Classrooms and Clinics: Urban Schools and the Protection and Promotion of Child Health, 1870-1930

Classrooms and Clinics: Urban Schools and the Protection and Promotion of Child Health, 1870-1930

Classrooms and Clinics: Urban Schools and the Protection and Promotion of Child Health, 1870-1930

Classrooms and Clinics: Urban Schools and the Protection and Promotion of Child Health, 1870-1930


Classrooms and Clinics is the first book-length assessment of the development of public school health policies from the late nineteenth century through the early years of the Great Depression. Richard A. Meckel examines the efforts of early twentieth-century child health care advocates and reformers to utilize urban schools to deliver health care services to socioeconomically disadvantaged and medically underserved children in the primary grades. Their goal, Meckel shows, was to improve the children's health and thereby improve their academic performance.

Meckel situates these efforts within a larger late nineteenth- and early twentieth-century public discourse relating schools and schooling, especially in cities and towns, to child health. He describes and explains how that discourse and the school hygiene movement it inspired served as critical sites for the constructive negotiation of the nature and extent of the public school's--and by extension the state's--responsibility for protecting and promoting the physical and mental health of the children for whom it was providing a compulsory education.

Tracing the evolution of that negotiation through four overlapping stages, Meckel shows how, why, and by whom the health of schoolchildren was discursively constructed as a sociomedical problem and charts and explains the changes that construction underwent over time. He also connects the changes in problem construction to the design and implementation of various interventions and services and evaluates how that design and implementation were affected by the response of the civic, parental, professional, educational, public health, and social welfare groups that considered themselves stakeholders and took part in the discourse. And, most significantly, he examines the responses called forth by the question at the heart of the negotiations: what services are necessitated by the state's and school's taking responsibility for protecting and promoting the health and physical and mental development of schoolchildren. He concludes that the negotiations resulted both in the partial medicalization of American primary education and in the articulation and adoption of a school health policy that accepted the school's responsibility for protecting and promoting the health of its students while largely limiting the services called for to the preventive and educational.


In the final decades of the twentieth century, American child health advocates and activist child healthcare providers rediscovered the urban public school as a potentially promising site for clinics that could deliver primary healthcare to city schoolchildren and youth. The need for such clinics had been made manifest by years of research, beginning with studies generated by the War on Poverty, demonstrating that economically disadvantaged inner-city children and youth received shockingly little basic medical and dental care or counseling and thus were very likely to have untreated conditions and defects or be at risk for developing them. Moreover, the logic behind siting such clinics in schools seemed both obvious and compelling. Schools were where the children were and thus where healthcare providers could have guaranteed access to them. Parents have to send their children to schools; they do not have to take them to private physicians’ and dentists’ offices or to public clinics. Additionally, since untreated diseases and conditions in schoolchildren were understood to contribute to absenteeism, distraction, dysfunctional behavior, and other causes of poor academic performance, it was arguable that schools had a vested interest in facilitating better healthcare for their students.

Thus was born the school-based health center (SBHC) movement and the consequent proliferation of primary care clinics in the nation’s schools. In 1981, when SBHCs were made eligible for Maternal and Child Health Block Grant funding, there were less than a few dozen such centers. By 1990 there were 150. Today, there are an estimated 1,900 to 2,000, mostly in urban school districts but also in poor rural ones. Funded by a patchwork of federal, state, municipal, and private foundation money, they provide care for both adolescents . . .

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