Improving Schools,Improving School Health Education,Improving Public Health: The Role of SOPHE Members

Abstract

The reciprocal relationship between health and education has garnered increased attention among public health professionals. The evidence is clear that the level of an individual’s education is related to health outcomes in adulthood and that healthier children are more likely to be academically successful than those with health issues. Unpacking and examining various aspects of this relationship is the focus of my 2017 SOHE Presidential Address. The three specific purposes of the presentation are to (a) understand the reciprocal relationship between education and health, (b) understand the characteristics of quality schools and quality school health education, and (c) to review strategies designed to activate school improvement as a public health strategy. In order to examine the relationship, I will address the relationship of social determinants and social justice to the quality of education with special attention to the impact of poverty. In addition, I will present possible reasons behind the linkage of higher educational attainment to better health outcomes, and the impact of health challenges on academic success for school-age children and youth. Finally, I will present characteristics of quality schools including considerations related to quality school health education programs. I conclude the presentation by presenting 11 specific actions for school improvement for consideration by SOPHE members and other public health professionals.

Keywords

school health instruction school-based health care school-based health promotion

I am honored to have served during the past year as President of SOPHE (Society of Public Health Education) and especially honored to have the privilege of delivering the 2017 SOPHE Presidential Address. It has been a wonderful experience to have worked with the outstanding Board of Trustees, the excellent SOPHE staff, our noteworthy leader, CEO Elaine Auld, and with all of you as a member among members. The title of my address is “Improving Schools, Improving School Health Education, Improving Public Health: The Role of SOPHE Members.” I am basing my presentation on four assumptions:

We all want to improve health outcomes for individuals of all ages in all communities through health education and promotion.

We all work in a community.

We all live in a community.

School health is public health.

Thus, based on these assumptions and focusing on the improvement of public health, I have identified the following three goals for those in the audience:

To understand the reciprocal relationship between education and health

To understand characteristics of quality schools and quality school health education

To review strategies designed to activate school improvement as a public health strategy

Beyond these goals, the intent of the presentation is that each person in attendance will leave the session with information and motivation to take at least one specific action to address the role of education in promoting health.

As many of you are aware, SOPHE has a long history of activity in school health. This past year, two important school health activities were initiated. The first activity is centered on the work of the School Health Standards Writing Group, co-chaired by Dr. Susan Goeckler, who has held several leadership positions in health education, most recently serving as Executive Director of the Directors of Health Promotion and Education, and by another national leader in school health, Dr. Adrian Lyde, an associate professor in the Department of Health Sciences at Illinois State University. The Writing Group is developing standards for teacher education for the primary accrediting body, the Council for Accreditation in Educator Preparation (CAEP). Through the development of standards, if approved, SOPHE will be designated as a Specialized Professional Association (SPA) by CAEP. This places SOPHE in a lead role in quality assurance with regard to the professional preparation of school health educators.

The second group is the National Committee on the Future of School Health Education. I am co-chairing this group along with Sharon Murray of the University of Colorado and current President of the American School Health Association. Sharon has a long history of leadership positions in school health education. As the title implies, this group is looking at the future of school health education. The charge to the Committee is threefold: (a) assess the status of school health education in the United States, (b) identify assets and barriers related to the implementation of quality school health education, and (c) identify strategies designed to enhance the perceived value of school health education and maintain and improve programs.

This Committee began meeting via conference call in the fall of 2016 and is moving forward in addressing the charge. The work of this group will be communicated to the profession and SOPHE members via conference presentations and publications.

Before I move into the specific content of the session, I want to acknowledge some important leaders in school health education. My career in school health education started in 1974 as a junior high school health education teacher in Prince Georges County, Maryland. All the leaders that I will acknowledge have been working in this area for at least 30 years and all of us have worked together in one way or another to promote school health education. Many of them are here at this conference. These are important names and these are key leaders, many of whom are working with SOPHE in their current school health education initiatives: Diane Allensworth, Clint Bruess, Gus Dalis, Susan Goekler, Lloyd Kolbe, David Lohrmann, Fran Meyer, Larry Olsen, William Potts-Datema, Susan Telljohann, Robert Valois, Donna Videto, and Kathy Wilbur.

