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Lesson 2.3

Health, Nutrition and Learning:
Are Schools Responsible for Students' Health?

This simple issue can make all the difference.

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School wellness programs play a significant role in making sure children have the support they need to succeed. And for good reason. According to the Centers for Disease Control and Prevention, “hunger, physical and emotional abuse, and chronic illness can lead to poor school performance." In turn, poor school performance is linked to "early sexual initiation, violence, and physical inactivity.” There is a powerful connection between education and health.

Food for Thought

Food aid is one of the oldest and most basic interventions in public school systems. Children cannot concentrate on learning when they are hungry. School food service began in the 1930s and the National School Lunch Program was authorized in 1946. Over the years the program has been expanded and modified multiple times. About half of California’s students qualify for free or reduced price lunch, and statistics about this program provide a common metric of poverty. Many children in poverty depend on school for at least five meals a week.

Too many children in poverty do not eat well. Poor diet, combined with lack of exercise, contributes to obesity, with serious long term health impacts.

Obesity rates in California in 2010 by Race/Ethnicity. Obesity rates in California in 2010 by Race/Ethnicity.

There is some good news. Although levels of obesity in preschool and school age children have more than doubled since 1980, in recent years the trend has reversed in many states including California. State laws to encourage changed eating habits appear to be paying off:

Source: Centers for Disease Control and Prevention (Data from 2008 to 2011) Source: Centers for Disease Control and Prevention (Data from 2008 to 2011)

Many organizations work to improve child nutrition. In California, ChildrenNow is a good resource for understanding the issues.

Remember the School Nurse?

Budget cuts have had a severe impact on the ability of schools to hire nurses. School nurses — if you have them — take care of a lot more than cuts and scrapes. They administer medications and vaccines, provide health counseling, support school wellness programs, and make health referrals.

The Robert Wood Johnson Foundation warns that the lack of nurses weakens school health services and puts children at risk. In every school, some children suffer from life-threatening conditions and diseases such as diabetes, seizures, asthma, bleeding disorders, and severe allergies. Medical advances have rendered many of these conditions treatable or manageable, but they do not manage or treat themselves.

California lags the nation in school nurses. According to KidsData.org, in California there were 2,784 children per school nurse in 2014. The National Association of School Nurses recommends a ratio of 750:1 for well children and 225:1 for student populations with special needs. And children with acute health care needs may require even more help to remain in school. School Health Services for Children With Special Health Care Needs in California, a report from PACE, points out the challenges facing our children and our schools, such as this eye-opener: "In the absence of nurses, a range of school personnel are being called on to provide health services, such as administering medication, treating life-threatening allergic reactions, performing gastrostomy tube feeding, injecting insulin, suctioning tracheotomies, and providing urinary catheterization."

Vaccinations

Vaccinations are a safe and effective way to prevent humanity from devastating diseases. They are a cornerstone of public health policy in California, which as of 2016 requires vaccinations for all students with very few exceptions. Prior to 2016, the law had allowed families to cite personal beliefs to opt out of vaccinations, leading to falling rates of immunity and increased risk of outbreaks. Certain exemptions are still allowed for a home-based private school or an independent study program with no classroom-based instruction. The California Department of Health provides a web site aptly titled Shots for School that enables you to check the immunization rate at your school.

California's vaccination requirements protect students from school-based outbreaks of the following deadly and disfiguring diseases: Diphtheria, Pertussis, Tetanus, Polio, Measles, Mumps, Rubella, Hepatitis B and Chickenpox. For additional information about vaccinations in California schools, including a map that estimates your community's vulnerability to outbreaks, see this blog post on vaccinations.

Physical Activity and "P.E."

Even though California mandates physical education (P.E.) for virtually every child virtually every day, most children do not get the daily physical activity they need.

According to the Centers for Disease Control and Prevention, physical inactivity is consistently linked to poor grades and lowered educational attainment. Among the campaigns to address this are ShapeUP SF and Team California For Healthy Kids. The Centers for Disease Control provides school health guidelines to promote healthy eating and physical activity.

P.E. classes aren't just for running around. For more about the role of P.E. in education in California, see Lesson 6.9.

Sex Education

Most people agree that schools need to teach sex ed. But they don't necessarily agree about what sex education should include, what the goals of sex ed programs should be, and whether specific programs can achieve those goals.

