From Education Week
By Irwin Redlener, M.D.
August 6, 2014
"I want to be a paleontologist," my young male patient said, squinting at a wrinkled clipping from the newspaper of a dinosaur skeleton at the museum as I examined him. An impressive aspiration for a 10-year-old who looked like he needed glasses, but more so because his family was homeless and had none of the resources that could propel a more fortunate child toward his goal.
But, like the tens of thousands of kids living in poverty that we see on Children's Health Fund mobile medical clinics across the country, he had a dream and deserved a chance to pursue it. They all do.
That is why it is unacceptable to me that we allow millions of children across America to struggle with health conditions that undermine their potential to succeed in school. Kids are sleeping at their desks after being up all night wheezing with untreated asthma. They are failing tests because they don't have the glasses they need to read a lesson on the blackboard. They are being held back a grade because they can't hear the teacher. They are acting out because they are traumatized by extreme stress in their home. These are the health burdens of poverty that weigh on children in classrooms every day.
If education is their ticket to a better future and the key to breaking the cycle of generational poverty, then we need to ensure that these children are healthy and ready to learn. No matter how substantial our social investments in curricula, class-size reduction, teacher training, and other strategies for the transformation of K-12 education, we are not going to be able to close the achievement gap until we deal with the factor of health in the equation of school success.
Children's Health Fund, the organization I founded with the singer-songwriter Paul Simon, has brought health care to the nation's most medically underserved children for 27 years. Our fleet of mobile medical clinics, each a complete "doctor's office on wheels," brings health care to kids at hundreds of schools, as well as to homeless shelters and community centers. So we know firsthand that many of the poorest children are likely to suffer disproportionately from health-related conditions, compounding the academic challenges they face.
In New York City's South Bronx, in neighborhoods like Hunts Point and Mott Haven that are particularly economically disadvantaged, the rates for children who are hospitalized for asthma attacks are double that of the city as a whole. School principals there tell us that they call an ambulance as often as once a week to respond to a child with an asthma attack. Asthma is a major cause of school absenteeism, with some children missing 30 or more days of school each year when the disease is not diagnosed or treated properly. How can a child sustain academic momentum with that kind of absenteeism?
Research also tells us that more than 20 percent of schoolchildren have some degree of visual impairment, and that 37 percent of children with mild hearing loss repeat at least one grade. And data confirm that hunger, dental pain, lead exposure, anemia, and behavioral-health problems all have a serious impact on a child's cognitive development and engagement in learning.
Along with asthma, which causes kids in the United States to miss 10.5 million school days each year, these conditions constitute what we have identified as the eight "health barriers to learning."
Taking care of health problems in a school setting is not a new idea. School-based health centers provide primary care for kids with a whole range of medical conditions. But a school nurse, when one is available, is not enough to provide the intensive screening for, and management and treatment of, the most serious conditions that are known to interfere with effective school performance.
There are also some good targeted programs for vision screening, asthma intervention, mental-health counseling, and other specific health conditions. Because kids in poverty often suffer from multiple health challenges, a more coordinated and comprehensive approach is urgently needed to focus on the health barriers to learning.
Otherwise, if you provide glasses for a child, but don't treat the asthma that keeps him out of school, you haven't solved the problem. If you ensure there is school breakfast available so kids are not distracted by hunger, but a child has a hearing defect, you haven't solved the problem. We need to bring laser-like focus to each of these health barriers, so that every child is healthy and ready to learn every day.
Unfortunately, the education and health-care communities often work in silos. To do right by kids, we need to pull the silos down and change the way education and health-care professionals work with children and their families. Whether we come from a medical or an educational vantage point, helping the children we work with overcome these hurdles so that they can reach their potential is something we all have a stake in.
For teachers and school administrators, there is a huge upside to be realized. Teachers are held accountable for students' learning. And yet children's capacity to learn is determined by so many things beyond a teacher's control, including matters of health. When these health issues are addressed early and effectively, children are able to take advantage of the energy, skill, and heart that teachers bring to their classrooms.
To chart a path forward, Children's Health Fund is launching a major new initiative. Healthy and Ready to Learn leverages our decades of experience providing clinical care to children with complex needs and lives in order to help equalize developmental and learning opportunities. Our model brings the school community, health-care providers, and parents together in a partnership to focus on addressing health barriers to learning.
With private funding, including a grant from Jaguar Land Rover, Children's Health Fund is implementing school-based pilots of this model in three New York City schools this fall. Specially trained health coordinators will follow evidenced-based protocols to screen the students for the eight health barriers and connect them with the care and services they need.
In addition, we will provide teachers and parents with further training to help in building the holistic Healthy and Ready to Learn model. We will evaluate the model's impact rigorously along the way, measuring absenteeism rates and behavioral disruptions, test results, promotion rates, and other health and education factors in each school's setting.
Our vision is a scalable model that can be replicated in high-poverty schools nationwide. We are working with our partners—churches, community centers, schools, and the like—to make the mobile units as accessible to patients as possible. This helps us design screening and intervention protocols that can be readily adaptable to different urban and rural contexts.
We all know the stakes are high. When students miss class or can't focus or control their behavior, they are less likely to complete a high school education. It is estimated that a high school diploma yields a $190,000 boost in personal income over a lifetime. Reducing the number of dropouts by 700,000 every year would yield America's taxpayers a net benefit of $1 trillion after 11 years.
It's time for the health and education sectors to join forces to help dedicated education professionals on the front lines do their jobs. Together, we can release children from the grip of poverty, and help them reach their full promise and potential.
Irwin Redlener, M.D., a pediatrician and a professor of pediatrics at Columbia University, is the president and co-founder of Children's Health Fund, a national nonprofit organization based in New York City that provides health care to disadvantaged children and families in the United States. He also directs the National Center for Disaster Preparedness and the Program on Child Well-Being and Resilience at the Earth Institute at Columbia University.