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Breaking Down the Silos to Address Youth Health Disparities: A Social Justice Imperative

Breaking Down the Silos to Address Youth Health Disparities: A Social Justice Imperative. Diane Allensworth, PhD Policy Analyst, Office of the Associate Director for Policy. AAHPERD Annual Meeting March 28, 2011. Objectives.

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Breaking Down the Silos to Address Youth Health Disparities: A Social Justice Imperative

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  1. Breaking Down the Silos to Address Youth Health Disparities: A Social Justice Imperative Diane Allensworth, PhD Policy Analyst, Office of the Associate Director for Policy AAHPERD Annual Meeting March 28, 2011

  2. Objectives • Document the links between the educational achievement gap and health disparities • Report on the findings of an Expert Panel assembled by SOPHE and ASCD • Identify strategies that can alleviate both the achievement gap and health disparities * Citations, references, and credits – Myriad Pro, 11pt

  3. Children & Youth: 25% of the Population — All of Our Future

  4. There are more than 74 Million Children in the United States • High number of children living in poverty -- 15.3 million/ 21%; (family of 4 with income below $22,050 ) • Using 200% of Federal Poverty Limit as definition: -- 42.2 % of U.S. children lived in "low income" households Poverty is linked with multiple negative outcomes for children and youth —31.3 million

  5. Children in Poor Families by Race/Ethnicity Children living in poor families: • 29% White • 32% Asian • 57% Native American • 62% Black • 63% Hispanic

  6. Dramatic decreases in infectious disease rates and childhood mortality in 20th century Dramatic decline in blood lead levels Gradual decline in child injury mortality since 1980 Student Health Indicators: The Good News

  7. 19% of high schools students report current cigarette use Dramatic increase in the number of overweight youth, now 16% (4%–5% in 1970s) 11.3% of youth have had at least one clinically significant emotional, behavioral, or substance abuse disorder Student Health Indicators: The Bad News

  8. Selected Social Determinants of Health for Children & Youth Lack of Health Services Unhealthy Environment Poverty Food Insecurity Poor Early Development Inequitable Education Race & Ethnicity

  9. Poor children and youth have more health problems More chronic disease More infectious disease More injuries More developmental delays More social/emotional behavioral problems Implications for Children Living in Poverty

  10. Poor children’s prognoses is worse with the same condition Poor receive less and lower-quality medical care Poor families “may” be less well equipped to manage their children’s health problems Case, A & Paxson, C. Children’s Health and Social Mobility. The Future of Children. 2006; 6(2), 151-173. Poor Children Have More Health Problems

  11. Education is the stepping stone to the “American Dream” Education is the factor consistently linked to longer lives High school graduates have Better health Lower medical costs Longer lives: 6-9 additional years Education: A Solution to Reduce Health Disparities

  12. There is an achievement gap between the academic performance of Poor students and students who are not poor Minority students and their non-minority peers Leading to… 7200students dropping out of school every school day— more than 1.2 million every year! Inequities in Schooling Limit Education as a Solution for Poor Children

  13. School Factors: Two thirds minority students attend high-poverty schools Poor schools/Run down facilities Lower per–pupil spending Less curriculum rigor/Less advance placement tests Less credentialed/experienced teachers More teacher turnover Lack of school safety Less parent participation Educational Inequities Associated with the Achievement Gap

  14. Frequent school changes Student health problems Low birth weight Disabilities Specific diseases --Diabetes --Sickle cell anemia Food insecurity & hunger Mental health problems Low health literacy Nonschool Factors Associated with the Achievement Gap

  15. Chronic Absenteeism among Poor Children Decreases Achievement • Chronic absenteeism in Kindergarten is associated with lower academic performance in 1st grade • Poor children who were chronically absent in Kindergarten were the lowest performing students in reading and math in the 5th grade Hedy N. Chang and Mariajosé Romero .Present, Engaged, and Accounted For The Critical Importance of Addressing Chronic Absence in the Early Grades. National Center for Children in Poverty, 2008.

