School Health as a Strategy to Improve Both Public Health and Education


Because schools materially influence both health and education, they substantially determine the future well-being and economic productivity of populations. Recent research suggests that healthier children learn better and that more educated adults are healthier. School health is a cross-disciplinary field of study and a fundamental strategy that can be used to improve both health and education outcomes. Modern school health programs include 10 interactive components: health education; physical education and physical activity; nutrition environment and services; health services; counseling, psychological, and social services; physical environment; social and emotional climate; family engagement; community involvement; and employee wellness. This review is written for both health and education audiences. It integrates recent research and developments in relationships among health, education, and economic outcomes; health and education systems; the school health program, its components, and their effectiveness; cross-disciplinary collaboration; local, state, national, and international infrastructures and strategies; implementation science; and relevant academic research, training, and service.


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Worldwide, about 1.3 billion young people are enrolled in primary and secondary schools across 241 countries (102). In the United States, about 130,000 public and private schools, in 13,000 school districts, employ 6 million teachers and staff to educate 55 million prekindergarten through grade 12 (PK–12) students every school day, usually for 13 of the most formative years of their lives (81). Among these students, 27% live in a mother-only household; 20% live in poverty; 13% receive special education services for disabilities; and 9% are non-English-speaking learners (82). In a given year, 13–20% of children experience a mental disorder, including anxiety, depression, behavioral or conduct problems, attention-deficit/hyperactivity disorder, and autism spectrum disorders. These disorders appear to be increasing (86). In 2017, 40% of high school students had engaged in sexual intercourse, 39% texted or emailed while driving, 30% used alcohol, 23% had asthma, 20% used marijuana, 16% were overweight, 15% had obesity, 14% inappropriately used prescription pain medicine, 13% used an electronic vapor product, 9% smoked cigarettes, and 7% had attempted suicide (62). In 2015, among 71 nations, US students ranked twenty-third in reading, twenty-fifth in science, and thirty-ninth in mathematics (84).

Public health agencies, medical organizations, and other concerned groups have long worked with schools to protect and improve the lives of young people (54), and school health strategies can be designed to improve both health outcomes and education outcomes (66). In 2015, the US Centers for Disease Control and Prevention (CDC) and ASCD (formerly the Association for Supervision and Curriculum Development), released the new whole school, whole community, whole child (WSCC) framework to disambiguate the school health program into 10 integrated school health program components, which are described in the following review. The purposes of these components are to assure that students are healthy, safe, supported by caring adults, effectively engaged in learning, challenged academically, and prepared to be successful in life (32).