The Short-Term Value of the "Healthy Primary School of the Future" Initiative: A Social Return on Investment Analysis

Marije Oosterhoff, Onno C P van Schayck, Nina H M Bartelink, Hans Bosma, Maartje Willeboordse, Bjorn Winkens, Manuela A Joore, Marije Oosterhoff, Onno C P van Schayck, Nina H M Bartelink, Hans Bosma, Maartje Willeboordse, Bjorn Winkens, Manuela A Joore

Abstract

Background: This study examines the social return on investment (SROI) of the "Healthy Primary School of the Future" initiative after 2 years. Methods: Healthy Primary Schools of the Future (HPSF) provide a healthy lunch and daily structured physical activity sessions, whereas Physical Activity Schools (PAS) focus on physical activity only. We evaluated the 2-years investments and effects (N = 1,676 children) of both school environments (four schools) compared to control schools (four schools). Investments and outcomes were grouped within the healthcare, education, household & leisure, and labor & social security sector. Outcomes that could be expressed in monetary terms were used for the calculation of social return on investment. Results: HPSF and PAS created outcomes for the healthcare sector by favorable changes in health behaviors, body mass index [both significant], and medical resource use [not significant]. Outcomes for the education sector included a favorable impact on perceived social behaviors and school satisfaction, and absenteeism from school [latter not significant], and more engagement with the community was experienced. The per child investments, €859 (HPSF) and €1017 (PAS), generated a benefit of €8 (HPSF) and €49 (PAS) due to reduced school absenteeism and medical resource use. Conclusions: Within 2 years of intervention implementation, the HPSF initiative created outcomes in several sectors, but the benefits did not outweigh the investments. Follow-up assessments as well as modeling long-term outcomes are needed to assess the total value of the interventions. Until then, the SROI framework can inform strategies for obtaining stakeholder support and intervention implementation. Trial registration: The study was registered in the ClinicalTrials.gov database on 14 June 2016 (NCT02800616).

Keywords: child; economic evaluation; health promoting schools; health promotion/economics; social return on investment.

Copyright © 2020 Oosterhoff, van Schayck, Bartelink, Bosma, Willeboordse, Winkens and Joore.

Figures

Figure 1
Figure 1
Impact inventory including the potential outcomes of school-based lifestyle interventions. HRQOL, health-related quality of life; PA, physical activity. Underlined text: The outcomes that could be expressed in financial terms (H3, H4, H6, E3, HL4, L2) were included in the calculation of social return on investment. Due to the small numbers for unpaid work (HL4) and parental absenteeism from work or education (L2), the potential benefits could not be reliably estimated and we refrained from including them in the calculation of social return on investment. We refrained from defining financial proxies for outcomes that are not financial in nature (e.g., behaviors) as this will lead to double counting due to the interdependencies between outcomes within the same or between domains (e.g., health behaviors, physical health, and HRQOL; between physical health and absenteeism from school). Non-financial outcomes, however, may have some additional value. We therefore complemented the SROI calculation with a SROI story. A longer time horizon was needed to examine the outcomes on cognitive performances (E2). HL1, HL2, and L1 were not (yet) formally measured within the quasi-experimental study.

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