Want to Lower Government Expenditures, Increase Life Spans, and Reduce Crime? Focus on School-Based Health

While the 2017 American Public Health Association’s (APHA) policy statement development process is underway, this article highlights a 2016 APHA statement that calls for action in the place that youth spend the majority of their time, only second to home…school. With academic years ranging from 160–190 days and youth spending the majority of their waking hours on those days at school, schools possess great capacity to positively influence the social determinants of our nation’s health. APHA’s Addressing Social Determinants of Health to Ensure On-Time Graduation policy statement (APHA, 2016) draws attention to and rallies support for that capacity.

Education is one of the greater social determinants of health. This runs true both for individuals and society. Graduation from high school is associated with increased life span (Wong, Shapiro, Boscardin, & Ettner, 2002), lower medical costs (Alliance for Excellent Education, 2006; Muennig, 2000), reduced crime (Raphael, 2004), and reduced dependency on government assistance (Muennig, 2000; Waldfogel, Garfinkel, & Kelly, 2005). That means greater investment into the factors that influence one’s ability to graduate are worth noting. Motivation and ability to learn are two such factors.

Lower-income and minority youth disproportionality experience health disparities that negatively influence their motivation and ability to learn. Per Basch (2011), the top seven disparities impacting motivation and ability to learn include: vision, asthma, teen pregnancy, aggression and violence, physical activity, breakfast, and inattention and hyperactivity (Basch, 2011).

To increase the likelihood that lower-income and minority will graduate, attention to seven health disparities highlighted by Basch must be made a priority. To do this, APHA policy number 20165, makes the following suggestions:

  • Researchers should include per pupil spending, educational attainment, and other indicators of school resources and effectiveness in measures of community health.
  • School boards, parents, and community members should monitor and evaluate implementation of the reauthorized Every Student Succeeds Act (ESA) at the local level to ensure equity in school resources, health services, healthy food access, and ensure that quality health education and adequate physical education are core school components.
  • Citizens should advocate for year-round, universal school breakfast, lunch, and snack or dinner funding, especially in schools with high proportions of students receiving subsidized meals
  • School food services staff, school administrators, and families should ensure that foods available as part of school meals meet guidelines and provide backpacks of food over weekends and school holidays for those who are food insecure.
  • Schools working with healthcare providers, insurers, and civic leaders should ensure that physical and mental health services are available in schools, especially in the communities most in need.

These “asks” require the inputs from multiple sectors and from both both individuals and groups. The outcome is a positive impact on those factors, namely ability to learn and motivation, which are casually related to high school graduation. In doing so, not only will the health and well-being of our nation’s child improve, but so to the health and well-being of our society.


Alliance for Excellent Education (2006, November 1). Healthier and wealthier: decreasing health care costs by increasing educational attainment. Retrieved from: http://all4ed.org/reports-factsheets/healthier-and-wealthier-decreasing-health-care-costs-by-increasing-educational-attainment/

American Public Health Association (2016). Addressing social determinants to ensure on-time graduation (Policy Number: 20165). Retrieved from https://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2017/01/13/social-determinants-and-graduation

Basch, C. E. (2011). Healthier students are better learners: A missing link in school reform to close the achievement gap. Journal of School Health, 81(10), 593–598).

Muennig, P. (2000). Health returns to education interventions. Retrieved from http://devweb.tc.columbia.edu/manager/symposium/Files/81_Muennig_paper.ed.pdf

Muennig, P. (2006) State-Level Health Cost Savings Associated with Improvements in High School Graduation Rates. Washington, DC: Alliance for Excellent Education.

Raphael, S. (2004) The Socioeconomic Status of Black Males: The Increasing Importance of Incarceration. Berkeley, CA: University of California.

Waldfogel, J., Garfinkel, I., & Kelly, B. (2005) Public assistance programs: how much could be saved with improved education? Retrieved from http://devweb.tc.columbia.edu/manager/symposium/Files/79_waldfogel_paper.ed.pdf

Wolfe, B.L. & Haveman, R.H. (2002), Social and non-market benefits from education in an advanced economy. Conference Series, 47(June) 97–142. Retrieved from http://www.bostonfed.org/economic/conf/conf47/index.htm

Wong, M., Shapiro, M., Boscardin, W., & Ettner, S. (2002). Contribution of major diseases to disparities in mortality. New England Journal of Medicine, 347:1585–1592.