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School Health
A Bridge Between Public Health and Health Care
Keynote Lecture: George Washington University
School Health Initiative
June 4, 1998
by Philip R. Nader, M.D.
Professor of Pediatrics
Chief, Division of Community Pediatrics
University of California, San Diego
"Health Care is not equivalent to Health. Education is not the same as learning. Health and learning must be defined by more than the current performance of the institutions that claim to serve these ends. " -1. Illich, Deschooling Society, Harper and Row,
New York, 1972
This quotation is no longer as current as when it was first used in 1976 in an article on School Health, but it is still as applicable to the challenge and promise of school health as that bridge between the health care system, public health, and the educational system.
Today there are many forces, largely economic at this point, reshaping and redirecting the health care system; and at the same time, forces within the educational system reflecting an emphasis on traditional academics, with more willingness to involve community partners in meeting other- than-traditional educational needs. At the same time, society places increasing expectations on the school to deal with the myriad of social issues which surface visibly on a daily basis in the school. Similarly, new social problems are being defined as health concerns because of their direct connection with morbidity and mortality. For example, operating a motor vehicle while under the influence of alcohol has direct economic impact on the health care system and the problems of violence in families, peers, and schools.
There are two major gaps on today's health care system: access to health care and lack of preventive services for youth. My goal today will be to lay out a rationale to explain why and how school health could become not just a part of -the mainstream health care system, but a lynchpin for the system to assure a way to deal with these two major gaps in today's health system. As with all issues in health care related to youth, this (r)evolution will depend on much larger changes which will sweep school health along with the tide of reform in the health care system as a whole. It is not inconsequential that this School Health Initiative, of which I am privileged to be a participant, is being sponsored by a School of Public Health. The same forces that are bringing public health and health care together are impacting school health. In fact, School Health may well be a convenient model to work out the integration of the public health agenda with the new realities of the health care system. The integration of a health with an educational agenda requires further collaboration - having a partnership with the Graduate School of Education at George Washington University is key.
The discussion will follow the outline below:
- The historical context of school health, public health, education, and the health care system in relationship to the pressing health needs of the population.
- A conceptual framework and some definitions of school health.
- An analysis of why some recent attempts to provide integrated cross-sectoral services haven't thrived, and why isolated unilateral single sector programs have only limited Success.
- Application of Lasker's "synergisms" for public health/health care to school health.
- A postulation of why now is the time, and some suggestions for strategic activities for the next 3 years.
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