Research Article: School policies, built environment and practices for non-communicable disease (NCD) prevention and control in schools of Delhi, India

Date Published: April 18, 2019

Publisher: Public Library of Science

Author(s): Shalini Bassi, Vinay K. Gupta, MinHae Park, Gaurang P. Nazar, Tina Rawal, Soumyadeep Bhaumik, Kanwal Preet Kochhar, Monika Arora, Santosh Kumar Tadakamadla.


To assess school policies, built environment and practices for prevention and control of non-communicable diseases in schools of Delhi, India.

School built environments and policies were assessed using a structured observation checklist in 10 private and 9 government schools which were randomly selected from all 184 co-educational schools with primary to senior secondary level education in Delhi, India. A self-administered questionnaire was also completed by teachers from each school (n = 19) to capture information specific to school policies. Surveys were also conducted with parent of students in class II (aged 6–7 years; n = 574) and student in class XI (aged 15–16 years, n = 755) to understand school practices.

The majority of government (88.9%; n = 8) and private (80%; n = 8) schools reported having comprehensive school health policy. In terms of specific health behaviours, policies related to diet and nutrition in government schools were mostly restricted to primary levels with provision of the mid-day meal programme. All schools had two physical education periods per week of about 45–50 minutes. Most schools were compliant with tobacco-free school guidelines (n = 15 out of 19) and had alcohol control policies (n = 13 out of 19). Parent and student reports of practices indicated that school policies were not consistently implemented.

Most schools in Delhi have policies that address health behaviours in students, but there was considerable variation in the types and number of policies and school environments. Government schools are more likely to have policies in place than private schools. Further work is needed to evaluate how these policies are implemented and to assess their impact on health outcomes.

Partial Text

Rapid changes in India’s demography, socio-economic profile, and lifestyles have led to the emergence of non-communicable diseases (NCDs) as a leading cause of morbidity and mortality. Currently, NCDs account for over three-quarters of deaths in adults aged over 50 years, and almost half of all deaths among younger adults [1].

All responses from the observations and questionnaires were summarized as frequencies and percentages using statistical software Stata v.12.0 (Stata Corp, Texas). We described the types of policies reported by teachers, out of the seven listed policies. Results are presented by type of school (private or government) and grade (primary and senior secondary). Results from the parent and student survey were also stratified according to the presence (or otherwise) of school policies as reported by teachers or observations.

The 19 schools (10 private and 9 government) that participated in the study were located in 11 of the 13 districts in Delhi. The overall sample (n = 1329) consisted of 59% male students, 46% students from government schools and 44% students from grade two. The student to teacher ratio was 29 with an average of 36 students per class in private and 34 students per class in government schools. A total of 342 parents of class II students (response rate 84%) and 371 students in class XI (response rate 87%) in government schools, and 232 parents of class II students (response rate 76%) and 384 class XI students (response rate 91%) in private schools took part in the study. All teachers approached (n = 19) participated in the survey.

To the best of our knowledge, this is the first study to comprehensively describe school policies, built environment and practices in relation to NCD risk factors in the state of Delhi, India. Almost all participating schools in Delhi had some policies and practices in place to address NCD risk factors. However, there was considerable variation in the types and number of policies in place and in school environments. There were discrepancies between school practices as reported by parents and students and those reported by teachers, and as per observations, suggesting gaps between stated policies and perceived or actual implementation.

While India makes an epidemiological transition with NCDs adding to the disease burden there is a need to mount an education sector response for prevention and control of NCDs. While a range of policies and practices are in place, there is a need for filling gaps, developing synergies across sectors and effective implementation. An evidence-based education sector response to NCD risk factors targeting the critical transition periods of early life, including adolescence, is required [26, 27]. While schools have a central role in influencing students’ behaviours, an effective response will require participation from families and cross-sector collaboration with providers of social and community services, including youth clubs and sports centres, which provide further opportunities for shaping young people’s behaviours.