Education, health, and wellbeing are closely intertwined. Education is strongly associated with health behaviours and life expectancy, and it may be considered one of the most important social determinants of health (1). To ensure students have the best possible opportunities for learning, more than 100 countries provide some form of school health services (2). The World Health Organization (WHO) and the United Nations Educational, Scientific and Cultural Organization (Unesco) have recognized the close connections of health and education and published several guideline documents to support the concept of health promoting schools (3).

Although many European countries provide free or subsidised education and health and welfare services to their children, recent years have seen increasing differences in academic achievement, health, and wellbeing among children and adolescents (4-6). The socio-economic status (SES) of the family bears more weight in education than before even in the Nordic countries which have previously been beacons of equity (7). In schools, especially absences due to illness are an increasing problem and teachers have very limited opportunities to intervene in them (8-10). Although school absences are associated with a lower educational level and poorer health in adulthood, systematic records on school absences and interventions to overcome them are still often lacking (11).

Increasing polarisation is also evident in health behaviour among adolescents: although binge drinking and smoking have decreased on a population level, socio-economic disparities in risky behaviour have increased (5, 12, 13). Furthermore, nearly all developed countries have witnessed a rise in mental health symptoms reported by adolescents. This rise began already prior to the COVID-19 pandemic, was exacerbated by social distancing measures, and has shown no signs of decline (14). Tackling polarisation and responding to adolescent mental health problems call for more targeted approaches, but concurrent, universal health promotion measures are also needed. In Finland, a social and healthcare service reform of historical proportions was undertaken in 2023 and gathered all social and healthcare services from more than 300 municipalities to 21 wellbeing services counties, while the city of Helsinki and Åland Islands are exceptions and organize their own services (15). Most true reforms, such as service redesign and integration, are still forthcoming. For example, a recent study supported the hypothesis that the concerns of teachers, parents and school nurses regarding primary school students are associated with the need and benefit of a consultation with a school physician (16), but no mechanism is in place to notify school healthcare providers of school absences or other concerns to ensure informational continuity of care (17).

In a critical assessment of school healthcare services in Finland, the evidence-base was modest. Some studies have estimated the benefits and potential harms of routine health checks conducted by school physicians in school years 1 and 5 (18), but no studies have targeted routine health checks in year 8. Furthermore, little is known about the health needs and access to services of children in other year levels at school. Meanwhile in child protection services, the proportion of adolescents in care began to increase before the pandemic and has shown no decline (19, 20). In many instances, child protection services have become the first point of contact although this position should belong to preventive and supportive family services. To increase effectiveness and to reduce inequities, policies and healthcare and welfare services should address structural and interpersonal discrimination that may further exacerbate socio-economic inequity (21). To date, no regularly measured quality indicators exist for service pathways of children and adolescents.

Researchers across disciplines have called for collaboration in research and development between professions and organisations because preventing social exclusion or finding solutions to help students with excessive school absences is impossible without cooperation of education, healthcare and social work professionals (8, 22). In an era of aging populations and decreasing birth rates, research combining these fields is of paramount importance.