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By Harriet Tyson
PRINCIPALS and teachers are straining every fiber to bring all their students up to the grade-level standards set by their districts or states. If they do not, they risk, in many places, less-than-glowing job evaluations, the humiliation of state takeovers of their schools, the denial of expected salary increases, involuntary transfers, or even the loss of their jobs. At the same time, front-line educators and their students are awash in a toxic sea of problems, especially in communities in which a high percentage of the children are poor, recent immigrants, unsupervised after school, lacking medical care, and exposed to mayhem in their neighborhoods.
In all kinds of communities, teachers' energies are sapped by having to attend to students who are upset, angry, depressed, or ill. When medical or psychological services are not forthcoming, teachers by default become crisis managers, fight mediators, grief counselors, and frustrated liaisons with distant and often impersonal human service bureaucracies and medical providers -- at the expense of the quality of the lesson in progress.
For decades, teachers have complained vehemently about their lot, but the public has often seen their complaints as an attempt to shift blame onto society. And policy makers have pursued a relentless "no excuses" line when it comes to academic achievement. Now this attitude of resistance to teacher complaints is beginning to crumble.
Many who labor in the arena of public policy are facing the reality that 15 years of energetic school reform efforts have produced some modest improvements, but not the hoped-for results. Merely setting standards, using better tests, telling teachers to teach better, tightening certification requirements, or getting rid of principals or superintendents when test scores don't rise hasn't brought us to the promised land -- or even to the edge of it. Many people now question the current orthodoxy that only academic outputs matter and that any discussion of inputs is a delaying tactic on the part of the educators. While there are no signs of any political retreat from the steely focus on academic outcomes, there is an awakening to the notion that education reform may require creative (meaning unfunded or underfunded) interventions that lower the barriers to learning and reduce risky behavior. First among those barriers are poor physical and mental health conditions that prevent students from showing up for school, paying attention in class, restraining their anger, quieting their self-destructive impulses, and refraining from dropping out.
The Poor Health of American Children
The traditional diseases of childhood have nearly disappeared, thanks to great advances in medical research and the managerial brilliance of the public health apparatus in the United States. But new health problems have emerged with a vengeance. One child in four -- fully 10 million -- is at risk of failure in school because of social, emotional, and health handicaps.1
The "new morbidities," as they are called in the public health community, are the adverse consequences of poor nutrition, lack of exercise, smoking, early sexual activity, drinking, drug abuse, violence, depression, and stress. The origins are psychological and social, but the consequences are medical, educational, and sometimes criminal: HIV/
AIDS, other sexually transmitted diseases, teen pregnancy, alcohol-related automobile accidents, addiction, injuries or deaths from stabbings or shootings, and suicide.
A quick rundown of the incidence of risky behaviors among young people gives a snapshot of the problems of students in grades 9 through 12. Consider the following items, taken, unless otherwise noted, from the 1997 Youth Risk Behavior Survey (YRBS) conducted by the U.S. Centers for Disease Control and Prevention:
Children who are aggressive and disruptive in the early grades are very likely to become involved in several of the "new morbidities." Children who do not learn to read in the first few grades, who read poorly, or who are retained in grade more than once are far more likely than their peers to be drawn into a pattern of risky behaviors. Thirty-five percent of students who don't read well will drop out of high school.5 Sixty percent of adolescents in treatment for substance abuse have learning disabilities.6 Half of juvenile delinquents tested were found to have undetected learning disabilities.7 Among the children classified with "learning disabilities," 75% to 80% are of average or above-average intelligence and still have significant reading disabilities, according to the National Institutes of Health.
Physical inactivity is now widespread among American students. The 1997 YRBS shows that 63.8% of students nationwide had engaged in activities that made them sweat and breathe hard for at least 20 minutes on three or more of the seven previous days. The remaining 36.2% are sedentary youngsters prone to the same health risks as sedentary adults.
