Coordinated School Health Programs and Academic Achievement: A Systematic Review of the Literature

Article excerpt

Over the past decade, public education has been increasingly held accountable through measures of academic achievement such as standardized testing. Pressure to improve test scores has resulted in greater emphasis on traditional classroom drills at the expense of programs like health for which there is little accountability required. In such a climate, it becomes important for coordinated school health programming to be able to demonstrate its impact on academic performance. The goal of this article was to systematically review the evidence assessing the link between health programming and academic achievement and to suggest ways in which that topic might be better studied in the future.

Education is a strong predictor of lifelong health and quality of life. (1) This finding is exhibited in different populations, places, and time. (2) At least 1 investigator (3) has argued that education causes health; however, the pathways through which education leads to better health and longer life expectancy are still not clearly understood. We do know that education, health, and social outcomes are very closely interdependent. (4) Success in school and years of schooling are major factors in determining social and occupational status in adulthood and health status throughout life. (5)

Among schoolchildren, academic success, health status, and risk behaviors are related in an interdependent, cyclical fashion. Poor school performance predicts health-compromising behaviors and physical, mental, and emotional problems. (6-8) Poor nutrition, substance abuse, sedentary behavior, violence, depression, and suicidality compromise school performance. This negative cycle, established during the school years, has profound consequences for the success and productivity of our communities. (9-11) Schools are a key part of the solution to this challenge and the school is a powerful force in American society. The education community is striving to enhance academic accomplishment through activities at the federal level, such as the No Child Left Behind Act; at the state level, through allocations of state funding and state laws; and at the local level, by incorporating curriculum choices, hiring talented personnel, maintaining facilities with limited resources, and raising funds through local bond elections.

Systematic reviews of the literature are important for decision making in health and education to provide evidence-based support for health programs and policy applications in the school setting. This article describes a comprehensive literature review of the evidence that Coordinated School Health Programs (CSHP) improve academic outcomes. CSHP provide policies, activities, and services in an organized manner to promote the health of school students and staff through: comprehensive school health education; family and community involvement; physical education; school counseling, psychological, and social services; school health services; school nutrition services; and school-site health promotion for staff and faculty. (12) The purpose of this systematic review was to identify and summarize evidence about CSHP-related determinants of academic achievement.

METHODS

Research Panel

A multidisciplinary panel was formed of 6 nonfederal, nonadvocate health researchers representing the fields of pediatrics, psychology, behavioral and social science, health promotion, and education from 3 different, collaborating Prevention Research Centers. These Prevention Research Centers are part of a national network of 33 academic centers, each with public health agency and community partners that conduct applied research and practice in chronic disease prevention and control, and are funded by the Centers for Disease Control and Prevention. Each panel member consulted experts in the fields of nutrition, physical activity, mental health, school health services, parent involvement, or school environment and policy for further information to increase the effectiveness of the search process. …