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The Interdependence of Health and Learning. California Department of Education School Health Connections July 2002. Impact of Focus on Testing. Testing, testing, testing Causes stress among teachers and administrators, which is not good for learning.

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the interdependence of health and learning

The Interdependence of Health and Learning

California Department of Education

School Health Connections

July 2002

impact of focus on testing
Impact of Focus on Testing

Testing, testing, testing

Causes stress among teachers and administrators, which is not good for learning.

Narrows the mission of education and contributes to teacher burnout,which is not good for learning.

Causes stress in students,which is not good for learning.

Holds schools accountable for only part of their mission.

education goals 2000
Education Goals 2000
  • All children will start school ready to learn.

With proper nutrition, physical activity, and access to health care, children get the basics that support learning.

  • 90% of students will graduate from high school.

Dropout prevention, substance use prevention, sexuality education and integration of services help students stay in school.

education goals 20004
Education Goals 2000
  • All students will demonstrate competency in core subject areas.

Though not designated a core subject in Goals 2000, health education is fundamental. National and California Challenge Standards have been developed for health education.

  • The Nation’s teachers will have access to programs to improve professional skills.

Quality school programs provide ongoing professional development for staff.

education goals 20005
Education Goals 2000
  • Every school will be free of drug, violence and firearms.

Substance use and violence prevention, counseling/mental health and safety programs indicate school is a place for healthy behavior.

  • Every school will promote partnerships to improve parent and community involvement.

School health councils, integrated services, and community wide health promotion strategies indicate:

Participation in health risk behaviors has been linked to negative outcomes on the following measures of school performance:

Symons, 1997, JOSH V.67 (6)

education behaviors are impacted by health
Education Behaviors are Impacted by Health
  • Attendance
  • Drop-out rates
  • Behavioral problems at school
  • Degree of involvement in school activities (homework and extracurricular activities)

Symons, 1997, JOSH V.67 (6)

education outcomes are impacted by health
Education Outcomes are Impacted by Health
  • Graduation rates
  • Grades
  • Performance on standardized tests

Symons, 1997, JOSH V.67 (6)

student attitudes are impacted by health
Student Attitudes are Impacted by Health
  • Toward school (aspirations for postsecondary education)
  • Feelings concerning safety on school property
  • Personal attitudes (self-esteem)

Symons, 1997, JOSH V.67 (6)

negative educational outcomes impacted by heatlth
Negative Educational Outcomes Impacted by Heatlth
  • A lack of interest in school
  • Behavior problems at school
  • Low self-esteem
  • High drop-out rate
  • Truancy
  • Destruction of school property

Symons, 1997, JOSH V.67 (6)

testing only addresses one of the educational goals but it now dominates the education process
Testing only addresses one of the educational goals BUT it now dominates the education process

Focusing instructional attention on testing is causing neglect of other important facets of the educational process.

Ironically, the neglect of those facets will result in lower test scores as well as failure to achieve our goals related to those other important facets.

Coordinated School Health

Health Education

Family &






Health Promotion

for Staff

School Health


School Nutrition






Counseling &

Social Services

physical education
Physical Education
  • Schools have reduced time for physical education and physical activity to increase instructional time.
  • Studies show it does not improve test scores.
physical education14
Physical Education
  • Schools that offer intensive physical activity programs see positive effects on academic achievement even when time for PE is taken from the academic day, including:
    • increased concentration;
    • improved mathematics, reading and writing scores; and
    • reduced disruptive behaviors.
  • Shepard RJ. (1997). Pediatr Exerc Sci, 9113-126.
  • Sallis JF, et al. (1999). Res Q Exerc Sport, 70(2), 127-134.
physical activity has been shown to improve brain function
Physical Activity has been Shown to Improve Brain Function

Controlled Studies Indicate that School Based Physical Activity Programs:

  • Increase oxygen uptake;
  • Improve physical performance measures;
  • Reduce susceptibility to stress;
  • Reduce disruptive behaviors;
  • Improve concentration; and
  • Improve reading, math, and writing scores.

