It is widely recognized that education influences health outcomes and community well-being. The National Academies of Sciences, Engineering, and Medicine’s Roundtable on Population Health Improvement previously hosted workshops on this cross-sector relationship, including Exploring Opportunities for Collaboration Between Health and Education to Improve Population Health (IOM, 2015) and Exploring Early Childhood Care and Education Levers to Improve Population Health (NASEM, 2018). To continue this discussion, the roundtable held a 1-day public workshop on June 14, 2018, at The California Endowment’s Oakland Conference Center. This workshop, School Success: An Opportunity for Population Health, explored how health sector capabilities could be used to help improve educational outcomes from pre-kindergarten through 12th grade.
As is the case with all cross-sector conversations, the roundtable approached this topic with an awareness that much of the health sector has modest knowledge about the educational field, but there was optimism about the opportunities for the sectors to work together and learn
1 This workshop was organized by an independent planning committee whose role was limited to identification of topics and speakers. The proceedings was prepared by the rapporteur as a factual summary of the presentations and discussions that took place at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants and are not necessarily endorsed or verified by the National Academies of Sciences, Engineering, and Medicine; the Health and Medicine Division; or the roundtable, and they should not be construed as reflecting any group consensus.
from each other, said Joshua Sharfstein of the Johns Hopkins Bloomberg School of Public Health. Drawing on his experience as a pediatrician, Sharfstein said that performance in school is highly reflective of a child’s health and that educational success is critical for children’s future health. Yet in pediatric health practices, providers generally know very little about how their patients are performing in school. He observed that this barrier between sectors is beginning to break down, and he said that he anticipated that the workshop would help to open up the conversation about what public health can do to improve educational outcomes.
As one of its major activities, the roundtable hosts workshops to discuss issues of importance for improving the nation’s health. The roundtable’s vision is of a strong, healthful, and productive society that cultivates human capital and equal opportunity. This vision rests on the recognition that outcomes such as improved life expectancy, quality of life, and health for all are shaped by interdependent social, economic, environmental, genetic, behavioral, and health care factors and that achieving these outcomes will require robust national and community-based policies and dependable resources.
The agenda for this workshop was developed by an independent planning committee, including Alexander Billioux of the Center for Medicare & Medicaid Innovation, Marc Gourevitch of New York University Langone Health, Robert Kahn of the Cincinnati Children’s Hospital Medical Center, Robert Kaplan of Stanford University, Phyllis Meadows of The Kresge Foundation, Elena Rivera of the Children’s Institute, Heidi Schumacher of the District of Columbia Office of the State Superintendent of Education, and Sharfstein. (The planning committee’s Statement of Task is provided in Box 1-1.) The workshop presentations were developed to cover the following topics:
- A brief review of why educational success is critical to health
- How health and public health tools can support educational success
- Case examples of health and public health organizations working with educational systems to improve specific educational outcomes
- Policy dimensions that can accelerate these collaborative efforts (e.g., addressing legal issues) and establish critical needs (e.g., promoting equity) to make progress in those areas
There is a two-way relationship between health and education, previously explored in the Workshop Summary titled Exploring Opportunities for Collaboration Between Health and Education to Improve Population Health (IOM, 2015). Education is one of the social determinants of health, and evidence indicates a direct relationship between educational attainment and health outcomes; for example, people with college degrees experience better health (NASEM, 2017; Woolf et al., 2007). Conversely, health status itself shapes educational attainment; for example, children with illnesses such as asthma or those with untreated vision problems may be likely to experience difficulties in school (see IOM, 2015).
The planning committee interpreted the charge (see Box 1-1) as a call to explore and highlight collaborations between the health and education sectors that are data driven and intended to improve both educational and health outcomes. All examples featured during the workshop included a focus on data and metrics, and many discussed specific data demonstrating improved outcomes.
The relationships among health, education, and context (housing, safety) are complex and not easy to disentangle. The planning committee invited Steven Woolf of Virginia Commonwealth University’s Center on Society and Health to start the day’s conversations about how the two featured sectors could collaborate by discussing those complex relationships.
The workshop was not intended to provide a holistic overview of education metrics meaningful to health actors or of the priority health needs and health care services needed to support educational attainment. Instead, it was designed to highlight select examples that could help to illustrate the potential for collaboration between the health and education sectors, structured whenever possible around specific educational metrics, and to orient participants to some of the opportunities and challenges found at this important intersection. The workshop also was not intended to identify next steps—that is beyond the scope of roundtable workshops. The charge to the planning committee listed as a potential topic for exploration certain examples of education metrics used in the health sector, but it became clear in planning and holding the workshop that although health sector collaboration with educators and schools presumes a recognition that health status matters for educational outcomes (e.g., students who can see the board thanks to glasses may do better in reading), some of the relationships between health sector inputs and education sector outcomes are not yet clearly elucidated.
The first session of the workshop provided a brief background on the relationship between education and health (see Chapter 2). The talk by Woolf was intended to show how the relationship between health and education is bi-directional (see Figure 2-2) and why contextual factors (e.g., community violence, housing instability) matter in that they interact with health and education inputs (e.g., schooling, clinical care) and outcomes (e.g., high school graduation, life expectancy).
In the language of public health, education is commonly discussed as an “upstream” factor that shapes health outcomes later in life. Schools, educators, and education policy “map” to such metrics as kindergarten readiness or high school graduation. In the context of cross-sector partnerships for improved outcomes, the health sector, in the form of health departments or hospitals, can support educators and schools and inform education policy, thus contributing to improved outcomes in education and in health. The workshop was intended to illuminate some of the strategies and approaches through which the health sector can do this work.
Following a talk by Charles Basch of the Columbia University Teachers College on health conditions that affect educational attainment, speakers shared brief case examples illustrating how health sector entities can contribute to improving educational outcomes and how public health and health care tools (e.g., surveillance, screening) can be used to support educational success (see Chapter 3). Case examples from Oregon and Cincinnati, Ohio, were presented, demonstrating health–education collaboration to improve specific education outcomes (see Chapter 4). Panelists then discussed policy issues that can impact health–education
collaboration to improve educational outcomes (see Chapter 5). The workshop concluded with observations and reflections shared by the speakers and participants (see Chapter 6). Participants shared points of interest on Twitter throughout the day by using the hashtag #health4ed.2
2 The #health4ed Twitter discussion that took place on June 14, 2018, in association with the workshop can be viewed at https://twitter.com/hashtag/health4ed?f=tweets&vertical=default&src=hash (accessed August 22, 2018).
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