Education and Health: A Reciprocal Relationship

So, this morning, we are going to unpack the relationship between health and education, and the connection of schools to public health education and public health overall. It is important to note that there is clear evidence that the level of an individual’s education is related to health outcomes in adulthood, and clear evidence that healthier children learn better and are more likely to be academically successful than those with health issues (Allensworth, 2015; Basch, 2011a; Bradley & Greene, 2013; Freudenberg & Ruglis, 2007; Wallen, 2015; Woolf, Johnson, Phillips, & Phillipsen, 2007).

This relationship is illuminated by the Centers for Disease Control and Prevention’s (CDC) assertion that health-related factors such as hunger, physical and emotional abuse, and chronic illness can lead to academic problems for students and that youth health risk behaviors are consistently linked to poor academic outcomes. This relationship’s linkage to adult health is characterized by the following CDC statement: “In turn academic success is an excellent indicator for the overall well-being of youth and a primary predictor and determinant of adult health outcomes” (CDC, 2015, p. 1).

Gene Carter, former Executive Director and CEO ASCD, emphasized the importance of recognizing this relationship in a plenary session at the 2014 SOPHE Annual Meeting by stating,

Health and education are related. They are interrelated. They are symbiotic. There is a connection between the two sectors. When one fails, so does the other. When one succeeds, that success feeds the other. We do not just have an isolated duty to want the child to be healthy and educated—we have a moral imperative.

Social Determinants/Social Justice

Health educators have long recognized the impact of social determinants on health behaviors and health outcomes. These same social determinants affect the quality of schools. In order to address the health and education connection for all children, families, and communities, we must continue to focus on both social determinants and the underlying social justice issues. These issues affect education and health and must be addressed through education, social action, legislation, policy change, environmental change, and so on. Educational attainment and health outcomes cannot be disentangled from social justice issues. Discrimination and inequity must be addressed. We must improve cultural competency, our overall sense of caring and responsibility to others, and the political awareness of children and adults so that we elect leaders who promote access, equity, and caring in order that we do our best to promote education and health for individuals and communities in the United States, and in all parts of the world.

There are many examples of social justice issues that affect education and health. The following list provides some examples. It is important to note that these are not all possible examples and do not take into account all issues, and that these issues are not mutually exclusive. They include racism, sexism, and other population-based discrimination; access to health care; employment; homelessness; inequity in educational access and opportunities; immigration; criminal justice, environmental justice; and poverty. I will focus on one of the social justice issues—poverty—and present examples of its impact on education in the United States.

Most local school districts in the United States receive a considerable portion of their funding from local property taxes. Obviously, those districts that have higher property tax bases bring in more money for school spending than other districts. Money is not the entire picture with regard to the quality of education, but the system of using property taxes for local school funding can perpetuate inequity in funding (and inequity in resources for teachers and students).

Consider the following examples of the impact of poverty on schools, students, and teaching and learning:

There are major differences in educational resources available in schools with large number of students living in poverty (Carter, 2016).

Children in poverty are often affected in school by poor health care, food insecurity, stress, delayed vocabulary development, and increased exposure to toxins (Jensen, 2013; Wood, 2003).

According to a University of California, Los Angeles, study, students in schools with high-poverty levels lose about 22 days of instruction compared to 12 days missed by students in schools with lower poverty levels (Carter, 2016).

With regard to language development among young children, children growing up in low socioeconomic (SES) conditions, on average, hear about 13 million words by age 4 while those living in upper income situations hear an average of 46 million words by that same age (Hart & Risley, 1995). Disparities in vocabulary and language processing efficiency have been found to exist as early as 18 months between infants from higher and lower SES families. At 24 months there was a 6-month difference between SES groups in processing skills critical to language development (Fernald, Marchman, & Weisleder, 2013).

Linking poverty and race, schools that are at least 90% White spend about $733 more per student than those schools comprised primarily of students of color (Spatig-Amerikaner, 2012).

As we consider these examples of the effects of poverty, we need to ask ourselves, “Do some children deserve more funding for education than others?” “What can be done to address this inequity?”

Better Education, Better Health

Clear evidence exists that higher levels of education attainment are related to better adult health outcomes. Two excellent articles present an examination of this relationship. One, “Giving Everyone the Health of the Educated: An Examination of Whether Social Change Would Save More Lives Than Medical Advances,” was authored by Woolf et al. and published in the April 2007 issue of the American Journal of Public Health. The second by Freudenberg and Ruglis, “Reframing School Dropout as a Public Health Issue,” was published in the October 2007 issue of Preventing Chronic Disease.

