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When School Nurses Are Not Enough

Updated: Feb 3, 2023

Original article written by Jane E. Brody for New York Times.

School children have had an especially challenging time navigating the tedious months of the pandemic, with recent reports showing that students fell four to seven months behind in math and reading compared to previous years, and with the most vulnerable students showing the steepest declines.

But while schools have typically tried to improve student achievement by focusing on academic testing and additional classes, they’ve too often neglected a major factor in their success: physical, mental and social health. This is especially true for children living in economically disadvantaged communities, who unlike their peers in wealthier communities often lack access to quality health care and resources.

Bringing health care to schools

Enter school-based health centers — facilities either in the school itself or nearby that not only tend to acute health issues like cuts and bruises, but also provide a suite of health services including primary, mental and dental care; substance abuse counseling; nutrition education and more. “They bring health care to where the children are, and they’re a very good way to provide health care to children who might not otherwise get it,” said Nicholas Freudenberg, a professor of public health at the City University of New York School of Public Health.

School-based health centers are a cardinal feature of community schools and other public schools that have increasingly recognized how difficult it is for many children to get their health problems adequately detected and treated. Such challenges may be especially acute for those living in low-income urban centers or rural areas. If a parent has to take time off from work or find a babysitter, or if transportation is unavailable or unaffordable to get a child to a medical visit, needed services are too often neglected until there’s a crisis, experts have said.

The nonprofit Paramount Health Data Project, which recently published a report on students’ health conditions in public and private schools in Indiana, found that the more often children visited the school nurse, the poorer their academic achievement on statewide tests, Azure Angelov, the project’s director, told me. The project’s data suggest “that students who are frequent visitors to the school nurse are simply unhealthy and frequently do not feel well during the school day,” Dr. Angelov and colleagues wrote in the

It is just this kind of coordination and follow-through provided by school-based health centers, thousands of which now exist nationwide, said Dr. Freudenberg.

Although hunger and nutrition are increasingly being addressed by schools and supported by federal programs, mental health issues like depression and anxiety often fall under the radar. When teachers think a child is struggling with emotional issues, having publicly supported services in or near the school can improve that child’s academic performance, Dr. Freudenberg said.

Furthermore, school-based health centers are often open to families and can connect parents to needed health services for themselves or others in the household.

Furthermore, school-based health centers are often open to families and can connect parents to needed health services for themselves or others in the household.

“The pandemic emphasized the fact that many children in poor communities don’t have healthy foods or access to mental health services,” he said, adding that as the pandemic wanes and children return to school, community support for their unmet health needs will be critical.

“Students K through 12 are likely to have health concerns during the course of their lives that can and should be addressed by schools to improve learning as well as their health,” Dr. Freudenberg said. “Schools can help them learn how to cope with difficult interpersonal situations.” For example, in New York City, he said, school-based health programs that provide sexual and reproductive care have helped lower the rates of sexually transmitted infections and teen pregnancy, enabling more young people to stay in school.

Dr. Basch and his co-authors emphasized in a 2015 report on health barriers to learning that “schools alone cannot close the gaps in education or eliminate health disparities. Families, communities, health care systems, legislators and the media each have essential roles.”

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