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Fit to Learn

Chuck Basch is on a quest to improve the health of the nation's schoolchildren.
It’s hard enough to get one teenager to think about long-term health consequences. Getting a whole nation of them to do it would seem a particularly tall order—yet that’s precisely what Chuck Basch has in mind, both to stem a steadily unfolding public health crisis and as a strategy to overcome the academic achievement gap that separates poor, inner-city youth from their wealthier white peers.
For the past two years, Basch, TC’s Richard March Hoe Professor of Health Education, has been engaged in the Herculean task of gathering and synthesizing information from virtually every important recent study conducted on seven health issues that can have a major impact on school performance: poor vision; asthma; teen pregnancy; aggression and violence; insufficient physical activity; insufficient breakfast; and inattention and hyperactivity. This past March, at a special forum presented by TC’s Campaign for Educational Equity (which had commissioned the research), Basch presented his findings in TC’s Cowin Conference Center, joined by TC alumnus Howell Wechsler, Director of the Division of Adolescent and School Health (DASH) for the U.S. Centers for Disease Control and Prevention (see story on page 60); Matthew Yale, Deputy Chief of Staff to U.S. Secretary of Education Arne Duncan; and Jane Quinn, Assistant Executive Director for Community Schools for the Children’s Aid Society.
“Over the past several decades, a variety of strategies have been tried to help close the achievement gap—standards, accountability, NCLB, more rigorous teacher certification —and they’re all important, but they won’t have the desired effect unless students are motivated and ready to learn,” Basch told his audience. “Educationally relevant health disparities” are key drivers of the achievement gap, Basch said, “but they are largely overlooked.”  
The numbers alone provide overwhelming support for that contention. Among the statistics Basch cited:
  • Visual problems affect more than 20 percent of
    American youth;
  • Asthma affects more than 14 percent of youth under 18;
  • One in three teens is expected to become pregnant; 
  • Twenty-eight percent of adolescents have been bullied
    at school;
  • Two in three students don’t get enough physical activity;
  • 20 percent of youth skip breakfast on any given day;.
  • About 8 percent of youth ages 6–17 have been diagnosed with hyperactivity.  

But the situation is far worse for urban minority youth. Among the examples Basch gave:

  • Black children are significantly more likely to suffer from asthma, and certain populations within Latinos—most notably Puerto Ricans—are as well. Urban minority youth also have higher rates of poorly controlled asthma, as indicated by over-use of the emergency room and under-use of efficacious medicines;
  • Non-Hispanic black teens have pregnancy rates three times as high as whites, and rates for Hispanic teens are four times as high as for whites;
  • Nearly 10 percent of Hispanic youths missed one or more days of school in the past month because they were afraid—a figure more than twice as high as for whites. Rates for blacks were more than 50 percent higher than for whites.
Yet, Basch said, “all of this is old news—everyone knows this.” What’s new, he said, is research on how these conditions work to impair educational outcomes. Basch has identified pathways through which this occurs, including sensory perception (if students can’t see and hear well, they can’t learn effectively); cognition (thinking, memory, focused attention and problem solving); and school connectedness (“it’s been widely documented that the extent to which students feel connected to their schools makes them more likely to succeed academically and socially and less likely to engage in health- and educationally compromising behaviors”).
And because each of the seven conditions works through one or more of these pathways, the combined effect of the seven is synergistic, creating a crisis that is more than the sum of its parts.
So what must happen to change that picture?
“The most important thing is not doing just one thing,” Basch said. “Instead, we must address a set of priorities simultaneously.” The country needs a national school health strategic plan, developed by the U.S. Department of Education, he said. Yet at the same time, because education in America is so decentralized, planning must also go on at the local level. Health-related measures must be integrated into school accountability mechanisms, and health goals must become part of individual school improvement plans. Beyond that, “different people involved in schools must play different roles to try to achieve the same goals,” because otherwise resources will not be used effectively. “If the school sends a note home saying that a child has vision problems, the parents must get that child to an optometrist, and the teacher must make sure that the child wears glasses in class.”
In addition, health education must become a fundamental part of the mission of schools, Basch said. For that to happen, schools of education must incorporate health into their curricula for preparing school administrators and teachers.
Of course, just putting information or even recommendations out there isn’t going to change the world. Basch’s next quest is to win backing for a major demonstration project in which he would implement a coordinated health project in a large group of schools and then evaluate its impact. If that sounds like a daunting task, consider that Basch has received more than $15 million in grants during his career, nearly all of it comprising large-scale preventive health interventions/evaluations in underserved communities. During the 1980s, he led the Washington Heights-Inwood Healthy Heart Project, a cardiovascular disease prevention program that targeted the mostly Latino families in northern Manhattan. Most recently, backed by a $2.2-million grant from the American Cancer Society, he and another TC faculty member, Randi Wolf, have been assessing the effectiveness of “academic detailing” of doctors and telephone outreach to patients as a means of improving rates of colorectal cancer screening among the predominantly black and Hispanic members of a large national labor union. And in between, he has mounted similar efforts focused on diabetic retinopathy, HIV/AIDS and other preventable health problems that disproportionately affect urban minority populations.
The common denominator in all this work is education—which explains why Basch has become convinced that schools are not only the ideal target but also the ideal medium for change.
“Most schools are already devoting some attention and resources to addressing important health barriers to learning, but these efforts are too often poor quality, not strategically planned to influence educational outcomes, and not effectively coordinated to maximize linkages between different school health components,” he says. “In other words, we’re already spending the money, but we’re not getting a good return on our investment.”
Basch believes that the current constellation of government leaders—beginning with President Barack Obama and Secretary of Education Arne Duncan—bodes well for making the kinds of fundamental changes he is urging in efforts to close the achievement gap. That was an opinion seconded by Matthew Yale of USDOE, who cited several indicators that the current administration is focused on health. These include First Lady Michelle Obama’s “Let’s Move” initiative, and the Elementary and Secondary Education Act, now up for reauthorization, which contains significant funding for an initiative focused on healthier schools.
Still, Yale said, there isn’t enough time in the school day and year to effectively address both academic and health priorities. He called the separation of the two areas “a false choice” and said “we need kids in the building longer.”
Wechsler, for his part, called Basch’s findings “insightful and clearly compelling.”
“People in the health fields are often asked, ‘where’s the evidence’” of the need for prioritizing health spending, he said, but Basch’s data will enable them to “turn the tables on policymakers.”
“A lot of health professionals who advocate for coordinated school health get the feeling they’re being eyed as crazy radicals for distracting from the essential mission of American schools—but that’s not the mission I learned about at TC,” Wechsler said. Noting that he was speaking in TC’s Horace Mann Hall, he repeated Mann’s famous quote that “On the broad and firm foundation of health alone can the loftiest and most enduring structures of the intellect be reared.”
“Somehow,” he said, “we have to get back to that.”

Published Thursday, May. 27, 2010


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