The Other 60 Percent

Q&A: Investing in student health reaps academic gains

Dr. Charles Basch, professor of health and education at Columbia University’s Teachers College, addressed the connection between student health and school success during his keynote address at the Colorado Association of School Nurses conference in Loveland on Nov. 2. In particular, he addressed seven key health factors that research shows are closely associated with students’ academic performance, but are often not addressed in a cohesive, coordinated way by schools.

Dr. Charles Basch
Dr. Charles Basch (photo courtesy of Charles Basch)

Dr. Basch’s address covered many of the findings from his 2010 report, “Healthier Students Are Better Learners: A Missing Link in School Reforms to Close the Achievement Gap.”

What are the seven health factors that you’ve found to be most relevant to students’ school performance?

Vision, asthma, teen pregnancy, aggression/violence, physical activity, breakfast and ADHD. Kind of an underlying theme of all those is physical and emotional health. That’s because physical and emotional health is either affected by or affects all of the seven problems…But it’s important to say that I’m not really advocating that every school system in every part of the country needs to focus on these seven things. But rather these are things that are highly prevalent and we know they can have powerful effects on educational outcomes.

What about dental health?

I think oral health is a huge issue…When I was reviewing the literature I used three criteria to select these factors and one was high prevalence and extent of disparities, and oral health problems clearly satisfy that one. The second one was evidence that these problems had causal effects on education outcomes and at that time I didn’t really find the evidence that oral health problems had effects…That doesn’t mean that they don’t. That just means that the research hadn’t been done.

There are other problems as well that might be deemed as priorities in given locations. It’s not a one-size-fits-all model. Clearly, the intent of the work is to show how and why…a set of health problems can have powerful effects on academic achievement.

And, in turn, are partially responsible for achievement gaps?

Absolutely, yes. The same children who experience disparities in academic achievement are the ones most likely to experience these health disparities. And both academic achievement disparities and health disparities are generally concentrated in areas of high poverty. So, there’s reciprocal relationships between these economic and health and educational factors, but unfortunately in too many cases we tend to deal with them in a siloed way.

Until recently, the public health community has not really been that interested in educational outcomes as a public health goal. That’s now changed. High school graduation and academic achievement are seen as a really important way to promote the health of the population.

And unfortunately,…schools have not really fully engaged health as a fundamental part of the school mission. There’s always been school programs, whether it be feeding programs or physical education program or screening programs…but it’s never really been embraced as a really basic part of the mission of schools. Therefore, the… benefits for children from those efforts have not been as great as they might be.

How well have school district leaders recognized the impact of the seven factors you talk about?

I think it’s quite variable from one place to another… I think it probably depends on the administrator and how closely they’ve been in touch with students, whether they’ve come up through the ranks as teachers and seen these things first hand… It seems that there’s definitely increasing recognition among school leaders about the importance of these issues and the need to address them in order to achieve the academic agenda.

Are there states or districts that are exemplars in the area of coordinated, strategic health efforts?

I think there are different kinds of activities going on in different locations…I know the Denver Public Schools, in fact, is doing some really interesting work related to their data systems, related to the asthma program, related to a variety of these issues.

There are pockets of exemplary programs all around the country and there are examples of states doing very innovative things, like the state of Tennessee requiring a school health coordinator in every district.

At this point, from my perspective…there’s not really a coherent effort nationally to get this issue on the education agenda.

What’s the role of state and national policies to demand that schools take a coordinated approach to school health?

Ultimately, it’s probably going to take such policies and the accountability that goes with those policies to really bring about meaningful changes. I think at the same time, there’s a need for increasing awareness and interest at the grassroots level, among parents, among school board members, among teachers and school leaders to recognize the importance of these issues and the value they can bring not only to academic achievement but to the overall development of children.

But policies and accountability measures are really important. Are there health goals in the school improvement plans? Are there healthy foods served in the school breakfast and lunch programs and on school grounds? Is there an effort to promote breakfast consumption by allowing children to eat breakfast in the classroom?

There is vision screening in most schools throughout the country, but is there the follow-up?….Is there an effort to provide good case management for children with asthma to help ensure they don’t miss a lot of school because of poorly controlled asthma?

One of the most important things: Is there a direct effort to promote a positive school climate where students feel connected to schools? … Is there a good physical education program, not just catered to the most athletic kids but really tries to engage all the kids in physical activity?

What kinds of things do you see happening in your hometown of New York City? Do you feel encouraged?

I do…New York City’s kind of a unique situation because it’s the largest school district in the nation…There’s a lot of different kinds of activities underway… to address the school breakfast issues and school lunch issues, which really need to be addressed.

We’re piloting a vision program to actually conduct optometric exams and provide glasses on-site immediately following. There’s efforts underway to provide children with physical activity breaks in the morning and afternoon each day to improve their ability to pay attention.

