A Framework for School Health Programs in the 21st Century

Article excerpt

Our world and our nation have changed; so too have our schools. Today, more than ever, school health programs could become one of the most efficient means available to improve both the health of our children and their educational achievement.

Increasingly, parents, school staff, public health workers, and others concerned about young people together are revitalizing long-neglected school health programs. To aid them, the following framework offers an outline of the contexts, components, goals, organization, and administration of contemporary school health programs. A more detailed version of the framework is being prepared.


Modern school health programs could address the health and education contexts in which they evolve. Today, the major causes of death, disability, injury, and illness among young people (ie, motor vehicle crashes, other unintentional injuries, violence, suicide, sexually transmitted diseases, and unintended pregnancies) and among adults (ie, heart disease, stroke, cancer, lung diseases, and diabetes) result from a few patterns of behavior that become established during school-age years--alcohol and drug abuse, behaviors that result in unintentional and intentional injuries, sexual behaviors, tobacco use, unhealthy diets, and physical inactivity. These preventable behaviors are taxing our health care, health insurance, and underlying economic systems to the breaking point.

Consequently, our public health and medical care systems are reforming. A recent report of the Institute of Medicine (IOM) (1) reasoned that

   Health is a primary public good because many aspects
   of human potential ... are contingent on it. In view of the
   value of health to employers, business, communities, and
   society in general, creating the conditions for people to
   be healthy should ... be a shared social goal. ... The special
   role of government must be allied with the contributions
   of other sectors of society. ...
   A public health system would include the governmental
   public health agencies, the health care delivery system,
   and the public health and health sciences academia. ...
   [But it also would include] communities and their many
   entities (eg, schools, [community] organizations, and religious
   congregations), businesses and employers ... as
   potential actors in the public health system. ...

The IOM consequently defined a public health system as "a complex network of individuals and organizations that, when working together, can represent what we as a society do collectively to assure the conditions in which people can be healthy." (1)

Like health, education also is a primary public good, and a public education system similarly might engage schools with other organizations to collectively assure the conditions in which young people can be educated.

Strategies implemented by various agencies as part of education reform to improve student achievement can be grouped into 6 categories:

1. Means to specify and monitor priority achievement objectives.

2. Means to improve education curricula, methods, and technologies.

3. Means to assure fiscal resources necessary to improve educational achievement of every child in every community.

4. Means to recruit, train, and retain well-qualified school teachers, administrators, and other staff in every community.

5. Means to engage each community in providing necessary support for its students and school staff.

6. Means to enable administrators of local, district, state, and national education agencies to manage these strategies.

Modern school health programs could provide one of those means listed fifth as a vital part of education and public health reforms.


Modern school health programs could include 8 components, which have been described in more detail elsewhere, (2) including school: (1) health services; (2) health education; (3) biophysical and psychosocial environments; (4) psychological, counseling, and social services; (5) physical education and other physical activities; (6) food services; (7) employee health policies and programs; and (8) integrated efforts of schools, families, and communities. …