EDUCATION DEPARTMENT / THE UNIVERSITY
OF THE STATE OF NEW YORK / ALBANY, NY 12234
James A. Kadamus
Selected Health Conditions That Impact Student Achievement
June 6, 2005
Goals 1and 2
Should the Board of Regents adopt a new policy that addresses the health issues of students as part of its closing the achievement gap strategy?
Review of policy.
This question will come before the EMSC-VESID Committee on June 20, 2005
The health of students has an enormous impact on their academic achievement. It requires the education community to join with public and private sector mental health, health and social service providers to address the widespread conditions that interfere with student learning and the prospects for students to have a healthy adulthood. With the recent surge in national and State initiatives to improve student performance, more attention is being given to identifying all those factors that impact student academic achievement. With the increase in our knowledge base, we realize that many children come to school with physical and mental health challenges that impede their ability to learn and compromise their likelihood of becoming healthy, capable adults. Increased research into child physical health indicators yields evidence substantiating their impact on learning.
Key physical health indicators that are receiving the most publicity right now include the dramatic rise in obesity, diabetes, and asthma among children. These diseases, which constitute three of the seven major risk factors cited by the Center for Disease Control (CDC), are also continually referenced in discussions of the broader areas of poor nutrition, lack of adequate physical activity and environmental hazards. While the literature speculates on causality and cure, data generally supports the fact that student risk in these areas is increasing.
As with many other risk indicators, students that are poor, live in impoverished communities, come from families where English is a second language and attend schools in need of improvement, have additional unmet needs with regard to optimal health maintenance. These students are also more likely to experience higher rates of academic difficulties. In order to close the achievement gap, more attention is needed to directing preventive health resources to the neediest communities.
Increasingly, the school community is identified, by federal and State systems, as part of the solution for improving student health. The attached paper begins the dialogue of the Board of Regents on health issues of our students, and it attempts to:
We recommend that the Board of Regents review the attached report and determine whether the proposed policy recommendations and next steps are sufficient in addressing health concerns of students as they relate to their academic achievement.
Asthma is a serious and growing health problem for children in this country. Between the years 2000-2002, approximately 4.6 million children in the United States between the ages of 0-17 years visited doctors' offices and hospital outpatient departments. Treatment for asthma during this time frame was estimated to cost $3.2 billion per year. In terms of the impact on school attendance, it is estimated that the cost of asthma to U.S. children is reflected in 14 million lost school days per year.
In New York State, asthma affects over 250,000 children. Between 1998-2000, asthma hospitalizations for children between ages 0-17 occurred at a rate of 35.3 per 10,000 children. In the 0-4 year age group, hospitalization rates were 72.1 per 10,000. Total Medicaid health care expenditures for recipients with asthma in New York State exceeded $1 billion in fiscal year 2000, inclusive of asthma related and unrelated medical services. According to the New York State Department of Health, among asthmatic children, 59 percent miss, on average, five school days per month.
As with many other health indicators, the impact of illness and deaths due to asthma is disproportionately higher among low-income populations, minorities, and children in inner cities. For example, in New York City school-based asthma prevalence among children 4-5 years old in 1999 was more than twice as high among children residing in low-income areas than among children residing in high-income areas. In recent years, the Bronx has been the New York City borough with the highest overall rates of asthma hospitalizations, deaths and prevalence among children as well as adults. It should be noted, however, that asthma hospitalization rates have been gradually declining in the United States since the peak in the mid-1980s, and in New York City since the peak in the mid-1990s, although the underlying reasons for both the upward and downward trends are not entirely understood.
Diabetes is a heterogeneous group of metabolic disorders characterized by high blood glucose levels. It is a major chronic disease in the United States. Over 18 million Americans have diabetes and, increasingly, health care providers are finding more and more children and teens with type 2 diabetes, a disease usually seen in people over age 40. Although there is no national data, some clinics report that one-third to one-half of all new cases of childhood diabetes are now type 2.
In New York State, over one million people, or approximately 7.1% of the population, have been diagnosed with diabetes. Of these, approximately 9,000 people with diabetes were under 19 years of age. As in the case of asthma, minority children who are obese and have a family history of type 2 diabetes are at especially high risk for this type of diabetes.
Several researchers have noted an association between diabetes and academic performance or attendance. Children with diabetes tend to be absent from school more than their peers who do not have diabetes. There is also some evidence that, among students with diabetes as a group, those with poorly controlled diabetes tend to perform worse on standardized tests than students whose diabetes is well controlled.
Poorly controlled diabetes can harm the eyes, kidneys, nerves, gums, teeth, and blood vessels, possibly resulting in blindness, lower limb amputations, and kidney failure. Diabetes can also cause heart disease, stroke, and even death if not well controlled. In order to keep diabetes under control, it is vital that a child or teen follow a healthy meal plan, get regular physical exercise, check blood glucose levels regularly and take all diabetes medication as prescribed.
