JAMA Forum: Enabling School Success to Improve Community Health

By Josh Sharfstein, MD, and Roberto Santamaria, MPH, MBA

Image: monkeybusinessimages/Thinkstock

From an innovative play space designed to teach children about concepts of engineering and mathematics to an outdoor teaching kitchen to help students learn about nutrition and to new school health services for vulnerable teens, several recent community investments by the local hospital in Nantucket, Massachusetts, aim to help the island’s children stay and succeed in school. And for good reason:  there may be no better long-term investment in health.

A wealth of evidence, recently presented by Professor Steven Woolf of Virginia Commonwealth University, supports a central role for rising levels of education in advancing the health of a community. Individuals with college degrees, for example, experience less coronary heart disease, emphysema, diabetes, kidney disease, and liver disease than do those with fewer years of schooling. At the other end of the educational spectrum, life expectancy is falling for those without a high school diploma. Part of the link between education and health is the more robust income that comes with higher-paying jobs. Having more education is also associated with healthier behaviors and less despair.

These findings are starting to attract attention among those working to address the social causes that underlie poor health. A recent meeting of the population health roundtable of the National Academies of Science, Engineering and Medicine in Oakland, California, focused on the question of how the health sector can provide value to education. The meeting highlighted a number of specific ways that hospitals, physician practices, and health departments are working to reduce chronic absenteeism and improve academic performance. These include:

  • Providing prescription eyeglasses to students who need them, through programs demonstrated to improve reading scores
  • Supporting the emotional needs of students through a range of services at school-based health centers
  • Offering directly observed therapy to children with asthma, reducing absenteeism
  • Offering influenza vaccination in school to keep children from falling ill and missing class.

Moving the Needle
Beyond individual initiatives, some health systems are teaming up with schools to move the needle on key metrics of educational success. For example, Cincinnati Children’s Hospital has set third grade reading as a core goal of its community health plan. Among its activities is a quality improvement program for teachers to help them succeed in the classroom. The Oregon Health Authority is setting expectations that health care providers support kindergarten readiness, in part through home visits and behavioral health supports to vulnerable parents. The District of Columbia Public Schools is planning to enlist local pediatricians in efforts to reduce chronic absenteeism, by sending information on days missed through the regional health information exchange.

These kinds of innovations, however, still have long way to go to become a regular part of the US health care system. A recent article on community needs assessments described 10 top community health needs, none of which related to educational success in kindergarten through grade 12 (the closest was “health education and literacy”). There is promising movement among hospitals for investing in housing, a critical social determinant of health. But much less attention has focused on education, despite the fact that most health systems already have the resources and the know-how to help children see the chalkboard and stay out of the emergency department.

The good news is that interest is picking up. A group of Boston pediatricians recently published a call to transform pediatric care to support school readiness, and the American Hospital Association is planning to release a toolkit on how hospitals can promote education.

Critical Barriers
Bridging the gap between education and health may require overcoming 2 critical barriers. The first barrier is access to data. Grades and attendance data are subject to Family Educational Rights and Privacy Act, a strict federal privacy standard that generally requires signed consent for release of information. Without access to data, however, it is difficult for health care organizations and public health agencies to design, execute, and improve programs to help children succeed in school. Partners should take advantage of opportunities to make the consent process easy for families, while lawmakers should consider allowing “opt out” rather than “opt in” consent for health programs.

The second barrier is payment. The Internal Revenue Service expects nonprofit hospitals to provide community benefits “to address social, behavioral, and environmental factors that influence health in the community.” Hospitals should be able to count any funds devoted to educational efforts as community benefit spending. The next frontier is for payers, including Medicaid programs, to directly incentivize health systems and physician practices to support toward measurable educational improvement. Oregon and New York are leading the way in considering innovative payment approaches. More broadly, philanthropies and civic partners interested in long-term economic progress can support joint programs between health and education that target school success.

Committing to educational progress requires a long view. There are no quick fixes. Long-term success will require making new investments and structural improvements in many school systems, as well as offering a range of resources to at-risk families. But the potential upside is tremendous. There may be no better predictor of the long-term health of a group of children than their success in school. Both health care and public health agencies have every reason to dial up their local schools and ask how they can help.

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About the authors:

Joshua M. Sharfstein, MD, is Vice Dean for Public Health Practice and Community Engagement at the Johns Hopkins Bloomberg School of Public Health. He previously served as Secretary of the Maryland Department of Health and Mental Hygiene, as the Principal Deputy Commissioner of the US Food and Drug Administration, and as Commissioner of Health for Baltimore. He is also a consultant to Audacious Inquiry and to Sachs Policy Group. A pediatrician, he lives with his family in Baltimore. (Image: Chris Hartlove)

 

Roberto Santamaria, MPH, MBA, earned his master’s in public health from Boston University, his master’s in business administration from Salve Regina University, Newport, Rhode Island, and is currently studying toward a doctorate in public health from the Johns Hopkins Bloomberg School of Public Health, Baltimore. He has worked as the director of public health for the Town of Nantucket, Massachusetts, since 2015. (Image: Jayme Aronson/JLA Photography)

 

About The JAMA Forum: JAMA has assembled a team of leading scholars, including health economists, health policy experts, and legal scholars, to provide expert commentary and insight into news that involves the intersection of health policy and politics, economics, and the law. Each JAMA Forum entry expresses the opinions of the author but does not necessarily reflect the views or opinions of JAMA, the editorial staff, or the American Medical Association. More information is available here and here.

 

 

 



Categories: Health Policy, Public Health, The JAMA Forum, Uncategorized

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