There’s many people in the city, and in the country, who really recognize the importance of this work, who really passionately care about children and see them as the next generation … and see the schools as probably the single most important social institution, after the family, to really help kids have a good chance to succeed in life.

Of all the groups you’ve delivered your message to, where has the biggest push for coordinated school health come from?

I wouldn’t say that there’s any one group. I think there’s a lot of interest from different groups. There’s increasing interest from state education departments and school districts,…from those providing primary care to children through school-based clinics,…pediatricians, school nurses,….school administrators and those professional association, like the Association for Supervision and Curriculum Development,…agencies of the U.S. Public Health Service and the Centers for Disease Control.

I’m very optimistic but at the same time there’s still so much work that remains to be done. One of the biggest challenges is that most of the funding agencies and most of the policies and most of the programs are very categorically oriented. So there’s a group that’s interested in violence prevention and there’s a group that’s interested in school breakfast and there’s a group that’s interested in vision…There’s all these disparate groups and in some ways they may be competing for attention and funding.

What’s really the most challenging and … one of the most important aspects of this work is pulling all these efforts together into a coherent, coordinated effort.

How do you envision pulling all those different groups together?

The way you get the common ground….is encourage the people who are the leaders within the schools to recognize that this initiative has to be seen as a coherent effort with different parts…That’s probably going to require a dedicated individual, changes in the staffing patterns, where you have a coordinator that recognizes different people are playing different roles, but they’re all forming a single, coherent program. Just helping people appreciate that having these problems in siloes, and the funding and research and programs and policies in those siloes, is not going to have nearly as beneficial effect on kids.

But if the grant-funding for these efforts is siloed, how do you address the various problems in a coordinated way?

That’s a really tough question and I don’t think there’s an easy answer to that question. That’s the existing infrastructure….so I don’t think that’s an ocean liner that’s easy to turn around very quickly. But I think there is a need to find ways to work within that structure to pull these different efforts together to form a coherent program…. and, over time, to look for leadership among agencies that have an opportunity to fund multidisciplinary approaches addressing multiple problems simultaneously.

That leadership’s likely to come from foundations that have the flexibility to do so, from individual philanthropists and potentially from government agencies….There’s really a need for leadership from the U.S. Department of Education and from state education departments.

Is there an audience out there that still needs to hear your message?

Virtually, all the different groups that I’ve spoken with tend to be receptive to it. It’s kind of a common sense message…I think that on a rehetorical level there’s lots of support for this. I think the challenge is translating these ideas into action…into policies, programs, accountability and data collection…evaluating it, showing the beneficial effects it can have.

I think one of the groups that’s important that we haven’t talked about so far are the people who prepare school administrators and school teachers, that is the colleges of education throughout the United States.

How did you get into this work?

I originally was interested in medicine and started off in a pre-med track and then the more I learned about the health of the population and seeing that it would make much more sense to focus on prevention. …The more I learned about prevention, it just became so clear to me that the schools were the social institution within our society that had just such a tremendous potential to make a difference in shaping the lives of youth.

I came to Teachers College about 30 years ago to pursue this agenda and it’s …not until very recently that I feel that it’s coming closer to becoming more of a reality and seeing lots of meaningful changes in the schools.

It’s only about the last 10 to 15 years that the research has strengthened to the extent where you can say this is how and why these problems affect academic achievement. This is how they affect cognition and memory and attention. This is how they affect school connectedness and why school connectedness is important….This is how they affect absenteeism. It’s taken until now for the research in neurosciences and child development and epidemiology to really get to the point where it seems pretty unequivocal that these are important factors that affect children’s motivation and ability to learn.

Kids eat free

Colorado could expand lunch subsidy to high school students

PHOTO: Helen H. Richardson/The Denver Post
Bernadette Cole serves food to students at Prairie View High School in Brighton.

When Colorado expanded a school lunch subsidy to middle school students, the number of sixth- through eighth-graders eating lunch at school went up in districts across the state.

Twenty-sixth percent more middle school students ate lunch at school in the Greeley-Evans district, where a majority of students live in poverty, but even in the more affluent Littleton district in Denver’s south suburbs, 11 percent more middle school students ate lunch.

For school nutritionists and children’s advocates, these kinds of results make the case for extending this same lunch subsidy to high school students.

“We know the co-pay is a barrier because of the large uptick in participation when it goes away,” said Erin Miller, vice president of health initiatives for the Colorado Children’s Campaign.

The “co-pay” is the 40 cents per meal that families who qualify for reduced-price lunch — but who make too much money to qualify for free lunch — are responsible for. The federal government picks up most of the cost for these lunches, and since 2008, Colorado has covered the 40 cents for the youngest students, rendering those lunches free to their families. This program has gradually expanded, reaching middle school students in legislation passed last year.

