safe and sustainable food

Within UCLan, the Healthy University Steering Group decided to establish a Healthy, Safe and Sustainable Food Working Group. Set up in 2010, this group has ten members from across the university, the students’ union and external agencies. Initial meetings mapped and highlighted the positive practices that UCLan and the Students’ Union already had in place, identified key areas for development, and forged linkages with other corporate agendas such as sustainable development. The group then developed a policy statement and a flexible and dynamic action plan, which forms part of the overall Healthy University Action Plan.

Links have been made with other UCLan groups in relation to research, curriculum and sustainable development. The group has been significant in bringing key actors together to manage the change process within the university – recognizing that shifts such as moving towards a healthier and more sustainable supply chain are ongoing and long-term. As part of its commitment to increase the provision of affordable, healthier, sustainable and ethical food, UCLan has undertaken consultation and training with chefs/catering staff and has reviewed menus, recipes, portion sizes and preparation methods – promoting ‘meal deals’ and increasing vegetarian and vegan options. It has also initiated moves towards an ‘edible campus’, achieved Fair Trade status and, working with an external supplier, provided clearer consumer information through appropriate labelling. In order to raise awareness of healthier eating, food safety and sustainable food messages have been integrated into menus and promotions. UCLan Catering Service offers beginners’ cookery courses for students and a student-led group, ‘Scran’, runs cookery demonstrations on campus and has links with local schools. Links have also been forged with Financial Services to promote healthy eating on a budget. The working group continues to bring a range of colleagues together to share work, develop new initiatives and facilitate collaborative and dynamic working.

Wider developments: UK Healthy Universities Network

In 2006, UCLan set up an informal network of HEIs interested in developing and implementing the Healthy Universities approach. This was strengthened and expanded through means of a HEFCE-funded project ‘Developing Leadership and Governance for Healthy Universities’, resulting in the establishment of the UK Healthy Universities Network, jointly led by UCLan and Manchester Metropolitan University. The Network’s vision states that “a Healthy University aspires to create a learning environment and organisational culture that enhances health, wellbeing and sustainability.” Its website www.healthyuniversities.ac.uk includes an online toolkit comprising a self-review tool, guidance packages and case studies (Dooris, Farrier, Doherty, & Powell, 2016).

Healthy Universities is one application of the settings approach, which Dooris (2005) suggests is underpinned by a conceptual framework characterized by an ecological model of health promotion, a systems perspective and a focus on whole system change. This approach means adopting a salutogenic perspective (Dooris, Doherty, & Orme, 2016), “shifting the focus from the deficit model of disease to the health potentials inherent in the social and institutional settings of everyday life” (Kickbusch, 1996: 5).

Drawing on early work by Baríc (1993), a conceptual model for Healthy Universities has been developed (Figure 1), which highlights the centrality of a whole university approach (Dooris, Cawood, Doherty, & Powell, 2010). This is underpinned by health promotion principles such as empowerment, equity, participation, partnership and sustainability (Rootman et al., 2001) and describes how a university can facilitate coherent and joined-up action by working across three key focus areas (relating to the environment of the setting, the core business of the setting, and connections to the wider community).

The approach involves not only responding to and being driven by both public health and core business agendas, but also securing high-level leadership, engaging a wide range of stakeholders, and combining high visibility health-related projects with system-level organization development. It also requires a proactive and systematic process that designates responsibilities and accountabilities; harnesses and connects health-related activities; assesses needs and capacities; sets priorities; implements and monitors progress against a delivery plan; conducts wider evaluation; and celebrates achievements (Dooris et al., 2010). A whole system approach encourages people to look for connections, see the wider context and to create a range of inter-related solutions rather than implement isolated and ad-hoc activities (Newton, Dooris, & Wills, 2016)

Figure 1: Healthy universities – A model for conceptualizing and applying the healthy settings approach to higher education. Source: Dooris et al. (2010)

• UCLan Healthy University

• UK Healthy Universities Network

• UK Healthy Universities Network Toolkit

• Okanagan Charter: An International Charter for Health Promoting University and Colleges (2015)

• Baríc, L. (1993). The settings approach – Implications for policy and strategy. Journal of the Institute of Health Education, 31, 17-24.

• Doherty, S., Cawood, J., & Dooris, M. (2011). Applying the whole-system settings approach to food within universities. Perspectives in Public Health, 131(5), 217-224.

• Dooris, M. (2001). The ‘health promoting university’: A critical exploration of theory and practice. Health Education, 101(2), 51-60.

• Dooris, M. (2005). Healthy settings: Challenges to generating evidence of effectiveness. Health Promotion International, 21, 55-65.

• Dooris, M., Cawood, J., Doherty, S., & Powell, S. (2010). Healthy universities: Concept, model and framework for applying the healthy settings approach within higher education in England. Final Project Report – March 2010. Preston: UCLan / London: RSPH.

• Dooris, M., Doherty, S., Cawood, J., & Powell, S. (2012). The healthy universities approach: Adding value to the higher education sector. In A. Scriven & M. Hodgins (Eds.), Health promotion settings: Principles and practice. London: Sage.

• Dooris, M., Doherty, S., & Orme, J. (2016). The application of salutogenesis in universities. In M. B. Mittelmark, S. Sagy, M. Eriksson, G. F. Bauer, J. M. Pelikan, B. Lindström, & G. A. Espnes GA (Eds.), The handbook of Salutogenesis [Internet]. Cham (CH): Springer; 2017. doi: 10.1007/978-3-319-04600-6_23. Retrieved September 6, 2017 from https://www.ncbi.nlm.nih.gov/books/NBK435864/.

• Dooris, M., Farrier, A., Doherty, S., Holt, M., Monk, R., & Powell, S. (2016). The UK healthy universities self-review tool: Whole system impact. Health Promotion International, 1-10.

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• Holt, M., & Powell, S. (2017) Healthy Universities: A guiding framework for universities to examine the distinctive health needs of its own student population. Perspectives in Public Health, 137(1).

• Kickbusch, I. (1996). Tribute to Aaron Antonovsky – ‘What creates health’? Health Promotion International, 11, 5-6.

• Newton, J., Dooris, M., & Wills, J. (2016). Healthy universities: An example of a whole-system health-promoting setting. Global Health Promotion, 23(Suppl. 1), 57-65.

• Okanagan Charter: An International Charter for Health Promoting University and Colleges. (2015). Retrieved September 6, 2017 from http://internationalhealthycampuses2015.sites.olt.ubc.ca/files/2016/01/Okanagan-Charter-January13v2.pdf 

• Rootman, I., Goodstadt, M., Hyndman, B., McQueen, D., Potvin, L., Springett, J., & Ziglio, E. (Eds.). (2001). Evaluation in health promotion: Principles and perspectives. Copenhagen: WHO Regional Office for Europe. Retrieved September 6, 2017 from http://www.euro.who.int/__data/assets/pdf_file/0007/108934/E73455.pdf

• World Health Organization (WHO). (1986). Ottawa charter for health promotion. Geneva: WHO.