The Global Search for Education: Health and Higher Achievement

Posted by: C.M. Rubin, The Global Search for Education

November 20th, 2015

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The Global Search for Education (GSE) is a regular contributor to the Edmodo Blog. Authored by C.M. Rubin, GSE brings together distinguished thought leaders in education and innovation from around the world to explore the key learning issues faced by today’s nations. Look for a new post every Friday and join the Global Search for Education Community on Edmodo to share your perspectives with their editorial staff.

Student health problems illustrate a compelling but generally neglected influence on the US domestic achievement gap, according to Dr. Charles (Chuck) Basch, author of Healthier Students Are Better Learners.  In Basch’s study, he concludes that health issues, which disproportionately plague low-income urban minority youth, play a major role in limiting their motivation and ability to learn. Basch further believes that intervention would improve both educational and health outcomes.  Currently there is no national American school mission or Department of Education initiative to reduce health disparities as part of a strategy to close our domestic achievement gap.

Dr. Howell Wechsler is Director, Division of Adolescent and School Health (DASH), Centers for Disease Control and Prevention (CDC). Wechsler’s work with DASH earned him the Milton J. E. Senn Award in 2006 from the American Academy of Pediatrics for achievement in the field of school health. In 2012, he was also awarded the American School Health Association’s highest honor, the William A. Howe Award. Dr. Charles (Chuck) E. Basch is the Richard March Hoe Professor of Health Education at Teachers College, Columbia University.  Chuck has provided consultation related to implementing Healthier Students Are Better Learners to state departments of education in Connecticut, Tennessee and Colorado, as well as to public school systems in Chicago, Boston, and Denver. I was able to chat recently with both Dr. Wechsler and Dr. Basch about the key issues.

I worked on education initiatives in Africa and understand the important connection between GSE 11-20_newhealthcare and successful learning outcomes.  First you must have healthy students.  Then you can educate them — do we think like that here?

Howell:  What I find fascinating is that when people who work on school health promotion across the world get together, we learn that things are not really all that different.  It is perhaps a little more challenging in the United States because local control of education is so strong here.  There are so many different places that you have to influence to get practices to change.  We don’t do a very good job of getting people to think of the needs of the whole child.  We train people in education.  We train people in public health.  But what is really needed here is a bridge or a mix between the two.  That’s not something people do easily.

What health issues affecting learning have you identified in students and what percentage can be found in low income homes?

Chuck:  I identified seven.  Poor vision, poorly controlled Asthma, aggression and violence, physical inactivity, skipping breakfast and ADHD.  These are not necessarily the ones that will be the most important in every locality, but they warrant consideration.  Also, while not specifically mentioned, mental and emotional health should be a pervasive underlying theme of any high quality school health initiative.  Each of these 7 problems affects or is affected by mental and emotional health. Further, each of these problems has high prevalence and disproportionately affects low-income, urban minority youth that is the same group greatly affected by the academic achievement gap.

If we could combat the health issues you’ve identified, how far could we go towards narrowing our domestic achievement gap?

Chuck:  It is difficult to say exactly since a well-conceived effort has never been tried.  But there is evidence that very substantive effect sizes can be achieved.  Addressing these problems is not a panacea.  We need effective teachers, high quality curriculum, standards and assessments, and data systems to track and provide feedback about where progress is and is not being made.  But no matter how well these school reforms are implemented, if students are not motivated and able to learn, the educational benefits of all of these efforts will be jeopardized.  Highly prevalent, specific health problems have powerful effects on students’ motivation and ability to learn, and have not been addressed well in our nation’s schools.

Health problems can be profound barriers to learning, but is it the job of schools to provide healthcare services?

Howell:  Most schools provide some kind of healthcare services to children through the presence of a school nurse; many link students and their families to community-based healthcare providers; and approximately 2,000 schools in the US have school-based health centers to provide at least some critically needed healthcare services to students on campuses.

Chuck: Schools should not be the social institution that is solely or even predominantly responsible for providing healthcare services to youth.  But given that schools are the social institution where youth are on a daily basis, they are ideally suited to provide such services, and are in a strong position to provide healthcare services to youth with great needs who are at high risk of not receiving needed services.  This is, of course, a value-laden question that does not have a “right” answer.  There are many expectations on schools in addition to their primary goal — educating youth.

Although opinions may vary on what schools should or should not direct attention to, the reality is that certain health problems/issues pose powerful barriers to teaching and learning.  These problems have persisted for decades and disproportionately affect low-income, urban minority youth.  Education leaders and policy makers have not established strategic, high quality, and well-coordinated policies and programs to address these health needs and until we do, the benefits of other school reform efforts will be jeopardized.

If not the job of schools, whose job is health?