  16. Course failure in 9th grade explains high school drop out rates Demographic & economic background characteristics (7% of course failures) Eighth-grade test scores explain an additional 5% (12% total) Absences explain an additional 53% (65% total) Source: Allensworth E, Eston, JQ. What Matters for Staying On Track and Graduating in Chicago Public High Schools. Chicago: Consortium on Chicago School Research at the University of Chicago, Research Report, 2007. Absenteeism: A Major Factor Associated with Dropping out of School

  17. Education and Health Are Interconnected Academic Performance Educational Attainment School Based Interventions Adult Health Status Child Health Status Nancy Murray, et al. Code Red, Education and Health: A Review and Assessment, Appendix E. http://www.coderedtexas.org/files/Appendix_E.pdf

  18. Questions? Comments?

  19. Breaking Down the Silos to Address Youth Health Disparities: A Social Justice Imperative Elaine Auld SOPHE, Executive Director

  20. Expert Panel • Organized by • Society of Public Health Educators • ASCD • Engaged Subject Matter Experts in • Health Care • Health Education • Education • Public Health

  21. SOPHE – ASCD Expert Panel June 21 - 22, 2010 Washington, DC 24 Participants Representing • Health Care • Public Health • Education • Adolescent Health • School Health

  22. SOPHE – ASCD Expert Panel on Eliminating Youth Disparities Goal: To develop best policy and practice goals for eliminating health disparities among youth.

  23. SOPHE – ASCD Expert Panel on Eliminating Youth Disparities Key Questions: What programs or policies have succeeded in addressing racial and ethnic health disparities among youth and what are their key ingredients for success? What recommendations around policy and practice should be set forth to reduce racial and ethnic disparities among youth? How can the public health and education sectors best work together to reduce these disparities?

  24. Recommendations by Expert Panel Action Items at • Community Level • State Level • National/Federal Level

  25. Cross-Agency Collaboration: • Utilize a community coordinating committee at the municipal/school district level and corollary school health teams at each school to pursue an agenda of continuous improvement in the health, learning and well-being of all students. • 30.8% (Rank: #4-6) Selected Action Items at Community Level School and Community agencies collaborate to • Support health and learning • Ensure all students graduate • Ensure a wholesome school/community climate

  26. Recommendations from Expert Panel 1. Cross-Agency Collaboration: • Utilize a community coordinating committee at the municipal/school district level and corollary school health teams at each school to pursue an agenda of continuous improvement in the health, learning and well-being of all students. 30.8%                    (Rank: #4-6)

  27. Cross-Agency Collaboration Indicators 1.a A community coordinating committee at the municipal/school district level and at each school 1.b School Health Teams provide input to the annual school improvement plan. 1. c The Municipal/District Community Coordinating Committee annually reports evidence of parent communication and engagement in each component of the school health program

  28. Recommendations from Expert Panel 2. Joint Accountability for Health & Learning In addition to current achievement indicators (e.g. academic achievement, graduation rates), require schools to measure and report health, safety, and well-being indicators (e.g. chronic absenteeism,  fitness, teen birth rates, connectedness) as a means of quality improvement.. 69.2%                  (Rank: #1)

  29. Joint Accountability for Health & Learning Indicators 2.a Annual measures disease-related absenteeism, truancy, tardiness, detention, fitness levels, teen birth rates, repeat teen births, scores on national proficiency exams in 4, 8 & 12th grade and graduation rates, student health behaviors, health literacy, and perceptions of school climate of students, staff, families and fitness data. 2.b Officials utilize student identification numbers so that their data can be shared

  30. Recommendations from Expert Panel 3. Health Care Access: Collaborate with community partners, community-based health agencies and other types of organizations so that every student has a “health home” that addresses physical health, mental health, including substance abuse prevention and treatment, reproductive health, oral health and vision. (Note – could include school-based health centers, nurses in every school). 48.2.0%                (Rank: #2-3)

  31. Health Care Access Indicators 3.a A nurse (particularly in all Title One schools) 3.b School Based Health Centers established 3.c Standardized national guidelines are used to manage chronic diseases of students. 3 d Skills-based cultural competency training for the school health team is provided

  32. Health Care Access Indicators Cont. 3.e Options for reproductive health care for adolescents are co-located preferably in school based/school linked or mobile 3.f FreeGuardasil/HPV vaccination for adolescents in Title One schools are provided via mobile units. 3.g Clinic staff address STI, HIV, and pregnancy prevention with adolescent regardless of presenting reproductive health problem.

