Invest in School-Based Health Centers to Improve Child Health

Building Back Better

Though children are said to have—on average—the least dangerous response to novel coronavirus infections, in other ways, kids have been particularly hard hit by the COVID-19 pandemic. Their physical and mental health has been harmed, with high rates of hunger and mental health deterioration documented. Their educations also have been interrupted, with most losing out on months or more of quality education.

Smart investments in school-based health centers can be a remedy.

In addition to disrupting the education of a generation of students, the closure of major school systems across the country during the COVID-19 pandemic has exacerbated existing inequalities in academic achievement by race, class, and nativity status—gaps that will have life-long consequences not only for the career opportunities of those individuals, but for their health as well. Much research has established the salutary effect of education on health. It is often assumed that the cognitive (the three Rs) and noncognitive (turn taking, sitting still, task management) skills imparted in school lead to better health across the life course.

Schools play a direct role in health promotion—a role that has been increasing over time. The new Biden administration should make it a priority to leverage the synergies between health and education in order to improve both.

Early evidence indicates that learning losses during COVID-19 have been substantial, and schools and communities are starting to plan for how to make up lost ground when schools are back in full swing. We also need to make plans for how to make up lost ground in health—from missed routine vaccines to increases in children’s obesity to mental health damage. Here, too, we can turn to schools for assistance.

Schools deliver healthy food to many food insecure children. They perform height, weight, and vision screens. They even have played a role in vaccinating children. Perhaps most important is the fact that it is teachers and other school officials that often notice something wrong with a child that stressed household members may have missed: depression or behavioral problems, signs of domestic abuse, or even just that a child seems sick and lethargic. Teachers and social workers provide an additional set of eyes to monitor child health.

Increasingly, students can directly receive medical care at school. Across the nation, nearly 2,600 school-based health centers (SBHC) exist. The number of SBHCs has doubled over the past 20 years, largely driven by increases in centers receiving federal funds. These “federal” health centers serve a range of geographic areas, with just under half in urban areas and more than a third in rural ones. In addition to primary care services, the majority of centers offer access to behavioral health professionals such as alcohol and drug counselors, therapists, or psychologists. Almost half of them enjoy an expanded care team, often including providers of dental and eye care—helping resolve common problems that interfere with student learning.

A recent study found that SBHCs reduce teen pregnancy rates. Other studies have found SBHC-induced reductions in students’ depressive episodes and suicide risks, as well as improvements in academic measures such as GPAs, attendance rates, and suspensions.

Despite all of this evidence supporting the importance of—and high returns from—SBHCs, the most recent data indicate that only 6.3 million students have access to an SBHC—about 11% of the total number of students. Expanding the number of centers will help more kids get the care they need, promoting both academic and health equity in the process.  This is critical to improving population health (and human capital), as it is estimated that 20.3 million kids suffer from insufficient access to health care (3.3 million uninsured; 10.3 million without primary care; and 6.7 million with unmet specialty care needs) (Estimates from 2016).

The pandemic is an important moment that has revealed the critical role that schools play in health promotion and in providing health care to the nation’s youngest citizens.  As we #buildbackbetter, we now have no excuse for acknowledging their critical importance to the health of the country.   We should expand the proportion of SBHCs from 11% to 100%.

Conley D, Schanzenbach DW. Invest in School-Based Health Centers to Improve Child Health. Milbank Quarterly Opinion. December 23, 2020.

About the Authors

Dalton Conley is the Henry Putnam University Professor in Sociology at Princeton University and a faculty affiliate at the Office of Population Research and the Center for Health and Wellbeing. He is also a research associate at the National Bureau of Economic Research (NBER), and in a pro bono capacity he serves as dean of health sciences for the University of the People, a tuition-free, accredited, online college committed to expanding access to higher education. He earned an MPA in public policy (1992) and a PhD in sociology (1996) from Columbia University, and a PhD in Biology from New York University in 2014. He has been the recipient of Guggenheim, Robert Wood Johnson Foundation and Russell Sage Foundation fellowships as well as a CAREER Award and the Alan T. Waterman Award from the National Science Foundation. He is an elected fellow of the American Academy of Arts and Sciences and an elected member of the National Academy of Sciences.

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Diane Whitmore Schanzenbach is director of the Institute for Policy Research and the Margaret Walker Alexander Professor in the School of Education and Social Policy at Northwestern University. She is a research associate of the National Bureau of Economic Research, and member of the National Academy of Education and National Academy of Social Insurance. Schanzenbach is a labor economist who studies policies aimed at improving the lives of children in poverty, including education, health, and income support policies. She graduated magna cum laude from Wellesley College with a BA in economics and religion, and received a PhD in economics from Princeton University.

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