Symons, 1997, JOSH V.67 (6)

school nutrition services
School Nutrition Services
  • Testing has little direct effect on nutrition services.
  • However, stress affects diet, with those who don’t need calories eating more and those who do need calories eating less.
school nutrition services17
School Nutrition Services

Poor diet, high in sugar, inadequate breakfast and snack food availability may all contribute to poor concentration.

Resources are diverted to other programs, which motivates schools to raise money by the sale of non-nutritious foods, including exclusive soft drink contracts.

school nutrition services18
School Nutrition Services
  • Schools that incorporate school breakfast programs in their food service see increases in academic test scores and daily attendance and class participation.
  • Powell CA, et al. (1998). Am J Clin Nutrition, 68(4), 873-879.
  • Murphy JM, et al. (1998). Arch Pediatr Adolesc Med, 152(9), 899-907.
  • Meyers AF, et al. (1989). Am J Dis Child, 143(10), 1234-1239.
  • Symons CW, et al. (1997). J Sch Health, 67(6), 220-227.
opinions of parents of adolescents about school health education
Opinions of Parents of Adolescents About School Health Education
  • 84% said that health education is either more important than or as important as other subjects taught in school.
  • 74% said schools should spend more time or the same amount of time teaching health education as they do for other subjects taught in school.

health education
Health Education
  • Studies show that health education is linked to improved academic achievement.
health education22
Health Education
  • Five years after a substance abuse curriculum, participants had higher overall academic achievement scores on the Comprehensive Test of Basic Skills than their national peers.
  • (Elias et al Am. Jl. Of Orthopsychiatry 61,no.3 (1991)
  • After participating in a life-skills class, 259 high risk youth in grades 9-12, showed increased grade point averages (GPA) across all classes while the GPAs of non-participants stayed essentially the same.
  • (Eggert et al, Am. Jl. Health Promotion 8(3):202-15, 1994)
use of tobacco alcohol and other drugs has been linked to
Use of Tobacco, Alcohol, and Other Drugs has been Linked to:
  • Poorer relationships with parents
  • Lower grades
  • Increased absenteeism
  • More frequent depression
  • More frequent risk-taking behaviors
  • Stifled creativity and ambition

Symons, 1997, JOSH V.67 (6)

students who use drugs display similar attributes to school dropouts including
Students who use Drugs Display Similar Attributes to School Dropouts, Including:
  • Less commitment and attachment to conventional values and institutions of family and school
  • Lowered sense of well-being

Symons, 1997, JOSH V.67 (6)

drug use is a threat to school climate through
Drug Use is a Threat to School Climate Through:
  • Erosion of self-discipline
  • Decreased motivation toward academic success
  • Increased risk for injury, violence, sexual behavior, and legal problems

Symons, 1997, JOSH V.67 (6)

studies confirm that school age childbearing is associated with
Studies Confirm that School-Age Childbearing is associated with:
  • Significantly reduced academic achievement
  • Higher drop-out rates
  • Decreased participation in school activities
  • Lower grades
  • Ongoing sexual risks

Symons, 1997, JOSH V.67 (6)

school counseling and social services
School Counseling and Social Services

School-based mental health services, with the involvement and support of families and educators, improve educational outcomes by addressing behavioral and emotional issues and other barriers to learning.

Youth receiving mental health services have experienced decreases in course failures, absences, and disciplinary referrals, and improved grade point averages.

Jennings J, et al. (2000). J School Health, 70(5), 201-205.

Nabors L, Reynolds M. (2000). Child Serv Soc Pol Res Pract, 3, 175-189.

Nabors L, Prodente M. (August, 2000). Poster presented at the annual meeting of the American Psychological Association, Washington, DC.

school health services
School Health Services
  • School-based (or linked) health services reduce absenteeism by providing on-site care for problems.
  • School-based providers detect numerous emotional problems early and institute needed care.
staff health promotion
Staff Health Promotion
  • The greatest challenge facing public education today is not API testing.
  • It is recruiting, training and retaining excellent teachers and administrators.
  • The University of California projects a shortfall of 65,000 teachers in California by 2010.
staff health promotion30
Staff Health Promotion
  • Many teachers are disheartened by the increasing demands placed upon them, the lack of public support, the long hours and poor wages, and the diminishing opportunities to see how their teaching makes a difference in the lives of students.
  • Reducing education to just test preparation may break the camel’s back.
staff health promotion31
Staff Health Promotion
  • Staff health promotion programs:
    • Send a supportive message to teachers.
    • Improve morale, absenteeism, and future health and well being.

