School Health

School HealthSchools face a crisis in child and adolescent health characterized by poverty, social alienation, lack of medical insurance, and Medicaid ineligibility (Tyson, 1999). In all schools some children are affected by new morbidities and mortalities such as stress related to divorce and immigration, vulnerability to sexual temptation, alcohol, drugs, tobacco, violence, depression, and suicide (Tyson, 1999).

Research confirms a direct link between children’s health and their capacity to learn at school. Health and education are no longer viewed as separate, but as intertwined and interdependent systems. This interdependence was confirmed in the National Action Plan for Comprehensive School Health Education, supported by the “American Cancer Society and representatives from over 40 national health, education, and social service organizations” (Symons & Benthann, 1997, p.220).

Comprehensive school health education (CSHE) has been a way to integrate health promotion in a community setting with the goals of the public health community. Schools provide a promising setting for community health promotion because as a public health institution, schools have contact with all families in society. In addition to providing a setting that promotes academic accomplishment, schools hold potential for promotion of public health. Allensworth, Wyche, Lawson and Nicholson (1995, p. v ), editors of the 1995 IOM report, Defining a Comprehensive School Health Program: An Interim Statement, described schools as “well situated to assist in protecting and promoting students health and well-being and to make a significant contribution to producing a new generation of healthy, productive adults.”

Schools and communities can accomplish much when working in partnership with community organizations and agencies. Tyson believes combined efforts of schools and communities can provide a “seamless web of education and services that lower the barriers to learning” (Tyson, 1999, p.5). In the U.S., over 53 million children, and over 4.4 million teachers, attend 129,000 schools. This large and uniquely accessible population provides an excellent focus for public health efforts through school health programs. A report from the U.S. Department of Health and Human Services, and the Centers for Disease Control and Prevention, entitled Healthy Youth: An Investment in Our Nation’s Future indicated “school health programs are one of the most efficient means of shaping our nation’s future health, education, and social well-being” (DHHS and CDC, 2003, p.2).

Likewise, McGinnis and DeGraw’s (1991) analysis of the Healthy People 2000 initiative concluded, “one-third of these objectives can be influenced significantly or achieved in or through the schools.” Although published in 1920, C.E.A. Winslow’s definition of public health remains a comprehensive and model definition (Turnock, 2001). The model comprehensive (aka coordinated) school health program (CSHP) represents the embodiment of Winslow’s vision of public health, in the microcosm of a public school setting. Comprehensive school health programs “propose to combine health education, health promotion and disease prevention, and access to health and social services, at the school site” (Allensworth et al., 1995, p.1).

According to the IOM, comprehensive school health programs include four unique features: family and community involvement, multiple interventions, integration of program elements, and collaboration across disciplines (Allensworth et al., 1995). Goals of a coordinated or comprehensive school health program seek to “identify the health problems in a community, build community consensus on what services are needed, integrate funding from various existing sources to meet those needs and develop a coordinated and comprehensive service approach to improve children’s health” (Ouellette, 2000, p.2).

Another term used in conjunction with CSHP, the full-service school, is defined in the IOM report as “the center for collocating a wide range of health, mental health, social, and/or family services into a one-stop, seamless institution.” (Allensworth et al., 1995, p.17; Dryfoos, 1994). The model provides a particularly broad spectrum of services, from health services to mental health services, to family welfare and social services (Allensworth et al., 1995). Public health and public education do not operate as independent systems. Research supports the conclusion that intertwining public health and public education proves mutually beneficial (Symons & Benthann, 1997). Thus, the CSHP model forms the mechanism by which Winslow’s definition of public health can come to fruition through a full-service school.

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