In 2015 the California legislature updated its policies for sex education and HIV/STD prevention. In doing so it significantly clarified what schools are obligated to teach. The California Healthy Youth Act requires public schools to provide all students in grades 7-12 with age-appropriate sexual health education that is "comprehensive and medically accurate." That definition leaves plenty of wiggle room for big variations among schools, but it was a big step from having no guidance at all.

For more about sex education in California have a look at the Ed100 blog post on the subject. The post explores how California schools are dealing with puberty education, teen pregnancy, consent and other topics.

A Healthy Environment for Learning

Health issues go far beyond a school nurse, healthy meals and physical activity. They include indoor air quality, asthma management and sun safety measures at school. If you see peeling paint, suspect the worst. Lead isn't just a problem in Flint, Michigan. In a Reuters study of 29 communities all over the state of California, up to 13% of children were found to have elevated levels of lead in their blood.

In order to increase overall family health and wellness, some communities use school sites to provide low-cost health services such as immunization and toddler wellness checks. (The most celebrated example is the Harlem Children’s Zone in New York). In the early 1990s, California created a Healthy Start program to provide seed money for these types of partnerships. In a few communities those efforts have been sustained without state funding. More recently, Oakland has started a new effort, working in partnership with Kaiser, a major provider of health services in the area.

Sleep!

Some have campaigned to get children to sleep more, based on evidence that children need 8.5 to 9.5 hours of sleep, and that they learn poorly when they are fatigued. According to research by RAND corporation, starting school before 8:30am does extensive economic harm; it estimates the cost to the state of California at about $1 billion per year (for perspective, that's about $150 per student per year). School calendars and hours have traditionally been under the control of school districts, but these findings have led some to argue that schools should be required to begin no earlier than 8:30am. EdSource summarizes the study findings and the policy context here.

We explore this topic further in our blog). The California State PTA provides resources for parents on healthy schools and healthy lifestyles.

Next Steps

All school districts that participate in the National School Lunch Program are now required to have a school wellness policy. These cover goals for nutrition as well as physical activity and other school-based activities that promote student wellness.

If you are trying to boost wellness in your school, this policy can be a place to start. Work with your PTA and principal to create parent information nights about wellness activities and additional needs at your school. For nutrition, think school snacks, classroom parties, snacks brought by parents, or foods given as incentives. Schools also must allow community input in the development, implementation, review, and update of the local wellness policy.

Updated August 2017

Review

In the past 10 years, California has implemented which of the following health interventions in schools?

