Compelling Evidence for Mounting a Nationally Coordinated School Health Effort

"Over the past several decades, a variety of strategies have been tried to help close the achievement gap -- standards, accountability, NCLB, more rigorous teacher certification -- and they're all important, but they won't have the desired effect unless students are ready and motivated to learn. Educationally relevant health disparities" are key drivers of the achievement gap, "but they are largely overlooked."  

The speaker was Charles Basch, TC's Richard March Hoe Professor of Health Education, and the topic was "Healthier Students Are Better Learners," Basch's new meta-study focusing on seven health risks that disproportionately impair the academic performance of urban minority youth. Addressing an audience in TC's Cowin Conference Center on March 9th, Basch presented his findings and then discussed them with respondents Matthew Yale, Deputy Chief of Staff to U.S. Secretary of Education Arne Duncan, and TC alumnus Howell Wechsler, Director of the Division of Adolescent School Health (DASH) for the U.S. Centers for Disease Control and Prevention. The event -- presented by TC's Campaign for Educational Equity -- was moderated by Jane Quinn, Assistant Executive Director for Community Schools for the Children's Aid Society.

Basch, whose study pulls together research from over 300 sources, called the health crisis for the nation's youth "staggering." Among the statistics he cited:

• Visual problems affect more than 20 percent of American youth
• Asthma affects more than 14 percent of youth under 18
• One in three teens is expected to become pregnant  
• Twenty-eight percent of adolescents have been bullied at school
• Two in three students don't get enough physical activity
• 20 percent of youth skip breakfast on any given day.
• About 8 percent of youth ages 6-17 have been diagnosed with hyperactivity  

And, Basch said, the situation is far worse for urban minority youth. Among the examples he gave:

• Black children are significantly more likely to suffer from asthma, and certain populations within Latinos -- most notably Puerto Ricans -- are as well. Urban minority youth also have higher rates of poorly controlled asthma, as indicated by over-use of the emergency room and under-use of efficacious medicines.
• Non-Hispanic black teens have pregnancy rates three times as high as whites, and rates for Hispanic teens are four times as high as for whites.
• Nearly 10 percent of Hispanic youths missed one or more day of school in the past month because they were afraid -- a figure more than twice as high as for whites. Rates for blacks were more than 50 percent higher than for whites.

Yet, Basch said, "all of this is old news -- everyone knows this." What's new, he said, is research on how these conditions work to impair educational outcomes. Basch has identified five pathways through which this occurs, including sensory perception (if students can't see and hear well, they can't learn effectively); cognition (thinking and memory); and school connectedness ("It's been widely documented that the extent to which students feel connected to their schools makes them more likely to succeed academically and less likely to engage in negative behaviors.

And because each of the seven conditions works through one or more of these pathways, the combined effect of the seven is synergistic, he said, creating a crisis that is more than the sum of its parts.

So what must happen to change that picture?

"The most important thing is not do just one thing," Basch said. "Instead, we must address a set of priorities simultaneously."

The country needs a national school health strategic plan, developed by the U.S. Department of Education, he said. Yet at the same time, because education in America is so decentralized, planning must also go on at the local level. Health related measures must be integrated into school accountability mechanisms, and health goals must become part of individual school improvement plans. Beyond that, "different people involved in schools must play different roles to try to achieve the same goals" because otherwise resources will not be used effectively. "If the school sends a note home saying that a child has vision problems, the parents must get that child to an optometrist, and the teacher must make sure that the child wears glasses in class."

In addition, health education must become a fundamental part of the mission of schools, Basch said. For that to happen, schools of education incorporate health into their curricula for preparing school administrators.

For his part, Yale -- who previously worked with Duncan in Chicago -- said that coordination between government agencies on health issues has been improving, as evidenced in particular by the federal response to last year's H1N1 (swine flu) outbreak. That effort brought together USDOE, CDC, the U.S Department of Agriculture and others, with education officials helping to write CDC guidelines.

"I don't think we're siloed anymore," he said.

Yale also cited other indicators that the current administration is focused on health. These included First Lady Michelle Obama's "Let's Move" initiative, and the Elementary and Secondary Education Act, now up for reauthorization containing an additional $41 million for an initiative focused on healthier schools.

Still, he said, there isn't enough time in the school day and year to effectively address both academic and health priorities. He called the two areas "a false choice" and said "we need kids in the building longer."

Wechsler, a former student of Basch's, called Basch's findings "insightful and clearly compelling."

"People in the health fields are often asked -'where's the evidence'" of the need for prioritizing health spending, he said, but Basch's data will enable them to "turn the tables on policymakers."

"Two decades ago, politicians decided to cut back on physical education on the assumption that less time in the gym meant more time in the classroom. Where was the evidence for that?" The results, he said, "threaten to sap the economic competitiveness of our country" and have led to "an epidemic of obesity."

Wechsler, too, said he sees improvement in cooperation at the federal level, though collaboration remains "an unnatural act between consenting adults."  

Meanwhile, the country needs to pick up on successful local examples of efforts to focus on health. These include the allocation by Tennessee, one of the poorer states, of funding to each school district for a health coordinator; the decision by 14 states to require that every school district have a school health index; and more.

"A lot of health professionals who advocate for coordinated school health get the feeling they're being eyed as crazy radicals for distracting from the essential mission of American schools -- but that's not the mission I learned about at TC," he said. Noting that he was speaking in TC's Horace Mann Hall, he repeated Mann's famous quote that "On the broad and firm foundation of health alone can the loftiest and most enduring structures of the intellect be reared."

"Somehow," he said, "we have to get back to that."

Published Thursday, Mar. 11, 2010