Various reasons have been presented for this relationship. Higher income has been presented as one outcome of education that leads to better health (Allensworth, Lewallen, Stevenson, & Katz, 2011; Freudenberg & Ruglis, 2007; Wallen, 2015; Woolf et al., 2007). It is posited that higher income leads to better health outcomes for adults because they are more likely to live in healthier neighborhoods; have better personal transportation; and have easier access to healthier foods, physical activity, and medical care.

Better educated individuals are also more likely to have better jobs that are in line with their personal aspirations and lead to higher job satisfaction (Freudenberg & Ruglis, 2007; Wallen, 2015; Woolf et al., 2007). These better jobs are more likely to offer benefits such as health insurance, paid leave, and retirement plans. Beyond the health benefits offered through their employment, individuals with higher levels of education are more likely to be better versed with regard to promoting their own health and the health of their family and community (Allensworth, 2011; Freudenberg & Ruglis, 2007; Woolf et al., 2007). This might be reflected in being better informed about healthful personal behaviors, being more skilled in interacting with health care providers and better able to navigate the health care system, and having a better understanding of community health issues.

Better Health, Better Education

Numerous health factors have an impact on students’ academic performance. Stress, physical and emotional abuse, hunger, safety concerns, and chronic illness often lead to academic challenges for school-age children and youth. In addition, students’ perception of a lack of feeling welcomed, supported, valued, connected, and engaged can have a negative impact on achievement (Allensworth et al., 2011; Basch, 2011a; Freudenberg & Ruglis, 2007; Wallen, 2015). In a 2011 issue of the Journal of School Health focused on health and learning, Basch presented the impact of conditions such as vision problems, asthma, teen pregnancy, aggression and violence, and lack of breakfast on the achievement of urban minority youth. All the aforementioned health issues faced by children and youth can lead to absenteeism, lack of concentration, lower grades, and an increased likelihood of dropping out of school.

Better Schools

With regard to the first part of the title of my presentation, “Improving Schools,” what do improved or better schools look like? To address this question, I will present what I describe as “Big-Picture Characteristics.” I describe these characteristics in this manner because they are qualities that can be identified by someone without a background or experience in education. They are either observable through interactions with students, teachers, and administrators, or based on information that is easily obtainable from schools. Again, these characteristics relate to observations discernible by noneducators as opposed to professional judgments that emanate from educators with regard to policy, curriculum, or instruction.

Numerous characteristics are presented in the professional literature. I believe the following, when present in schools, increases the chances of students in those schools to achieve academic success:

A sense of mission, vision, and leadership (Lyon, 2015; Slade, 2015)

An invitational environment for all parents and community members (Hodges & Angermeier, 2015; Slade, 2015; Wallen, 2015)

A community school model—full-service schools (Allensworth, 2015; Lyon, 2015; Slade, 2015)

Students who feel connected to and engaged with their school (Basch, 2011a; Wallen, 2015)

Accessible, quality early childhood, pre-K programs (Allensworth, 2011; Wallen, 2015)

Discipline/suspension policies that are fair, equitable, and student-centered (Lewontin, 2017)

Policies and programs that address absenteeism and dropout rates (Allensworth, 2015; Freudenberg & Ruglis, 2007)

Health addressed in school improvement plans (Basch, 2011b; Slade, 2015; Wallen, 2015)

Instruction that addresses social justice issues (Au, Bigelow, & Karp, 2007)

Quality school health education (Basch, 2011b;Birch, Priest, & Mitchell, 2015)

The presence of a coordinated approach to health and academic achievement based on the Whole School, Whole Community, Whole Child model (Birch & Videto, 2015)

Quality School Health Education

The second part of the presentation title is “Improved School Health Education.” Note that the last two characteristics of quality schools related to school health. Outstanding schools should have outstanding school health programs including quality school health education. Unfortunately, few of us, and few stakeholders (including school decision makers), have experienced quality school health education programs. Most people have experienced programs that were not taught sequentially from elementary though high school, were taught by teachers not prepared in health education (often a teacher with primary preparation in physical education—a different discipline), and taught in a manner that did not engage students actively in learning and excite them about health. This is not quality school health education!

The following listing is presented as characteristics of a quality school health education program (Birch et al., 2015):

Stakeholders are engaged in the curriculum development process.

The curriculum is based on national or state health education standards and is research-based and theory-driven.

Instruction promotes knowledge acquisition and critical thinking skills, the development of health skills, and the initiation and maintenance of healthy behaviors.

Content is addressed sequentially in an age and developmentally appropriate manner.