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Questions & Comments

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user avatar
Carol Kocivar June 20, 2016 at 9:50 am
Summer Meals
According to the National School Boards Association:
"....(M)ore than 80 percent of the children who qualify for summer meal programs do not participate. State boards can do two things to expand the reach of summer nutrition programs: They can support the adoption of state mandates for participation, and they can partner with other state organizations to improve community outreach."
http://www.nasbe.org/wp-content/uploads/Hayes-Fobbs_Summer-Nutrition-Final.pdf
user avatar
Jeff Camp - Founder January 20, 2016 at 11:57 am
Sex education is an important element of the health curriculum schools in California are required by law to deliver. In 2015, California's legislature passed SB695 (the "affirmative consent law.") https://www.cabinetreport.com/curriculum-instruction/new-laws-require-update-of-school-sex-ed-programs. In 2016 the curriculum requirements were expanded to include sexual health, HIV/AIDS, gender identity, sexual orientation as well as "negotiation, refusal and decision making skills."
user avatar
Disappointed by Public School October 2, 2015 at 1:03 am
Jenny, are you in California? b/c there are laws that PE has to be taught by someone who knows what they are doing, that it has to be about gaining skills and improving. It canNOT just be recess. They are supposed to provide 200 minutes/10 days of school in 1-6th grade.
If your school is not providing that, you can contact Don Driscoll JD who is suing the Dept of Ed for not complying with the law and sign on... dond@driscoll-law.com
What has happened with PE, I think, is that there is all this focus on "no child left behind" Pass the tests. So the money is spent on testing and taken away from PE.
At least your school has the breakfast. Our school does not provide breakfast although 5% of our students quality for it. (I know that's not a huge % but no child should be left hungry and could account for a lot of the "adhd" in our classes)
Our school went from a healthy vendor to an unhealthy one that doesn't understand the nutritional regulations.
user avatar
Jenny N September 28, 2015 at 4:48 pm
Our school provides breakfast for every student, regardless of income. We're fortunate in that. But, we only get a school nurse once per week and physical education is not what it was when I was a kid. No PE teachers, not even a gymnasium at our school. I'm new to the current system and am really curious to learn what has lead to things changing so dramatically in the past 30 years.
user avatar
Tara Massengill April 18, 2015 at 6:53 pm
Why is it that the government (read "tax payers") provide free meals to jailed criminals, but many school kids still have to pay for their lunches? Does this seem unreasonable to anyone else?
user avatar
Disappointed by Public School October 2, 2015 at 1:11 am
if kids are indigent then they get free or reduced price lunch. reduced price is for the less indigent.
user avatar
geecookie2011 April 18, 2015 at 7:21 am
(please forgive all the typos)
I'm not sure how accurate a lot of things that are coming out in school about concerned with obesity but I do know that our children are starving more then ever. When My Granddaughter and also in children her own grade and younger comes home who in her case is very very petite. She is more hungry than before. she is hungry I need you don't want to snack she wants to eat and then later want to eat dinner and she says it's because she is extremely hungry. Due to she have breakfast at 8:20am and then she eat lunch at 12 and still in school for another 3.4 hours afterward. Then come home at 4:pm what to eat then eat dinner the rest of the Family when we all come home at 6:30pm. I find there should be a more concern eating at that time more a risk of obesity because they're not as active as they are doing school hours because they are in school 90% of the Daylight hours.
Also my concern is if this is my granddaughter who most of the time is blessed to have some type of food in the home, I wonder about children who has little to no foods or resources in their home. So what happened to those children, who if they can get a solid meal at school, like a real breakfast and lunch. Who don't get or alittle dinner. I can't help to wonder if my granddaughter comes home hungry. Then what is it like for the students who is not provide a better meals at home. Because what I see in our cafeteria these days look like a snacks, truly not a lunch or breakfast. Especially in low poverty locations, title 1 students who are being funded so that they can have decent meals at school while learning. I have seen that if a child is hungry he or she will not be suitable to properly get a fair quality education just thinking out loud. Ms Cookie G
user avatar
jenzteam February 27, 2015 at 9:18 am
"In 2005, California banned sales of sugared beverages on school grounds."
This is a complete myth since my kids have access to Gatorade (which contains as much sugar and chemicals as soda) and sugared cookies and snacks every single day. I had to battle the school district to disallow my kids from purchasing anything on their "account". I finally stopped paying into the school lunch program and packing lunches in order to control their diets. You DEFINITELY don't see schools selling organic veggies and whole grain foods. It's still pizza, fries, cheeseburgers, chips, and other cheap foods - which they profit from selling. What is most irritating is that the schools still profit from selling these items as "add ups" from the free/reduced lunch program. So again, I can pay $.40 for lunch and $2 for a Gatorade or bottle of water. It's about profits. I have yet to see a salad bar or fresh/steamed vegetables included on the school lunch menu.
As for physical activity, we take care of that in our home. As for the school, my kids tell me they are allowed to "walk" the mile if they want instead of run it. They are not required to meet any standards and both have A+ in PE. Why are we requiring PE for 4 years in CA if there are no expectations to perform?
user avatar
Disappointed by Public School October 2, 2015 at 1:11 am
There are regulations to have certain # of minutes physical education. If your school is not meeting them, you should contact dond@driscoll-law.com who is suing the DOE for being complicit in districts not meeting the PE requirements if you want to sign onto the suit.