A healthy staff does a better job of teaching, creates a better working and learning environment, and sets a good example for students.

essential functions of a healthy school environment
Essential Functions of a Healthy School Environment
  • Minimizes distractions
  • Minimizes physical, psychological and social hazards
  • Creates a climate for students and teachers to do their best work
  • Expects that all students can succeed
  • Implements supportive policies

(Health is Academic, 1998)

indoor air quality iaq and schools
Indoor Air Quality (IAQ) and Schools
  • 5.5 million children in the US suffer from asthma (up 160% in 20 years in children under 5).
  • Asthma is the leading cause of school absenteeism due to chronic illness.
  • IAQ is a key factor in asthma exacerbations and half the nation’s schools have poor IAQ.
environmental protection agency and iaq
Environmental Protection Agency and IAQ
  • EPA’s response:
    • Indoor Air Quality: Tools for Schools (1999)
    • Institute of Medicine study, Clearing the Air (2000)
    • IAQ Practices in Schools Survey (voluntary, 2001)
    • By 2005, 15% of public and private schools will implement sound IAQ practices

a healthy school environment sets the stage for other seven components
A Healthy School Environment Sets the Stage for Other Seven Components
  • Tobacco-free policies reinforce health education.
  • Tasty, healthy food choices reinforce physical education and health education.
  • Counseling, psychological & social services can help identify and resolve conflicts and reduce violence at school.

(Health Is Academic, 1998)

family and community involvement
Family and Community Involvement

Schools that collaborate with students’ families, local businesses, community organizations, and health services see improved classroom behavior, increased PTA membership, and improved family functioning.

McDonald L & Sayger T. (1998). Drugs & Society, 12, 61-85.

family and community involvement37
Family and Community Involvement

School districts that collaborate with social service providers across other districts, counties, and cities strengthen social structures for students and their families and observe improved scholastic performance.

“The combined academic, health, and social programs began to show positive achievement gains by the third year of the project.”

Mitchell M. (2000). Public Health Reports, 115, 222-7.

six preventable health risks

Six Preventable Health Risks

Tobacco use

Abuse of alcohol and other drugs

Sexual behaviors that increase risk for HIV, STDs and pregnancy

Behaviors that risk intentional and unintentional injuries

Physical inactivity

6. Poor eating habits

Let’s take a look at a single risk factor over time.

Data from the National Behavioral Risk Surveillance System reported in the Journal of American Medical Association 1999; 282:16


Prevalence of Obesity Among U.S. Adults

BRFSS, 1999



AH, et al.

J Am




obesity trends among u s adults brfss 2000
No Data <10% 10%-14% 15-19% 20%

Source: Mokdad A H, et al. JAMA 2001;286:10

Obesity* Trends Among U.S. AdultsBRFSS, 2000

(*BMI 30, or ~ 30 lbs overweight for 5’4” person)

healthy schools healthy communities
Healthy Schools/Healthy Communities


School Performance

Increased Social Capital

Healthy Communities

“The relationship between schooling and health outcomes is one of the strongest generalizations to emerge from empirical research in the U.S.”

Nagya R. (2000). Applied Economics, 32, 815-822

  • Hold schools accountable for their entire mission of education and the promotion of successful child development.
  • Coordinated school health programming is a fundamental piece of this larger mission.
  • Even if we must narrowly focus on test results, the scores will be better if we incorporate coordinated school health into our education system.
California School Health Coordinator Leadership InstituteThese slides can be downloaded from:

Some slides courtesy of

Alan W. Cross, MD

Director, Center for Health Promotion and Disease Prevention

University of North Carolina at Chapel Hill