In addition, the eating habits of American children are poor and grow worse as they advance through the grades. The immediate consequences of eating too much salt, fat, and sugar and too few fruits, vegetables, and grains are obesity, high blood pressure, juvenile diabetes, and high rates of dental caries. Poor eating habits laid down in childhood are desperately hard to break, as every dieting adult knows.
Asthma has reached near-epidemic levels, although there is not yet a national asthma registry. The incidence is higher in the cities than in the suburbs, but even some suburban jurisdictions report that asthma is the leading cause of school absences, emergency room visits, and hospital admissions.
Finally, environmentally caused illnesses are on the rise among children and adults who work in school buildings. Children are more susceptible to environmental hazards than adults, and those hazards are increasing in numbers and intensity, both in and out of school buildings.8 Poor indoor and outdoor air quality, contaminated water supplies, and bacterial contamination of food cause many missed school days and sometimes serious and lasting health problems.
The Poor Health of Poor Children
Children are the poorest group of Americans. What's more, they are getting poorer, and the frequencies of the contemporary health plagues are all markedly higher among children of the poor than among children of the middle class.9 U.S. Census data show that, in 1993, 14.4% of American children were living in poverty. By 1996, the rate had risen to 20.5%. Among that group are a stunning 11.3 million American children under the age of 18 who are not covered by medical insurance. Moreover, 92.1% of uninsured children in 1996 had at least one working parent.10 Welfare reform removed many children from Medicaid eligibility because their eligibility was contingent upon the receipt of cash benefits. The good news is that the federally sponsored Child Health Insurance Program (CHIP) promises some relief; an estimated four to five million of the 11 million uninsured children will qualify for health insurance under CHIP when it is fully implemented.
We Have Been Here Before
This is not the first time in American history that schools have been overwhelmed by a widespread crisis in child health. In the late 19th and early 20th centuries, when the last wave of immigration was in full swing, public health officials began to conduct sanitary inspections of school buildings, and cadres of nurses routinely examined schoolchildren in order to stem the tide of absences caused by the spread of infectious diseases. Health education became entrenched in the curriculum. There were crusades to stamp out tuberculosis, and the temperance movement pressed the schools to teach children about the effects of tobacco, alcohol, and narcotics on the human body. Physical education was introduced into the schools because school leaders believed it was important to health and learning. At the turn of the century, doctors removed tonsils and adenoids on school property because parents couldn't afford the carfare to the nearest dispensary.11
As the wave of poor immigrants subsided in the early 1900s, so did the impetus for school-based or school-linked health services. The American Medical Association (AMA) became adamant about limiting the role of school nurses and public health physicians to health screenings and restricting them from providing treatment, either on school property or at public health clinics.12 (The AMA has changed its stance in modern times.) The wall between public health and education became higher in the middle decades of the 20th century, and their respective bureaucracies and professional cultures became more isolated from one another.
Many features of the 1990s echo those of the turn of the century: a tidal wave of immigrants, urban and rural poverty, the enduring racial divide, a lack of affordable housing and health care for the poor, and political resistance to linking education and public health. Some new elements have been added to the picture, including a drop in the age of sexual maturation, an increase in single-parent families, a reduction in the number of stay-at-home mothers, the emergence of HIV, the appearance of new and more addictive drugs, the increased availability of firearms, and skyrocketing medical costs.
The features of the 1990s, both old and new, constitute risk factors
for young people and directly affect their health and well-being. And their
impact is not limited to those who are poor. In virtually all school communities,
the problems that contribute to the new morbidities and mortalities are
present. Children in all circumstances are affected by the stresses of divorce
and immigration, and adolescents everywhere are vulnerable to sexual temptation,
alcohol, drugs, tobacco, depression, suicide, and violence.
A Solution: The Coordinated School Health Initiative
The coordinated school health initiative has emerged in response to the state of affairs in children's health and education today. It follows decades of mutual disengagement between the schools and community programs for public and private health, mental health, dental health, social services, recreation, and youth development. This disengagement has led to wasteful duplication of services, a jumble of separately funded prevention programs, and a widespread failure to integrate services essential to children's health and learning. The movement to provide coordinated school health services engages all the centers of activity -- in and out of school -- that relate to student health and success in school. It determines what the health problems are in particular school communities, builds community consensus on what services should be provided, melds funding from a variety of existing sources, and knits together a coherent and comprehensive approach that can make a difference in improving children's health.
