Healthy Settings: Improving Health and Wellbeing In Higher Education and Criminal Justice Settings
Submitting InstitutionUniversity of Central Lancashire
Unit of AssessmentSocial Work and Social Policy
Summary Impact TypeSocietal
Research Subject Area(s)
Medical and Health Sciences: Public Health and Health Services
Education: Specialist Studies In Education
Summary of the impact
The Healthy Settings Unit at UCLan www.uclan.ac.uk/hsu
has contributed to the adoption of the `whole system' settings approach to
the promotion of health and wellbeing within a range of sectors nationally
and internationally — including higher education and criminal justice.
This impact has included: recognition of higher education as a key setting
for health improvement by the UK Government, World Health Organization
(WHO) and International Union for Health Promotion and Education (IUHPE);
implementation of Healthy Universities as a model for promoting student,
staff and community wellbeing by an expanding number of higher education
institutions (HEIs) within the UK and globally; and investment in and
roll-out of a whole system Healthy Prison model across North West England
— stimulating extensive national and international engagement and debate.
The research comprised a mix of praxis-based theoretical and empirical
Phase I (1995-2001) used action and case study research, rooted in
UCLan's commitment to establish one of the first Healthy University
initiatives in the UK. Drawing on this experience, Dooris developed a
social ecosystem model, conducted an evaluation of UCLan's Healthy
University programme, and collaborated with WHO to develop settings-based
theory and formulate a strategic framework for Healthy Universities.
Phase II (2001-2007) was largely concerned with theory
development. Drawing on insights from Phase I and synthesising findings
from wider literature, Dooris formulated a generic conceptual framework
for healthy settings that identified three characteristics: an ecological
model of health promotion, a systems perspective and a whole system
organisational change focus. Additionally, he proposed a number of new
models to guide healthy settings practice and highlighted three key
challenges to the evaluation of healthy setting initiatives — relating to
the construction of the evidence base for health promotion; the diversity
of conceptual understandings and real-life practice; and the complexity of
evaluating ecological whole system approaches. Drawing on complexity
theory and critical realism, this work was further developed in
collaboration with colleagues from Canada and other countries. In order to
test these theoretical developments, Dooris also undertook international
empirical research with global leaders in healthy settings.
Phase III (2008-2013) combined regional and national-level
empirical research with further theory development. A multi-method study
(£10,000 funded by Higher Education Academy/ Department of Health)
conducted by Dooris and Doherty examined Healthy Universities activity in
English HEIs and explored the potential for a national programme to be
developed. The findings confirmed that higher education offers significant
potential to impact positively on the wellbeing of students, staff and
wider communities; and demonstrated widespread interest in adopting a
whole system Healthy Universities approach — reflecting an increasing
recognition that investment for health within higher education will
contribute not only to health targets but also to mainstream agendas such
as staff and student recruitment, experience and retention; and
institutional and societal productivity and sustainability. The research
also highlighted support for a National Healthy Higher Education
Programme. Building on this, Dooris and colleagues were funded by HEFCE to
conduct a high-profile implementation project (Section 4) and commissioned
to conduct consultative research leading to a new conceptual model and
recommendations for the development and operationalization of a National
Healthy Universities Framework for England (£25,000 funding from
Department of Health via Royal Society for Public Health). In parallel
with this, Baybutt and Dooris applied learning from Phases I and II to
criminal justice settings — evaluating the Target: Wellbeing Pan-Regional
Prisons Programme (£756,000 combined implementation and evaluation funding
from Big Lottery); researching the effectiveness of an Offender Health
Trainer Service; and examining the benefits of adopting a whole system
approach to regional tobacco control. Throughout this phase, Dooris and
colleagues also collaborated to develop new thinking and theory regarding
the integration of health and sustainability within and across settings.
References to the research
1. Tsouros, A., Dowding, G., Thompson, J. & Dooris, M. (Eds.)
(1998) Health Promoting Universities: Concept, Experience & Framework
for Action. Copenhagen: WHO Regional Office for Europe. ISBN: 9289012854
2. Dooris, M. (2004). Joining up settings for health: a valuable
investment for strategic partnerships Critical Public Health 14(1),
49-61. doi: 10.1080/09581590310001647506
3. Dooris, M. & Doherty, S. (2010) Healthy Universities: time
for action — a qualitative research study exploring the potential for a
national programme. Health Promotion International 25(1): 94-106.
