Over the last three decades, the prevalence of obesity among young people between 6 to 19 years has tripled. With increasing obesity rates, young people are now vulnerable to chronic conditions such as high cholesterol levels, high blood pressure, and diabetes among others. High rates of obesity, declining engagement in physical exercises, poor nutrition among other factors have contributed to the decline in student health. Schools have a responsibility to promote physical health and healthy eating habits among students through policies, practices and creating the right environment. Students spend most of their time in school; therefore, schools should invest in student health through physical education, proper nutrition, and school wellness programs. Schools should develop student health programs in collaboration with specialists from the national, state, local and community agencies based on in-depth review of research, theory and best practices on student health. Investing in student health is hugely beneficial to students and schools. Healthy students who engage in physical activities and proper nutrition reduce the risk for most diseases; they also have good mental and social health, and this improves their academic performance.
Historical Context
The state of student health has changed drastically over the years. Student health is affected by economic, social, and political factors within their homes, schools, community and the entire nation. Student health is a comprehensive term referring to the physical, mental, and social well-being of students. The topic of student health is vital as healthy students perform well. When students are in good physical and mental health, they will focus all their attention on education and education-related activities.
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The Centers for Disease Control and Prevention (CDC) recommends at least 60 minutes of vigorous or moderate intensity physical activity every day for children and adults. However, the daily physical activity has declined drastically among children and adults. According to Kohl & Cook (2013), for the past three or four decades, the volume and intensity of daily physical activity among children have declined drastically. Zalewska et al. (2017) state that a majority of students (young people) in the US do not receive the recommended physical activity with only 35% of high school students reporting participation in the recommended physical activity.
Children spend so many hours at school or engaging in school-related activities such as homework and projects. When they are not doing school work, students are learning a new language or an instrument, leaving no room for physical play. Kohl & Cook (2013) note that in the past four decades the number of students walking and biking to school has declined substantially. Most students take the bus or are dropped at school by their parents, and yet most students used to walk to school in the past.
The modern lifestyle has played a role in the creation of poor student health. Adoption of sedentary life characterizes the modern lifestyle due to technology. Students would rather watch movies or play video games instead of engaging in physical activities such as running or biking. The modern lifestyle has also popularized fast food; students can easily access fast food. Fast food is rich in fats and sugar, hence the declining student health. Hopkins & Gunther (2015) explore the changes in school feeding programs and the role in student health. School feeding programs such as NSLP, SBP, and SFSP are federal programs meant to provide food to school children while improving their nutrition. Nonetheless, the availability of unhealthy food choices in school canteens is yet to be regulated. Common beverages in school canteens are sports drinks, sodas, and fruit drinks, and they are sold with high-fat salty snacks. Some schools have begun limiting the sale of high-calorie low-nutrition snacks, but most schools are yet to limit (Hopkins & Gunther, 2015).
The current situation is worrying. Young people are engaging in activities that are detrimental to their health. Obesity is on a constant rise, while the engagement in physical activities is slowly declining. Students are not getting proper nutrition as their diet is now filled with high-calorie low nutrition snacks. Schools and parents should work together to address the problem.
Analysis
The CDC (2018) report on student health emphasizes the importance of establishing healthy behaviors during childhood. When students adopt healthy habits at a young age, they are more likely to preserve the habits in adulthood. Schools have a crucial role to play in promoting healthy habits and patterns because students spend most of their time in school. The CDC came up with the Whole School, Whole Community, Whole Child (WSCC) model featuring eight components of coordinated school health. The eight components are health education, nutrition environment and services, employee wellness, social and emotional school climate, physical environment, health services, family and community engagement, and physical education and physical activity. The WSCC model shows that student health has many dimensions, and yet most schools fail to create a student health program with all the dimensions.
Before analyzing student health as a crucial component of the education system, it is crucial to define student health and its importance. Health refers to the state of being free of illness or injury. Health entails both physical and mental aspects of human well-being; hence, student health focuses on the physical, mental, and emotional wellbeing of school going children/ individuals. Healthy students are in a position to learn and attain good academic performance in comparison to students with health issues (Lucarelli et al., 2014) . Some health conditions such as obesity and diabetes can be prevented through the adoption of a healthy lifestyle, while other conditions cannot be prevented. Schools should play its role in promoting healthy habits through policies and the right environment to prevent certain health conditions. Student health problems do not arise from poor diet and lack of exercise only, as students should be in a clean and safe environment. The school environment and materials used in food preparation, playground and even in the classroom should promote student health.
The health promotion role is crucial for the well-being of students and schools in general. The CDC ’s dimension of student health shows that student health is made up of many aspects ranging from physical activity, proper nutrition, managing chronic diseases, family and community engagement, health education, employee wellness among other concepts (CDC, 2018). Most schools implement only a few components of the CDC’s healthy schools; for example, the school that has healthier nutrition options might neglect physical activity programs. Schools have also failed to improve their processes to help students adopt life-long healthy habits and health literacy. Schools should not focus on preventative health only, and they should also improve school health services to help students manage minor and chronic conditions such as common school injuries and asthma. Schools should equip health personnel with the right knowledge, equipment and processes to meet the diverse health needs of students. Schools should also collaborate with parents and the community in general to promote student health in and outside school.
