Original article written by the Editors for Scientific American.
After years of disrupted lessons during the pandemic, it's clearer than ever that schools are more than just places to learn: they are vital safe spaces for students to build friendships, receive nourishing meals and talk to trusted adults. And they can be more—schools can also provide health care.
Around 3,000 school-based health centers (SBHCs) operate in more than 30 states all around the U.S., offering primary and preventive care for students who live in medically underserved areas. Staff at the SBHCs treat flu, asthma, diabetes and other common ailments. They administer vaccinations and screen for dental, vision and hearing problems, and some provide mental health care and reproductive health care.
These clinics, which are often partnerships between school districts and local community health organizations and hospitals, bring services to children who need them most and who have the greatest risk of falling behind in school because their health needs go unmet.
The pandemic was hard on existing SBHCs, and as we reckon with lost years of education, it's time for government at all levels to recognize that all children need accessible and affordable health care. As lawmakers draw up budgets, reallocate funds and begin a new school year, existing clinics should be able to operate without budgetary fears, more dollars should go to school-based clinics, and more community partners should participate financially and physically in efforts to bring health care to the kids who lack it.
“Healthy kids learn better,” says Robert Boyd, president and CEO of the School-Based Heath Alliance (SBHA), a nonprofit that promotes health centers in schools. More than 20 million children in the U.S. lack sufficient access to health care, and the most direct way to address that need is to bring doctors to them. “Many of their parents are unable to get away from work to take them to appointments,” Boyd says. “And even if they are able to get away from work, often the kids miss a whole day of school. By having the health center right there in the school facility, they can do what they need to do and get back to class.” And schools are often among the most trusted institutions within communities, making it easier to reach students who are anxious about visiting doctors' offices or whose parents mistrust outside providers.
Delivering health care through schools has been shown to improve kids' physical well-being and educational outcomes. A 2005 study in the Journal of Adolescent Health found that after health centers opened in U.S. public schools, their students' risk of hospitalization for asthma went down 2.4-fold, and their trips to the emergency room for asthma decreased by 33.5%.
Other studies have shown that clinics in schools can increase vaccination rates among students, reduce mental health problems and boost students' use of contraception.
On the education front, kids who use such centers have improved attendance and grades, are more likely to be promoted to the next grade and less likely to get suspended—and are overall more prepared for college. Based on all of this evidence, a Centers for Disease Control and Prevention task force recently recommended SBHCs as a key strategy to advance health equity—that is, to reduce the access disparities that exist between wealthier, privileged populations and everyone else.
Yet most school communities that could desperately use such clinics lack them. In 2021 Congress appropriated $5 million to support new and expanded services at SBHCs. That money funded 25 facilities—yet the program got more than 300 applications. And fewer than half of U.S. states currently fund school health centers. Although the clinics can also bill Medicaid and insurance for students who have coverage, they need stable funding for operating expenses, including hiring well-trained staff.
Many existing centers had to close temporarily or permanently during the pandemic, and centers struggled to retain staff and funding. One bright spot is that more than 60% of the centers that responded to an SBHA survey began offering telehealth services between 2020 and 2021, broadening their reach. And many were able to administer COVID vaccines to populations that lacked access to the lifesaving shots.
Getting kids the care they need where they need it has always made sense, and it's more urgent than ever. The time is right to expand school-based health centers to all underserved students.
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