A GAO study reports that poor children have more health problems than other children, their conditions are often more severe, and they are less likely to receive regular health care. Poor children typically receive only episodic and crisis-related care, leaving preventive, chronic, and dental health needs not met. For example, of the 19 million children eligible for Medicaid's Early and Periodic Screening, Diagnostic, and Treatment Program in 1992, fewer than 7 million had been screened. More than 40 percent of poor school-aged children had no dental visits in 1989, compared with 28 percent for all children. Children from poor families (those with less than $10,000 annual income) are nearly twice as likely to be hospitalized and spend more than twice the number of days in the hospital than are children from families with annual incomes of $35,000 or more (GAO, 1994b). Poor children are also more likely to be limited in school or play activities by chronic health problems and to suffer more severe consequences than children from high-income families when afflicted by the same illness (Newacheck et al., 1995).

The new social morbidities, which are expressed as negative behaviors, also have a disproportionate impact on poor students. While school health programs attempt to address many of the social and environmental factors that influence human behavior, biomedical factors can also profoundly influence behavior and thus the effectiveness of school programs. For example, an obsessive–compulsive disorder would affect dramatically the ability of an individual to benefit from behavioral interventions. It may be that a significant share of the negative health behaviors currently ascribed primarily to social and environmental factors actually are caused by, or at least aggravated by, biomedical factors. Thus, health and education outcomes may be much less promising for a child with an undiagnosed and untreated neurological deficit—or other ''hidden" biomedical disorders—growing up in social and environmental deprivation.

Schools with many children who live in poverty have higher rates of absenteeism and grade retention—or repeated grades—among their student populations. Further, these students have more health problems and inadequate nutrition. Compounding these problems is the increased mobility associated with poor and at-risk children. Changing schools frequently disrupts the child's education, making learning and achievement difficult (GAO, 1994a).

Schools with higher percentages of students in poverty are often inferior structurally, may be unsafe, and may even be harmful to children's health. It is estimated that approximately $112 billion is necessary to repair or upgrade America's facilities. Of this, $11 billion (10 percent) is needed in the next three years to comply with federal mandates that require schools to make all programs accessible to all students; to remove or correct hazardous substances, such as asbestos, lead in water or paint,



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