Health in Schools: How Are We Doing?

Children spend more time in school than any place except home, and success in school is directly linked to a child’s health. Those two facts alone should mark the importance of health in our schools.

But the topic becomes more significant when you consider the wide range of risks and conditions facing our youngsters. Obesity, bullying, and violence; allergies; and chronic illnesses like asthma and diabetes have risen dramatically in recent years and show few signs of declining. Consider that more than 20{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of the 1.2 million children in Massachusetts schools have some kind of medical condition.

Add to that continuing concerns about H1N1 and seasonal flu and a severe shortage of school nurses, and you have a situation that should cause deep concern among parents, teachers, and school and public officials alike.

The scarcity of school nurses is a nationwide problem. Massachusetts has only 2,100 nurses for its school children, and nationally, only 45{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of public schools have a full-time nurse. Another 30{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} have a part-time nurse, and 25{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} don’t have any nurse at all. The preferred ratio is one nurse for every 250 to 500 children, but in some locations in the country, a single nurse may be responsible for as many as 2,000 children.

The poor economy, causing budget cuts at the federal, state, and local levels, is making the challenge even bigger. Recent state cuts, for example, have caused 13 of 80 school districts across the state to lose their essential school health services grants, funds that support a range of services, including administration, basic and emergency care, substance abuse prevention, and nursing positions.

Despite that, as a physician and nurse who have worked on school-health matters at the national, state, and municipal levels, we can tell you that good news and bright spots do exist.

To start, Massachusetts is one of the best states in the nation for school health, particularly with regard to school-nurse leadership. Further, the caliber of our school nurses is higher than it’s ever been. Each must be a registered nurse, have a bachelor’s degree, and engage in continuing education. Each must also be licensed by both the Board of Registration in Nursing and the Department of Elementary and Secondary Education and have at least two years of experience before becoming a school nurse. Most have 10 to 15 years of experience in such areas as emergency or intensive care, pediatrics, and mental health.

That experience translates into solid performance. School nurses in Massachusetts have an enviable 92{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} return-to-class rate, demonstrating an ability to keep children in school and able to learn. And each school year, nurses save upwards of 175 children by administering epinephrine in response to life-threatening allergic reactions.

Finally, the state Department of Public Health has taken an active and thorough approach to school health. Its two-volume, 1,300-page Comprehensive School Health Manual provides detailed policies and practices for school health, addressing such topics as infectious disease control; mental, nutritional, and oral health; injury and violence prevention; and substance abuse and addictive behavior, among others.

But challenges remain. The biggest is funding, to provide more nurses and resources for our students. Another constant test is trying to meet the expectation that schools can handle it all — education, discipline, guidance, counseling, safety, health, and even substitute parenting.

It’s important to remember, however, that school health is more than having a nurse on site. School health entails all the services, activities, policies, and programs in schools designed to remove barriers to teaching and learning. It includes a healthy building, a healthy environment, healthy foods, physical fitness, staff who are role models, and a dedicated administration.

And that’s where parents, teachers, administrators, and public officials can work together to play a critical role. We encourage everyone to get involved, ask about school nurses and the health care available, and advocate for improvements if needed.

It bears repeating: success in school is directly linked to a child’s health. Good school-health programs contribute to a safe environment and create a sound structure for children to learn.

To learn more, visit the National Association of School Nurses at or the American Academy of Pediatrics Council on School Health at –

Dr. Linda Grant is medical director of the Boston Public Schools. Kathy Hassey is director of the School Health Institute at Northeastern University.