Authors
- Kolbe, Lloyd J. PhD
- Rixey, Sallie MD, MEd
Article Content
The Community Preventive Services Task Force (CPSTF) was established in 1996 to help federal, state, and local health departments, other government agencies, communities, health care providers, employers, and schools to identify population interventions that are scientifically proven to save lives, increase life spans, and improve quality of life.1 In this issue of the Journal of Public Health Management & Practice, Knopf and colleagues2 report a CPSTF review of the extent to which out-of-school-time academic interventions for at-risk students, most of whom are from low-income and racial/ethnic minority families, can improve reading, mathematics, and other academic achievement outcomes.3 Another CPSTF review recently reported on the extent to which various interventions can increase high school completion.4,5 Indeed, among all 216 interventions that CPSTF assessed and reported by April 2015,6 we counted 32 that were designed to be implemented by the nation's schools.
Especially during the past few decades, data have shown that health, education, and income are reciprocally interdependent. Healthier students simply learn better, whereas more educated adults live longer, healthier, and wealthier.7-12 The 2 CPSTF reviews referenced earlier assessed interventions designed to improve student education as a means to improve health as well, although most of the 32 school interventions assessed by the CPSTF were designed to improve student health as a means that also might improve education. Illustratively, there is renewed interest in reducing school absences as a means to improve both health and education.13,14 Unfortunately, those at greatest risk for poor health also are at greatest risk for poor education and poor income. These accumulating, interactive inequities exacerbate each other and have been getting worse.15 Today, more than half of our nation's public school students live in low-income households16 and only 80% of white males, 65% of Hispanic males, and 59% of black males graduate from high school.17 Those with less education are more likely to develop unhealthy lifestyles, experience more psychological distress, suffer more illnesses and disabilities, generate more medical care costs, be less productive at work, earn less, and die younger.18 We may never rectify growing inequities in health, education, or income opportunities unless we purposefully address their interdependence. Indeed, Centers for Disease Control and Prevention Director Tom Frieden has argued: "Interventions that address [such] social determinants of health have the greatest potential public health benefit ... [and that] the health sector is well positioned to build the support and develop the partnerships required for change."19(p594)
The health sector formally is beginning to focus on and address interrelationships among health, education, and income. Healthy People 2020 lists numerous national school objectives, including to improve school health programs20; to increase the proportion of 4th-, 8th-, and 12th-grade students whose reading and mathematics skills are at or above achievement level for their grade; to decrease school absenteeism among adolescents due to illness or injury; and to increase the proportion of students who graduate from high school.21 In fact, increasing the high school graduation rate is one of the 26 "High-Priority" Healthy People 2020 objectives.22 Furthermore, the Institute of Medicine recently identified high school graduation as one of the 15 "best measures" for improving health and health care23; and America's Health Rankings24 and County Health Rankings and Roadmaps,25 respectively, provide ongoing state- and county-level data about graduation rates.
The Centers for Disease Control and Prevention and partners recently launched a new Whole School, Whole Community, Whole Child Approach to help the nation's schools improve both education and health,26 and more than 100 national governmental and nongovernmental health, education, and other agencies that serve young people already are working independently to improve both education and health.27 Will these health and education agencies establish collaborative mechanisms to help each other achieve their interdependent goals?28-34 As one example, our nation's not-for-profit hospitals are required to annually generate and report "community benefits" to maintain their IRS (Internal Revenue Service) tax exemptions.35-38 These hospitals might work with schools, health departments, health care providers, and university training programs to collaboratively plan, provide,39-44 and perhaps integrate45-49 patient-centered primary, mental, and behavioral health care to improve the health and education of students in the communities these agencies serve-especially for students at greatest risk for poor health, education, and income. To create and report community benefits, hospitals, health departments, and schools might work together to provide one or some combination of subsidized, discounted, or free health care for students in need (eg, for those enrolled in Medicaid), community health improvement services (eg, improving school attendance, academic achievement, graduation rates), health professions education (eg, training public health and medical professionals to work with schools), and research (eg, about the effectiveness of such efforts to improve targeted health and education outcomes).50
As Knopf and colleagues have concluded in this issue of Journal of Public Health Management & Practice, the school programs they reviewed were "...effective in increasing academic achievement for at-risk students. [But,] Ongoing school and social environments that support learning and development may be essential to ensure the longer term benefits of [such] programs."2
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