Dr. Charles Basch, professor of health and education at Columbia University’s Teachers College, addressed the connection between student health and school success during his keynote address at the Colorado Association of School Nurses conference in Loveland on Nov. 2. In particular, he addressed seven key health factors that research shows are closely associated with students’ academic performance, but are often not addressed in a cohesive, coordinated way by schools.

Dr. Charles Basch
Dr. Charles Basch (photo courtesy of Charles Basch)

Dr. Basch’s address covered many of the findings from his 2010 report, “Healthier Students Are Better Learners: A Missing Link in School Reforms to Close the Achievement Gap.”

What are the seven health factors that you’ve found to be most relevant to students’ school performance?

Vision, asthma, teen pregnancy, aggression/violence, physical activity, breakfast and ADHD. Kind of an underlying theme of all those is physical and emotional health. That’s because physical and emotional health is either affected by or affects all of the seven problems…But it’s important to say that I’m not really advocating that every school system in every part of the country needs to focus on these seven things. But rather these are things that are highly prevalent and we know they can have powerful effects on educational outcomes.

What about dental health?

I think oral health is a huge issue…When I was reviewing the literature I used three criteria to select these factors and one was high prevalence and extent of disparities, and oral health problems clearly satisfy that one. The second one was evidence that these problems had causal effects on education outcomes and at that time I didn’t really find the evidence that oral health problems had effects…That doesn’t mean that they don’t. That just means that the research hadn’t been done.

There are other problems as well that might be deemed as priorities in given locations. It’s not a one-size-fits-all model. Clearly, the intent of the work is to show how and why…a set of health problems can have powerful effects on academic achievement.

And, in turn, are partially responsible for achievement gaps?

Absolutely, yes. The same children who experience disparities in academic achievement are the ones most likely to experience these health disparities. And both academic achievement disparities and health disparities are generally concentrated in areas of high poverty. So, there’s reciprocal relationships between these economic and health and educational factors, but unfortunately in too many cases we tend to deal with them in a siloed way.

Until recently, the public health community has not really been that interested in educational outcomes as a public health goal. That’s now changed. High school graduation and academic achievement are seen as a really important way to promote the health of the population.

And unfortunately,…schools have not really fully engaged health as a fundamental part of the school mission. There’s always been school programs, whether it be feeding programs or physical education program or screening programs…but it’s never really been embraced as a really basic part of the mission of schools. Therefore, the… benefits for children from those efforts have not been as great as they might be.

How well have school district leaders recognized the impact of the seven factors you talk about?

I think it’s quite variable from one place to another… I think it probably depends on the administrator and how closely they’ve been in touch with students, whether they’ve come up through the ranks as teachers and seen these things first hand… It seems that there’s definitely increasing recognition among school leaders about the importance of these issues and the need to address them in order to achieve the academic agenda.

Are there states or districts that are exemplars in the area of coordinated, strategic health efforts?

I think there are different kinds of activities going on in different locations…I know the Denver Public Schools, in fact, is doing some really interesting work related to their data systems, related to the asthma program, related to a variety of these issues.

There are pockets of exemplary programs all around the country and there are examples of states doing very innovative things, like the state of Tennessee requiring a school health coordinator in every district.

At this point, from my perspective…there’s not really a coherent effort nationally to get this issue on the education agenda.

What’s the role of state and national policies to demand that schools take a coordinated approach to school health?

Ultimately, it’s probably going to take such policies and the accountability that goes with those policies to really bring about meaningful changes. I think at the same time, there’s a need for increasing awareness and interest at the grassroots level, among parents, among school board members, among teachers and school leaders to recognize the importance of these issues and the value they can bring not only to academic achievement but to the overall development of children.

But policies and accountability measures are really important. Are there health goals in the school improvement plans? Are there healthy foods served in the school breakfast and lunch programs and on school grounds? Is there an effort to promote breakfast consumption by allowing children to eat breakfast in the classroom?

There is vision screening in most schools throughout the country, but is there the follow-up?….Is there an effort to provide good case management for children with asthma to help ensure they don’t miss a lot of school because of poorly controlled asthma?