Chuck: Providing healthcare and, more importantly, promoting wellness and quality of life is not the responsibility of any single social institution.  Families, communities, healthcare institutions, faith-based organizations, categorical organizations, governmental agencies, foundations and philanthropists, and yes, schools, all have an important role to play.  And the problems are so large and so challenging among low-income youth that it will take contributions from all of these elements of our society to address these health needs in an efficient and timely way.  What is currently lacking and sorely needed is coordination among the different entities investing in health promotion and disease prevention among youth.

What national, state, and local health care reform strategies would you like to see put in place to ensure student health?

Chuck:  From my perspective, the question should be a bit broader.  Part of a larger problem is that the problems of health disparities, educational disparities and poverty are closely inter-related in causal ways, yet our long-standing infrastructure for addressing these problems, and the policies, programs and funding associated with them, are disconnected in silos.  This situation is not only pervasive in government, but in the private sector as well – see for example the Gates Foundation – educational investments are focused domestically and public health investments are focused globally.  This is not, from my perspective, a good way to invest social resources to help youth facing many educational and health challenges simultaneously.  To break out of a cycle of poverty, which is characterized by intergenerational high risk for educational failure, health problems, and low chances for upward social mobility, these inter-related problems must be addressed through inter-related solutions.

What positive healthcare initiatives have you seen around the country that might inspire more focus on healthcare if we had more funding for low-income schools?

Howell:  Well, there was a big increase a few years ago in funding for school based health centers and I think from a public health and education perspective that is a positive development.  However, the number of schools that have health centers still remains a small fraction of what the need is.  There are a lot of efforts underway to develop linkages between schools and community health centers and other community healthcare providers knowing that sometimes it is just too challenging (there are economic barriers at times) to actually open clinics on school sites.  So there are efforts to build awareness for services that are available in the community and make them more accessible to students.

What role should schools play in promoting healthcare?

Howell:  Schools should work closely with health departments and local healthcare providers. They can facilitate the delivery of healthcare services through agreements with healthcare providers, manage it themselves, or link students and their families to community based providers.   Schools also should teach students the knowledge and skills they need to effectively use healthcare services.

Imagine you had the job of advocating for better healthcare for poor students. How would you pitch it?

Howell:  There are multiple ways to go.  First of all, the data and the evidence are growing and that would be important to stress.  There is also a very strong common sense argument that obviously young people cannot achieve if they are burdened by health problems.

We are starting to make progress in expanding the evidence base.  For many years, when people went into schools and did an education intervention, they only looked at education outcomes and not health outcomes.  People who were doing public health interventions in the schools just looked at the health outcomes but did not consider the education results.  So that’s one of the main reasons it has taken so long for us to build a body of evidence.

Even though CDC is a public health agency, we also fund education agencies. Most of the funding we give out goes to health departments but my division funds education agencies.  In our core programs, for many years we have required the education agencies that we fund to collaborate with health departments.  So if you were a state education agency and you wanted funding, it had to be a partnership between the health and the education department and the resources had to be shared.

It was a fascinating exercise trying to bridge these two worlds.  We actually found that public health people were fairly ignorant about how to influence schools — and schools were not always clear on how to work with health departments — so we commissioned the National Association of State Boards of Education to write a manual and develop a training program called “How Schools Work and How to Work with Schools.”  After that we commissioned a public health organization called the National Association of Chronic Disease Directors to do the sequel, which was “How Health Departments Work and How to Work with Health Departments.”

Getting people to cross sectors is a huge problem in this country.  People need to look past the test scores or the easy and obvious solutions to dig down and look at the root causes that are really impeding academic achievement.

Continue the conversation in the Global Search for Education Community on Edmodo

CM Rubin 2

Dr. Charles Basch, C. M. Rubin, Dr. Howell Wechsler

C.M. Rubin is the author of two widely read online series for which she received a 2011 Upton Sinclair award, “The Global Search for Education” and “How Will We Read?” She is also the author of three bestselling books, including The Real Alice in Wonderland, is the publisher of CMRubinWorld, and is a Disruptor Foundation Fellow.

42 responses to “The Global Search for Education: Health and Higher Achievement”

  1. Carrie Renfro says:

    I am always amazed at the food the students get at lunch. I have been in the cafeteria kitchen in the morning and it looks like it is fine. Then at lunch the food looks greasy and unhealthy. The student’s complain their stomachs hurt after lunch and they are always hungry. It is difficult for hungry students to learn. My student’s come from the inner city and have limited knowledge of quality food choices.

  2. Sarah Thompson says:

    I agree that “health problems influence a student’s achievement gap and plays a major role in limiting their motivation and ability to learn”. I’m thankful that at our school we have access to a dentist, clinic, a vehicle to take students to medical appointments, and have a breakfast and lunch program.

