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A Framework for School Health Programs in the 21st Century

Posted on: Tuesday, 2 August 2005, 12:00 CDT

Our world and our nation have changed; so too have our schools. Today, more than ever, school health programs could become one of the most efficient means available to improve both the health of our children and their educational achievement.

Increasingly, parents, school staff, public health workers, and others concerned about young people together are revitalizing long- neglected school health programs. To aid them, the following framework offers an outline of the contexts, components, goals, organization, and administration of contemporary school health programs. A more detailed version of the framework is being prepared.

CONTEXTS

Modern school health programs could address the health and education contexts in which they evolve. Today, the major causes of death, disability, injury, and illness among young people (ie, motor vehicle crashes, other unintentional injuries, violence, suicide, sexually transmitted diseases, and unintended pregnancies) and among adults (ie, heart disease, stroke, cancer, lung diseases, and diabetes) result from a few patterns of behavior that become established during school-age years-alcohol and drug abuse, behaviors that result in unintentional and intentional injuries, sexual behaviors, tobacco use, unhealthy diets, and physical inactivity. These preventable behaviors are taxing our health care, health insurance, and underlying economic systems to the breaking point.

Consequently, our public health and medical care systems are reforming. A recent report of the Institute of Medicine (IOM)1 reasoned that

Health is a primary public good because many aspects of human potential ... are contingent on it. In view of the value of health to employers, business, communities, and society in general, creating the conditions for people to be healthy should ... be a shared social goal .... The special role of government must be allied with the contributions of other sectors of society ....

A public health system would include the governmental public health agencies, the health care delivery system, and the public health and health sciences academia .... [But it also would include] communities and their many entities (eg, schools, [community] organizations, and religious congregations), businesses and employers ... as potential actors in the public health system ....

The IOM consequently defined a public health system as "a complex network of individuals and organizations that, when working together, can represent what we as a society do collectively to assure the conditions in which people can be healthy."1

Like health, education also is a primary public good, and a public education system similarly might engage schools with other organizations to collectively assure the conditions in which young people can be educated.

Strategies implemented by various agencies as part of education reform to improve student achievement can be grouped into 6 categories:

1. Means to specify and monitor priority achievement objectives.

2. Means to improve education curricula, methods, and technologies.

3. Means to assure fiscal resources necessary to improve educational achievement of every child in every community.

4. Means to recruit, train, and retain well-qualified school teachers, administrators, and other staff in every community.

5. Means to engage each community in providing necessary support for its students and school staff.

6. Means to enable administrators of local, district, state, and national education agencies to manage these strategies.

Modern school health programs could provide one of those means listed fifth as a vital part of education and public health reforms.

COMPONENTS

Modern school health programs could include 8 components, which have been described in more detail elsewhere,2 including school: (1) health services; (2) health education; (3) biophysical and psychosocial environments; (4) psychological, counseling, and social services; (5) physical education and other physical activities; (6) food services; (7) employee health policies and programs; and (8) integrated efforts of schools, families, and communities.

The seventh and eighth components bear brief comment. As more educators leave the profession than enter and remain in it, we face a growing shortage of qualified school staff. The seventh component of modern school health programs, school employee health policies and programs, purposefully can be designed to increase recruitment, reduce stress, and improve the health, productivity, commitment, and longevity of those most qualified to work in schools.

Further, among means to improve educational achievement as listed, there are evolving more "means to engage each community in providing necessary support for its students and school staff," especially to reduce barriers to learning. The eighth component, integrated efforts of schools, families, and communities to improve the health of school students and employees, purposefully can be designed to unite with other efforts of families and community agencies-such as community schools,3 21st Century Community Learning Centers,4 and youth development programs-to collaboratively improve health, education, and social outcomes.

GOALS

As described more fully elsewhere,5 modern school health programs specifically could be designed to achieve 1 or a combination of 4 different types of goals. First, they can be designed to improve health literacy (ie, health knowledge, attitudes, and skills). Indeed, the IOM recently called for a delineation of actions relevant agencies could take to help the nation's schools improve health literacy.6

Second, school health programs can be designed to improve health behaviors and health outcomes (eg, they can increase physical activity and decrease vaccinepreventable diseases). Third, they can be designed to improve educational achievement (eg, school breakfast programs can improve scores on standardized tests as well as reduce tardiness, absences, behavioral disruptions, and symptoms of anxiety and depression). Fourth, modern school health programs can be designed to improve social outcomes (eg, youth development programs can increase connectedness to prosocial organizations).

Needless to say, not all school health programs are effective. Importantly, programs that are not specifically designed and organized to achieve a given goal should not be expected to attain that goal.

ORGANIZATION

To be most effective, relevant education, health, and social service agencies-at national, state, district, and school levels- collectively could organize and evaluate their actions within and across levels to help local schools attain specific goals. For example, as described elsewhere,7 agencies across levels strategically have organized to help the nation's schools reduce tobacco use, unhealthy dietary patterns, physical inactivity, and obesity.

