Intersections between education and health

Health and education are areas of significant focus for Ohio policymakers, representing the largest shares of Ohio’s biennial budget for state fiscal years (SFY) 2016-2017. Among the 971 bills introduced in the 131st General Assembly between Jan. 1, 2015 and Nov. 4, 2016, 42 percent were related to health and/or education.

With support from the United Way of Central Ohio, HPIO has started to explore the intersections of education and health. In 2016, we convened an Education and Health Policy Advisory Committee, which has helped to guide this important work.

The first publication, Connections between Education and Health, was released in January, and the second publication,  Connections between Education and Health No. 2: Health Services in Schools, was released in July. We plan to release two additional publications later in 2017. We will also be updating this resource page on a continuous basis throughout the year.

Education basics for health stakeholders

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State education links

  • Ohio Department of Education: The Ohio Department of Education (ODE) oversees the state’s public education system, which includes public school districts, joint vocational school districts and charter schools. The Department also monitors educational service centers, other regional education providers, early learning and child care programs, and private schools. The Department’s tasks include administering the school funding system, collecting school fiscal and performance data, developing academic standards and model curricula, administering the state achievement tests, issuing district and school report cards, administering Ohio’s voucher programs, providing professional development, and licensing teachers, administrators, treasurers, superintendents and other education personnel. The Department is governed by the State Board of Education with administration of the Department the responsibility of the superintendent of public instruction. (Copied directly from the ODE website)
  • State Board of Education
  • Ohio Department of Higher Education
  • Early Childhood Ohio

Education in the U.S.

  • No time to lose: How to build a world-class education system state by state: Recent studies have found the U.S. workforce to be among the least educated in the world. This research report, prepared by a study group of the National Conference of State Legislators (NCSL), offers recommendations for states on how to improve their education systems. The group studied countries which perform best on the Programme for International Student Assessment and identified common elements present in world-class education systems. These included a strong early education system, a reimagined and professionalized teacher workforce, robust career and technical education programs, and a comprehensive, aligned system of education.
  • U.S. Department of Education data and statistics: This webpage offers an extensive array of links to education data and resources, which visitors can browse by topic.
  • The Lumina Foundation: This is an independent, private foundation focused on post-secondary education opportunities and attainment. They are committed to increasing the proportion of Americans with degrees, certificates and other high-quality credentials to 60 percent by 2025. Their report, A Stronger Nation, tracks progress toward this goal for the U.S. overall, as well as for each individual state.

The Every Student Succeeds Act (ESSA)

Education policy briefings from Philanthropy Ohio

  • Standards and assessments: Ohio has developed standards in English language arts (ELA), mathematics, social studies, science, fine arts and foreign language, as well as a set of aligned assessments. This brief explores Ohio’s history of academic standards and assessments, explains how Ohio is currently updating its standards and describes how ESSA will affect state assessments.
  • K-12 measures and accountability: This brief outlines how Ohio measures and reports school and district performance and describes additional requirements from ESSA.
  • School improvement and turnaround: This brief explores strategies for turning around low performing schools. It examines Ohio’s current approach to school improvement and the investments made to support turnaround efforts, highlights successful turnaround and school improvement strategies and identifies changes that will result from ESSA.
  • Ensuring a cycle of effective teaching: This brief explores the elements of effective teaching, including teacher preparation programs; teacher recruitment and retention; teacher compensation; teacher leadership and professional learning; and evaluation.

School funding: This report from EdBuild provides an overview of Ohio’s education funding policies.

Community schools: Community schools, often called charter schools in other states, are public nonprofit, nonsectarian schools that operate independently of any school district but under a contract with an authorized sponsoring entity that is established by statute or approved by the State Board of Education. Community schools are public schools of choice and are state and federally funded. More details can be found at ODE’s community schools webpage.

