Office of the Director

Office of the Associate Director for Policy

Diane Allensworth, PhDPolicy Analyst,

Office of the Associate Director for Policy

AAHPERD Annual MeetingMarch 28, 2011

Breaking Down the Silos to Breaking Down the Silos to Address Address

Youth Health Disparities: Youth Health Disparities: A Social Justice ImperativeA Social Justice Imperative

ObjectivesObjectives

Document the links between the educational achievement gap and health disparities

Report on the findings of an Expert Panel assembled by SOPHE and ASCD

Identify strategies that can alleviate both the achievement gap and health disparities

* Citations, references, and credits – Myriad Pro, 11pt

Children & Youth: 25% of the Population — All of Our Future

Children & Youth: 25% of the Population — All of Our Future

There are more than 74 Million Children in the United States

High number of children living in poverty-- 15.3 million/ 21%; (family of 4 with income

below $22,050 ) Using 200% of Federal Poverty Limit as

definition:-- 42.2 % of U.S. children lived in "low income" households

Poverty is linked with multiple negative outcomes for children and youth

—31.3 million

Children in Poor Families by Race/Ethnicity

Children living in poor families:

29% White 32% Asian 57% Native

American

62% Black 63% Hispanic

Student Health Indicators: The Good News

Dramatic decreases in infectious disease rates and childhood mortality in 20th century

Dramatic decline in blood lead levels

Gradual decline in child injury mortality since 1980

Student Health Indicators: The Bad News

19% of high schools students report current cigarette use

Dramatic increase in the number of overweight youth, now 16% (4%–5% in 1970s)

11.3% of youth have had at least one clinically significant emotional, behavioral, or substance abuse disorder

Selected Social Determinants of Health

for Children & Youth

Lack of Health

Services

Food Insecurit

y Pov

erty

Unhealthy

Enviro

nment

Poor Early Development

Inequitable

Education

R

ace &

Ethnicity

Implications for Children Living in Poverty

Poor children and youth have more health

problems More chronic disease More infectious disease More injuries More developmental delays More social/emotional behavioral

problems

Poor Children Have More Health Problems

Poor children’s prognoses is worse with the same condition

Poor receive less and lower-quality medical care

Poor families “may” be less well equipped to manage their children’s health problems

Case, A & Paxson, C. Children’s Health and Social Mobility. The Future of Children. 2006; 6(2), 151-173.

Education: A Solution to Reduce Health Disparities

Education is the stepping stone to the “American Dream”

Education is the factor consistently linked to longer lives

High school graduates have• Better health• Lower medical costs• Longer lives:

6-9 additional years

Inequities in Schooling Limit Education as a Solution for Poor Children

There is an achievement gap between the academic performance of

Poor students and students who are not poor

Minority students and their non-minority peers

Leading to…72007200 students dropping out of school every school day—more than 1.2 million every year!

Educational Inequities Associated with the Achievement Gap

School Factors: Two thirds minority students attend high-poverty schools

Poor schools/Run down facilities Lower per–pupil spending Less curriculum rigor/Less advance

placement tests Less credentialed/experienced teachers More teacher turnover Lack of school safety Less parent participation

Nonschool Factors Associated with the Achievement Gap

Frequent school changes Student health problems• Low birth weight• Disabilities• Specific diseases--Diabetes--Sickle cell anemia • Food insecurity & hunger• Mental health problems

Low health literacy

Chronic Absenteeism among Poor Children Decreases Achievement

Chronic absenteeism in Kindergarten is associated with lower academic performance in 1st grade

Poor children who were chronically absent in Kindergarten were the lowest performing students in reading and math in the 5th grade

Hedy N. Chang and Mariajosé Romero .Present, Engaged, and Accounted For The Critical Importance of Addressing Chronic Absence in the Early Grades. National Center for Children in Poverty, 2008.