Uncoordinated school health programs. Examples of an uncoordinated approach to student health can be observed in many schools. Lack of coordination is so normal that many schoolpeople accept fragmentation, duplication, and inconsistency as a fact of life. Examples abound.
These examples of poor communication, mixed messages, lopsidedness, wasted motion, counterproductive moves, and missed opportunities are the ground from which coordinated school health programs have arisen.
Coordinated school health programs. The guiding principle of the coordinated school health movement is that schools and communities can do a lot more than they now do with the money, staff, time, and creativity they have. Working in partnership with health agencies, community institutions, and families, schools and communities can create a seamless web of education and services that lowers the barriers to learning experienced by so many of today's young people.
Coordinated school health efforts reflect a state of mind. They rest on the premise that everybody in a child's environment can contribute something, while no one can address a child's health problems effectively by working alone. All players need to be able to cross disciplinary boundaries, employment categories, and social-class barriers. Providing for coordinated school health services requires a strong school leader who isn't afraid to take stands on issues that matter to children's well-being. It is also essential to have a skilled coordinator to pull all the disparate forces together and a strong school-site health team to pool knowledge, manage cases, and ensure the connections to agencies outside the school. Teacher involvement in school health teams is crucial because teachers have their fingers on the actual pulse of a school and have a sense of what kinds of arrangements will earn the trust and participation of students and families. The cost of coordinated school health programs is either nil or modest, and the payoff is large.
The Eight-Component Model for a Coordinated Program
In the 1980s Diane Allensworth and Lloyd Kolbe articulated an eight-component model for a coordinated school health program.14 Many of these components already exist in schools.
1. Health promotion for staff provides health assessments, education, and fitness activities for faculty and staff members and encourages their greater commitment to promoting students' health by becoming positive role models.
2. Health education consists of a planned, sequential, K-12 curriculum that addresses the physical, mental, emotional, and social dimensions of health.
3. School health services focus on prevention and early intervention, including the provision of primary care, access and referral to community health services, and the management of acute and chronic health conditions.
4. Counseling, psychological, and social services include school-based interventions as well as dependable links to private and public mental health services in the community. Services are provided to students as individuals and in groups.
5. Nutrition services are responsible for offering a variety of nutritious and appealing school meals, maintaining an environment that promotes healthful food choices, and supporting nutrition instruction in the classroom and cafeteria.
6. Physical education is a planned, sequential, K-12 curriculum promoting physical fitness, movement skills, sports skills, and lifelong physical activity.
7. Promoting a healthy school environment means providing a safe physical plant, as well as a healthy and supportive environment for learning.
8. Family and community involvement engages a wide range of resources and marshals support to enhance the health and well-being of students.15
Efforts to create coordinated school health programs can originate at the school level, but schools find the process easier when the state or district designates a school health coordinator with superior negotiating skills and a working knowledge of the issues and funding challenges involved. A state or district coordinator can help individual schools form a school health team -- a critical first step -- and can help design a survey of community needs and community health resources. The school health coordinator guides the local school in planning a program that suits the community's needs and values, prompts all staff members to explore how they can help improve the adverse circumstances and behaviors that keep students from learning, and assists in developing standards for measuring the effectiveness of the effort.
The very formation of a school health team often liberates the energies of teachers who see problems and have ideas about how to solve them but are unable to put their ideas into practice by themselves. Here are a few no-cost examples from South Carolina:
Health promotion for staff members. Tena Hoyle, who is training coordinator for the South Carolina Healthy Schools Partnership, helps local schools plan coordinated school health efforts. She has found that a staff wellness program is a good place to begin, not only because it improves faculty energy, morale, and attendance, but also because it sharpens teachers' awareness of the consequences of unhealthy living and makes them more interested in promoting the health of their students. Budget directors and insurance companies like staff wellness programs too because the cost of hiring substitutes drops sharply, and healthier teachers make fewer claims against the health insurance plan.16
Most staff wellness programs operate on a shoestring because most of the costs are already borne by the district. Athletic facilities and equipment are already there; nurses who screen students for hypertension and cholesterol are available to screen teachers as well.
