Restructuring school physical activity policies towards improving health equity

Background and Issues: Increasing disparities in childhood obesity and physical activity prevalence among students in public schools reflect inequities in health and physical education (PE). A robust public health infrastructure, however, is lacking for school physical activity (PA) promotion and obesity prevention within PE programs. Likewise, no accountability system exists that includes school nurses' expertise to address students' adherence to PA policy requirements and measurable weight-related outcomes. Description: We used an innovative Structural Socio-ecological Model of Obesogenic School Ecosystems along with the five principles of the recent Institute of Medicine Report Integrating Primary Care and Public Health- improving population health; community engagement; infrastructural sustainability; aligned leadership; and shared use of data and analysis- as a guiding framework for this analysis and recommend action. Lessons Learned: The practice of using school PA policies to promote PA and prevent obesity development at the population-level is in its infancy. School nurses' expertise and sociocultural-tailored interventions in PE can be utilized. Leadership is not aligned between schools and local health departments, which have access to community resources and data on students' health behaviors that might support and improve existing school PA policies and PE programs. Recommendations: Public health nurses, mainly school nurses, should lead in forming strategic alliances with the local health departments and participate in schools' health policy making and implementation processes. School PA policy components for PE programs should be restructured to focus on students' adherence to policy requirements and promote use of sociocultural-tailored interventions in PE to create infrastructural sustainability.