  3. Mariana says:

    As with many of the issues that plague education, there is a huge disconnect between policy and the realities of the classroom. Health is obviously a very important one since it is rather difficult to provide quality instruction to a student that is not feeling well, is hungry or scared about what he/she will face once the relative safety of the school day is over. Until both sides of the coin can sit down and have a conversation that enlightens both parties, the problem will remain

  4. Laura Leboeuf says:

    Well, like a vehicule that doesn’t have the right oil or gasoline in it, it won’t run properly. The same runs true for children. If they don’t have the right feed to nourish their bodies, they won’t function to their optimal potential. Our school wide “Healthy Snack Policy” is enforced and encouraged by local farmers in our area. We have local orchards who drop off crates of apples for students to take if they don’t have a healthy snack for the morning recess.

  5. Cheryl Jindeel says:

    This article is presents good information about some of the issues of student health. I completely agree that health and wellness is the responsibility of all. On a daily basis I see its effect in my classroom through continuous absences due to health reasons.

  6. Health problems derived from malnutrition , genetic or acquired bodily , mental , spiritual or emotional diseases can thwart learning all over the world and it needs the alert and diligent intervention of major social institutions to help solve both health and learning problems.Those organizations should report cases ,communicate among them so as to search for the best ways and resources to provide each individual with a suitable answer .Empathy is a key word and an ill person should stand for an ill cell of a social tissue that requires the contribution of stakeholders to help cure him/her just like guardians of the immune system do.

  7. finita says:

    It’s amazing to find out that health problem become the concern

  8. WJ Reagin says:

    It is a never-ending struggle to balance economics with healthy choices. If students cannot develop healthy habits in school where will they be able to foster these?

  9. Cristina Centro Xabier says:

    In the end, we are not solely teachers, we are psychologists, nurses, grandpas… Many may not agree with this “overflow” of work, but children spend a great amount of their lives in school and I find it humanly imposible to remain a teacher and not care for them when I see they look tired or have not had breakfast… This issue (coming to school without having breakfast) is where we’ve been focusing in my school for the last 2 years. Science teachers, Homeroom teachers… we’ve developed a PBL called “Healthy breakfast” to engage our students in good eating habits. Seems to be working!

  10. Harly Umboh says:

    Health problems is most important issue for school
    thanks for this article

  11. brad Bielawski says:

    I think it is important for schools to partner with local healthcare authorities. We need to give our parents options of where to go to keep their kids healthy if they don’t have the resources.

  12. Donna says:

    Education can play a crucial role in helping healthcare awareness in the world. When teachers try to instill knowledge of good healthcare we can help peoples well being. In exchange students will be able to learn more because they will be healthier.

  13. Teresa Perles says:

    Indeed, children whose health is poor will usually do poorly at school. Hence, schools are an important starting point to find and help them. Also, teaching students how to look after their health is more important for life than some subjects taught nowadays.

  14. Ljiljana Lez-Drnjevic says:

    My students are involved in the eTwinning project Eat Healthy – Be Healthy, inspired by Jamie Oliver’s Food Revolution Day. The project promotes healthy eating in the school and at home. They like it but it’s hard to change the habbits. Here is our glog about it: I hope that our little steps will make a change. Small but change.

  15. Sarah Eaton says:

    I agree. Our Title 1 school participates in health lunch and breakfast choices, our outdoor garden where students learn about gardening and get to eat the healthy vegetables they grow. We are also a Fit4Kids school. We have a running club and participate in active lessons.

  16. Fanny Villagra says:

    Certeinly we can edúcate students if they aré healthier, but in most of the countries do not even ask abouth it.

  17. Marica says:

    Providing healthy snacks for schoolchildren is very important and it is global problem, School projects may improve student achievement. I am the coordinator of school project ,,Healthy Planet-Healthy Food”. We have made researches.Students also took photos of their snacks, then they researched about ingredients.

  18. Antoinette Green says:

    I agree with the authors if we really want to close the achievement gap with students that we need to look at all the factors that are impeding academic achievement. Schools must continue to look for any health concerns affecting the child and be able to connect families to the resources to assist them.

  19. I enjoyed reading your post and I couldn’t agree more. I have been an educator for the past 14 years and have witnessed many instances of poor health, malnutrition and low academic performance. Although our school tries to go the extra mile to ensure food is sent home monthly with needy students, we still have a long way to go in tackling these concerns. The ideas and research provided in this post were very insightful and inspiring. I would love to see an initiative that would remedy these concerns and provide students with the security of health benefits, food and increased academic success.

  20. Matt Marino says:

    I’m not sure health and education go hand in hand as you seem to imply. I grew up in an extremely unhealthy household where there was never any food with absentee alcoholic parents and never had any issues within academia. I guess there are exceptions to every rule, but I believe that it is more likely you make of what you want with education.