Health education. The time and attention that schools spend on health education had been shaved in recent years, despite entreaties from health educators to increase the quality and intensity of health education. In the current environment, it remains unlikely that their pleas will be heard, since knowledge of health topics is not yet a part of the standardized academic testing programs that dominate American education today. But the available research, skimpy and short-term though it is, suggests that classroom teaching about health has positive effects on student behavior, especially if the instruction is interactive and gives students a chance to learn the skills that are necessary to form healthy habits. When it is part of a total school response to health matters, health education can reduce risky behaviors.
Health educators can and do extend their reach by drawing more staff members into the effort. Nurses often teach specific health and wellness topics or run small counseling groups for students with eating disorders, asthma, or other conditions. Counselors teach students how to resolve conflicts, manage anger and stress, resist peer pressure, and develop healthy relationships. The health teacher and the cafeteria manager can coordinate instruction and menus, using the cafeteria as a site for hands-on nutrition education.
Health services. Schools today have become involved in preventive health services and the management of chronic diseases. In addition to their traditional tasks of monitoring immunizations, weighing and measuring students, screening for vision and hearing problems, and tending to minor injuries, schools are now beginning to screen for high blood pressure, cholesterol, and other indicators of impending health problems. Since 1994, schools have been required to administer medicines, injections, or catheters at school to children with a variety of dis-abling conditions or chronic diseases, and they have often done these things with untrained staff. This fact alone dictates a more coordinated approach to school health services. Managing a medication program not only requires smooth and accurate communication between students, parents, and doctors, but it increasingly requires changes in the rules about what nurses are equipped and permitted to do.
A school-based health center staff may consist of just a school nurse and a counselor, with strong links to medical and counseling services outside the school. In communities with more intense needs, a center staff might also include a nurse practitioner or a physician's assistant (a staff member with the authority to treat many minor illnesses and injuries and carry out the orders of physicians), a medical technician to conduct routine laboratory tests and screenings, a part-time doctor and dentist, and a school psychologist or clinical social worker. How much time each of these specialists devotes to the clinic is determined by a careful count of the population to be served and by a survey of its health needs. It is important to note that most of the people who staff these centers were already employed by a local health, mental health, or human services department. They have simply moved to be where the patients are.
Putting a health center in or near a school recognizes the reality that, in many neighborhoods, referring parents and students elsewhere for treatment doesn't work. Because they lack transportation or can't take off from work, many parents don't keep appointments; public health providers are then paid to twiddle their thumbs waiting for no-shows. However, parents do keep appointments in school-based clinics, and most observers believe it is because parents have developed bonds with the school staff and are able to get to the site. Often, they can walk.
Health centers offering a full array of medical services are usually situated in neighborhoods where there are concentrations of health and social problems and where few residents have health insurance or the personal means to pay for private health care.
In coordinated school health programs, school counselors or nurses have often become effective links between the education, health, and mental health components of the program. Because they are in the school on a regular basis, they understand the norms and rhythms of schooling. Thus they are in a good position to mediate the sometimes conflicting imperatives of students, teachers, and health providers -- for example, explaining why it would be damaging to a student to require her to miss the same class period each week in order to attend a counseling session.
Nurses and counselors typically coordinate appointments with outside providers, making sure that parents are sympathetic to the need and able to take the child to the appointment. Sometimes, though, the health care system imposes barriers to treatment. Many students who need intensive or emergency help cannot be treated because they are not eligible for Medicaid and their families cannot afford the fees. Sometimes managed care organizations put severe limits on services (e.g., only a 24-hour hospital stay or just six hours of counseling for a suicidal child). Nevertheless, school health coordinators -- whether principals, counselors, nurses, or teachers -- are creatively navigating these financial and bureaucratic shoals and helping a lot of seriously sick and troubled children get the services that can make all the difference in their lives in school and out.
