Wanted: Policies and Resources That Align the Health-Education Connection

By John Schlitt, School-Based Health Alliance President

Student School BasketballA report from the National Association of Chronic Disease Directors helps drive home the fact that a child’s health and academic success are inextricably linked. Their latest report, a comprehensive review of empirical literature (122 peer-reviewed studies), examines the inverse relationship between high-risk health behaviors and school achievement. The six behaviors most strongly associated with poor academic outcomes were violence (including victimization), tobacco use, alcohol and other drug use, sexual activity, inadequate physical activity, and inadequate nutrition. In all, 96 percent of studies found statistically significant relationships.

This isn’t news, of course, and the authors admit as much. In 2010, Charles Basch at Columbia University’s Teachers College compiled a similar—and exhaustive—defense for addressing student health problems as a “fundamental part of school reform,” even zeroing in on many of the same educationally relevant health disparities (he added vision, asthma, and hyperactivity to his list).

Others are beating the health-education connection drum as well. Nick Freudenberg turned the healthy students make better learners maxim on its head, arguing conversely that better learners make healthier adults. In affirming the powerful influence of education on health disparities, Freudenberg cogently framed school dropout as a major public health threat and issued a call to action for health and education officials to come together around this common goal. National public health leaders responded by including for the first time an education-related indicator among its Healthy People 2020 goals for adolescents.

Also taking up the call is APHA and its Center for School, Health and Education, which is drawing attention to school-based health solutions that can help prevent school dropout and improve graduation rates. A newer voice on the scene, the Center for Society and Health at Virginia Commonwealth University has launched a suite of information resources that make the argument for cost-effective investments of the public treasury in education because of the lifetime of health benefits they reap.

ASCD is one of the few national education organizations to give full credence to the mind-body connection. Its Whole Child Initiative is an effort “to change the conversation about education from a focus on narrowly defined academic achievement to one that promotes the long term development and success of children.”

Despite the persuasiveness of these proof points and their adherents, we seem to be losing ground in creating shared accountability across health and education sectors so that all children can enjoy good health and school success. Nurses are woefully under-represented in our nation’s schools, while health and physical education are being squeezed out of crowded academic schedules.

Even as the health and education sectors reform, redesign, and reimagine themselves to deliver better outcomes, they haven’t made the interrelatedness connection. There’s no policy or finance structure to incentivize joint accountability. School-based health centers are one obvious manifestation of that shared responsibility between sectors. But they are a rare minority.

Perhaps it’s that the horizon for success is so proximal that there’s little patience among politicians for the longer view—even though upstream, collaborative solutions ultimately will yield far greater dividends.

Much has been made of the opportunities to integrate public health and primary care to address powerful social determinants of health. Imagine if we broadened our circles of intersection to include education, and focused the resources of the collective on those six or seven indicators that contribute to school failure and its well documented (and expensive) sequelae? I’m certain there’s an innovation grant award in there somewhere.



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