Advancing the Role of School-Based Health Centers in Driving Health Justice
Original commentary written by April Joy Damian, PhD, MSc, CHPM, PMP and Robert Boyd, MCRP, MDiv and published in the Journal for School Health.
School-based health centers (SBHCs) provide vulnerable children and youth in the United States with access to primary care, behavioral health care, oral health care, and vision care where they spend a large proportion of their time — at school. SBHCs are strategically located in low-resource neighborhoods. As many as 89% of SBHCs provide access to one or more schools designated as Title I, meaning they receive federal financial assistance because of the high percentage of students from low-income families. Additionally, school populations with access to SBHCs have, on average, a higher percentage of enrolled students who identify as Latinx (38%) and African American (24%) compared to schools nationwide (24% and 15%, respectively), thereby targeting and reaching youth typically under-served by the health care system.
Given the growing body of literature supporting the positive impact that SBHCs have on student health and education outcomes, the authors offer their professional perspectives on the potential role of SBHCs in promoting health and well-being amidst the "converging pandemics of COVID-19 and racism in the United States," and present future recommendations beyond COVID-19 for how SBHCs can "serve a key driver in moving the needle on health justice." The authors outline their points both in the context of COVID-19 and beyond the pandemic.
ROLE OF SBHCS IN THE COVID-19 CONTEXT
The authors write that SBHCs have important role in addressing the misinformation surround COVID-19 and promoting health literacy in their respective communities. Given that misinformation disproportionately impacts the populations SBHCs target and serve– racial and ethnic minorities, nonnative speakers of English, those with low socioeconomic status, and medically under-served people– it is vital that SBHCs track progress in health literacy, and educate children and their families about preventive behaviors, including proper hygiene, during pandemics. Furthermore, there is the opportunity to leverage the locality of SBHCs to enhance availability and accessibility to testing. Given that school staff already may be overwhelmed by the changes in delivering instruction, SBHCs, if properly resourced, may be able to help alleviate this burden by providing the necessary personnel and infrastructure to provide testing and vaccinations to students, teachers, and staff, as well as facilitate coordination and information exchange with health departments and staff. Lastly, given immediate impact of the pandemic on the mental health of youth, SBHCS have a vital role to play in ensuring access to psychosocial support for students and families.
BEYOND THE PANDEMIC: LONG-TERM VISION FOR SBHCS IN THE HEALTH JUSTICE MOVEMENT
The pandemic has both exacerbated and brought to light the long-standing challenge of health and social inequities that have existed since the birth of the United States. Whereas elected political officials should beheld accountable for protecting the health and well-being of all peoples, every sector has a role and responsibility for advancing health justice, including racial equity and justice. The authors write that a major challenge is attracting health care workers to serve in schools in low-income communities. Schools and SBHCs must compete with better paying private sector and hospital jobs. Therefore the authors propose 2 incentives in the 117th US Congress: (1) a $5000 annual tax credit for all workers serving in Title I schools and (2) student loan forgiveness for all workers that chose to serve in Title 1 schools. Both of these proposals would necessarily include teachers,administrators, and health care workers, regardless of their employer. Furthermore, due to emerging research on implicit bias in healthcare settings, ensuring that this workforce is racially diverse that looks like and shares similar experiences with the students they serve is equally important. Lastly, enhancing cooperation both between and within the health and education sectors is important to ensure the long-term investments in healthcare and education for low-income students.
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