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Volume 29, Number 6
November/December 2013

Healthy Students, Healthy Schools

New initiatives focus on students’ well-being


“Water first! Water first!” excited students shouted at field day at Henry Ford Elementary School in Redwood City, Calif. The cheer reverberates often through the school, a message taught to promote drinking water instead of soda or juice. At field day students also ran the Lettuce Run, took turns in the Carrot Relay, and answered riddles about produce.

All children in the Redwood City Elementary District are given a free water bottle to fill at water filtration systems in the schools and drink from throughout the day. And the district does all it can to engage families in wellness, from training parents to talk with other parents about the benefits of healthy eating and exercise to putting them in charge of health fairs and fitness runs at their schools.

Redwood City’s approach is one example of how a growing number of schools and school systems across the country are making health a part of children’s daily routines. The idea is that schools are responsible for children’s entire well-being, not just their academic success, and that the former fuels the latter.

Student health is not an entirely new focus, but for decades the education and health sectors rarely worked together in meaningful ways. And when schools did participate in health initiatives, they were seen as a sideline rather than a fundamental part of a school’s overall plan, according to Charles E. Basch, a professor of health and education at Teachers College, Columbia University. As long as student health was considered—if it was considered at all—as insignificant to academic performance, schools and districts were unlikely to devote resources to improving it.

But that has changed. Now there is not just more public awareness about the increase in risk factors like childhood obesity, Type 2 diabetes, and asthma but also a growing body of research linking good health with higher levels of student achievement. Schools are starting to analyze data on student health outcomes and integrate health into school improvement plans, rather than just assigning a health coordinator to lead occasional awareness campaigns.

“For years, teachers have known that students who are healthy perform better in school,” says Whitney Meagher, project director at the Center for Safe and Healthy Schools at the National Association of State Boards of Education. “The difference is now we have the research to back it.”

National organizations have long pressed the importance of student health, and they continue to do so. Redwood City’s initiatives, for instance, are based on a coordinated school health model promoted by the federal Centers for Disease Control and Prevention (CDC), which has recently increased grants to include student health programs in all 50 states. In response to the increasing rates of childhood obesity, in 2010 First Lady Michelle Obama launched Let’s Move, a comprehensive initiative engaging parents, schools, health care providers, and community-based organizations with the aim of putting children on a path to a healthier future. Among the recommended steps for schools are creating health advisory councils to make policy recommendations, incorporating nutrition and physical education (PE) into the school day, planting a garden, and seeking official healthy-school status through a new certification system.

In addition, school boards, state boards of education, and state legislatures are issuing policies that require schools to incorporate student health as part of their overall program. The CDC and community partners, such as local hospitals, health departments, and businesses, are awarding grants and collaborating with states, districts, and schools to build walking tracks, set up salad bars in school cafeterias, provide nurses and counselors, and offer nutrition and PE programs that in other districts are falling victim to budget cuts.

“Healthy eating habits are a key ingredient to students’ academic success,” says Cameron French, deputy press secretary at the U.S. Department of Education. “By working with partners at all levels, we can foster a generation that is less prone to disease, has higher academic achievers, and is more educated about food and its effects on health.”

Research: Healthy Students Perform Better
Research linking good health with higher achievement is mounting. A 2010 report by Basch found a causal connection between a number of health indicators—including vision problems, uncontrolled asthma, lack of physical activity, and skipping breakfast—and low academic achievement. That year, the CDC published The Association Between School-Based Physical Activity, Including Physical Education, and Academic Performance, which compiled 50 reports to suggest that increasing PE in schools helps children academically. And in 2013 the Journal of Adolescent Health released a study entitled “Do Health and Education Agencies in the United States Share Responsibility for Academic Achievement and Health?” The authors reviewed 122 articles over 25 years and found that 97 percent of the studies reported statistically significant inverse relationships between health-risk behaviors and academic achievement. (See sidebar "What Makes a Healthy School").

Most recently, the results of a large-scale study in Nebraska, published in the Journal of Pediatrics in August 2013, revealed that better fitness in fourth- through eighth-graders was linked to higher achievement scores on state tests in math and reading. An additional study, published in the online scientific journal PLOS ONE in September 2013, investigated the relationship between fitness, learning, and memory in nine- and 10-year-olds on a task that involved remembering names and locations on a fictitious map. The results suggest that students who are fit are more likely to retain information, and the authors note that “reducing or eliminating physical education in schools, as is often done in tight financial times, may not be the best way to ensure educational success among our young people.” 
Choosing Priorities
Despite these results, Basch contends that the U.S. Department of Education has not provided the necessary leadership and incentives to make a comprehensive approach pushing health front and center in schools and tying it to school improvement plans the norm. In general, most investment in school health has come from the public health sector rather than the education sector, he says. School health funding “usually focuses on the crisis of the day—HIV, the war on drugs, violence,” Basch says. “Health has never been embraced as a fundamental issue for schools, despite the prevalence of basic health needs that limit equal access to educational opportunities.”