High-visibility political struggles over whether the schools should teach youngsters about contraception or provide them with free condoms have led many people to believe that school-based health clinics are primarily about passing out birth control pills and condoms. But the reality is that school-based health centers are developed only after a deep process of building consensus in the community. Clinics don't offer family-planning services in communities that oppose them; even in communities that welcome such services, parental permission is essential.
Today there are at least 900 school-based health centers in the U.S., and many have been in operation long enough to have demonstrated their benefits to both health and education. Here are two examples of programs, one small and one large, that have had positive results.
Disruptive behavior has been sharply reduced at Broadacres. High student turnover, which greatly vexed the teachers, has been sharply reduced because parents don't want to move away from the familial atmosphere and array of supports available at Broadacres. According to D'Ovidio, parents are more at ease and more connected to the school and one another. The teachers are free to concentrate on teaching, and, probably for that reason, test scores are up.
The principal's welcoming attitude toward innovation has spurred school staff members to create other helpful programs. For example, the teacher of English as a second language started a homework club after school for students and their parents. While the students are getting help with their studies, the parents learn how to help their children with math and reading, how to prepare inexpensive and nutritious recipes, and how to obtain public services. All the while, the parents are improving their English. The night custodian noticed that the children were not physically fit and asked to start a sports program for the children and their parents. She got a small stipend and equipment from the county recreation department and now runs a popular weekend program.17
The medical component of the Dallas program has produced dramatic improvements in school attendance -- the issue that was the main stimulus for the development of the program. Dallas is building a coordinated school health program in each school and has imposed new accountability requirements that go beyond academic test scores. The lion's share of youth problems, though, fall into the category of mental health, and the mental health component of the Dallas program has produced such stunning outcomes in such a short time that educators everywhere need to sit up and take notice.
Counseling, psychological, and social services. The mental health component of the Dallas program places a high value on families and believes in their unique power to help a child in trouble. For that reason, the clinic rarely sees a child unless a family member is present. According to Jenni Jennings, director of the mental health component of the Dallas operation, family members are willing to show up. Virtually 100% of parents now attend appointments, as opposed to 50% when mental health services were housed in a community mental health center.
The Dallas program operates on a resiliency model, rather than a pathology model. Staff members at the clinic search for and build on the strengths they believe lie within each person and family, and they show parents great respect. Families are welcomed by a greeter, who offers sandwiches, cookies, and drinks and who reads to or plays with the children. Parents rarely resist attending, but when they do, the clinic works hard to find another family member -- a grandmother, aunt, or sibling -- because the clinic's philosophy is that every child is loved by somebody in his or her family. In order to accommodate working parents, the clinic is open into the evening hours and on weekends. Clinic employees work flexible schedules, and private therapists work in the evenings on an hourly basis.
Before a child and his or her family ever come to the clinic, a child study team in the local school has done a lot of preliminary work. These teams include principals, counselors, nurses, and teachers, and they are trained by the clinic staff to study children and do what they can to solve problems at the school level. If the strategies and accommodations at the school level don't work, the team then makes an appointment with the clinic, and the team and the parents make the case for the child's inclusion in the clinic program.
Once a student and his or her family are enrolled in that program, a therapist explores the family dynamics. According to Jennings, even a small shift in family dynamics often ripples through the family in positive ways. Clinic staff members sometimes visit the school to observe the child in classes. They develop a treatment plan and provide prescriptions for the local school team and for all the teachers who come in contact with the child. The plan observes confidentiality protocols, but it nevertheless brings teachers into the loop with tips on how to help the child in class.
The mental health service has achieved the following results over the past two years: a 95% decrease in discipline referrals, a 32% decrease in absences, and a 13% decrease in course failures.18 These powerful results demonstrate the value of coordinated mental health services that are well-designed, competently staffed, family friendly, and respectful toward teachers. They also underscore the point that the most direct way to lift the burden off of teachers' shoulders is to address, systematically and intensively, the emotional problems of young people.
