NEWS

According to Healthy People 2010, schools have more influence on the lives of young people than any other social institution except the family and provide a setting in which friendship networks develop, socialization occurs and behavioral norms are developed and reinforced.2 Of the 107 Healthy People 2010 objectives related to adolescents and young adults, 10 focus on the role of schools in improving the health of young people.3
Adult health status is directly associated with higher educational levels, regardless of income.4 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 more likely than their peers to be drawn into a pattern of risky behaviors.5 People who acquire more education not only are healthier and practice fewer health risk behaviors, but their children also are healthier and practice fewer health risk behaviors.6 Increasing the high school completion rate, a major goal of the education system, is also fittingly a health objective for the nation (objective 7.1).2
Preventable health risk behaviors that are often formed in childhood, persist into adulthood and are frequently interrelated include poor dietary choices; inadequate physical activity; behaviors that can result in violence or unintentional injuries; engaging in sexual behaviors that can cause HIV infection, other sexually transmitted diseases and unintended pregnancies; and the use of tobacco, alcohol and other harmful drugs.7 Certain risk behaviors are more likely to occur among particular subpopulations of students defined by sex, race/ethnicity and grade.7 These behaviors can lead to serious health problems and disabilities that are costly burdens on individuals, families, and the nation.2 For example, annual hospital costs for obesity-related conditions among youth aged 6 to 17 increased from $35 million to $127 million from 1979 to 2000.8
Well-prepared and supported school staff can provide credible health information and direction on forming healthy attitudes, beliefs and habits. Students who participate in health education classes that use effective curricula have been found to increase their health knowledge and improve their health skills and behaviors.9 School-based programs have proven effective in significantly reducing student binge drinking,10 tobacco use,11-13 physical inactivity,14 unhealthy dietary patterns15 and obesity.16 For many young people, schools might be the only place they ever receive accurate information and guidance to prevent workplace injuries and other adult health problems.
Elementary and secondary schools are also valuable settings for the provision of public health services. The 53.8 million students and 3.6 million staff members in nearly 129,000 public and private elementary and secondary schools comprise 20 percent of the U.S. population.17 More than 95 percent of children ages 5-6, 98 percent of children ages 7-15, and 93 percent of children ages 16-17 are enrolled in school17 and thus in easy reach of public health agencies. Schools often provide services that might not be available elsewhere. For example, schools provide most of the mental health services provided to children.18 Many agencies work with schools to help provide critical health services,19,20 particularly for students with disabilities21 and those from families in poverty.22
II. The Central Role of Health in Promoting Education Goals
It has long been clear that education and health are inextricably intertwined.23 Schools cannot achieve national educational goals if students and staff are not healthy and fit physically, mentally and socially.5,24 As the U.S. Department of Education has acknowledged, “Too many of our children start school unready to meet the challenges of learning, and are adversely influenced by…drug use and alcohol abuse, random violence, adolescent pregnancy, AIDS, and the rest.”25
Student learning and academic achievement can be inhibited by poor nutritional status,26-28 poor indoor air and environmental quality,29-30 uncontrolled asthma31 and other chronic health conditions, undiagnosed and untreated vision and hearing problems, injuries, unaddressed social and mental health troubles, early pregnancy, alcohol and drug use and other health problems.30,31 Educational institutions at all levels are coping with increasing prevalence of chronic health conditions that require ongoing monitoring and care by trained health professionals.32 One child in four has been estimated to be at risk of failure in school because of social, emotional and health problems.33
School health programs can improve education outcomes.31,34,35 For example, a school health program designed to teach low-income elementary school students and their parents how to better manage asthma significantly increased effective asthma management behaviors, reduced asthma episodes and improved school grades.36 School-based mental health services provided in partnership with community organizations can help elementary and secondary students succeed in school.34 Parents and the general public consistently demonstrate strong support for promoting health37,38 and fitness39 goals in schools.
III. The Coordinated School Health Program Model
The twin goals of education and health inspire the Coordinated School Health Program (CSHP) model, which is designed to purposefully integrate the efforts and resources of education, health and social service agencies to provide a full set of programs and services without fragmentation or wasteful duplication.5,31,40 The CSHP model, which is more comprehensive than prior approaches to school health,40 provides a practical, systematic and cost-efficient31 approach to the provision of prevention education and services. Staff interviewed from schools with a coordinated approach to school health associated this approach with higher test scores, more alert students, more positive attitudes, skill development, and readiness to learn.41
The CSHP model involves the active coordination of the following eight components such that each component reinforces the other:42
1. A Healthy School Environment: School buildings and the area surrounding them are safe, secure and free of tobacco and biological and chemical agents that are detrimental to health; physical conditions including noise, lighting, temperature and air quality are conducive to learning; the psychosocial climate and culture of the school promotes academic achievement and overall well-being while preventing violence and bullying; and the school facilitates and actively promotes physical activity, healthy eating and other lifelong health habits.
2. Comprehensive Health Education: A planned, sequential, PreK-12 curriculum taught by qualified, proficient teachers addresses the physical, mental, emotional and social dimensions of health and allows students to develop and demonstrate increasingly sophisticated health-related knowledge, attitudes, skills and practices. The curriculum is consistent with the National Health Education Standards43 and incorporates a variety of topics including personal health, family health, community health, consumer health, environmental health, sexuality education, mental and emotional health, injury prevention and safety, nutrition, prevention and control of disease, tobacco-use prevention and substance abuse prevention.
3. Physical Education: A planned, sequential PreK-12 curriculum taught by qualified, proficient teachers provides cognitive content and learning experiences in a variety of activity areas such as: basic movement skills; physical fitness; rhythms and dance; games; team, dual, and individual sports; tumbling and gymnastics; and aquatics. A quality physical education program is consistent with the National Physical Education Standards,44 promotes each student