A bill that passed out of the House Education Committee Thursday would cover the 40-cent cost difference for high school students, a longtime goal of advocates.

“The state of Colorado has been trying to ensure that kids in poverty have access to food for a decade,” said Danielle Bock, nutrition services director for the Greeley-Evans district and a public policy and legislative consultant with the Colorado School Nutrition Association. “This is the final step.”

Miller said hunger affects children in school not just academically but also emotionally, with hunger even associated with higher suicide rates. Advocates have pushed to expand the state subsidy because participation in school lunch goes down as children get older, even as their caloric needs go up.

Currently, households that earn less than 130 percent of the federal poverty level, or $32,630 for a family of four, qualify for free lunch through the federal program. Families who earn between 130 and 185 percent of the federal poverty limit, or up to $46,435 for a family of four, qualify for a reduced-price lunch. It’s children from that second category families who will benefit if this bill becomes law.

Bock said the vast majority of school food service agencies in Colorado have unpaid lunch debt that, under federal law, they can’t just write off. School districts either pick up the costs out of their general fund or try to collect from parents, which sometimes leads to the controversial practice of “lunch shaming,” in which schools serve less nutritious and appealing alternative lunches to students whose parents owe money.

Lawmakers started out wanting to ban lunch-shaming, but school nutritionists convinced them it would be better to have the state cover some of the extra lunch cost for families who are struggling to make ends meet.

When Denver ended the practice of serving “alternative” meals to families who hadn’t paid for lunch, the amount of lunch debt skyrocketed, with a large portion of it coming from families who had not signed up for subsidized lunches and might have the means to pay.

According to a fiscal analysis, Colorado plans to spend $2.2 million on lunch subsidies this school year. Expanding the program to high school students would cost an additional $464,000 next year, with that money going into school food service budgets.

pass the microphone

This Memphis senior was kicked out of three high schools. Here’s how he got on track to graduate.

PHOTO: Gillian Wenhold, The Social Exchange
Despite what John Chatman calls a “really tough childhood” where he was often left on his own, he’s on track to graduate from alternative school G.W. Carver College and Career Academy this year.

In front of more than 100 people, John Chatman recalled the bullying he endured as a child for having a stutter.

Chatman was one of seven educators and students who took the mic at Chalkbeat’s February story storytelling night. The stories centered around school discipline practices, a topic we recently covered in this special report.

“Growing up in the area I grew up in, it’s hard to deal with that,” said the 18-year-old. “You’re an outcast. … It made me hate school, because I never could enjoy it. I may answer a question and stutter, [and other students would] get to laughing and cracking jokes.”

Kids stopped making fun of him in middle school when Chatman became a star middle school football player in Memphis — but the prestige that came with playing football disappeared when he was injured on the field.

“I took my injuries and replaced them with the streets,” Chatman said. “Throughout my ninth-grade year, I was starting to lose myself. … By 11th grade, I didn’t know who I even was.”

During that period, Chatman said he was kicked out of three high schools and eventually wound up at G.W. Carver College and Career Academy, an alternative school for expelled students, housed in former Carver High School.

“This school changed my life forever, Chatman said.

To hear more about how Chatman’s life changed, watch the video (or read the excerpt) below.

The storytelling night was hosted by Chalkbeat Tennessee, Spillit, and The Knowledge Tree. The video was filmed by Gillian Wenhold for The Social Exchange, a pay-as-you-can public relations and content creation firm for nonprofits, and businesses owned by women and people of color.

My 11th-grade year was the time I decided I had to change. The change was when I finally got kicked out of school. Well, I’d been kicked out of school but this was the kick-out-of-school that kicked me in my back real hard and said you only have one strike left. If you mess this up, this is it. It’s over with. You’re not going to see the light of day. Due to that, I ended up going to Northeast, and it still didn’t get better. In fact, I’m going to tell y’all the transitions of my schools. It started at ninth grade at Central, couldn’t come back to Central and I had to go to East , got kicked out of East and went to Northeast. Got kicked out of Northeast and now I’m back at Carver.

I’ll tell y’all, this school changed my life forever. I wouldn’t be here right now if it wasn’t for that school. It happened like this. There was a guy named Roger. We used to run together during the same time period. …

[During a presentation of past Carver graduates], an image of Roger popped up clear on the screen. It wasn’t up for nothing bad, he was on the road to making a six-figure [salary]. I was like, ‘This was the same person I used to shoot dice with?’… Now he’s living a life and I’m stuck here. I’m still doing the same stuff I’ve been doing and not getting no different result, and that’s called insanity… I took it, and I told myself if he can do it, I know I can.

Spillit, storytelling
PHOTO: Xzavier Bonds
Chatman speaks to a packed room during Chalkbeat’s storytelling event.