Giving children a better start in life
When Prof. dr. Onno van Schayck (CAPHRI) looks back on his career, a few projects stand out: the nicotine vaccine (which, unfortunately, did not work), the A2 project leading to the motorway tunnel (for which his research into lung function in children was crucial), a project in India where small stoves were developed to prevent children and mothers from being exposed to smoke, and ‘The Healthy Primary School of the Future’. “That project really is quite special,” he says. “Because its effects are immediately visible. Because it gives children a better start in life. Because it shows that science and society can work together to achieve something wonderful”.
A phone call that changed everything
It was an ordinary working day, sometime in the early 2010s, when Prof. dr. Onno van Schayck answered the phone. On the other end was a member of the Supervisory Board of the Movare school board in Parkstad Limburg. The message was clear and urgent: “We have a major problem. Our children are growing up in a vicious circle of school dropout, illness, and unhealthy behaviour. How can we break that cycle?”. Parkstad was not an exception. In neighbourhoods such as Rotterdam-Zuid, Amsterdam-West, Kanaleneiland, and Overvecht in Utrecht, researchers had been seeing the same patterns for years: children growing up in circumstances where their health, education, and future prospects were under pressure.
Van Schayck, already an experienced professor with decades of research into lifestyle and prevention behind him, immediately sensed that this was a unique opportunity. Not just to apply science, but to bring about real change. “We’ve known for a long time that adults are hard to change,” he says. “But children? They are curious and open to new experiences. If you introduce healthy behaviour in a playful way, they’ll take to it”.
The foundation: support above all else
The idea for the Healthy Primary School of the Future (HPSF) was born but putting it into practice would prove a challenge. Van Schayck and his team (a mix of scientists, GGD public health professionals, school boards, teachers, parents, and pupils) knew that if the initiative was to succeed, it had to belong to everyone. No top-down approach, no compulsory measures, but a movement that grew from the bottom up. “At parental information evenings, I would sometimes hear: ‘What is this professor from outside Limburg doing here? Does he want to take over the way we raise our children?’, laughs Van Schayck. “Fortunately, I’d been living in Limburg for years, so I understood the dialect and what was being said. My answer was simple: we do nothing without you. If less than 80% of parents and teachers support the plan, we won’t go ahead with it”.
That was a radical choice. Officially, a simple majority of 50% plus one was sufficient for participation in decision-making, but the team set the bar higher. Schools where there was insufficient support dropped out and only those where enthusiasm was strong went ahead.
The experiment: four schools, thousands of measurements
In 2015, the time had come. Four primary schools in Parkstad took part: two with the full intervention (healthy eating, extra physical activity, extended school day) and two with extra physical activity only. Four other schools served as a control group. In total, around 2,500 pupils were followed for four years, using activity trackers, food diaries, measurements of BMI, waist circumference, and abdominal fat, and interviews with parents, teachers, and children. The results were striking:
- Obesity was curbed: in the control group, the BMIZ score (adjusted for age and gender) rose significantly; a mini-epidemic in a nutshell. Among the children who received the full intervention, the trend remained flat. Even abdominal fat, the most harmful form of fat and a key predictor of diabetes and heart disease, increased less strong compared with children in the control group.
- Happier children: after just six months, researchers observed that children were feeling better and school became more enjoyable. The atmosphere changed: calmer lunchtimes, more social interaction, less rushing about. Pupils scored higher on school satisfaction questionnaires (rising from an average of 6.7 to 8.7).
- Less bullying: an unexpected but welcome effect. Research showed that of the 50 anti-bullying programmes in the Netherlands, only three had been scientifically proven to be effective, and all three shared elements with HPSF. “We had not predicted it, but in hindsight it made sense,” says Van Schayck. “When children feel safe, they bully less. And when there is less bullying, they learn better”.
- Improved educational performance: the most striking result was seen in educational attainment. Children in Parkstad typically scored 17% below the national average on annual maths tests. But at the HPSF schools, children scored 6% above the national average. “A difference of almost 25%,” emphasises Van Schayck. “If you maintain that for eight years, you’ll receive a different secondary-school recommendation. That is equality of opportunity at its very best”.
The ripple effect: from Limburg to the Netherlands
The results spoke for themselves and schools that were initially sceptical eventually joined in. Parents noticed that their children were happier at home, ate fewer sweets, and were more active. Some children even started correcting their parents: “Mum, this isn’t healthy!” The movement spread like ripples in a pond. In 2019, when the first data were published, the response was overwhelming. Former State Secretary Paul Blokhuis (Ministry of Health, Welfare, and Sport) asked the RIVM to calculate what it would cost to roll out HPSF nationwide. The answer: one billion euros. But the return on investment was enormous. In a social cost-benefit analysis, Social Finance demonstrated that every euro invested in HPSF generates almost €7.50 in return.
Nevertheless, implementation did not go smoothly. “In the Netherlands, we are lagging behind countries such as Sweden and Finland, where healthy school lunches have been normal for years,” says Van Schayck. “But because the contrast is so stark here, the effects are even more impressive”. Fortunately, there were local authorities, particularly in low SES neighbourhoods, that embraced the initiative. In Limburg, the number of HPSF schools grew from 4 to 40 over the years, with the ambition to expand further. Nationwide, there are now hundreds of schools interested in getting started, sometimes under different names (such as JUMP-in in Amsterdam). “It’s not called HPSF everywhere, but that doesn’t matter. What matters is the core principle: healthy food, physical activity, and a safe, stimulating environment.”
Why this project is so special
Van Schayck has led around 60 research projects during his career. Most were scientifically interesting, but not all were successful. HPSF was different. “This is one of the few projects where everything worked out better than we could have dared to hope, and on so many levels”.
What makes HPSF so unique?
- Co-creation: it is not a university project, but a project developed together with schools, parents, and children. “If you impose something from the top down, you get resistance. We built it together.”
- Scientific evidence: never before has there been such a large-scale, long-term, and controlled study into the effects of a healthy lifestyle on primary school-aged children.
- Social impact: the project demonstrated that prevention works, not just in theory, but in practice.
The future: from experiment to standard
Ten years after the first HPSF experiment began, the project stands at a crossroad. The HPSF Implementation Foundation will soon be dissolved and integrated into JOGG, the national organisation dedicated to promoting a healthy weight among young people. “They can coordinate it nationally,” says Van Schayck. “We will continue to conduct research, but the focus is shifting towards implementation”. The ambition is clear: in 10 to 20 years’ time, HPSF (or a variant of it) should become the norm in the Netherlands. “I can hardly imagine it not going ahead,” says Van Schayck. “Every child deserves this. And when you look at the cost-benefit analysis, it’s a no-brainer. We’ve shown that it’s possible. Now it’s up to politicians, local authorities, and schools to carry it forward. Because every child deserves this opportunity”.
Text: Eline Dekker
Photo: Joey Roberts