Agencies within each level include not-for-profit organizations, especially voluntary associations (eg, American Cancer Society), professional organizations (eg, National School Boards Association, American School Health Association), and philanthropies (eg, Robert Wood Johnson Foundation). At the national level, the National Coordinating Committee on School Health and Safety provides a means for such national health and education organizations to work together.

Agencies within each level also increasingly include private- sector agencies, such as managed care organizations that provide health care for employees and sometimes students, vendors who supply schools with food and beverages, and businesses that care about today's students and tomorrow's workers.

Finally, agencies within each level include publicsector agencies. At the national level, relevant executive branch agencies are located within the US Departments of Health and Human Services, Education, Agriculture, and the Environmental Protection Agency. The federal Interagency Committee on School Health provides a means for these organizations to work together.

Health and education committees within the legislative branch often provide necessary authority and resources for executive agencies to help implement specific school health policies and programs. At the national level, the Friends of School Health have organized concerned national, not-for-profit health and education organizations to collectively establish national school health priorities and to inform Congress about means to accomplish these priorities.

Finally, the judicial branch increasingly is addressing the health of school students and employees (eg, to assure schools provide required health services, protect students and employees from environmental hazards).

Colleges and universities could perform critical functions by helping local, district, state, and national agencies: organize efforts, conduct research to evaluate and improve these efforts, and provide necessary preservice and inservice education for school administrators and staff in each of the 8 components.

Thus, within and across national, state, district, and local levels, the various agencies listed above purposefully can organize their collective efforts to increase the effectiveness and efficiency of modern school health programs, consolidate the political support needed to implement such programs, and make it easier for school administ\rators and employees at the local level to administer otherwise unorganized efforts.

ADMINISTRATION

As recommended by the IOM8, each local school, district, and/or state could establish (1) a school health coordinator, (2) a school health team comprising school staff responsible for each of the 8 components, and (3) a school health council that can include-in addition to the school administrator, school health coordinator, interested parents, and students-representatives from agencies in the jurisdiction that collectively can help provide guidance, resources, and support for the school health program (eg, the school board and school food authority, health department, other government agencies, health care providers, businesses, community agencies that serve youth). Indeed, the Child Nutrition and WIC Reauthorization Act of 2004 requires that by the first day of the 2006-2007 school year, each local educational authority must have a measurable local school wellness policy that has been developed with involvement of such representatives.

CONCLUSION

In summary, Mother Theresa noted: "You can do what I cannot do. I can do what you cannot do. Together we can do great things." As reflected above, school health programs in the 21st century could be called healthy schools, health-promoting schools, modern school health programs, or coordinated school health programs. It matters not what we call them or how they vary. It matters that they simply comprise the best efforts of individuals and agencies purposefully working together-helping each other-to improve the interdependent health and education of students. Our young people, our families, our schools, and our communities deserve less-and they should wait no longer.

References

1. Institute of Medicine. The Future of the Public's Health in the 21st Century. Washington, DC: National Academies Press; 2003:xiv.

2. Marks E, Wooley SF, Northrup D, eds. Health Is Academic: A Guide to Coordinated School Health Programs. New York, NY: Teachers College Press; 1998.

3. Blank M, Melaville A, Shah BP. Making the Difference: Research and Practice in Community Schools. Washington, DC: Institute for Educational Leadership, Coalition for Community Schools; 2003.

4. No Child Left Behind Act of 2001. Pub. L. No. 107-110, 115 Stat. 1425 (January 8, 2002); sec. 4201-06; 21st Century Community Learning Centers.

5. Kolbe L. Education reform and the goals of modern school health programs. State Educ Stand. 2002;3(4):4-11.

6. Institute of Medicine. Health Literacy: A Prescription to End Confusion. Washington, DC: National Academies Press; 2004:142-166.

7. Kolbe L, Kann L, Patterson B, Wechsler H, Osorio J, Collins J. Enabling the nation's schools to help prevent heart disease, stroke, cancer, COPD, diabetes, and other serious health problems. Public Health Rep. 2004;119(3):286-302.

8. Institute of Medicine. Schools and Health: Our Nation's Investment. Washington, DC: National Academy Press; 1997.

9. Child Nutrition and WIC Reauthorization Act of 2004. Pub. L. No. 108-265, 118 Stat. 729 (June 30, 2004); Sec. 204; Local Wellness Policy.

Lloyd J. Kolbe, PhD, FASHA, Professor, (lkolbe@indiana.edu). Department of Applied Health Science, Indiana University, Bloomington, IN 47405. This manuscript was commissioned by the National Coordinating Committee on School Health and Safety in May 2004, and presented at the 11th Annual Summer Institute of the American School Health Association, at Harvard University, on August 6, 2004.

Copyright American School Health Association Aug 2005

Source: Journal of School Health, The

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