  21. Judie says:

    It is of concern that schools, while the main institution students spend time, and that more of the time identification of health issues comes from teachers. Parents work so hard to keep heads above water, students spend more time at home on devices or in front of television and the disconnect becomes broader through no fault of anyone except that’s the way it is. Keeping close contact between parents, schools and students is so difficult and I truly believe that there should be the provision of professionals outside the “education” budget to assist these students who would otherwise not receive the full help the need and deserve.

  22. Mr Burke says:

    Interesting article, which I absolutely agree with. I’ve worked with students in low-socio-economic areas for the past 18 years & you often see some arrive at school who have skipped breakfast, or haven’t slept or who are sick but attend school anyway. In our school we have run breakfast programs in a variety of ways, but the most successful has been one run by a local volunteer group which has been going now for a few years. It’s only once a week, but they have made great strides with some of our students.
    We also have a staff member who is a trained nurse, but isn’t officially a school nurse. However, she has done a lot of work for our scshool community organising health intervention programs, the latest of which was a dental clinic which happened just this past week.
    Schools can’t solve all the issues, but we do our best to try to reduce them.

  23. Dae Habalo says:

    I agree with Mr. Howell on building awareness and teaching students on how to avail those healthcare services. I’ll share these tips to our community.

  24. Bobby Lewis says:

    This topic is so important in our society today.

  25. Sethi says:

    A very interesting read. School and Education is about So much more than tests or just focusing on what happens at school. It is about having a Holistic approach to a child’s future and Education in the wider sense of that word. Thank you for sharing!

  26. Amy Sharpe says:

    We keep changing what we serve in the cafeterias saying it will be healthier (our cafeteria no longer really cooks anything-simply heats up food), but the choices don’t look healthier or appetizing. The cereal bars they serve in the mornings can’t be healthier than eggs!

  27. Merewyn Patrick says:

    The school that I work at feels these impacts of poor health. We are currently applying for a magnet grant that will help us focus attention on the wellness of all our students.

  28. Cecilia Monserrat says:

    Why not make it an institutional challenge? Government workers together with schools’ depatments and also teachers? It would be a good way to prevent and identify health problems.

  29. Gabriel Areas says:


    I am a teacher from Nicaragua in Central America. Our government has legislated so that every child at the elementary level gets a free breakfast at school. The initiative has proven effective as retention increased and more children are able to finish elementary school and move on to junior high.

  30. Aditya Pratama says:

    The health problem is really an issue in the developing country like my country, Indonesia. Many children suffer from malnutrition and it really affect their performances in school. It became nation-wide policy for every school in Indonesia to create school based health center, known as UKS (Usaha Kesehatan Sekolah).

  31. Edmarie Querubin says:

    I let my students exercise in the morning before the start of the class. The school does not allow students to eat unhealthy food and drinks.

  32. Sarah Jacobs says:

    I think this shows just how important health curriculum and physical education is to schools and that school districts need to do a better job in incorporating health into every day activities. While I understand that the job should not solely land on the shoulders of the schools, it is important that it is one of the many places where health is addressed.

  33. Irem Binici says:

    I believe as it’s true. While kids are healthy and well slept, they’re really good at lostening and understanding at computer lab s9 their work are better.

  34. Amy Kingsley says:

    I’m so thankful that our school offers free breakfast for students who need it. We have many kids who leave their house before 7am to take a long bus to school and arrive with empty tummies.

  35. Sheryl Place says:

    Many students in American schools eat more meals at school than at home. Healthy eating would be/is a great concern of mine as you continue to study health and higher education. Good news, all students are provided FREE breakfast every day.

  36. Toh Wee Teck says:

    Healthy students is the first step to help students gain success in their education.

  37. Alicia says:

    I was able to relate this article to my current students. A poor diet affects learning. Although students try to hide it well, they do not perform as desired because of illness or lack of a healthy breakfast.

  38. Jeff says:

    I wonder if a group could be gotten together to unite the different aspects of groups that are needed to help like the families, communities, schools, faith, etc. perhaps under the name “Peas in a Pod”

  39. Mary Jo Heiberger says:

    Thank you for doing this important research. I believe many educators have long believed that there was a correlation between health and education, now you have provided the evidence.

  40. Oscar Porras says:

    Great article that talks about something that sometimes goes unnoticed when thinking about students and a well rounded education. Students not only books and clothes but sometimes providing opportunities for meals makes a difference.

  41. Yahaya Mohammed says:

    am very exited about the article. impact the author have said it all, but the only thing is that we must join hands together we can archive as partnership.

  42. Dr . Gouri Kumra says:

    Respected leaders,
    I have conducted two art camps on children from 3 to 13 years. Where playing with colours unviels the child’s aggression , temperament ,and negativity . I want this book to be published as it relates with sibling rivalry . Children living in oppression as living in the brothel, jail, or suffering from brain aberration , tend to draw sharp ridges, and their sketches are repeated . There are many such observation which need to be researched

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