Absenteeism: A Major Factor Associated

with Dropping out of SchoolCourse failure in 9th grade explains high school drop out rates

Demographic & economic background characteristics (7% of course failures)

Eighth-grade test scores explain an additional 5% (12% total)

Absences explain an additional 53% (65% total)

Source: Allensworth E, Eston, JQ. What Matters for Staying On Track and Graduating in Chicago Public High Schools. Chicago: Consortium on Chicago School Research at the University of Chicago, Research Report, 2007.

Education and Health Are Interconnected

School BasedInterventions

Academic Performance

Educational Attainment

Adult HealthStatus

Child HealthStatus

Nancy Murray, et al. Code Red, Education and Health: A Review and Assessment, Appendix E. http://www.coderedtexas.org/files/Appendix_E.pdf

Questions? Comments?

For more information please contact Diane Allensworth, E-mail: DAllensworth@cdc.gov Office of the Associate Director for Policy, Centers for Disease Control and Prevention

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Office of the Director

Office of the Associate Director for Policy

Breaking Down the Silos to Address Youth Health

Disparities: A Social Justice Imperative

Elaine AuldSOPHE, Executive Director

Expert Panel

• Organized by – Society of Public Health Educators – ASCD

• Engaged Subject Matter Experts in – Health Care– Health Education– Education– Public Health

SOPHE – ASCD Expert PanelJune 21 - 22, 2010Washington, DC

24 Participants Representing • Health Care• Public Health• Education• Adolescent Health• School Health

SOPHE – ASCD Expert Panel on Eliminating Youth Disparities

Goal: To develop best policy

and practice goals for eliminating health disparities among youth.

 

SOPHE – ASCD Expert Panel on Eliminating Youth Disparities

 Key Questions: What programs or policies have succeeded in

addressing racial and ethnic health disparities among youth and what are their key ingredients for success?

What recommendations around policy and practice should be set forth to reduce racial and ethnic disparities among youth?

How can the public health and education sectors best work together to reduce these disparities?

Recommendations by Expert Panel

Action Items at• Community Level• State Level• National/Federal Level

Selected Action Items at Community Level

School and Community agencies collaborate to

• Support health and learning• Ensure all students graduate• Ensure a wholesome school/community

climate

•Cross-Agency Collaboration: Utilize a community coordinating committee at the municipal/school district level and corollary school health teams at each school to pursue an agenda of continuous improvement in the health, learning and well-being of all students.30.8%                    (Rank: #4-6)

Recommendations from Expert Panel

1. Cross-Agency Collaboration: • Utilize a community coordinating

committee at the municipal/school district level and corollary school health teams at each school to pursue an agenda of continuous improvement in the health, learning and well-being of all students.30.8%                    (Rank: #4-6)

Cross-Agency Collaboration Indicators

1.a A community coordinating committee at the municipal/school district level and at each school

1.b School Health Teams provide input to the annual school improvement plan.

1. c The Municipal/District Community Coordinating Committee annually reports evidence of parent communication and engagement in each component of the school health program

Recommendations from Expert Panel

2. Joint Accountability for Health & Learning

In addition to current achievement indicators (e.g. academic achievement, graduation rates), require schools to measure and report health, safety, and well-being indicators (e.g. chronic absenteeism,  fitness, teen birth rates, connectedness) as a means of quality improvement..

69.2%                  (Rank: #1)

Joint Accountability for Health & Learning Indicators

2.a Annual measures disease-related absenteeism, truancy, tardiness, detention, fitness levels, teen birth rates, repeat teen births, scores on national proficiency exams in 4, 8 & 12th grade and graduation rates, student health behaviors, health literacy, and perceptions of school climate of students, staff, families and fitness data.

2.b Officials utilize student identification numbers so that their data can be shared

Recommendations from Expert Panel

3. Health Care Access: Collaborate with community partners,

community-based health agencies and other types of organizations so that every student has a “health home” that addresses physical health, mental health, including substance abuse prevention and treatment, reproductive health, oral health and vision. (Note – could include school-based health centers, nurses in every school).

48.2.0%                (Rank: #2-3)

Health Care Access Indicators

3.a A nurse (particularly in all Title One schools)

3.b School Based Health Centers established

3.c Standardized national guidelines are used to manage chronic diseases of students.

