Localising the Global Standards for Health-Promoting Schools: A Comparison of China and Germany

Objective: This study examines the localisation in China and Germany of the Global Standards for Health-Promoting Schools (HPS) developed jointly by WHO and UNESCO, focusing on how global frameworks are taken up and localised within different cultural and policy contexts. Methods: A qualitative comparative design combined policy review with systematic content analysis. Two national school-facing documents were analysed using the WHO/UNESCO’ HPS domains as a coding framework. We compared domain emphases and mapped a condensed set of indicators to specific national statements, using localisation labels (adopt, intensify, externalise, disperse, omit). Social–ecological systems theory provided a multilevel lens for interpreting how institutional structures and cultural expectations shaped localisation. Results: Divergence from the HPS standards was strongest in school health services and in the school social–emotional environment (SEE). In China, health services were embedded in schools through the use of dedicated staff, facilities and routine provision, reflecting a “big school–big health” model that sought to integrate educational and health responsibilities. In Germany, services were largely community- or needs-based and externally coordinated, reflecting a “small school–small health” model with clearer system differentiation. With respect to the school SEE, Germany addressed the requirements via school culture and student-centred competencies, while China addressed SEE mainly through auditable requirements spread across domains. Conclusion: Different systemic and cultural contexts generate distinct localisation pathways and trade-offs. The findings of this study highlight a “missing middle” between global standards and practical application, and suggest that progressive implementation is more workable when countries also put in place concrete supports—either in-school professional support and safeguards, or clear referral routes and cross-sector coordination.