Where We Live, Learn, and Work Influences Our Health
Beyond those things that we know matter for health—eating well, getting exercise, seeing a doctor and receiving treatment when we are ill—the Centers for Disease Control and Prevention’s (CDC) Healthy People 2020 notes that “health is also determined in part by access to social and economic opportunities; the resources and supports available in our homes, neighborhoods, and communities; the quality of our schooling; the safety of our workplaces; the cleanliness of our water, food, and air; and the nature of our social interactions and relationships”.1
These “social determinants of health” may impact health immediately or not for many years. But acting early to address these root causes of poor health outcomes and disparities can make a difference. Community health organizations and schools can play a powerful role in interventions aimed at social determinants of health.2
SBHCs Work at the Intersection of Public Health, Primary Care, and Education
Health and education are linked: healthier children are better students and a better education yields greater health outcomes over a lifetime. The Community Preventive Services Taskforce has recently recommended school-based health centers (SBHCs) as a strategy to improve health and education outcomes, particularly among low-income children.3 SBHCs increase access to health care by providing services in a convenient location where students already spend their time4, 5, 6 and help keep children in class who may otherwise be absent for health reasons.7, 8, 9, 10
SBHCs have a number of different staffing models. Those with the most comprehensive—primary care and mental health plus, where primary care and mental health staff are joined by other provider types like health educators, social service case managers, or others—have the power to intervene across a broad array of issues.12 Furthermore, SBHCs are uniquely positioned to integrate prevention into their clinical care to effectively address a full range of health determinants and can serve as a resource for group and classroom health education, school-wide screenings and prevention programs, and support other school staff in creating a positive school climate.12
School-Based Health Alliance Resources
Children’s Health and Education Mapping Tool
This tool will help school-based health practitioners harness the power of Geographic Information Systems (GIS) for data-driven decision-making to address the chronic inequities that persist among low-income children and adolescents in health care access and utilization. The tool can map child and adolescent-specific data across multiple dimensions of need in order to identify high need areas, define geographic areas that are underperforming relative to national averages for specific indicators, and can target locations of new health centers and services nationwide. The Children’s Health and Education Mapping Tool includes a number of indicators related to the social determinants of health and traditional measures of health access and outcomes.
This tool will help school-based health practitioners address the chronic inequities that persist among low-income children and adolescents in health care access and utilization. The tool can map child and adolescent-specific data across multiple dimensions of need in order to identify high need areas, defined as geographic areas that are underperforming relative to the national average across one or more indicators, and can be used to target locations of new health centers and services nationwide. The Children’s Health and Education Assessment Tool includes a number of indicators related to the social determinants of health and traditional measures of health access and outcomes.
Centers for Disease Control and Prevention
The CDC has a number of helpful guides and explanations of the social determinants of health.
Robert Wood Johnson Foundation
The Robert Wood Johnson Foundation has a variety of projects and resources dedicated to addressing the social determinants of health. They have also named the number of SBHCs as one of their measures to help mobilize a culture of health.
(1) Centers for Disease Control and Prevention. Healthy People 2020: Social Determinants of Health. 2014.
(2) University of Kansas. Community Toolbox: Addressing Social Determinants of Health and Development 2014.
(3) Guide to Community Preventive Services. Promoting health equity through education programs and policies: school-based health centers. 2015.
(4) Juszczak L, Melinkovich P, Kaplan D. Use of health and mental health services by adolescents across multiple delivery sites. The Journal of Adolescent Health. Jun 2003;32(6 Suppl):108-118.
(5) Kaplan DW, Calonge BN, Guernsey BP, Hanrahan MB. Managed care and school-based health centers. Use of health services. Archives of Pediatrics & Adolescent Medicine. Jan 1998;152(1):25-33.
(6) Kisker EE, Brown RS. Do school-based health centers improve adolescents’ access to health care, health status, and risk-taking behavior? The Journal of Adolescent Health. May 1996;18(5):335-343.
(7) Gall G, Pagano ME, Desmond MS, Perrin JM, Murphy JM. Utility of Psychosocial Screening at a School-Based Health Center. Journal of School Health. Sep 2000;70(7):292-298..
(8) Walker SC, Kerns SE, Lyon AR, Bruns EJ, Cosgrove TJ. Impact of School-Based Health Center use on academic outcomes. The Journal of Adolescent Health. Mar 2010;46(3):251-257.
(9) McCord MT, Klein JD, Foy JM, Fothergill K. School-based clinic use and school performance. The Journal of Adolescent Health. Mar 1993;14(2):91-98.
(10) Van Cura M. The relationship between school-based health centers, rates of early dismissal from school, and loss of seat time. Journal of School Health. Aug 2010;80(8):371-377.
(11) Lofink H, Kuebler J, Juszczak L, et al. 2010-2011 School-Based Health Alliance Census Report. Washington, DC: School-Based Health Alliance; 2013.
(12) Clayton S, Chin T, Blackburn S, Echeverria C. Different setting, different care: integrating prevention and clinical care in school-based health centers. American Journal of Public Health. Sep 2010;100(9):1592-1596.