Because healthy students not only excel academically but also are more likely to be engaged positively in social, community, and extra-curricular activities, the benefits of supporting student health, nutrition, and physical fitness are far-reaching. Employment, public safety, and community pride and partnerships are able to be cultivated when young people are supported to be healthy.
Health Care Access and Nutrition. Rigorous research confirms the clear connection between health status and academic achievement. We know that:
- Healthy children miss fewer days of school, are more attentive, and are better behaved.29
- Healthy children are more successful in school, and are more likely to graduate from high school and go to college.30
- Health disparities contribute to the achievement gap.31
- Children with health insurance are more likely to get the health care they need.32 The result is healthier, more attentive, and higher-performing students in the classroom.
- Health insurance makes a difference in school performance. Children covered by California's Healthy Families Program showed a 63 percent improvement in "paying attention" and a 64 percent improvement in "keeping up with school activities" over their performance when uninsured.33
Research also confirms that providing health services and facilitating access to health care in school can improve educational outcomes, keeping children in the classroom, improving achievement, reducing disciplinary referrals, and improving school climate.34
Despite the acknowledged importance of children's health, at least 700,000 California children who are eligible for existing coverage programs are not enrolled. By 2014, an additional 900,000 children are estimated to be eligible for health insurance offered through the California Health Benefit Exchange. Helping families enroll their children and other family members in health insurance is a natural fit for schools since that is where the majority of children are.
California's 176 school health centers serve only a small proportion of the children who are uninsured or lack access to health care. The ratio of school nurses to students in California is worse than that of 40 other states and has suffered as a result of recent budget cuts. Since the 2008-2009 academic year, there has not even been data on the number of school nurses employed by districts. Implementation of other school health interventions and health insurance outreach is uneven, and the state has no data on the number or types of programs in place.
Except for administering a handful of health-related funding streams, CDE has not historically played a strong leadership role in advancing or coordinating school health services or programs. The Superintendent has an extraordinary opportunity to provide the statewide leadership necessary to encourage and support schools as they become viable community centers where access to enrollment, information, and health care services are provided.
Physical Fitness and Nutrition. Research has also established the contribution of regular physical activity participation and good nutrition, not only to key health outcomes such as obesity prevention, but also to educational outcomes such as attentiveness, concentration, and academic performance. Studies show that:
- Active and fit students have better standardized test scores and grades.
- Classroom physical activity breaks improve attention and behavior; breaks without physical activity do not.
- Moderate to high levels of physical activity in physical education classes tend to improve academic achievement.
- Structured group exercise breaks for students and school staff have been shown to improve on-task time, academic test scores, absenteeism and disciplinary referrals.
Given these findings, physical activity can now be considered a strategy for enhancing academic performance. Physical education is the primary opportunity in childhood to enhance movement skills and knowledge, habituate students to regular activity, and teach for lifetime engagement. The quality of physical education instruction in California schools is uneven and lacks sufficient leadership needed to achieve its very worthy outcomes for all students. The need to maximize efforts and focus actions around physical education and physical activity is evident.
Good nutrition is an additional key component of building and maintaining health and can be facilitated by both education programs for children and families and the provision of healthy foods on the school campus.
Health, Nutrition, and Physical Fitness Key RecommendationsCDE can do much to help foster children's health and fitness. The Department should:
- Help connect eligible children to health coverage by working with appropriate state entities to design school-outreach strategies.
- Provide leadership in the development of school health centers and mental health services by working with the California Department of Public Health and other agencies to help schools coordinate and more fully tap diverse sources of state and federal funding, and to make it easier for schools to construct facilities for school health centers.
- Take advantage of new tele-health technology and funding to increase access to health services at schools.
- Create incentives to recognize improvement in student, teacher, classified staff, and administrator physical activity during the school day.
- Disseminate models and provide training to teachers, classified staff, and administrators to implement activity breaks, active recess, and other resources. Provide toolkits and models of successful incorporation of physical activity on the CDE website.
- Incorporate measures of physical education opportunities and performance into accountability structures, such as the new Academic Performance Index.
- Enhance child nutrition by providing accessible, engaging information for teachers, classified staff, administrators, children, and families; ensuring that every school has working water fountains with water quality meeting community standards; requiring that all food offered on school campuses meets USDA nutritional standards; and partnering with the Farm Bureau, Department of Food and Agriculture, and NGOs to expand the number of school gardens, as well as access to nutrition information.
29. C.A. Kearney, "School Absenteeism and School Refusal Behavior in Youth: A Contemporary Review," Clin Psychol Rev., Vol. 28, No. 3 (2008): 451-471; B. Lapin and A.J. Bodurtha Smith. Dental Care: The Often Neglected Part of Health Care (New Haven, CT: School of the 21st Century at Yale University, 2008). I.M. Loe and H.M. Feldman, "Academic and Educational Outcomes of Children with ADHD," J Pediatr Pscyhol, Vol. 32, No. 6 (2007): 643-654.
30. S.L. Blumenshine, et al., "Children's School Performance: Impact of General and Oral Health," J Public Health Dent., Vol. 68, No. 2 (2008): 82-87; J. Breslau, et al., "Mental Disorders and Subsequent Educational Attainment in a U.S. National Sample," J Psychiatr Res, Vol. 42, No. 9 (2008): 708-716; M.I. Jackson, "Understanding Links Between Adolescent Health and Educational Attainment," Demography, Vol. 46, No. 4 (2009): 671-694; N. Freudenberg and J. Ruglis, "Reframing School Dropout as a Public Health Issue," Prev Chron Dis, Vol. 4, No. 4 (2007): 1-11.
31. J. Currie, "Health Disparities and Gaps in School Readiness," Future of Children, Vol. 15, No. 1 (2005): 117-138; K. Fiscella and H. Kitzman, "Disparities in Academic Achievement and Health: The Intersection of Child Education and Health Policy," Pediatrics, Vol. 123, No. 3 (2008): 1073-1080.
32. L. Dubay and G.M. Kenney, "Health Care Access and Use Among Low-Income Children: Who Fares Best?" Health Affairs, (2001); Kaiser Commission on Medicaid and the Uninsured, Children's Health: Why Health Insurance Matters, (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, 2002).
34. M.S. Atkins, et al., "School-Based Mental Health Services for Children Living in High Poverty Urban Communities," Adm Policy Ment Health, Vol. 33, No. 2 (2006): 146-159; N.G. Murray, et al., "Coordinated School Health Programs and Academic Achievement: A Systematic Review of the Literature," J Sch Health, Vol. 77, No. 9 (2007): 589-600; S.C. Walker, et al., "Impact of School-Based Health Center Use on Academic Outcomes," J Adol Health, Vol. 46, No. 3 (2010): 251-257.