3 d Skills-based cultural competency training for the school health team is provided

Health Care Access Indicators Cont.

3.e Options for reproductive health care for adolescents are co-located preferably in school based/school linked or mobile

3.f Free Guardasil/HPV vaccination for adolescents in Title One schools are provided via mobile units.

3.g Clinic staff address STI, HIV, and pregnancy prevention with adolescent regardless of presenting reproductive health problem.

•  

Recommendations from Expert Panel

4. Health Promoting Environment: Establish and enhance universal access to

school and community based primary and secondary preventive health services that include physical, social and emotional well being in accordance to national standards/guidelines.

46.2%      (Rank: #2-3)

Health Promoting Environment Indicators

4.a Students perceive that the school climate is nurturing and supportive.

4.b Students are assigned an adult mentor.

4.c Students perceive that they are safe in school, going to and from school.

Health Promoting Environment Indicators Cont.4.d Students attend a school with a healthy

food environment in which all food at school meets or exceeds USDA Guidelines.

4.e Food insufficiency in students is recognized and addressed.

4.f Youth advocacy and community engagement efforts encourage tobacco free environments.

4.h Families are encouraged to limit student screen time to a minimum of two hours daily.

Recommendations from Expert Panel

5. Health and Physical Education Instruction:

Health education and physical education are provided as core subjects in K-12 school curricula with accountability for achieving the national health & physical education time and content standards.

30.8%        (Rank: #4-6)*

Health and Physical Education Instruction Indicators

4.a Sequential K-12 health education classes are provided to achieve health literacy.

4.b Consistent instruction about the dangers of tobacco use is provided .

Health and Physical Education Instruction Indicators

4.c Youth are engaged in planning and implementing peer education programs.

4.d Social media campaigns are implemented to promote healthy behaviors around sexuality, active lifestyle, no tobacco use, and good nutrition habits.

Health and Physical Education Instruction Indicators Cont.

4.e All students receive a minimum of half of their daily physical activity in schools via 5-10 minute physical activity breaks in the classroom, recess, and/or physical education classes.

4.f Local education agencies annually assess students’ fitness levels (using a tool such as the FITNESSGRAM) followed by the development of individualized student fitness improvement plan that involves families.

Health and Physical Education Instruction Indicators Cont.

4.g Community agencies and schools negotiate partnership to open school’s recreational facilities during out of school time.

Summary Action Items at Community Level

School and community agencies collaborate to• Ensure that every student has a “medical/health

home”• Ensure health & education data are shared & used.• Prevent/address students’ reproductive health issues• Address health & physical education needs. • Ensure a healthy school & community environment

Selected Action Items at State Education & Health Agencies

Work with state education agencies to increase:• Required frequency of physical education to

recommended national standards.

• Required frequency of health education to recommended national standards

• Reporting of students’ fitness scores to the state annually to monitor continuous improvement.

• Improve equity in funding for minority schools.   

Selected Action Items at National/Federal Level

• Tax incentives for result-based partnerships at the community level among education, public health & health care sectors for improving the health and achievement of all students, esp. low-income, minority and ethnic students.

 • Tax incentives to locate health services in

underserved areas easily accessed by student/families.

  • Tax incentives provided for medical residency

programs to promote access to educational experiences in school health

 •  

Selected Action Items at National/Federal Level

• Medicaid providers address specific set of indicators for the Whole Child.

• Health education and physical education are included as core subjects in ESEA re-authorization

Selected Action Items at National/Federal Level

• Federal agencies develop funding and accountability mechanisms that cut across health and education sectors to ensure that the needs of the whole child are met from infancy through adolescence for all children and particularly low income, minority and ethnic students.

 

Selected Strategies for National/Federal Level

Reimbursement to schools for the school-based feeding programs is increased so that healthier options can be purchased and the dependency on competitive food options that generate income for schools is eliminated. 

Questions?

• Contact Elaine Auld: eauld@sophe.org

• Contact Diane Allensworth: dda6@cdc.gov