In response to a condition that threatens health, safety, welfare, or property, officials in the executive branch of government may declare a state of emergency (SOE) to trigger the allocation of local, state, and federal resources. SOEs are often declared to address natural or man-made resource shortages or hazards. The lead contamination of the Flint water supply is one such example. Although unrecognized as such, severe deprivations of education should likewise be considered an SOE similar to other resource shortages that increase the risk of morbidity and mortality.

Social factors play a fundamental role in health outcomes,1 and the link between education attainment and health is particularly robust.2,3 Low educational attainment significantly increases the risk of disease and premature mortality.2,3 Thus, in school districts where education quality and graduation rates fall far below national averages, substandard education contributes to increased morbidity and mortality over the life course.4 To address this well-known social determinant of health,5 the government should use short- and long-term policy solutions, including the use of SOE declarations.

The SOE concept discussed in this commentary is separate from the already extant "state emergency management" of school districts in communities such as Detroit, Michigan,6 and Florence, South Carolina.7 Under state emergency management, the state takes over the management of a failing school district according to legislation created for this purpose.8 In Detroit, for example, the schools have been under emergency management since 2009, with the most recent manager focusing on debt restructuring.9 Despite such management, the Detroit Federation of Teachers sued the school system in January 2016, arguing that it is still failing to provide a "minimally adequate education" to students.9 This substandard education is the emergency, warranting an SOE declaration to trigger resources and assistance beyond those allocated to the education administration through normal channels and under emergency management.

An SOE declaration is available to government when resource shortages threaten the health, safety, welfare, and property of a community. This is directly applicable to severe deprivations of education that stem from resource shortages and fundamentally threaten the health, safety, and welfare of students. The following discusses the health ramification of emergencies in education and describes SOE powers, the conditions that trigger an SOE declaration, and the implications of such a declaration. The commentary concludes by noting that the social justice framework underlying public health provides a valid basis to address severe deprivations of education through all policy levers available to government, including emergency powers.

Emergencies of Education

Graduating from high school has long-term personal and societal benefits,10 and low educational attainment is a strong predictor of premature mortality.11,12 It is estimated that approximately 145 000 deaths per year could be avoided if those who had not completed high school went on to graduate.12 Furthermore, the societal benefits of increased high school graduation include averting productivity loss and public assistance costs, as well as reducing crime and health care costs.4

The gap in life expectancy between low and high levels of education has been increasing over time.11,12 Education is a fundamental cause of health through a variety of mechanisms including higher income and social status, greater access to health care and health-supporting social networks, and greater psychological well-being.4 Education also develops cognitive skills relevant to health-related decision making, finding and understanding information, and adhering to treatment regimens. Hence, targeting education through policy may be more effective than trying to intervene on a variety of health habits and behaviors later in life.

School failure is concentrated in low-income communities with large ethnic and racial minority populations.13 Resource shortages have resulted in an inability to pay teachers, buy textbooks, and clean and repair school facilities. The infestation of rodents, cockroaches, and mold and overcrowding create short-term health risks. However, low educational attainment results in longer-term health consequences.4,10-12 School districts with educational attainment 3- to 4-grade levels below national averages are ripe for classification as an SOE.

State of Emergency Declarations

Every state has a statute providing the governor with the authority to declare an SOE, and some states bestow this authority on local officials. An SOE declaration triggers the provision of state and local resources. All states, territories, and the District of Columbia (collectively, states) additionally have a compact, the Emergency Management Assistance Compact (EMAC), to provide cross-state support in times of emergency.14 Governors of the affected state may also request that the president declare an SOE pursuant to the Robert T. Stafford Disaster Relief and Emergency Assistance Act (Stafford Act) to provide federal resources to the region.15

Severe deprivations of education can arguably fit within the current SOE framework. State statutes differ in their definitions, but the Stafford Act defines "emergency" broadly for purposes of federal assistance, as an "occasion or instance for which, in the determination of the President, [sic] federal assistance is needed to supplement state and local efforts and capabilities to save lives and to protect property and public health and safety, or to lessen or avert the threat of a catastrophe."15

EMAC's Article 1 provides for mutual assistance among the states in managing an emergency declared by a governor, "whether arising from natural disaster, technological hazard, man-made disaster, civil emergency aspects of resources shortages, community disorders, insurgency, or enemy attack."14 Resource shortages that result in severe deprivations of education create civil emergencies. Public education is a public service such as those provided by the police and fire departments. Resource shortages of these public services create a civil emergency warranting an SOE declaration.

The conditions triggering the declaration of an SOE are highly variable and have many facets: the relative immediacy and harmfulness of the event, the type and temporal nature of the consequences, and the number of people affected. But no one facet is determinative. Governors and mayors have declared an SOE for problems in need of immediate response (eg, California wildfires) and those in need of longer-term solutions (eg, homelessness in Seattle-King County; Virginia motor vehicle fuel shortage). SOEs have been declared prior to an event (eg, New Jersey in preparation for Hurricane Katrina), during an event (eg, California drought), and after an event (eg, September 11). They have been declared both for natural and man-made events and for conditions that expose people to short- or long-term health risks. They have been declared when no one in the state was affected (eg, Connecticut to prepare for Ebola virus infection), when several people were affected (eg, Florida, 9 cases of Zika virus infection), when several thousand were affected (eg, California methane leak), and when more than 100 000 people were affected (eg, lead in Flint water supply). Thus, no specific set of criteria establishes a presumptive SOE as a priori legitimate. Deprivations in education need short- and long-term solutions, influence hundreds of thousands of lives, and expose those affected to short- and long-term health risks.

Implications

An SOE declaration for severe deprivations of education would trigger local and/or state resources and create the condition to request cross-state support and federal aid. Available resources can include coordination, infrastructure, personnel, and financial, logistical, and technical assistance. School districts may fear loss of local control, but this already occurs under current state emergency management procedures.

The SOE provides immediate relief in the short term and allows governments to prepare and seek funding for longer-term solutions. For example, the Seattle-King County November 2015 SOE declaration for homelessness resulted in increased allocation of county funding, additional shelters, and expanded services by January 2016.16 The county also developed longer-term policy solutions and sought state and federal support.

Conclusion

Although severe deprivations of educational opportunities may not meet current notions of an SOE, one can imagine a state policy where the fundamental concept of what constitutes a threat to humanity is reframed to include such deprivations. Addressing severe deprivations of education directly through emergency procedures in addition to long-term policy solutions aligns with the social justice value of public health's mission. As a field, public health is dedicated to raising population health while focusing on the most disadvantaged.17 Public health policy making often concentrates on addressing behavioral risk factors (eg, instituting recess, school food nutrition guidelines). The goal of supporting healthier behaviors and communities is important but also has limitations when people are systematically disadvantaged to a point that their ability to make healthy choices is limited and their prospect for health is below that of the rest of the nation.17 The social justice lens of public health provides a further basis for recognizing that failing schools are in an SOE, warranting a declaration to garner resources aimed at alleviating this fundamental cause of disease and health disparity.

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