Health-Promoting Schools in Israel, Applying the Ottawa Charter for Health Promotion.

BACKGROUND: School-based health promotion programs can improve children's health outcomes. This study examined levels of implementation of health promotion by Areas of Action in health-promoting schools (HPS) and non-HPS in Israel. METHODS: A cross-sectional survey was conducted among principals from 637 of 771 Israeli elementary and middle schools (52% Jewish, 48% Arab). The questionnaire assessed school activities according to Action Areas and domains of the Ottawa Charter. RESULTS: HPS recognition rates were 64% in secular Jewish schools and 69% in Arab schools. Among non-HPS schools, 54% (n = 164) reported health promotion activities. HPSs had higher activity levels than non-HPSs in the domains of policy (M = 7.79 vs. 5.45), environment (7.78 vs. 6.85), health education (2.01 vs. 1.67), and staff training and empowerment (1.71 vs. 0.97), all p < 0.001. Community involvement was also higher (90.8% vs. 58.6%, χ2 (1) = 62.92, p < 0.001. In Jewish schools, a higher socioeconomic status (SES) correlated with increased activity (B = 0.13, β = 0.107, t = 2.38, p < 0.05). Among Arab schools, SES was not significantly related to most domains, except for staff training and community involvement, where associations were negative. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: A comprehensive, equity-oriented policy is needed to ensure equal opportunities for health promotion, particularly in underserved communities. CONCLUSIONS: Strengthening the implementation of the Ottawa Charter principles alongside formal recognition of HPSs is fundamental to advancing effective school health promotion.