One of the most important things: Is there a direct effort to promote a positive school climate where students feel connected to schools? … Is there a good physical education program, not just catered to the most athletic kids but really tries to engage all the kids in physical activity?

What kinds of things do you see happening in your hometown of New York City? Do you feel encouraged?

I do…New York City’s kind of a unique situation because it’s the largest school district in the nation…There’s a lot of different kinds of activities underway… to address the school breakfast issues and school lunch issues, which really need to be addressed.

We’re piloting a vision program to actually conduct optometric exams and provide glasses on-site immediately following. There’s efforts underway to provide children with physical activity breaks in the morning and afternoon each day to improve their ability to pay attention.

There’s many people in the city, and in the country, who really recognize the importance of this work, who really passionately care about children and see them as the next generation … and see the schools as probably the single most important social institution, after the family, to really help kids have a good chance to succeed in life.

Of all the groups you’ve delivered your message to, where has the biggest push for coordinated school health come from?

I wouldn’t say that there’s any one group. I think there’s a lot of interest from different groups. There’s increasing interest from state education departments and school districts,…from those providing primary care to children through school-based clinics,…pediatricians, school nurses,….school administrators and those professional association, like the Association for Supervision and Curriculum Development,…agencies of the U.S. Public Health Service and the Centers for Disease Control.

I’m very optimistic but at the same time there’s still so much work that remains to be done. One of the biggest challenges is that most of the funding agencies and most of the policies and most of the programs are very categorically oriented. So there’s a group that’s interested in violence prevention and there’s a group that’s interested in school breakfast and there’s a group that’s interested in vision…There’s all these disparate groups and in some ways they may be competing for attention and funding.

What’s really the most challenging and … one of the most important aspects of this work is pulling all these efforts together into a coherent, coordinated effort.

How do you envision pulling all those different groups together?

The way you get the common ground….is encourage the people who are the leaders within the schools to recognize that this initiative has to be seen as a coherent effort with different parts…That’s probably going to require a dedicated individual, changes in the staffing patterns, where you have a coordinator that recognizes different people are playing different roles, but they’re all forming a single, coherent program. Just helping people appreciate that having these problems in siloes, and the funding and research and programs and policies in those siloes, is not going to have nearly as beneficial effect on kids.

But if the grant-funding for these efforts is siloed, how do you address the various problems in a coordinated way?

That’s a really tough question and I don’t think there’s an easy answer to that question. That’s the existing infrastructure….so I don’t think that’s an ocean liner that’s easy to turn around very quickly. But I think there is a need to find ways to work within that structure to pull these different efforts together to form a coherent program…. and, over time, to look for leadership among agencies that have an opportunity to fund multidisciplinary approaches addressing multiple problems simultaneously.

That leadership’s likely to come from foundations that have the flexibility to do so, from individual philanthropists and potentially from government agencies….There’s really a need for leadership from the U.S. Department of Education and from state education departments.

Is there an audience out there that still needs to hear your message?

Virtually, all the different groups that I’ve spoken with tend to be receptive to it. It’s kind of a common sense message…I think that on a rehetorical level there’s lots of support for this. I think the challenge is translating these ideas into action…into policies, programs, accountability and data collection…evaluating it, showing the beneficial effects it can have.

I think one of the groups that’s important that we haven’t talked about so far are the people who prepare school administrators and school teachers, that is the colleges of education throughout the United States.

How did you get into this work?

I originally was interested in medicine and started off in a pre-med track and then the more I learned about the health of the population and seeing that it would make much more sense to focus on prevention. …The more I learned about prevention, it just became so clear to me that the schools were the social institution within our society that had just such a tremendous potential to make a difference in shaping the lives of youth.

I came to Teachers College about 30 years ago to pursue this agenda and it’s …not until very recently that I feel that it’s coming closer to becoming more of a reality and seeing lots of meaningful changes in the schools.

It’s only about the last 10 to 15 years that the research has strengthened to the extent where you can say this is how and why these problems affect academic achievement. This is how they affect cognition and memory and attention. This is how they affect school connectedness and why school connectedness is important….This is how they affect absenteeism. It’s taken until now for the research in neurosciences and child development and epidemiology to really get to the point where it seems pretty unequivocal that these are important factors that affect children’s motivation and ability to learn.