Ohio school report cards

Ohio’s educational performance

  • Education Week Quality counts 2017 Ohio highlight report: For 21 years, Education Week has been grading states on their educational performance. A state’s overall grade is determined by averaging its scores on three indicators tracked by the report: chance for success, school finance and K-12 achievement. This year, Ohio ranked 22nd among all 50 states and the District of Columbia, with an overall grade of C and score of 74.2 out of 100 points. The overall U.S. also received a grade of C.
  • Setting sights on excellence: Ohio’s school report cards, 2015-2016: This report by the Thomas B. Fordham Institute presents an analysis of Ohio’s 2015-2016 school report cards. In addition to a statewide analysis, the report offers a more in-depth look at Ohio’s eight biggest cities. It also explains recent changes in Ohio’s assessments and accountability system.
  • Ohio’s annual report on the Kindergarten Readiness Assessment: The Kindergarten Readiness Assessment (KRA) is intended to gauge how prepared students are to engage in kindergarten-level instruction. The KRA addresses growth and development in four main areas: language and literacy, social foundations, mathematics, and physical well-being and motor development. Based on this assessment, in 2014-2015, 37.3 percent of Ohio’s kindergarten students were “Demonstrating Readiness”, meaning they entered kindergarten with sufficient skills, knowledge and abilities to engage with kindergarten-level instruction. An additional 39.1 percent were “Approaching Readiness” and needed some supports to be able to engage with kindergarten-level instruction. Finally, 23.6 percent were “Emerging in Readiness”, meaning they needed significant support to be able to engage with kindergarten-level instruction. The report also analyzes the data and shows differences by race, gender, disability status, income and English language proficiency.
  • Building Ohio’s Future Workforce: This report from the Governor’s Office of Workforce Transformation and the Governor’s Executive Workforce Board presents Ohio’s most prominent workforce challenges and outlines recommended solutions for these challenges.

Statewide educational attainment goal: The Ohio Department of Higher Education and the Ohio Department of Education, in collaboration with the Governor’s Office, have established a statewide post-secondary attainment goal for 2025 – that 65 percent of Ohioans, ages 25-64, will have a degree, certificate or other postsecondary workforce credential of value in the workplace by 2025.

Health basics for education stakeholders

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Health-related state agencies

Health in the United States

HPIO health policy briefs

  • Private health insurance basics: This series of fact sheets gives policymakers and other stakeholders a better understanding of private health insurance in Ohio.
  • Ohio Medicaid basics 2015: Updated every two years to coincide with the state biennial budget, Ohio Medicaid Basics provides an expansive overview of the Medicaid program in Ohio, broken down into easy-to-follow sections. The next iteration will be released in early 2017.
  • Ohio public health basics: This policy brief, published in January 2013, examines public health in Ohio, with sections on how public health is structured and funded at the state and local levels in Ohio; public health’s role in improving population health and controlling health care costs; and public health priorities for the 21st Century.
  • Ohio prevention basics: This brief provides an overview of prevention in Ohio. Some of the topics covered include the value of prevention, how we pay for prevention and Ohio’s prevention infrastructure and workforce. The publication also provides examples of the many types of prevention, including clinical preventive services, community-based programs and population-based policy strategies.
  • What is “Population health”?: This brief describes the consensus understanding of population health that resulted from discussions among members of a workgroup of healthcare and public health stakeholders, which was convened by HPIO in 2014. It provides a definition of population health and describes five key characteristics of population health strategies.
  • Beyond medical care: In addition to medical care, health is shaped by our behaviors and by social, economic and physical environments. Upstream prevention strategies that address the causes of health problems rather than just the downstream consequences can help to improve health value in Ohio. This report provides actionable steps to improve Ohio’s commitment to upstream prevention through a balanced portfolio of health improvement activities both inside and outside the healthcare system.

Health status of Ohioans

  • Ohio 2016 State Health Assessment: HPIO conducted the 2016 state health assessment (SHA) under a contract with the Ohio Department of Health and leadership of the Governor’s Office of Health Transformation. The SHA is a comprehensive and actionable picture of health and wellbeing in Ohio, including over 140 metrics organized into data profiles, as well as information gathered through five regional forums, a review of local health department and hospital assessments and plans and key informant interviews.
  • HPIO’s 2017 Health Value Dashboard: The 2014 Health Value Dashboard was a first-of-its-kind combined state ranking of health outcomes and healthcare spending. This second iteration of the Dashboard shows that Ohioans are living less healthy lives and spending more on health care than people in most other states.
  • Ohio’s 2017-2019 state health improvement plan (SHIP): Released by the Governor’s Office of Health Transformation and the Ohio Department of Health in February 2017, the SHIP is a strategic menu of priorities, outcome objectives and evidence-based strategies designed to address three of Ohio’s greatest health challenges: mental health and addiction, chronic disease, and maternal and infant health. The SHIP was developed based upon findings from the 2016 state health assessment.