Your school is NOT allowed to sell unhealthy foods/drinks by law for profit, until after school. They are violating the regulations.
here are the requirements..
http://publichealthadvocacy.org/_PDFs/SB12Summary.pdf
You can file a report with the DOE by emailing or calling Shirley Rhodes 916-323-8521
user avatar
Brandi Galasso February 9, 2015 at 10:44 am
Schools have to care enough about their students to notice where the problems are. Schools are responsible to a certain extent, because after all they are providing our students with breakfast and lunch 5 days a week. that's more then they are home. So they should be making healthy choices and then teaching students why they are healthy and over what foods that are not. Involve the kids in discussions about what they are eating. Also they should be providing some physical activity and teaching them from an early age the importance of exercise and how to do it without hurting yourself or others. Schools like ours that don't provide balls because they are too lazy to blow them up for students is not right. It took me 2 years to fight just to get them to give balls they already had to students is not right and those people should work in another area if kids are too much trouble for them, that can really effect a school negatively.
user avatar
Carol Kocivar - Ed100 October 26, 2014 at 3:40 pm
Schools play a role in protecting public health through required vaccinations. Here is a checklist that can help.
Immunization and Health Checkup - CalEdFacts
http://www.cde.ca.gov/ls/he/hn/cefimmunization.asp
Want to see where there have been preventable disease outbreaks?
Here’s a link to a map that provides detail for California, US and the world. http://www.cfr.org/interactives/GH_Vaccine_Map/#map
user avatar
Jeff Camp - Founder October 2, 2014 at 6:40 pm
Vaccinations: Schools play a vital role in public health by ensuring that all children are immunized against serious contagious diseases. Universal vaccination has been so successful at eradicating disease that it faces the risk of being taken for granted; in some communities parents have used "personal belief exemptions" to opt out of vaccinating their children at rates that have permitted diseases to re-emerge. Is your child attending a school that is vulnerable to an outbreak? Find out here: http://blogs.kqed.org/stateofhealth/2014/09/11/vaccine-opt-out-rate-doubled-in-7-years-look-up-your-school-online/#find
user avatar
Richard Rothstein March 14, 2011 at 7:45 am
A distinguished and diverse coalition of education, health, and social service experts, in a their campaign for a “Broader, Bolder Approach to Education,” have issued a statement calling for the establishment of school-based clinics in schools serving disadvantaged children as one of the most important strategies for raising the achievement of disadvantaged children. The California School Health Centers Association (CSHC) is a statewide organization that advocates for, disseminates information about, and provides training and other resources for operators of, and those interested in starting, school-based health centers.

Overall, lower-class children are in poorer health.

-> Those with vision problems have difficulty reading. In the United States, 50 percent of poor children have vision impairment that interferes with academic work, twice the normal rate. Lower-class children may be more likely to have vision problems because of less adequate prenatal development than middle-class children whose pregnant mothers had better medical care and nutrition. Visual deficits also arise from disadvantaged children being placed in inexpensive low-quality child care settings where they watch too much television, activity that does not develop hand-eye coordination and depth perception - 42 percent of black fourth graders watch six hours or more of television a day, compared to 13 percent of whites. Middle-class children more likely have manipulative toys that develop such coordination. A longitudinal study of entering kindergarteners reveals that fine motor skill development at age 5 is a stronger predictor of later mathematics and reading performance than is kindergartners' pre-literacy knowledge (of the alphabet, of counting numbers, of phonemes).

-> Lower-class children also have more hearing difficulties, possibly because of untreated ear infections that occur in children whose overall health is less robust. Ear infections are easily treatable for children with access to regular pediatric care. But lower-class children with less access to such treatment are less attentive, on average, in school.
Children without dental care have more toothaches; untreated cavities are nearly three times as prevalent among poor as among middle-class children. Although only some cavities produce toothaches, children with toothaches pay less attention in class and are more distracted during tests, on average.
Children who live in older buildings have more lead dust exposure that harms cognitive functioning and behavior. High lead levels also contribute to hearing loss. Low-income children have dangerously high blood lead levels at five times the rate of middle-class children.

->Lower-class children, particularly those who live in densely populated city neighborhoods, are also more likely to contract asthma – the asthma rate is substantially higher for urban children, for those whose families are on welfare, and for those from single parent or poor families. Asthma is provoked partly from breathing fumes from low-grade heating oil, diesel trucks, and buses (school buses idling at schools are a serious problem); excessive dust and allergic reactions to mold, cockroaches, and secondhand smoke also contribute. In neighborhoods with high asthma rates, children suffering from the disease are more likely to live in homes where adults smoke.
Asthma keeps children awake at night. If attending school, asthmatics are more likely to be drowsy and inattentive, more irritable and with more behavioral problems, and more likely to refrain from exercise and thus be less physically fit. Middle-class children typically get treatment for symptoms, while low-income children get treatment less often. Asthma has become the biggest cause of chronic school absence, with sufferers from low-income families more likely to miss school than those from middle-class families.

->Youngsters whose mothers consumed alcohol during pregnancy have more difficulty with academic subjects, are less able to focus attention, have poorer memory skills, less ability to reason, lower I.Q.’s, less social competence and more aggression in the classroom. In adolescence, these children continue to have difficulty learning. Fetal alcohol syndrome, a collection of the most severe cognitive, physical and behavioral difficulties experienced by children of prenatal drinkers, is ten times more frequent for low-income black than for middle-class white children.

->Smoking in pregnancy also contributes to lower achievement. Children of mothers who smoked prenatally do more poorly on cognitive tests, and their language develops more poorly. They have more serious behavioral problems, more h
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