Schools and Health Our Nation's Investment (1997) / Chapter Skim
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Executive Summary
Executive Summary
Pages 1-15
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has noted that six categories of behavior are responsible for 70 percent of adolescent mortality and morbidity: unintentional and intentional injuries, drug and alcohol abuse, sexually transmitted diseases and unintended pregnancies, diseases associated with tobacco use, illnesses resulting from inadequate physical activity, and health problems due to inadequate dietary patterns. A significant segment of our nation's youth is at risk for dropping out of school as a consequence of a broad range of health and behavioral problems; further, many children do not have access to basic preventive and primary care.
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the physical environment, involving proper building design, lighting, ventilation, safety, cleanliness, freedom from environmental hazards that foster infection and handicaps, safe transportation policies, and having emergency plans in place; (2) the policy and administrative environment, consisting of policies to promote health and reduce stress, and regulations ensuring an environment free from tobacco, drugs, weapons, and violence; (3)
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The second critical area is education, which consists of physical education, which teaches the knowledge and skills necessary for lifelong physical fitness; health education, which addresses the physical, mental, emotional, and social dimensions of health; and other curricular areas, which promote healthful behavior and an awareness of health issues as part of their core instruction. The third critical area is services, which includes health services, that depend on the needs and preferences of the community and services for students with disabilities and special health care needs; counseling, psychological, and social services, which promote academic success and address the emotional and mental health needs of students; and nutrition and foodservices, which provide nutritious meals, nutrition education, and a nutrition-promoting school environment.
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Three recent documents the National Standards for Physical Education, the School Health Policies and Programs Study2 (SHPPS) , and the CDC's Guidelines for School and Community Health Programs to Promote Physical Activity Among Youth emphasize the new priorities and recommendations in physical education and collectively provide a sound basis for developing quality physical education programs in the future.
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Recommendations The committee believes that three recently released documents the National Action Plan for Comprehensive School Health Education, the National Health Education Standards, and the SHPPS report collectively provide comprehensive recommendations and a strong framework to move health education forward in the future. Beyond this, however, several aspects of health education merit further emphasis and discussion.
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Additional courses or electives in health education at the high school level would be preferable to a single semester. The committee debated how to reconcile the call for students to receive health education every year, from kindergarten through the twelfth grade, with the reality of the crowded curriculum at the secondary level and decided that the critical issue should be whether high school students achieve the performance indicators described in the National Health Education Standards, not the amount of "seat time." Thus, the committee recommends that the "seat time" be a minimum of at least one semester, but that student health knowledge and understanding be assessed at the end of this course.
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Schools are also required to provide a wide range of health services for students with disabilities and special health care needs. There is agreement among virtually all school districts that a core set of services is needed in schools, but the topic currently generating a great deal of discussion is the role of the school in providing access to "extended services" that go beyond traditional basic services, such as primary care, social, and family services.
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Thus, the committee recommends the following: Research should be conducted on school-based services, particularly on the organization, management, efficacy, and costeffectiveness of extended services. Additionally, the committee found that there is no current consistent school health data collection process among and between schools.
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Thus, the committee recommends the following: Established sources of funding for school health services should continue from both public health and education funds, and new approaches must be developed. Strategies that have shown promise and should be explored further include billing Medicaid for services to eligible students, developing school-based insurance groupings, forming alliances with managed care organizations and other providers, instituting special taxes, and placing surcharges or special premiums on existing insurance policies.
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At the state level, the infrastructure can be anchored by a structure similar to the ICSH-NCCSH arrangement at the national level. The committee recommends that an official state interagency coordinating council for school health be established in each state to integrate health education, physical education, health services, physical and social environment policies and practices, mental health, and other related efforts for children and families.
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Under this leadership, schools should address the major issues facing students and/or the components of the CSHP, develop policies, coordinate activities and resources, and seek the active involvement of students and families in designing and implementing programs. In order to implement quality comprehensive school health programs, the training and utilization of competent, properly prepared personnel should be expanded.
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Furthermore, since CSHPs are unique to a particular setting, the results of even the most rigorous evaluations may not be generalizable to other situations. Interventions associated with the separate, individual components of CSHPs health education, health services, and nutrition services should be developed and tested using rigorous methods involving experimental and control groups.
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Research is needed about the effectiveness of specific intervention strategies such as skills training, normative education, or peer education; the effectiveness of specific intervention messages such as abstinence versus harm reduction; and the required intensity and duration of health services and health education programming. Evidence suggests that common underlying factors may be responsible for the clustering of healthcompromising behaviors and that interventions may be more effective if they address these underlying factors in addition to intervening to change risk behaviors.
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This view appears to be broadly accepted, since the committee has found that many of the components of a CSHP already exist in many schools across the country health education, physical education, nutrition and foodservice programs, basic school
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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.
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