The Affordable Care Act (ACA)

How education and health are connected

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Virginia Commonwealth University’s Center on Society and Health – Education and Health Initiative

  • Education: It matters more to health than ever before (Brief) (Video)– This video explains why education is so critical. From a health standpoint, it explains the considerable differences in life expectancy and disease prevalence among people with different levels of educational attainment and discusses some of the reasons for these disparities. The video also talks about the importance of an educated workforce for our nation’s economy and ability to compete globally. As the demand for lower-skilled jobs continues to decrease, educating the population becomes even more important. Similarly, the complementary brief not only describes how investing in education will save lives, but also how it will save money due to the resulting decreases in health care costs and the ensuing economic returns from a more globally-competitive and productive workforce.
  • Why education matters to health: Exploring the causes (Brief) (Video) – This video and issue brief describe how education and health are connected. They explain how individuals with higher educational attainment generally have more opportunities to be healthy due to having more exposure to people, resources and information that positively impact health. Also explained is the importance of committed parents and a nurturing home environment for children’s future health and success. The brief describes these ideas in greater detail and touches on the fact that poor health can hinder a child’s educational success due to school absences and an inability to concentrate in class.
  • Investments in education are investments in health: the state perspective – This brief asserts that investments in education are likely to lower health care spending. It explains that state health care dollars are disproportionally spent on caring for individuals with lower levels of education, as these people tend to have poorer health and are more likely to have chronic conditions. The brief also outlines the many other financial benefits to educational investment aside from health care savings, including greater productivity and less need for economic assistance and safety net programs.

Why does education matters so much to health? – This short issue brief explains that more education leads to better health. It further explains that the educational attainment of parents impacts the health and future success of their children. Because of low educational attainment among adults and other current trends, young people today may be less likely than members of their parents’ generation to graduate from high school, which will pose significant obstacles for future generations.

The effect of educational attainment on adult mortality in the United States – In the past 50 years, life expectancy in the U.S. has increased by eight years for women and nearly 10 years for men. However, these increases have not been realized by all population groups. This report explains that educational attainment plays a significant role in how long a person is expected to live. It examines the effects of educational attainment on adult mortality and life expectancy for different age, gender and racial/ethnic groups in the U.S. It also explores educational differences in mortality across various causes of death. Finally, the report considers the reasons behind these differences and presents policy implications.

Health is vital for student success: An overview of relevant research – This report describes how students who are physically and emotionally well, present, and engaged are better learners. It focuses on how various aspects of health impact grades, test scores, attendance and graduation. Some of the health-related topics discussed include behavioral health, nutrition, physical activity and education, dental issues, asthma, teen pregnancy, and substance use.

Healthier students are better learners: A missing link in school reforms to close the achievement gap – The author of this research article asserts that regardless of any school reform efforts that are initiated, educational progress will be significantly limited if students are “not motivated and able to learn”. The article describes seven health issues that are highly prevalent, especially among low-income and minority youth, and that can adversely affect academic achievement but can be addressed through school health programs and services. These health problems include vision; asthma; teen pregnancy; aggression and violence; physical activity; breakfast; and inattention and hyperactivity.

Critical connections: Health and academics – This study summarizes literature on the connection between health and academic achievement using the Whole School, Whole Community, Whole Child (WSCC) framework. The WSCC model offers school leaders a comprehensive approach for addressing the health-related barriers to learning. The study asserts that “schools can improve the health and learning of students by supporting opportunities to learn about and practice healthy behaviors, providing school health services, creating safe and positive school environments, and engaging families and communities.” More information about the WSCC model can be found in the “Promising models to integrate education and health” section of this resource page.

Specific areas of consideration for policymakers

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Resources will be added under each of these topics.

School wellness initiatives

Health literacy

Chronic absenteeism

The relationship between school attendance and health – This brief defines chronic absenteeism and explains some of the most common causes including physical health, mental health, safety issues and social factors. It outlines some of the negative consequences of chronic absenteeism, identifies population groups with higher rates of chronic absenteeism and presents policy recommendations.

Preventing Missed Opportunity: Taking Collective Action to Confront Chronic Absence – This report explains that chronic absence is highly concentrated, with half of chronically absent students being in just 4 percent of the nation’s school districts. It outlines common characteristics among schools with high rates of chronic absenteeism, emphasizes the importance of tracking chronic absenteeism at the state and district levels and suggests ways in which the data can be used to effectively and efficiently reduce chronic absenteeism.

Early childhood education and family supports

Early Childhood Experiences and Health – The brief discusses the impacts of experiences in early childhood, how they can shape health throughout the lifetime, and how early childhood care, education and family support programs can act as buffers, especially for socially disadvantaged children. It further outlines both the individual and societal benefits found to result from several well-known early childhood development programs.