Basch suggests a three-part framework for schools and school districts: strategically selecting priorities and goals with a focus on health problems that affect teaching and learning, implementing evidence-based programs that are effective in changing behaviors, and coordinating the health and education sectors.

“What we need in education is the whole-child perspective,” Basch says. “Children are affected by multiple issues. They might be sleep deprived, depressed, sedentary, and hungry, and we need to address all these issues simultaneously. I’m often asked, ‘What is the most important thing we need to do to address health in schools?’ and my answer is, there is no one thing. We need to set a strategic set of priorities and focus on all of them.”

Some schools and districts strategically focus on one health issue. Charlotte-Mecklenburg Schools in North Carolina, where about 15,000 of the district’s 136,000 students have asthma, received a CDC grant to address asthma control and related school absences. “When we looked at our health data, we saw an increase in the number of students with asthma,” says Nancy Langenfeld, the district’s coordinated school health specialist. Principals got on board for the initiative, she says, when they were shown that students with asthma missed more school than other students. The district, working with the Mecklenburg County Health Department, set up school health teams; involved school nurses in case management and education for students with asthma; coordinated initiatives to improve the air quality in classrooms, including early identification and cleanup of mold in classrooms; provided respiratory therapists in schools; and offered asthma education curricula. As a result, the district was able to identify more students with asthma, get them proper treatment, reduce asthma-related absences, and, teachers say, ultimately help those children academically.

Joe McCarthy, a PE teacher at Meadowview Elementary School in Farmington, Minn., and a member of Minnesotans for Healthy Kids Coalition, believes it’s no coincidence that academic achievement increased at his school once it began to focus intensively on two areas: physical fitness and healthy eating. Fifth-graders lead a set of exercises, called JAMmin’ Minutes, in the lower-grade classrooms to get kids moving and wake up their brains. “When you exercise, blood flow increases into the brain,” McCarthy says. “And when kids are moving there are also fewer behavior problems.” He has started a running club at recess, an afterschool club that provides more physical activities and incentives to stay fit, and parent nights to provide nutrition and fitness education. He encourages teachers to incorporate physical movement into literacy and math lessons.

In the Merino School District, a rural district in Colorado, students were put in charge of deciding how to improve their own health. A committee of 15 high school students developed the health and wellness policy for the 318-student district and presented it to the school board, wrote a grant application to the Colorado Legacy Foundation, and decided how the money should be spent.

The students proposed creating a trail with 20 fitness stations—something Principal Lonnie Brungardt said he never would have thought of—and built a greenhouse where they grow vegetables to serve in the cafeteria. They also created a schoolwide event called The ABCs of Physical Activity—26 days of different physical activities, one for each letter of the alphabet (J for jumping jacks, P for putt-putt), to get kids moving and understanding the benefits of physical fitness. And the entire student body went on a hike in Rocky Mountain National Park.

“With more physical activity, we’ve noticed fewer behavior problems,” says Superintendent Lynn Zemanek. “We’ve also purposefully built in PE breaks and nutritious snacks when we have high-stakes testing. Physical activity is now part of our retention strategy and our school improvement plan.”

Spreading the Word
Although many schools are zeroing in on student health, the question remains: Why aren’t more schools making health a priority? “Just as the hardest part of going to the gym is getting through the gym door, for schools it’s taking that initial step and making the leap of faith that this will make a difference for students,” says Sean Slade, director of healthy school communities at ASCD, a professional education organization, which is working with the CDC to refine their school health model to emphasize the role of health in academic success.

And, of course, anything that costs money and takes time is a challenge in today’s resource-strapped environment. States dictate health policies, but they don’t necessarily provide funds for them—or hold schools accountable for following through on them. Michigan, for instance, developed a state school health committee; the state board of education creates model policies and leaves it up to local districts to implement coordinated school health plans as they see fit. “We do a lot of encouraging,” says Whitney Vance, nutrition consultant at the Michigan Department of Education, “but the challenge is none of our policies have teeth.”

So for now, these initiatives are taking hold in schools and districts with a sense of urgency and in those that have strong partnerships to get the work done. In Redwood City, the school system’s initiative was funded with the help of a local community partner, the Sequoia Healthcare District, and created in cooperation with county departments of education and health. That kind of cross-sector coordination will likely be necessary for schools to get momentum in helping their students grow healthier.

“This is the most exciting time for school health,” Basch says. “We are getting closer and closer to the tipping point of social change. I’m very optimistic, but we have a lot of work to do.”

Lisa Rosenthal is a freelance education journalist based in Burlingame, Calif.

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