The current work on school health promotion in Europe is organized through the Schools for Health in Europe (SHE) network with 43 participating countries represented by a national coordinator (Buijs, 2009). Building on the previous work within ENHPS and the International Union of Health Promotion and Education (Clift and Jensen, 2005; IUHPE 2009; St Leger et al., 2010) the SHE network endorses five core values (equity, sustainability, inclusion, empowerment and action competence, and democracy) and five pillars (whole school approach to health, participation, school quality, evidence, schools, and communities) as a common basis of the SHE approach to school health promotion (Buijs, 2009). 

Over the 30 years of use, the concept of health-promoting schools has been interpreted differently in different cultural, geographical and educational contexts, thus obtaining a wide range of meanings. Different interpretations emphasise different aims and expected outcomes of health-promoting schools. A large variety of approaches and related underlying values have been repeatedly debated in the literature (e.g. Green and Tones, 2010).

The gap between the analytical conceptualisations and the realities of practice thorough Europe and wider is extensive. Even though the systematic review of the effectiveness of the health-promoting schools by Stewart-Brown (2006) emphasises that the programmes that are more likely to be effective are complex, multidimensional and embedded in more than one domain of school life, most of the studies within the field focus on classroom-based or topic-based programmes and neglect the whole-school and salutogenic strategies to health education and promotion, which can be conducive to the development of key competences relevant for health improvement, for example action competence, critical health literacy and empowerment.

Against this background, the purpose of this symposium session is to discuss three conceptual frameworks for examining the key competences which constitute expected outcomes of health education/promotion in school, and which are consistent with its overall theoretical and value foundation. The overlapping dimensions and the differences among them will be in the focus of the discussion, as well as the ways of their operationalization and measurement. The three frameworks are:

•  health literacy
•  action competence
•  sense of coherence

The symposium session is planned with the following structure:

• Introduction (VS, 10 min)
• One input discussing action competence as an outcome of health education/promotion (MC, 15 min)
• One input discussing health literacy as an outcome of health education/promotion (LP, OP,15 min)
• One input discussing sense of coherence as an outcome of health education/promotion (BL, 15 min)
• Discussant: critical summary of the inputs, raising questions for discussion (JS, 15 min)
• Plenary discussion with the individual presenters in a panel (20 min)