5. Eadie, D., MacAaskill, S., McKell, J & Baybutt, M. (2012)
Barriers and facilitators to a criminal justice tobacco control
coordinator: an innovative approach to supporting smoking cessation among
offenders. Addiction 107 (Suppl. 2): 26-38.
Details of the impact
[Numbers in square brackets refer to underpinning research listed in
Section 3; letters and `Contact X' in square brackets refer to sources
used to corroborate the impact in Section 5.]
a) International Level
The reach and significance of Dooris' generic research on healthy
settings  is evidenced by his publications being cited on the WHO
Healthy Settings global web portal [A]. The Healthy Universities research
[1, 3, 4] was a catalyst to WHO reinvigorating its engagement with higher
education as a setting — and UCLan was acknowledged as key in the genesis
of Healthy Universities and being one of only two universities worldwide
to be linked from this portal [A]. Furthermore, Dooris is the European
Healthy Universities representative on a WHO Working Group on Implementing
Health 2020 and Strengthening Public Health through Improved
Collaboration and Synergy of Health Promotion Networks [Contact 1].
The generic settings  and criminal justice research [5, 6] in 2013
acted as a lever for the WHO Health in Prisons Project Steering Group to
prioritise international research into the whole system prison approach,
being undertaken by Baybutt and Dooris on behalf of its Collaborating
The research [1-6] made a significant contribution to the decision of
IUHPE to adopt healthy settings as a priority theme and recognise
universities and prisons as important settings [Contact 1]. Dooris chaired
IUHPE's Global Working Group on Healthy Settings until 2011 and was a key
member of the Executive Scientific Committee for its 20th World
Conference in 2010, with lead responsibility for convening the conference
stream on healthy settings. A meeting convened by Dooris at this
conference led to the establishment of a European Health Promoting
Universities Network www.eurohpu.aau.dk:
this has 15 member countries, with Dooris as the UK focal point.
Additionally, Dooris was the invited keynote speaker leading the healthy
settings stream at 2012 IUHP European Conference and a key note speaker on
healthy settings at the 2013 Nordic Health Promotion Research Conference,
the 2013 Danish Public Health Society Annual Conference and the 2013
Australian Health Promotion Association Annual Conference. Baybutt was on
the planning group for the Healthy Settings sub-plenary at the 21st
World Health Promotion Conference in 2013 and the invited specialist
speaker on prisons, health and justice [Contact 1; Contact 2].
Dooris' work  underpins Section 4 of Ireland's 2011 Health Promotion
Strategic Framework [B], which explicitly draws on his conceptual research
— and the Irish Health Service Executive have commissioned Dooris' Healthy
Settings Unit to transfer the learning from their research through
developing and delivering a `train the trainers' course, extending the
impact into health promotion practice.
b) National Level
The Healthy Universities research [1, 3, 4] has made a significant
contribution to national strategy and guidance. Building on a case study
of UCLan's work within the earlier `Choosing Health' publication, the
Government's 2010 public health strategy reinforced the importance of
universities as a setting for health — stating that "Healthy Schools,
Healthy Further Education and Healthy Universities programmes will
continue to be developed by their respective sectors, as voluntary
programmes, collaborating where appropriate and exploring partnership
working with business and voluntary bodies" [C]. The inclusion of
Healthy Universities was clearly influenced by the work of Dooris and
colleagues and represented a significant achievement in an era of
`stripped down' government, offering continued legitimacy to the growing
number of HEIs adopting this whole system model of working [Contact 2].
Dooris is also an expert adviser to the Welsh Government in the
development of its own Healthy and Sustainable FE and HE Framework, which
draws extensively on the work of Dooris and colleagues [1, 3, 4] [Contact
Research by Dooris and Doherty [1, 3] has been recognised and cited by
bodies such as Universities UK, National Union of Students and the Royal
College of Psychiatrists — the latter stating in 2011 that "the
`Healthy Universities' systemic and holistic approach is commended and
should be adopted as widely as possible" [D].