Teachers actively engage students in learning through diverse instructional techniques and materials that are culturally inclusive.

Learning is evaluated using authentic assessment techniques.

Teachers are professionally prepared in health education and passionate about teaching the subject.

Health education is linked to other school programs through the Whole School, Whole Community, Whole Child approach (WSCC)

Actions for Your Consideration

We have examined the connection between education and health, considered characteristics of quality schools and characteristics of quality school health education. Now, I am ready to identify roles for you, as SOPHE members, as advocates in these areas.

Consider the Freudenberg and Ruglis (2007) quote:

If medical researchers were to discover an elixir that could increase life expectancy, reduce the burden of illness, delay the consequences of aging, decrease risky behaviors and shrink disparities in health, we would celebrate such a remarkable discovery. Robust epidemiological evidence suggests that education is such an elixir. (p. 1)

The late Marian Hamburg (1994), a noted health education leader, presented this specific challenge to health educators:

The potential for success, however, is greatly dependent on the extent to which those concerned with school health take leadership in working with education reformers in the development of new strategies for integrating health into education. Health education professionals need to join the movement not separate from it. (p. 16)

The very pointed suggestion from Dr. Hamburg was reinforced by SOPHE Past President Diane Allensworth when she urged SOPHE members in her 2010 Presidential Address to “Step up to the plate” to advocate for education and health in schools. Thus, what I want to do is provide possible actions for all of you to consider as both health education professionals and community members. Not all actions will be a fit for all of you. However, I think each of you should find something that you can do to help us move forward.

Let us take a quick look at these actions—and as we do, let me emphasize two important advocacy suggestions. First, any health action that we propose to a school or school district should be presented as a health and education action. Remember, understandably, many school decision makers see their primary mission as promoting learning but do not see the health connection; you have to make that connection. Second, many decision makers have perceptions of school health education based on dismal memories of past experiences or observations; you need to ensure that you have clearly presented a picture of a quality school health education program. Also, note that some of the following actions can be undertaken in your role as a public health professional, as a community member, or, for some of you, as a parent.

Initiate a specific action to inform and mobilize stakeholders to promote student access to quality education (form an action committee, online discussion group, provide presentations on the topic, etc.).

Consider the inclusion of improving or supporting better schools as a component of all community health activities. For example, if a community health education agency or organization is working with middle schools in improving school nutrition programs, the connection between education and health should be presented to school leaders along with the importance of quality school health education. This should be viewed as both an education effort for the middle school students and an advocacy opportunity for more comprehensive school health programs. Our efforts should not be limited to categorical, grade-specific topics.

Be the catalyst for the formation of school health councils in your school district or school health teams in an individual school.

Advocate for accessible, quality pre-K programs that emphasize education and health for young children.

As SOPHE chapter leaders/members, reach out to school health education teachers as potential chapter members. Provide professional development opportunities for school health educators at chapter conferences.

Integrate instructional coverage of the education–health connection and information about school health education into university public health programs. All public health graduates should understand this connection and the importance of quality education and school health education.

As faculty members in university community and public health education programs, develop teaching, research, and advocacy partnerships with colleges/schools of education on your campus.

Conduct relevant research and program evaluation that informs stakeholders and provides directions to our efforts to promote education and school health.

Be informed voters—know the positions of school board members and other local office-seekers on education and health issues.

If you are the parent of a school-age child, be advocates for health in meetings and conferences with teachers and administrators, in back to school nights, and other interactions with school faculty and administrators.

Be a candidate for your local school board.

Conclusion

We live in a challenging time for education and public health. We must act on our personal and professional values at the local, state, national, and international levels. This has always been important but I think it is even more important now than ever before in my adulthood.

That being said, I want to close with a quote that I have taken the liberty to adapt from columnist and author, Thomas Friedman, from his 2005 book, The World is Flat: A Brief History of the 21st Century:

We need to flourish in the world that we live in. It will take the right imagination and the right motivation. We, as adults, along with the current generation of children, need to be strategic optimists with more dreams than disruptive memories or discouraging visions of the present. We need to wake up each morning and not only imagine that things can be better but also act on that imagination each day. (p. 635)

I hope that each of you has identified something that you can act on to move education and public health forward. I am appreciative of my opportunity to serve as SOPHE President. Thanks for your support and all that you do for SOPHE and our profession.

Footnotes

Declaration of Conflicting Interests

The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author received no financial support for the research, authorship, and/or publication of this article.

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