Impact of school closures on the health and well-being of primary school children in Wales UK; a routine data linkage study using the HAPPEN survey (2018-2020)
Authors: James Michaela , Marchant Emily , Defeyter Margaret A. , Woodside Jayne V. , Brophy Sinead 
Published: February 2021

AbstractIntroductionIn response to the COVID-19 pandemic, school closures were implemented across the United Kingdom. This study aimed to explore the impact of school closures on children’s health by comparing health and wellbeing outcomes collected during school closures (April – June 2020) with data from the same period in 2019 and 2018.MethodsData were collected online via the ‘HAPPEN At Home’ survey, which captured the typical health behaviours of children aged 8 – 11 years between April - June 2020. These data were compared with data in 2018 and 2019 also collected between April-June, from HAPPEN. Free school meal (FSM) status was used as a proxy for socio-economic deprivation. Analyses were repeated stratifying by FSM.ResultsComparing responses between April – June in 2020 (n=1068), 2019 (n=1150) and 2018 (n=475), there were improvements in physical activity levels, sleep time, happiness and general wellbeing for children during school closures compared to previous years. However, children on FSM ate less fruit and vegetables (21% (95%CI (5.7% to 37%)) and had lower self-assessed school competence compared to 2019. Compared to those not on FSM they also spent less time doing physical activity (13.03% (95%CI: 3.3% to 21.7%) and consumed more takeaways (16.3% (95%CI: 2%-30%)) during school closures.ConclusionThis study suggests that schools play an important role in reducing inequalities in physical health. The physical health (e.g. physical activity and diet) of children eligible for FSM may be impacted by prolonged school closures.What is already known on this subject?In response to the COVID-19 pandemic, by mid-March 2020, 138 countries had implemented national school closures to reduce the number of social contacts between pupils, therefore interrupting the transmission of COVID-19 as part of pandemic plans. UNESCO warned that the global scale and speed of the educational disruption would be unparalleled. There is an ongoing debate with regard to the effectiveness of school’s closures on transmission rates, but the fact schools are closed for a long period of time could have detrimental impacts on pupil’s physical and mental health.This study provides evidence of any differences in the health and wellbeing of children prior to and during the COVID-19 enforced lockdown and school closures between March and June 2020. These findings could have a significant impact for the future and support schools to better understand their pupil’s physical, psychological, emotional and social health. It also contributes to a significant literature gap regarding the impact of school closures on school-aged children.What this study adds?Improvements in physical activity levels, sleep time, happiness and general wellbeing were observed in general for children during school closures compared to previous years. However, children on FSM reported eating less fruit and vegetables and had lower self-assessed school competence compared to 2019. Compared to those not on FSM they also spent less time doing physical activity and consumed more takeaways during school closures. These trends are not evident among children not on FSM. All children reported improvements in wellbeing during lockdown especially on the happiness with family measure.Overall, findings suggest schools help to reduce inequalities in physical health for socio-economically deprived children. During school closures children from deprived backgrounds are likely to have poorer physical health (e.g. less time spent doing physical activities and poorer diet) and this is not observed in children who are not in receipt of FSM. This research suggests that school closures will result in widening health inequalities and when schools return measures will need to be in place to readdress the widened gap in physical health.