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Healthier Students are Better Learners

obriena's picture

It has long been suggested that health disparities between low-income kids and their peers contribute to the academic achievement gap. If you are looking for evidence to support that theory, a recent research review by Charles E. Basch—Healthier Students are Better Learners: A Missing Link in School Reforms to Close the Achievement Gap—offers it.

Long story short (and it is a long report), Basch describes the evidence showing how groups of children differ in the incidence of (and access to care for) each of seven “educationally relevant health disparities”: vision, asthma, teen pregnancy, aggression and violence, physical activity, breakfast, and inattention and hyperactivity. He also reviews evidence on the “causal pathways affecting educational outcomes” (I think that means he shows that not only are there disparities, but that these disparities actually do affect achievement).

One brief, and extremely simplified, example: Children with asthma sleep less. Children who sleep less tend to have worse academic performance than those who sleep more, because sleep influences cognitive function. Low-income children, for a variety of reasons, have asthma at higher rates than middle- and upper-income children. So even assuming that low-income children come to school with all else equal and that they then attend schools that do an equally good job of educating them (both things we know not to be true), these health disparities put them at a disadvantage.

Say you buy Basch’s argument, and you believe that health disparities widen the achievement gap. The next question is, so what? Is it the job of the school to provide health care to students? Many argue no. But they also argue that schools must overcome the disparities that kids come to school with and make sure that all kids achieve at the same level.

Here’s a thought: Maybe schools themselves do not have to provide medical care to students. But maybe schools can partner with others in the community and provide a space where those whose job it is to provide medical care to children can do so. Such spaces are called school-based health centers, and there are about 2,000 in the United States.

The school-based health center is gaining political support. It fits into the Obama administration’s Promise Neighborhoods initiative. The new Patient Protection and Affordable Care Act creates federal grant programs to fund the expansion and support of school-based health centers (learn more from the National Assembly on School-Based Health Care here).

And research supports it. Studies have shown that school-based health centers have reduced inappropriate emergency room use. They have reduced Medicaid expenditures. And they have decreased absences and discipline referrals (the National Assembly on School-Based Health Care summarizes the research and provides academic references here). While a direct link to academic performance is still unproven, it is not a hard leap to think that decreased absences and discipline problems can help us in our school reform efforts. This promising strategy deserves more attention.

Read some brief stories on places where school-based health clinics have been tried: Montrose County School District RE-1J (CO), Washington Elementary School (NJ) and Chula Vista (CA). Tomorrow look for an in-depth story on how Montrose County School District RE-1J planned and implemented its school-based health centers.  And stay tuned next week for a conversation with a Montrose nurse practitioner on the day-to-day work and outcomes of these clinics.


I'd be concerned that a

I'd be concerned that a school-based health center:

1. Would exclude people in the general community who choose not to educate their children in public school, but yet must fund the health center;

2. Would help children with birth control, securing abortion "services," or allow pro-abortion pamphlets to be distributed and/or left in restrooms.

3. Would share medical information with the school and/or neglect to keep parents in the loop. Specific permission should be required from parents before any test or exam is performed.

But if it were privately-funded? Optional? Not supported by tax dollars in any way (including building costs and upkeep, land expenses)? Sounds good with the proper safeguards in place. Children with chronic conditions would likely miss far less school. One of my children had asthma and missed 19 days before we pulled him out mid-November. SOME of those days could have been avoided if I thought the teacher knew the signs of a child struggling to breathe and if I KNEW that he would be checked regularly throughout the day by a nurse. But in good conscience, I could not send him knowing that the teacher had 27 kids in her class, was old and didn't notice stuff (sorry, but true in this case), and the school nurse's time was divided between two buildings across town from one another.

I guess I'm curious as to why you're so strongly in support of these "Promise" neighbourhoods when even relatively suburban neighbourhoods can't keep a full-time nurse at each building. Wouldn't that be a more practical goal to begin with?

Mrs. C—You raise some

Mrs. C—You raise some excellent concerns about school-based health centers. I hope you read tomorrow’s post on the planning and implementation of school-based health centers in a Colorado district and the upcoming post on a conversation with a school-based nurse practitioner in that district. They will address some of the concerns you mentioned, though I am sure that they will raise others! For example, tomorrow’s post includes some information on funding these centers, as well as the population served by them. One tidbit to allay some of your concerns: At least in the district featured, you don’t have to be a student at the school where a health center is located to use those services—or even a student at all.

To the goal of a full-time nurse at each building—absolutely. That would be fabulous. But district and state budgets are shrinking, and a very quick Google search led me to articles on school nurse positions being cut or potentially cut in districts in Georgia, New York, Pennsylvania, and Oklahoma, just to name a few, as a result. One of the great things about school-based health centers is that they do not necessarily rely on district funds to pay for the nurse position. At a school-based health center, a nurse’s salary may be paid using a grant from a private foundation or a governmental organization. The services may be donated by a community health provider. And I am sure there are a number of other mechanisms that could pay it, though I am not an expert. So the nurse position would be less dependent on district/state funds, and the district/state funds that would be used to pay a nurse could go to another purpose.

Of course, this raises concerns with equity. Clearly communities have different capacities for both medical care and for fundraising. Would some communities be unable to develop such health centers, further disadvantaging children (and adults) in those communities? It also raises questions of sustainability—would private funds dry up in tough economic times? Would government grant programs be eliminated? Then what?

So perhaps I got a little ahead of myself in presenting school-based health centers as, in some ways, a silver bullet. But I do think, given some of the benefits that have been shown where these centers have been tried, that more consideration should be given to using them as part of a broader education reform strategy.

Thanks, Anne, and looking

Thanks, Anne, and looking forward to your posts. :)

Being healthy can helps us to

Being healthy can helps us to do the things that we want to do freely. Education is very much important for it holds the key to success. However, there are some instances wherein children refuse to go to school. Just like for example the incident that happen on Houston, Texas wherein the teacher was caught on tape with a student’s cell phone beating a student. Well, teachers must really learn on how to prolong more their patience.

Learning should be fun.

Learning should be fun. Children with healthy body can perform well in school, however it is also important that the school itself and the people around should create a healthy and peaceful environment conducive to learning.