为促进学校体育“健康第一”教育理念的有效落实，帮助提升青少年学生体质健康水平，运用文献资料法和逻辑分析法，系统分析了学校体育树立和落实“健康第一”教育理念的历史过程及现实困境，提出了落实“健康第一”教育理念的优化路径。研究认为，新中国成立初期、20世纪末至21世纪初、 党的十八大以来等不同历史阶段的“健康第一”教育理念均肩负着增强体质健康、推进素质教育、实现健康教育的责任，树立和落实“健康第一”教育理念是学校体育的历史选择和根本要求。但在落实过程中却面临着思想指向被泛化、身体安全被过度强调、人文价值被忽视、主体责任缺乏监管等现实困境，导致 “健康第一”教育理念难以有效落实。为此，需要实施“一体化设计、一体化推进”的策略，不断加强顶层制度设计，推进体育健康教育，践行体教融合政策，压实执行主体责任，才能有助于“健康第一”教育理念的有效落实，帮助提升青少年学生体质健康水平。

In order to promote the effective implementation of the educational concept of “health first” in school physical education and help improve the physical health level of young students，this paper systematically analyzes the historical process and practical difficulties of establishing and implementing the educational concept of “health first” in school physical education by using the methods of literature and logical analysis，and puts forward the optimized path of implementing the educational concept of “health first”.The research shows that the concept of “health first” education in different historical stages from the early days of the founding of new China，the end of the 20th century to the beginning of the 21st century and since the 18th National Congress of the Communist Party of China all shoulder the responsibility of enhancing physical health，promoting quality education and realizing health education. Establishing and implementing the concept of “health first” education is the historical choice and fundamental requirement of school physical education.However，in the process of implementation，it is faced with practical difficulties，such as the generalization of ideological orientation，the excessive emphasis on physical safety，the neglect of humanistic value and the lack of supervision of subject responsibility，which makes it difficult to effectively implement the educational concept of “health first”.Therefore，we need to implement the strategy of “integrated design and integrated promotion”，constantly strengthen the top-level system design，promote physical health education，practice the integration policy of physical education and education，and compact the main responsibility，so as to contribute to the effective implementation of the educational concept of “health first” and help improve the physical health level of young students.

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福建省社会科学规划青年项目(FJ2018C063)；国家社会科学基金“十三五”规划 2019 年度教育学课题(BLA190212)