health services, counseling and psychological services, and policies addressing the quality of the school environment. The question then arises: What would it take to transform existing programs in typical communities into the vision of a comprehensive school health program?

First, although many components of a CSHP already exist widely, their implementation and quality require attention. New standards and recommendations have been released in many fields that have yet to reach the local level. Another serious deficiency is the apparent lack of involvement of critical community stakeholders in designing and supporting current programs. Perhaps the most difficult issue to resolve before existing programs can be considered "comprehensive" involves the role of the school in providing access to services typically considered the responsibility of the private sector, such as certain preventive and primary health care services. "Providing access" does not necessarily mean that services will be delivered at the school site; rather, it implies ensuring that all students are able to obtain and make use of needed services. Each community must devise appropriate strategies to ensure that all of its students have access to these basic preventive and primary care services.

Although there are divergent opinions about some categorical aspects of school health programs, the committee found a uniform belief that school health programs are important and valuable. Nonetheless, despite this uniform opinion, there is a wide gap between the conceptualization of programs and their implementation. Before school health programs can achieve their promise, concerted action will be needed to bridge this gap. Such action could include coordinating scattered activities; improving the quality and consistency of implementation; engaging the participation of crucial stakeholders; and providing an adequate, stable funding base.

Although dedication and cooperation will be required, the committee believes that the vision of a comprehensive school health program is attainable, and the situation is not so complicated that, even today, a local community could not begin to work toward this vision. The committee is not calling for schools to do more on their own; instead, it is asking communities to recognize and take advantage of the key role that schools can play in promoting and protecting the health and well-being of our nation's children and youth. An investment in the health and education of today's children and young people is the ultimate investment for the future.



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