Nutrition services. School food service programs are going in two directions at once. As of 1995-96, many schools (13%) had contracted out their food services to fast-food operators, and another 1% to 3% of the surveyed cafeteria managers were planning to offer brand-name food in the coming year. As of 1994-95, a small number of schools (8%) were using food service management companies, but that number was predicted to increase rapidly.19 School food managers cite finances as the main reason for shifting to outside providers. Many managers are required to make a profit, and brand-name fast food or meals from food service companies cost less and sell better. But these meals are typically higher in fat, salt, and sugar than school lunches, and their frequent consumption can create health problems for students in the short run and lay the foundation for unhealthy adulthood.
Meanwhile, many other schools and districts are trying to comply with the U.S. Department of Agriculture's "Dietary Guidelines for Americans" by producing meals with less fat, salt, and sugar and more grains, vegetables, and fruits. They offer apples and oranges, which most students will eat, and salad bars, which appeal to many teens who won't eat cooked vegetables. When school health teams have insisted on healthy school food and when school leaders have taken an interest in nutrition, schools have found ways to reconcile student tastes, high nutritional standards, and financial imperatives.
Physical education. Physical education has taken a beating in recent years, and so has student fitness. Although most younger students in American schools engage in some form of physical activity in or out of school, the number of high school students who participated in daily physical education declined from 42% in 1991 to 25% in 1995.20 With that decline in participation have come the expected and adverse health consequences.
In their anxiety to increase the time spent on tested academic subjects, many states and localities have reduced physical education requirements or made physical education optional, despite overwhelming medical evidence that physical activity is essential to good health. Only Illinois still requires students to take a physical education course every year.
Experts attribute the decline in student participation in physical education classes and after-school activities to several factors. Once the classes became optional, the students loaded up with core academic classes, and those who liked music or art added classes in those areas rather than in physical education. In many places, students who felt incompetent at sports skills avoided physical education classes when they had the chance to do so, and they avoided after-school sports for the same reason.
In response to this turn of events and to the worsening physical condition of students, physical educators are emphasizing physical fitness and the laying down of habits of physical activity that students are likely to continue throughout life: walking, running, aerobics, weight training, stretching, swimming, tennis, dancing, and golf. The goals of cardiovascular fitness, weight control, strength, and flexibility have largely replaced the goal of building skills for competitive sports.
In coordinated school health programs, physical education teachers work with the nurse and the cafeteria manager to devise a regimen for students who are overweight, diabetic, or hypertensive. They form closer ties with after-school sports and recreation programs, and they help steer inactive students into them. They negotiate with the administration to end the self-defeating practice of punishing students by barring them from physical education and sports. Some even organize weekend family sports and recreation activities.
Healthy school environment. A team approach to school environment can bring many eyes, ears, and noses to bear on social and physical obstacles to health, safety, and learning. Small changes can make a big difference, as when Judith Ladd, a counselor in Virginia, noticed the mashing of fingers, banging of heads, and angry exchanges that took place when the whole student body went to their lockers at the same time. The solution was simple and cut down on a lot of friction in the school: students in each grade were assigned every other locker, rather than adjacent ones, and the grades were released to use their lockers at different times.
As student sensitivities to environmental hazards become better understood, environmental sanitarians are becoming more scientific about ventilation standards for schools. Although cause-and-effect relationships are still hard to pin down, school facility managers are often able to cut down on allergic responses and illnesses by making more careful choices of school building materials (e.g., carpeting, paints, and flooring materials), instructional supplies, and cleaning compounds. Systematic inspection of indoor and outdoor equipment can cut down on many school injuries. A team effort, though, is needed to notice and deal with the many aspects of the social and physical environment that affect student health and safety.
Family and community involvement. Family and community involvement has become a mantra among American educators, but action to "involve" noneducators as equals is still a rarity. However, it is less rare in schools with coordinated school health programs, because these programs respect what parents know about their children and appreciate how crucial they are to their children's health and well-being. To the extent that schools are conducting health screenings or actually treating students' health problems, effective parent involvement is a necessity, because parents must give permission for many of the procedures and programs that schools can provide.