Research by Baybutt and colleagues [McAllister et al, Stirling
University) examining the benefits of adopting a whole system approach to
regional tobacco control has strengthened the evidence base and thereby
contributed to national-level policy debate .
c) Institutional and Population Level
Perhaps most significantly, the research has had far-reaching influence
on institutional practice, impacting on population health and wellbeing —
through the implementation of the Healthy Prisons model by establishments
across the North West region [Contact 4; and through the adoption of the
Healthy Universities approach by a growing number of HEIs within the UK
and internationally [E; Contact 2].
The research on prison-based wellbeing (with a particular focus on
horticultural and environmental projects)  has highlighted the reach of
such work (3828 beneficiaries) and the value of such activity in
transforming individual offenders' lives [Contacts 4-5]. Furthermore, it
has demonstrated the importance of adopting a whole-system approach that
addresses wellbeing, reoffending, citizenship and social justice agendas —
thereby levering further Big Lottery and National Offender Management
Service funding for Healthy Prison implementation and evaluation by
Baybutt and Dooris within North West establishments, with current interest
in wider roll-out into North West probation and other community settings
and into prisons beyond the region [Contacts 4-5]. Evaluative research of
offender health trainer services has led to wider roll-out within the
North West and strengthened the case for further investment in the work.
Building directly on their research [1, 3], Dooris and Doherty (with
Powell at MMU) were in 2009 awarded £200,000 from HEFCE for an
implementation project Developing Leadership and Governance for
Healthy Universities www.healthyuniversities.ac.uk.
This enabled previous [1-3] and concurrent  research findings to inform
developments — and specifically for: the UCLan- convened National Network
to be formalised and expanded, with membership increasing from 47 HEIs and
10 other stakeholder organisations in 2008 to 73 HEIs and 22 other
stakeholder organisations in 2013; a website and toolkit to be developed,
facilitating the translation of research into practice through offering
guidance packages, case studies and a self-review tool; and advocacy and
leadership for Healthy Universities to be strengthened through a
high-level Leadership Advisory Group jointly chaired by the Chief
Executives of the Leadership Foundation for Higher Education and the Royal
Society for Public Health [E; Contact 2]. The reach of this work is
evidenced by the extensive use of the website (9,043 unique visitors from
125 countries since its launch in 2010); the request from the Welsh
Assembly and HEIs outside of England for UCLan to widen the Network's
remit from England to the UK [Contact 3]; increased demand for `associate'
membership of the Network by HEIs in countries outside of the UK (e.g.
Australia; Canada; Ireland; New Zealand); and requests for Dooris and
Doherty to act as advisers and to speak at Healthy University events (e.g.
Simon Fraser University, Canada; University of Sydney, Australia;
University of Calgary, Qatar; University of Extremedura, Spain).
Sources to corroborate the impact
A. World Health Organization Healthy Settings Web Portal.
B. Health Service Executive (2011) The Health Promotion Strategic
Framework. Dublin: HSE. [Section 4/Figure 3]
C. H.M. Government (2010) Healthy Lives, Healthy People.
London: Department of Health.
D. Royal College of Psychiatrists (2011) Mental Health of
Students in Higher Education: College Report CR166. London: RCP. www.rcpsych.ac.uk/files/pdfversion/CR166.pdf
[Recommendation 9, p.14; pp.49-51]
E. Dooris, M. & Powell, S. (2012) Developing Leadership
and Governance for Healthy Universities: Final Report to HEFCE.
Contact 1: Marie Claude-Lamarre, Executive Director, International
Union for Health Promotion and Education.
Contact 2: Prof. Richard Parish, Chief Executive, Royal Society
for Public Health (to June 2013) — now Executive Director, Health
Contact 3: Sue Bowker, Head of Life Course Branch — Health
Improvement Division, Welsh Government.
Contact 4: Maggie Moody, Target: Wellbeing Portfolio Manager,
Contact 5: Alan Scott, Deputy Director of Custody — Public Sector
Prisons North West, National Offender Management Service, Ministry of