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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, euro859 (HPSF) and euro1017 (PAS), generated a benefit of euro8 (HPSF) and euro49 (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.

Original languageEnglish
Article number401
Number of pages11
JournalFrontiers in Public Health
Publication statusPublished - 21 Aug 2020


  • social return on investment
  • health promotion
  • economics
  • child
  • health promoting schools
  • economic evaluation

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