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Schools and Health: Our Nation's Investment (1997)
Institute of Medicine (IOM)

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. "2 Evolution of School Health Programs." Schools and Health: Our Nation's Investment. Washington, DC: The National Academies Press, 1997.

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School & Health: Our Nation's Investment

ogy Assessment, 1995). This document describes regulations and risks pertaining to environmental hazards, such as asbestos and lead; exposure to infectious agents, such as influenza virus and disease-causing bacteria; unintentional injuries, such as sports and playground accidents; and intentional injuries, such as homicide and fighting.

Policy and Administrative Environment. Rules and regulations are established to promote the physical, psychological, and social health of students. Health and safety promotion is prominent. A smoke-, drug-, weapon-, and violence-free environment is enforced, with clear and reasonable penalties. Extracurricular sports and physical fitness activities are promoted for all students, and healthful foods are sold in the school lunch, school breakfast, and a la carte options in the school cafeteria, as well as through vending machines, school events, or fund-raising drives. Schedules are designed not merely to improve efficiency but also to reduce stress; for example, class release times may be staggered to minimize crowding in halls and avoid unnecessary sources of conflict, and lunch periods may be scheduled to provide adequate time to enjoy healthful meals. When appropriate, students have input in establishing policies and discipline procedures, and discipline is administered in a fair and evenhanded manner. A consistent process is in place for reporting, analyzing, and preventing injuries and health problems.

Psychosocial Environment. Students and staff function in a supportive atmosphere that encourages open communication, respects individual differences, and promotes each student's reaching full academic and social potential. The diverse needs of individual students are addressed, and families are kept informed and involved. There is a collaborative rather than adversarial spirit among students and staff, and a sense that everyone is pulling together toward the same goals. A cooperative, not overly competitive, atmosphere exists in academic instruction. Expectations are high, but students are not left to flounder or fall through the cracks. Academic assistance is easily available and actively promoted for those students needing additional help. Faculty and staff take the initiative to look for and help resolve student problems that may affect learning, morale, and well-being. Policies related to provision of services for at-risk students, such as free and reduced-price meals, are made in ways that do not stigmatize recipients. A crisis response system is established to support students in the event of violence, suicide, disaster, or other incident.

The psychosocial environment has been shown to have a significant impact on student achievement and functioning. It has been speculated that in some situations, a healthful psychosocial environment may be as

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