Obesity and Poor
Over the past three decades, the United States childhood obesity rate has more than doubled for preschool children aged 2-5 years and adolescents aged 12-19 years, and it has more than tripled for children aged 6-11 years. At present, approximately nine million children over 6 years of age are considered obese. The obesity epidemic affects both boys and girls and has occurred in all age, race, and ethnic groups throughout the United States. There is evidence that certain ethnic minority populations, children in low socioeconomic status families, and children in the country's southern region tend to have higher rates of obesity than the rest of the population. For example, up to 24 percent of African-American and Hispanic children are above the 95th percentile in their age group. Among boys, the highest prevalence of obesity is observed in Hispanics and, among girls, the highest prevalence is observed in African-Americans.
The obesity epidemic affects New York State as a whole, including adults and children, as well as schools and businesses. Obesity-attributable medical expenditures cost New York State government and businesses $6 billion a year. Medicaid alone spends $3.5 billion in this regard. Significantly, almost half (43%) of the children in New York City's public elementary schools are overweight and over a quarter of them qualify as obese.
Although evidence of a direct effect of weight on achievement is less conclusive, emerging research does show an association. A study in the 2003 Journal of the American Medical Association found that severely overweight children and adolescents were four times more likely to report "impaired school functioning" than healthy children and adolescents. A 2004 study of 11,192 kindergarteners found that overweight children had significantly lower math and reading test scores at the beginning of the year than did their non-overweight peers, and that these lower scores continued into first grade.
Under nutrition also has a negative impact on learning. Researchers have observed that undernourished children attain lower scores on standardized tests, are more irritable, have difficulty concentrating and have less ability to resist infection and may miss more school. Similarly, there is evidence that well-nourished students who skip breakfast perform worse on tests and have poor concentration.
Environmental Hazards: Lead
In addition to the health problems noted above, there is ample evidence that certain environmental hazards impair learning and are detrimental to younger children. The effects of lead and mercury on human development are especially well documented.
In the case of lead, small children tend to absorb more lead than an adult primarily because their bodies are still developing. Thus, even small doses of lead can be hazardous. Even at low levels, exposure to lead is associated with lower IQ levels, impaired hearing, reduced attention span and poor classroom performance. At high levels, lead can seriously damage the brain. Impoverished children have a higher rate of exposure to lead in the form of peeling paint or paint chips, since they tend to live in older buildings.
Similarly, exposure to high levels of mercury can damage the nervous system and kidneys. Exposure to mercury is a concern in children and unborn babies because their nervous systems are still developing, and mercury tends to bio-accumulate in the nervous system. Health effects include brain damage, behavioral, and developmental problems. An acknowledgement of the importance of curtailing exposure to mercury is evidenced by the New York State Department of Environmental Conservation (DEC) law affecting the presence and use of mercury and mercury added products in all New York State elementary and secondary schools, which took effect on September 4, 2004.
It should be noted that the degree of harm from exposure to lead or mercury depends on a number of factors, including the frequency, duration, and dose of the exposure(s) and individual susceptibility factors (e.g., age, previous exposure history, nutrition and health). In addition, one's total exposure to lead or mercury from all sources in the environment -- air, soil, dust, food, and water -- should be taken into consideration.
Summary of SED Initiatives to Address Health Conditions and Environmental Factors That Impact Student Achievement
The following describes current initiatives that are being conducted to address health conditions and environmental factors by several teams in the Office of Elementary, Middle, Secondary and Continuing Education: Student Support Services; Child Nutrition Program Administration; Facilities Planning; and School Improvement and Community Services (New York City).
Student Support Services Team
The following policy recommendations and next steps are proposed for consideration of the Board of Regents in assessing whether these recommendations are sufficient to address the health concerns of students as they relate to closing the achievement gap:
A. Reinforce commitment to promote awareness of the links between health and academic success:
· Incorporate the interdependent aims of positive education and health outcomes into the vision and mission statements of USNY.
· Maintain the requirements for K-12 health education and physical education.
· Set goals that align health outcome objectives and education performance indicators.
· Strengthen and expand interagency partnerships at the State and local levels with agencies and community-based organizations whose mission concerns improving the physical health of children and youth. Each office in SED involved in health related activities will ensure this is in their workplans.
B. Promote systemic change that ensures the continuation of coordinated school health programs that support academic success.
· Encourage fiscal support for programs that link health and education.
· Encourage the passage of legislation that supports coordinated health programs.
family-oriented/parent education training sessions that foster parents' and
guardians' awareness of their critical role in promoting healthy
D. Consider seeking expanded funding for the Comprehensive School Health Program