Social-emotional learning

Social Emotional Learning in Elementary School – This issue brief defines social-emotional learning (SEL) as “the process through which children and adults acquire and effectively apply the knowledge, attitudes and skills necessary to understand and manage emotions, set and achieve positive goals, feel and show empathy for others, establish and maintain positive relationships and make responsible decisions.” The brief explains the five competencies that comprise SEL (self-awareness, self-management, social awareness, relationship skills and responsible decision making), presents research findings on the benefits of SEL and describes effective SEL programs at the elementary school level.

Improving social emotional skills in childhood enhances long-term well-being and economic outcomes – This brief focuses on the long-term benefits of social emotional skills, with an emphasis on those that affect economic outcomes. It explains that good social emotional skills can lead to better education, employment and physical and mental health and to fewer problems with substance abuse, antisocial behavior, relationships, delinquency and crime. It discusses benefits both at the individual level and the societal level.

School climate

Mental health services in schools

Advancing education effectiveness: Interconnecting school mental health and school-wide positive behavior support – The Interconnected Systems Framework (ISF) combines Positive Behavioral Interventions and Supports (PBIS) and School Mental Health (SMH) systems to improve educational outcomes for all children, especially those with or at risk of developing mental health challenges. A summary of the lengthy ISF monograph is provided at this link, as well as a link to download the full report, which discusses the ISF concept, provides guidance for implementation and describes current implementation efforts at the state, district and school levels.

Adverse childhood experiences

Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study – This groundbreaking study brought light to the relationship between exposure to adverse childhood experiences and health in adulthood. It considered seven categories of adverse childhood experiences (psychological, physical or sexual abuse; violence against the mother; or living with household members who abused substances, were mentally ill or suicidal, or were ever imprisoned) and found a graded relationship between the number of categories of childhood exposure and many different adult health risk behaviors (e.g., smoking, alcoholism, drug use) and diseases (e.g., heart disease, cancer, diabetes).

Trauma-informed schools

Addressing Children’s Trauma: A Toolkit for Ohio Schools – This report provides an explanation of trauma and its impacts on school-aged children. It describes how schools can reduce the adverse effects of trauma, provides an overview of trauma-informed schools and offers policy recommendations.

Child Trauma Academy – The “CTA Library” on this website provides links to a variety of resources on trauma.

Dropout prevention

School disciplinary policies

Promising models to integrate education and health

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Whole School, Whole Community, Whole Child (WSCC) model

The WSCC model combined and built upon two existing models – the Whole Child initiative developed by the ASCD (formerly known as the Association for Supervision and Curriculum Development) and the CDC’s coordinated school health (CSH) approach. The Whole Child initiative aimed to shift the conversation about education from being narrowly focused on academic achievement to one that promotes the long-term development and success of the whole child. Since 1987, the CSH approach had served as the model for integrating health-promoting practices into the school setting. In 2013, the CDC and ASCD, in collaboration with key leaders in the fields of education, health, public health and school health, developed the WSCC model.

In recognition of the connection between education and health, the WSCC model calls for greater collaboration across the community, school and health sector to improve both the health and academic success of students. With the child as the ultimate focus, the WSCC model combines the tenets of the Whole Child model – that the child is challenged, healthy, safe, engaged and supported – with elements of the CSH approach. The WSCC model includes ten school components, having added a few to the CSH list:

  • Health education
  • Physical education and physical activity
  • Nutrition environment and services
  • Health services
  • Social and emotional climate
  • Counseling, psychological and social services
  • Physical environment
  • Employee wellness
  • Family engagement
  • Community engagement

The WSCC model provides school leaders with a new comprehensive approach for addressing the health-related barriers to learning. It also provides the opportunity for health and education professionals to leverage their limited resources and work together to provide more effective and efficient programs and services to students.

School-based health centers

School-based health centers (SBHCs) provide a variety of health care services to youth in a safe, convenient and accessible environment – normally inside their school or on school grounds. Services provided vary among SBHCs and are often tailored to meet the needs of the children in the community they serve. Some types of services that may be available in SBHCs include: primary care services, chronic disease management, mental health and/or substance abuse counseling, dental services and health education on topics such as nutrition or reproductive health. Centers are staffed by a licensed professional – normally a nurse practitioner or physician assistant.

