When schools do not deal with children's health by design, they deal with it by default.—Marx, Wooley, and Northrop, Health Is Academic
Many factors affect how well educational institutions can influence student achievement: the socioeconomic status of students' families; the community tax base; social, cultural, and religious influences; and the economy. Although these factors are beyond the school's control, schools can address issues of health and safety. Students face a multitude of health-related challenges: unsafe neighborhoods; violence; family problems; and chronic, untreated health conditions. Individual problems also abound: asthma, attention deficit hyperactivity disorder, drugs, eating disorders—the list is long and familiar.
Teachers, administrators, and others in the school community struggle to respond to these complex problems, at times complaining that it is not the school's role to do so. Certainly, school staff members did not create the health and social problems of their students. But there is much that they, together with their communities, can do to address health and safety issues.
A Model for a Coordinated Approach
- A healthy environment reflects a school's efforts, through supportive policies, programs, and safety measures, to provide a positive physical, social, and emotional climate for students.
- Comprehensive health education gives students classroom instruction to develop the knowledge, attitudes, and skills that they need to avoid risky behaviors and to maintain and improve their health.
- Physical education teaches students fitness skills and promotes lifelong physical activity.
- Health services include early diagnosis and prevention of health problems and management of, or referrals for, acute and chronic health conditions.
- Counseling, psychological, and social services help develop positive learning environments and offer early intervention, services, and referrals for the cognitive, emotional, behavioral, and social needs of students and their families.
- Nutrition services provide attractive, nutritious, and affordable meals while promoting healthy eating behaviors.
- Staff health promotion includes activities to maintain and improve the health of school staff, contributing to better morale and providing healthy role models for students.
- Family and community involvement creates partnerships to support students' health and academic achievement by making the most of available resources and expertise.
Many of these elements already exist in schools, but they could be identified and organized more effectively. Administrators must address all aspects of students' lives to ensure that they achieve in school and become healthy, productive citizens.
School Examples
At the Veazie Street Elementary School in Providence, Rhode Island, teachers can refer students to a family school support team that consists of the principal, a guidance counselor, a clinical social worker, the school nurse, a school psychologist, and the curriculum coordinator. Principal Nancy Penza observes,In urban education, there are too many forces and pressures at work in the home, even in intact families. When a child is sent to the [school] office, we ask, "Is someone working with this child?" I cannot stress enough how important our clinic staff is. The kids see these people as an integral part of school.
The team meets weekly with teachers to identify, diagnose, and address the psychosocial needs of students and their families. The school incorporates health education and physical education into the curriculum to encourage lifelong healthy lifestyles. A family resource center, staffed by Americorps volunteers who are also parents, increases communication among school, home, and community.
Contrast this with the well-intentioned but less effective activities in a Virginia school. A teacher presents a lesson on the food pyramid and a nurse counsels a group of obese girls, while cafeteria workers prepare pizza and French fries and the school business manager counts the proceeds from the soft drink and candy machines (Tyson, 1999). Working at such cross-purposes not only undermines health but also represents a lost opportunity for all school staff to reinforce the contributions of teachers and school nurses.
The school district in Animas, New Mexico, makes the most of limited resources to incorporate the components of a coordinated school health program. In lieu of a physical education teacher, the elementary school keeps students physically active and teaches the value of physical activity by implementing a Walking Across America program. Students measure the distance of their regular walks and track their progress in an imaginary trip.
Because the district cannot afford to establish a school-based health center, a county health advisory council assists by identifying supplemental health resources in the area. The contributions of parents, students, and community members have produced a community health services directory and a cookbook with healthy recipes. A conflict resolution program called Take It to the Table, in which students learn to shake hands and sign a contract, contributes to a safe environment.
Community Support
- Understanding and awareness. Key members of the school community agree that schools must address health issues if they are to meet their educational goals.
- A coordinator. A coordinator has the ear of school decision makers and has release time, space, and resources to coordinate health-related activities within the school or district, with other agencies, and with the community.
- A school health team. An inter-disciplinary school health team, which includes administrators and representatives of the program components, the school board, students, families, and community organizations, meets regularly to plan, assess, and monitor coordinated activities.
- Subcommittees. Subcommittees representing the program components and health-risk factors address their unique needs and cooperate with other subcommittees.
- Assessment. The school or district identifies health-related factors that interfere with student achievement and well-being and surveys policies and resources to determine the status of the health program.
- A school health plan. The school health team develops a plan with realistic goals and objectives, clearly defined roles and responsibilities, and strategies for those implementing the components to work with one another and with the school community.
- Links to the school mission. The school's mission statement includes support for health activities. In addition, the school improvement or site-based management team has a school health representative. The school improvement plan incorporates the school health plan, and line items in the budget support the implementation of a coordinated school health program.
- Staff development. Regular training sessions build staff skills and commitment and prepare new staff.
- Monitoring and evaluation. Schools regularly monitor progress toward implementation and adapt strategies and activities on the basis of their findings.
Building on Strengths
As with any change that involves the entire school or district, successful development takes time—sometimes as long as 15 years. But every district and school has health-related elements in place. These may include an annual health fair, a health-education curriculum, a student-assistance program, conflict-resolution classes, or a no-smoking policy. Capitalizing on one strength can be the basis of a broader coordinated program.
Being an educator these days is not easy. Absenteeism, dropout rates, apathy, violence, or substance abuse are constant concerns. But teachers, principals, school nurses, counselors, and families do not have to deal with these issues by themselves. Well-coordinated school health activities that are incorporated into the fabric of the school can actually free educators' time and energies so that they can focus on academics. Rather than add to a school's burden, coordinated school health programs can lighten it.
