This version was published in 2004. An updated version is available from 2011.
For many years, it seemed that schools' obligations in the realm of student health were limited to treating playground injuries, conducting head-lice searches, and providing a central location for children's vaccinations. Today, in part because of rising rates of obesity, diabetes, and asthma among adolescents, schools are being asked to take a much more active role in promoting students' physical well-being. Attention has been focused in particular on physical activity, nutrition and health education, and environmental conditions in school buildings.
In the past 20 years, the percentage of American adolescents who are overweight has tripled to 15 percent, according to the federal Centers for Disease Control and Prevention (Centers for Disease Control and Prevention, 2002-A). Experts often cite lack of physical activity as a leading cause of the rising obesity rate among children, pointing to the increasingly prevalent roles of cars, television, and computers in children's lives (U.S. Department of Health and Human Services, 2001; CDC, Feb. 2003).
While much of this sedentary time is passed outside of school, many look to schools to fix the problem. In a recent survey sponsored by the National Association for Sport and Physical Education, for example, three in four parents said more school-based physical education could help control or prevent childhood obesity. Providing opportunities for daily physical activity is also at the core of the recommendations for schools made in a 2001 report on obesity by the U.S. surgeon general (National Association for Sport and Physical Education, 2003; U.S. Department of Health and Human Services, 2001).
While physical education is not viewed as a core academic subject in many states, adequate physical activity by students has been linked to higher academic achievement. Some studies show that students who devote a significant amount of time to physical activity exceed the academic achievement of those who do not; active students often exhibit higher energy and greater concentration (Dwyer et al., 2001; Shepherd, 1997).
The success of schools in promoting physical activity among children and adolescents has so far been mixed. A 2000 national survey conducted by the CDC shows that some 95 percent of schools required students to take physical education courses. In addition, more than 99 percent of coed middle, junior high, and high schools offered interscholastic sports, while more than 71 percent of elementary schools provided regularly scheduled recess (CDC, 2000). However, in a separate document, the CDC warns that more than one-third of high school students still "do not regularly engage in vigorous physical activity and only 32 percent of high school students attend physical education class daily" (CDC, July 2003). Likewise, a recent analysis by the National Institute of Child Health and Human Development found that a sample of 3rd graders got an average of only 25 minutes a week of moderate to vigorous activity in school (National Institute of Child Health and Human Development, 2003). Some observers have contended that school systems have had to reduce recess time and limit after-school sports because of rising pressures to meet state academic demands (Borja, 2002).
High obesity rates and a growing concern about student nutrition have also caused schools to reconsider their cafeteria menus. A 2001 U.S. Department of Agriculture study found that, in the 1990s, schools participating in the National School Lunch Program—the federal government's subsidized-meals program for student—made significant improvements in the nutritional value of the lunches they provided, including reductions in fat and saturated fat levels. Other schools appear to be following suit (U.S. Department of Agriculture, 2001; Borja, 2002).
While school-sponsored meals manifest a commitment to better nutrition, other sources of food in schools fall short, observers say. In particular, vending machines and school-run shops frequently offer students enticing selections of junk foods and high-sugar sodas, which have been linked to an increased risk of childhood obesity (U.S. General Accounting Office, 2003; Harvard School of Public Health, 2001.)
Administrators are often reluctant to give up the use of vending machines, since schools routinely rely on sales and licensing contracts from vendors to supplement budgets for supplies and student activities. But some schools have recently established policies to limit unhealthy food products available on their campuses. Food-group representatives have objected that, rather than restrict students' choices, schools should educate students about making sensible eating decisions (GAO, 2003; Borja, 2002).
In addition to providing adequate nutrition with their meals, schools increasingly must be vigilant in ensuring the safety of the food. In the 1990s, 16,000 children were reported to be affected by food-borne illnesses (GAO, 2002). Controversy has recently emerged over a May 2003 decision by the U.S. Department of Agriculture to allow irradiated ground beef into the National School Lunch Program. While Bush administration officials say the process will help prevent food-borne illnesses, other scientists maintain that the risks of irradiated food are a greater threat (U.S. Food and Drug Administration, 2000; Epstein and Hauter, 2001).
While food-borne disease poses a significant health risk to students, the most common chronic illness among students by far is asthma, with nearly 5 million children affected (National Center for Environmental Health, June 2003). Environmental irritants found in schools—particularly mold, cockroaches, and dander—can cause asthma attacks in students to be more pronounced and common. According to the U.S. Environmental Protection Agency, asthma accounts for more than 14 million missed school days per year. It can also disrupt students' sleep and daily routines (U.S Environmental Protection Agency, 2000).
To combat the problem, the EPA advises schools to take systematic action to rid their buildings of asthma "triggers" and to develop comprehensive "asthma management plans" that coordinate treatment for affected children. Calling attention to the complexity and breadth of the epidemic, meanwhile, a panel of national experts on asthma has called for a greater national coordination of efforts to treat and prevent the illness (including programs for schools), as well as a greater commitment of resources (U.S. Environmental Protection Agency, 2000; Lara et al., 2002).
School environments can also affect students through allergens, poor ventilation, and dangerous chemicals. Citing a 1999 U.S. Department of Education finding that 43 percent of schools in the United States reported at least one unsatisfactory environmental condition, the EPA has launched a large-scale public-awareness campaign to help school employees and parents prevent, identify, and correct air-quality problems. The agency has found that poor air quality can have measurable effects on both student health and academic performance (U.S. Environmental Protection Agency, 2002).
In approaching all of these student health issues, a common recommendation has been the adoption of comprehensive school health policies. Under this approach, physical and health education are brought into regular classroom instruction, encouraging healthy choices as part of academic learning. Healthy physical environments, significant support-service staffing, and community outreach are also recommended as part of such programs. While many school health professionals favor the model, however, budget constraints have limited its application in schools (CDC, 2002-B; National Association of State Boards of Educations, 2002).