  33. Recommendations from Expert Panel 4. Health Promoting Environment: Establish and enhance universal access to school and community based primary and secondary preventive health services that include physical, social and emotional well being in accordance to national standards/guidelines. 46.2%      (Rank: #2-3)

  34. Health Promoting Environment Indicators 4.a Students perceive that the school climate is nurturing and supportive. 4.b Students are assigned an adult mentor. 4.c Students perceive that they are safe in school, going to and from school.

  35. Health Promoting Environment Indicators Cont. 4.d Students attend a school with a healthy food environment in which all food at school meets or exceeds USDA Guidelines. 4.e Food insufficiency in students is recognized and addressed. 4.f Youth advocacy and community engagement efforts encourage tobacco free environments. 4.h Families are encouraged to limit student screen time to a minimum of two hours daily.

  36. Recommendations from Expert Panel 5. Health and Physical Education Instruction: Health education and physical education are provided as core subjects in K-12 school curricula with accountability for achieving the national health & physical education time and content standards. 30.8%        (Rank: #4-6)*

  37. Health and Physical Education Instruction Indicators 4.a Sequential K-12 health education classes are provided to achieve health literacy. 4.b Consistent instruction about the dangers of tobacco use is provided .

  38. Health and Physical Education Instruction Indicators 4.c Youth are engaged in planning and implementing peer education programs. 4.d Social media campaigns are implemented to promote healthy behaviors around sexuality, active lifestyle, no tobacco use, and good nutrition habits.

  39. Health and Physical Education Instruction Indicators Cont. 4.e All students receive a minimum of half of their daily physical activity in schools via 5-10 minute physical activity breaks in the classroom, recess, and/or physical education classes. 4.f Local education agencies annually assess students’ fitness levels (using a tool such as the FITNESSGRAM) followed by the development of individualized student fitness improvement plan that involves families.

  40. Health and Physical Education Instruction Indicators Cont. 4.g Community agencies and schools negotiate partnership to open school’s recreational facilities during out of school time.

  41. Summary Action Items at Community Level School and community agencies collaborate to • Ensure that every student has a “medical/health home” • Ensure health & education data are shared & used. • Prevent/address students’ reproductive health issues • Address health & physical education needs. • Ensure a healthy school & community environment

  42. Selected Action Items at State Education & Health Agencies Work with state education agencies to increase: • Required frequency of physical education to recommended national standards. • Required frequency of health education to recommended national standards • Reporting of students’ fitness scores to the state annually to monitor continuous improvement. • Improve equity in funding for minority schools. 

  43. Selected Action Items at National/Federal Level • Tax incentives for result-based partnerships at the community level among education, public health & health care sectors for improving the health and achievement of all students, esp. low-income, minority and ethnic students. • Tax incentives to locate health services in underserved areas easily accessed by student/families. • Tax incentives provided for medical residency programs to promote access to educational experiences in school health

  44. Selected Action Items at National/Federal Level • Medicaid providers address specific set of indicators for the Whole Child. • Health education and physical education are included as core subjects in ESEA re-authorization

  45. Selected Action Items at National/Federal Level • Federal agencies develop funding and accountability mechanisms that cut across health and education sectors to ensure that the needs of the whole child are met from infancy through adolescence for all children and particularly low income, minority and ethnic students.

  46. Selected Strategies for National/Federal Level Reimbursement to schools for the school-based feeding programs is increased so that healthier options can be purchased and the dependency on competitive food options that generate income for schools is eliminated.

  47. Questions? • Contact Elaine Auld: eauld@sophe.org • Contact Diane Allensworth: dda6@cdc.gov

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