  • The health, well-being and educational success of school-age youth and school-based health care: This issue brief from The American Public Health Association Center for School, Health and Education discusses the benefits of SBHCs and how they can impact barriers to education such as bullying and school violence; hunger, obesity and access to quality food; teen pregnancy and mental well-being, depression and suicide
  • The School-Based Health Alliance’s website offers a lot of useful information on school-based health centers in the U.S. and resources including a literature database and national census of SBHCs. Below are some links that may be particularly helpful to those who are unfamiliar with SBHCs:
    • The About school-based health centers webpage provides a general explanation of school-based health centers.
    • The School-Based Health Alliance developed a set of seven core competencies that “represent the knowledge, expertise, policies, practices, and attributes that every SBHC is expected to demonstrate in its pursuit of student wellness.”
    • The health and learning link provides information on a number of health-related issues that SBHCs can help to address.

Community schools

Using public schools as hubs, community schools bring together many partners to offer a range of supports and opportunities to children, youth, families and communities. Their integrated focus on academics, health and social services, youth and community development and community engagement leads to improved student learning, stronger families and healthier communities.

  • The Coalition for Community Schools website provides useful information and resources about community schools, including descriptions of successful community school models around the U.S.
  • Community schools: A whole-child framework for school improvement – This issue brief explains the opportunities created by community schools (powerful learning, integrated health and social supports, and authentic family and community engagement), the collaborative practices that foster these opportunities (inclusive leadership, shared ownership for results, strategic community partnerships, resource coordination and data-driven planning) and the capacity-building supports that enable successful implementation (all-stakeholder leadership development, professional development, coaching for continuous improvement).
  • Ohio example of community schools: Cincinnati Public Schools Community Learning Centers

Existing initiatives to integrate education and health

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At a national level

The National Collaborative on Education and Health
The National Collaborative on Education and Health “brings together advocates, policymakers, school stakeholders and funders to work toward more fully integrating education and health. This means building schools’ capacity to address the needs that exist today and the needs we can’t yet anticipate. It is also about building the health sector’s capacity to engage the community, including schools, in truly promoting health.”

The work of the National Collaborative grew out of the Health in Mind: Improving Education through Wellness report, which highlighted the need for this increased collaboration and offered federal-level policy recommendations which would help close the achievement gap and create a healthy future for all children.

The success of this report eventually led to the formation of the National Collaborative on Education and Health, which was launched in March 2014 by the Healthy Schools Campaign and Trust for America’s Health. After the Health in Mind report, the group pivoted its work beyond the role of the federal government and looked more broadly to public and private leaders in the health and education sectors to identify missed opportunities for health and education systems to work together to support student health, wellness and learning.

The work of the Collaborative primarily occurs through working groups that convene practitioners, experts and policymakers around a specific topic which is chosen by its national steering committee. The working groups identify best practices and develop recommendations on their respective topics. One current focus area is mental health.

Healthy Students, Promising Futures
Through this initiative, the U.S. Department of Education and U.S. Department of Health and Human Services acknowledged the need to better connect health and education services. In January 2016, they released a joint letter to chief state school officers and state health officials introducing Healthy Students, Promising Futures and the associated toolkit: State and local action steps and practices to improve school-based health. The toolkit offers high-impact opportunities to:

  • Increase access to health insurance to promote better academic outcomes;
  • Create school environments with the physical and mental health supports to help students succeed academically and lead healthy lives; and
  • Strengthen coordination and collaboration between health and education systems at the local and state levels.

Work has continued on this initiative. The U.S. Department of Education, in partnership with the U.S. Department of Health and Human Services and the Centers for Medicare and Medicaid Services, is currently convening a learning collaborative as a part of Healthy Students, Promising Futures to address the need for expanded access to and resources for school health services.

Campaign for Grade-Level Reading
The primary goal of the Campaign for Grade-Level Reading is “to ensure that more children from low-income families succeed in school and graduate prepared for college, a career and active citizenship.” Grade-level reading at the end of third grade is the focus of the Campaign, as this is an important predictor of school success and high school graduation. The Campaign is supported by a broad range of public, private and nonprofit sector organizations around the nation.

  • Campaign for Grade-Level Reading video: This video illustrates the gaps that often exist between children from low-income families and their more affluent peers. The video then explains how the Campaign for Grade-Level Reading attempts to eliminate these gaps.
  • The Campaign’s “Growing Healthy Readers” initiative aims to ensure children from low-income families are in good health and developing on track.

Around Ohio

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