As I explained in my last post, the evidence overwhelmingly supports the theory that a student’s level of poverty is the biggest factor in their educational outcomes. For the next few posts, I’m going to look at why that’s the case, starting first with healthcare.
You’d have to have been under a rock for the last year to avoid the ongoing healthcare debate, but what a lot of people don’t realise is that it’s not just a health and social justice issue - it’s an education issue. Children from families living at or below the poverty line suffer from a range of health issues not experienced by children from wealthier backgrounds. The disparity begins before birth, with low-socioeconomic status (low-SES) children experiencing low birth weights (Hoffman, Llagas & Snyder, 2003) and low rates of breastfeeding (McDowell, Wang & Kennedy-Stephenson, 2008), followed by higher rates of exposure to lead, causing permanent brain damage (Richardson, 2005), higher rates of childhood illness and asthma (Halfon & Newacheck, 1993), uncorrected vision problems, and food insecurity (Nord, 2009). All of these factors have been shown to significantly affect educational achievement and/or attainment.
To make it worse, these children who are more likely to get sick also have less access to quality healthcare. A survey from the National Center for Healthcare Statistics (2010) found that approximately 1 in 12 of all US children under the age of 18 had no health insurance in 2009. Not just the ones living in poverty - all of them. Half of those who are insured are covered by Medicaid or similar federal or state programs. 1 in 20 of all children in the US either delayed or did not seek medical care in 2009 due to cost. When applying these statistics to the LAUSD student body, this implies that at least 55,000 students in the district are uninsured, and over 33,000 students cannot afford to seek medical care when necessary. That’s a lot of stats, so let’s think about that for a second. 33,000 children living within 30 miles of me, and many of you, put off seeing a doctor when they are sick. They go to school with earache, toothache, feeling sick, and for some reason we still expect these kids to learn.
Of course, lack of decent healthcare doesn’t just affect students a few times a year when they’re not feeling well - undiagnosed vision problems are a huge issue. When one school in Boston screened all of its kids for near- and far-sightedness, the school’s overall reading test scores increased by 4.5% in a single year (Rothstein 2004). While the LAUSD does have a policy in place to screen students every 3 years, it’s unclear whether they manage this: we know that this adds up to about 206,000 children, and from the stats above we can guess that about 18,000 are uninsured, but the district’s own vision clinic numbers suggest that they only manage to screen 5,500 kids a year. Moreover, they only test long-distance vision. Sure, these kids can probably see the whiteboard, but it doesn’t help them much if they can’t read their textbooks (Gould & Gould, 2003).
I could go on about this for pages - we still haven’t discussed pre- and post-natal care, rates of breast feeding, the massive rates of asthma, and I’ve not even started on the financial toll on families when parents get sick. The real question is, how do we improve things? Well, the passage of the Affordable Care Act was a good start, although it’s questionable how many of the families near the poverty line will really be affected - you’ve still gotta be able to afford those premiums, and when it’s a choice between paying for healthcare and putting food on the dinner table, what would you do? On the other hand, there is a policy that has been shown to work wonders, and that’s School-Based Health Centers (SBHCs). .
SBHCs are, as the name suggests, health centers based on school campuses, offering health education, medical care, vision screening, dental care and mental health services. They are completely free to both students and their families (at least partly paid for through Medicaid and Medi-Cal), and their location means that no-one has to travel to see a doctor. The big problem is that, out of 9,900 or so schools in the LAUSD, only 32 have SBHCs. The main barrier to establishing more SBHCs is cost (of course), but the research shows it’s an investment worth making. Students with access to these services have higher GPAs, lower dropout rates and higher graduation rates (e.g. Vinciullo & Bradley, 2009; Walker et al. 2010; Kerns et al. 2012).
One of the most promising ways of cutting costs is to work with local med students as volunteer staff. A 2007 study found that 52% of medical schools in the US ran a free student-led health clinic (Simpson & Long, 2007). Students at UCLA already volunteer their time for the annual weeklong Remote Area Medical free health clinic, and USC students have already attempted once to set up a free clinic in collaboration with the homeless shelter, PATH, although no record exists of it today. It seems that a closer collaboration with these universities could provide at least some of the person-power to ensure that children in our schools arrive healthy and ready to learn.
Next time? Nutrition. How many of the children within 10 miles of Caltech - one of the richest universities in the country - do you think go to school hungry every morning, because their parents can’t afford to feed them?
Gould, M. C. & Gould, H. (2003). “A Clear Vision for Equity and Opportunity.” Phi Delta Kappan, December
Halfon, N. & Newacheck, P. W. (1993). Childhood Asthma and Poverty: Differential Impacts and Utilization of Health Services. Pediatrics 91(1), 6-61
Hoffman, K., Llagas, C., Snyder, T. D. (2003). Status and Trends in the Education of Blacks (NCES-2003-034). National Center for Education Statistics, Washington DC.
Kerns S. E.U., Pullmann, M. D., Walker S. C. et al. (2011). Adolescent Use of School-Based Health Centers and High School Dropout. Arch Ped and Adol Med. 165(7): 617-623.
McDowell MA, Wang C-Y, Kennedy-Stephenson J. (2008). Breastfeeding in the United States: Findings from the National Health and Nutrition Examination Surveys 1999-2006. NCHS data briefs, no. 5, Hyattsville, MD: National Center for Health Statistics.
National Center for Health Statistics. Health, United States, 2010: With Special Feature on Death and Dying. Hyattsville, MD. 2011. Retrieved from: http://www.cdc.gov/nchs/data/hus/hus10.pdf#074
Nord, Mark. (2009). Food Insecurity in Households with Children: Prevalence, Severity, and Household Characteristics. EIB-56. U.S. Dept. of Agriculture, Econ. Res. Serv. September 2009. Retrieved from http://www.ers.usda.gov/Publications/EIB56/EIB56.pdf
Richardson, J. W. (2005). “The Cost of Being Poor: Poverty, Lead Poisoning, and Policy Implementation” ISBN 0-275-96912-6, Westport, Conn Praeger.
Rothstein. R. (2004). Class and Schools: Using Social, Economic and Educational Reform to Close the Black-White Achievement Gap. Washington, DC: Economic Policy Institute
Simpson S.A., Long J.A. (2007) Medical student-run health clinics: important contributors to patient care and medical education. J Gen Intern Med. 22(3):352–356.
Vinciullo, F. M. & Bradley, B. J. (2009). A correlational study of the relationship between a coordinated school health program and school achievement: a case for school health. Journal of School Nursing, 25(6):453-65
Walker S. C., Kerns, S. E. U., Lyon, A. R., Bruns, E. J., Cosgrove, M. S. W. (2010). Impact of school-based health center use on academic outcomes. Journal of Adolescent Health 46(3): 251-257