The subject of health -- whether of parents or of students -- strikes even closer to the bone than other issues in education. Getting parents involved in designing, promoting, and participating in a school health program is probably easier than getting them to attend meetings of parent/teacher organizations, back-to-school nights, or sessions describing new tests.
A Narrow Focus or a Larger Vision?
In their near obsession with improving test scores, many school systems and individual schools have unwittingly worked against their own interests. Such measures as contracting with fast-food operators, cutting back on health courses and physical education, shortening the time for recess and lunch, and paring cleaning and maintenance services to the bone are proving to be counterproductive.
Coordinated school health efforts come from a broader perspective on human development -- and, where they exist, they work to counter the constricted focus on traditional academic subjects in American education. They reaffirm the relevance of health knowledge; good nutrition; physical fitness; prudence in matters of sex, drugs, and personal safety; freedom from the fear of violence; and the importance of a wholesome environment to both health and educational productivity.
In many schools, some aspects of coordinated school health programs have occurred naturally. However, the linking of all eight components is still a work in progress in most places. In the initial stages, turf wars among professionals from the various disciplines are common; mutual trust and respect take time to develop. Thus it can take years to build a seamless, successful, and fiscally accountable web of services that respond to today's crisis in child health.
The patching together of funds from a labyrinth of federal and state programs requires skill and persistence. Harmonizing professional groups' differing requirements for accountability, reporting, and confidentiality presents its own set of challenges. To really get things done, collaboration at the highest levels of local government and professional governance may be necessary in order to remove absurd obstacles. Despite the obstacles, though, decisive school leaders who stay focused on health as a priority equally as important as learning are making a critical difference in improving the life chances of many children.
Great teaching requires a relaxed attentiveness and the serene exercise of intellectual and moral authority. In that mode, teachers experience the satisfaction of having produced a day of seamless lessons. They feel the joy of seeing an entire class, including the rowdies in the back row, engaged in an intense discussion of the meaning of a literary work or historical episode. They feel rewarded when they perceive the inaudible click in their students' heads as they comprehend the logic of a mathematical algorithm. But for too many teachers today, such days of peak performance and classwide epiphanies are rare.
Teachers' days are shattered by the eruptions of troubled students and by the demands of sick students. Their teaching must break through the emotional flatness of so many students who are depressed, sluggish in body and mind, or preoccupied with inner demons. If we wish to improve school outcomes, we will have to pay attention to the many forces that negatively influence student attendance, attentiveness, behavior, and persistence. As a society, we must find a way to ride out the wave of family breakdown, social disorder, immigrant assimilation, and economic dislocation. And the way we find must be affordable.
Only when schools consider coordinated school health programs to be as essential as history, social studies, or language arts will they be able to maximize academic achievement and positive health outcomes among the children and youths they serve.
This Special Report was developed under contract with Education Development Center, Inc., Newton, Mass., with fiscal support provided by a cooperative agreement (U87/CCU110236) with the U.S. Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Adolescent and School Health, Atlanta, Ga. The contents of the Special Report are the responsibility of the author and do not necessarily reflect the official views of the U.S. Centers for Disease Control and Prevention. Health Is Academic: A Guide to Coordinated School Health Programs, edited by Eva Marx and Susan Frelick Wooley with Daphne Northrup (Teachers College Press, 1998), suggests actions that schools and districts can take to implement such programs. The book is available for $24.95 plus shipping by phoning 800/575-6566 or contacting http://www.tc.columbia.edu/~tcpress. |
REPRINTS You may wish to order reprints of this Special Report for classroom use or for distribution to state legislators and other groups. You can purchase 50 copies of this report for $15 or 100 copies for $25 (plus $3 shipping and handling). Phone the Order Department, 800/766-1156, or write Special Report Reprints, Phi Delta Kappan, P.O. Box 789, Bloomington, IN 47402. |
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