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Reconceptualising health services for school-age children in the 21st century
  1. Mitch Blair1,
  2. Diane DeBell2
  1. 1Department of Paediatrics, River Island Academic Centre for Paediatric and Child Health, Imperial College, Middlesex, UK
  2. 2The Faculty of Health and Social Care, Anglia Ruskin University, Cambridge, UK
  1. Correspondence to Professor Mitch Blair, Department of Paediatrics, River Island Academic Centre for Paediatric and Child Health, Imperial College, Northwick Park Hospital Campus, Watford Road, Harrow, Middlesex HA1 3UJ, UK; m.blair{at}

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This paper describes the historical background and philosophy of development of health services for school-age children in England. The school health service originated in the early 20th century in response to increasing awareness of significant childhood morbidity and has shifted from a ‘seek and treat’ to a ‘prevent and promote’ paradigm. The latter is currently supported by a clear evidence based policy—the Healthy Child Programme 5–19 years which, it is argued, is highly relevant to modern morbidities and continues to require strong nursing and medical leadership of a multi-agency, multidisciplinary team.


This article was originally commissioned as ‘Do we still need school doctors?’ The problem with this title is that it carries some historical presumptions that deserve further examination in their own right. We also need to look more deeply at the issue of children's current health needs at school-age and how best to address these in a whole system, which includes clinicians working in or for schools.

Until recently, the tendency has been to fail to see children's health in terms of family, school and community environments that interact to affect the whole child and thus health outcomes. The French philosopher Michel Foucault, understood this when he described the way modern medicine and medical practice initially evolved into a description of categories of illness rather than ecologies of care, the latter being the predominant paradigm across several centuries earlier.1

From the 1970s, Urie Bronfenbrenner rekindled interest in ecological systems theory. He described the intimate relationship between the wider environment and the family and the family in turn with the child. Bronfenbrenner's ecological description of child health provided the impetus behind creation of the Head Start programme in the USA and, in turn, the foundation for the Sure Start programmes in the UK.2

In 2000, From Neurons to …

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  • Competing interests MB was former advisor to the Department of Health on the Healthy Child Programme at the time of drafting. No DH approval for publication was sought.

  • Provenance and peer review Commissioned; externally peer reviewed.