When College Nurses Are Not Sufficient
Schoolchildren had a particularly difficult time navigating the grueling months of the pandemic. Recent reports showed that students lagged four to seven months behind in math and reading compared to previous years, and the most at-risk students saw the biggest declines.
But while schools have typically tried to improve student performance by focusing on academic tests and additional courses, too often they have neglected one major factor in their success: physical, mental, and social health. This is especially true for children in economically disadvantaged communities who, unlike their peers in more affluent communities, often lack access to quality health care and resources.
There are many reasons why such children often struggle to perform well in school, but education experts say there is no better time than now to devote more resources to their often limited access to the health services they need. Just as shouting doesn’t allow a deaf person to hear or better light a blind person to see them, feeding facts and figures to teens with untreated health problems is unlikely to help them learn.
Charles E. Basch, professor of health and education at Columbia University’s Teachers College, wrote in a 2011 special edition of the Journal of School Health, “Healthier students are better learners,” a fact he called “a missing link in school reform.” to close the achievement gap. ”In the report, he said schools trying to improve academic achievement should aim their efforts to reduce health inequalities that could affect a student’s education.
“The health needs of children were not seen as a central task of schools,” said Dr. Bash. “Yet there is a clear link between mental and physical health and children’s ability to learn.” And by failing to adequately address such needs, he said, “society is losing talent.”
Bring health care into schools
Enter school health centers – facilities either within the school itself or nearby that are not only prone to acute health problems such as cuts and bruises, but also offer a range of health services, including primary, mental, and dental care; Drug abuse counseling; Nutrition education and more. “They bring health care where the kids are, and they’re a very good way to take care of children they might not otherwise have,” said Nicholas Freudenberg, professor of public health at the City University of New York School public health.
School-based health centers are a key feature of community schools and other public schools, which have increasingly recognized the difficulty for many children to adequately identify and treat their health problems. Such challenges can be particularly acute for those living in urban centers or low-income rural areas. Too often, when a parent needs to take time off from work or find a babysitter, or when transportation of a child to a doctor’s visit is unavailable or unaffordable, needed services are neglected until a crisis strikes, experts say.
The nonprofit Paramount Health Data Project, which recently released a report on the health status of students in Indiana public and private schools, found that the more children visited the school nurse, the worse their academic performance on statewide tests, the director told me. The project’s data suggests that “students who frequently attend school nurses are simply unhealthy and often do not feel well during the school day,” Dr. Angelov and colleagues in the report. “That affects their ability to learn.”
While most public schools have at least one full-time or part-time nurse, this is barely enough to care for children, who often have complex and interrelated health problems that can hinder learning. For example, a child with poorly controlled asthma may avoid exercise and have difficulty sleeping if the brain has a steady memory. In addition to medication and routine follow-up care, this child may need diet and exercise advice and assistance with eliminating allergens from the household.
A multi-pronged approach
Dr. Basch said that too often educational reformers focus on addressing individual problems, such as children coming to school hungry.
“Breakfast alone is not enough,” he says, “nothing will have a lasting effect on a child’s ability to learn.” Basch, too, will help children succeed better.
The school health centers, of which there are now thousands nationwide, offer precisely this coordination and support, said Dr. Freudenberg.
Although hunger and nutrition are increasingly being addressed by schools and supported by federal programs, mental health issues such as depression and anxiety often fall under the radar. If teachers believe a child is struggling with emotional issues, publicly supported services in or near school can improve that child’s academic performance, said Dr. Freudenberg.
In addition, school health centers are often open to families and can connect parents to necessary health services for themselves or others in the household.
“The pandemic has underscored the fact that many children in poor communities do not have a healthy diet or access to mental health services,” he said, adding that when the pandemic wears off and the children return to school, community support for their unmet health needs is going to be critical.
And not just for small or poor children or those who have lost close family members to Covid-19. Many high school students are now also facing significant health problems, particularly if they have had debilitating depression or anxiety related to pandemic-related disorders in their life.
“Students K through 12 are likely to have life-cycle health concerns that schools can and should address to improve learning and improve their health,” said Dr. Freudenberg. “Schools can help them deal with difficult interpersonal situations.”
For example, in New York City, school-based health programs that provide sexual and reproductive care have helped lower the rate of sexually transmitted infections and teenage pregnancies so that more young people can stay in school.
Nevertheless, Dr. Basch and his co-authors in a 2015 report on health barriers to learning that “Schools alone cannot close educational gaps or eliminate health inequalities. Families, communities, health systems, lawmakers and the media all play an essential role. “