Most schools have failed to take their role in health promotion seriously. Schools do the bare-minimum regarding the issue of student health. Schools invest in a school nurse and they think that the nurse will meet all health needs. Jamal et al. (2013) criticizes the approach taken by school towards student health claiming that the approach has worsened the situation. According to Jamal et al. (2013) the school role in health promotion is divided into two: promotion of health-related behaviors and general development of student competencies. Schools have to do more than availing a nurse to treat minor health emergencies such as bruises and cuts. When addressing health-related behaviors, schools have to introduce comprehensive policies on physical activity, alcohol and drug abuse, proper nutrition policies among other health issues. Evidence shows that schools do not have adequate health-related policies and those with adequate health-related policies do not follow through. Schools often rely on health education where they educate students on healthy habits, but they fail to create a healthy environment and to reinforce healthy behaviors among students. For example, schools educate students on the dangers of alcohol and drugs, but they fail to put in place effective policies to prevent alcohol and drug abuse among students in school and after school. Health education is important, but health education should be complemented by health policies and activities created by the school with the aim of improving student health and holding them accountable.
Schools are also not doing enough to promote physical activities. According to Kohl & Cook (2013), elementary and middle school children spend 10-40% of their time in physical education where they engage in moderate or vigorous intensity physical activities. Schools have an average of two physical education class periods in a week each for 30 minutes. Elementary and high schools should increase the physical education periods per week to ensure that students get at least 30 minutes of moderate to high-intensity physical exercises every day. Schools should also develop different programs and activities to encourage students to take part in physical activities. Students are more likely to participate in a sport when the school has availed the necessary tools necessary for the sport.
Research Review
According to Dermici et al. (2017), good health is a basic human need. Health is synonymous with well-being, and it is related to safety/physiological needs in the Maslow ’s hierarchy of needs. Human health is not only physical, but it also relates to social and mental aspects of one’s well-being. Maslow classified the five hierarchy of needs into lower and higher level needs, but they are all crucial. Everyone wants to feel safe, well and protected against bodily harm and mental anguish. Dermici et al. (2017) also add that student does not learn well if they are not healthy. When schools fail to advocate for healthy behavior, students find themselves struggling with obesity, eating disorders and conditions related to poor nutrition. Health problems can have immediate negative implications on learning; for example, students with eating disorders have abnormal eating habits that make them uneasy and afraid to eat in front of other students.
A study by Fairclough et al. (2013) focusses on the increasing number of overweight and obese children. The authors evaluate the effects of Children ’s Health, Activity, and Nutrition: Get Educated! (CHANGE!) A program aimed at promoting physical activity and proper nutrition among school children. By the end of the CHANGE program, the participants had a decrease in waist circumference and positive changes in BMI. The study by Fairclough et al. (2013) shows the potential of school programs in improving student health. Some school-based interventions have succeeded with the right administrative support and family intervention on physical activity and dietary changes. The school setting is a logical setting because schools have existing infrastructure in place as well as staff, facilities, and policies to promote healthy habits. Schools make small and healthy modifications to school meals that will effectively reduce the risk of obesity among students. Schools can also use curriculum through health education to promote healthy eating habits. The CHANGE intervention program is an example of the many programs designed to promote healthy habits among elementary school students. CHANGE focused on physical activities and dietary changes while involving family. CHANGE program took place for 20 weeks, and a follow-up of 30 weeks was applied. The intervention program had positive results in the form of BMI and weight circumference of the participants.
Another study by Dermici et al. (2017) supports the conclusion of the study by Fairclough et al. (2013). Dermici et al. (2013) explored the effects of school-based exercise practices (SBEP) on obesity and student health in general among female students between 9 to 11 years. The study used an Intervention Group (n:85) to test the effects of physical exercises among students against a control group which engaged in physical education lessons for 45 minutes for three times in a week. After four months of intervention, the study found out that the proportion of obesity within the intervention group was at 25.2% while the rate of overweight was at 14.2% while the control group experience almost no decrease in BMI. The intervention group also had higher scores in the dimension of the total quality of life, physical well-being, emotional well-being, self-esteem and self-efficacy levels (Dermici et al., 2017).
Pellicer-Chennoll et al. (2015) conducted a study on physical health and its effects on academic achievement in adolescents. According to Pellicer-Chennoll the topic of the effect of physical health on student performance is widely studied, and researchers attempt to establish a relationship among different variables. In the study, 460 students participated in the longitudinal study of four years. Different measures were used to evaluate the student level of physical activity such as BMI and other reports. The study concluded that students engaging in higher levels of physical activity had lower BMI and higher academic performance in comparison to students with low engagement in physical activities. The longitudinal study evaluated the evolution of students in 4 years, and it found out that approximately 25% of students clustered in the adverse profile (poor performance) moved to the positive profile as they engaged in more physical activities. A number of studies concluded that a healthy lifestyle with regular engagement in physical activity and proper nutrition has improved mental and academic performance of a student. Some studies show that physical activity significantly improves performance in Mathematics, while others state that it improves performance in language and social sciences. Mathematics or numeracy studies have the highest correlation with physical fitness (Pellicer-Chenoll et al., 2015). Schools should encourage healthy habits among students to improve their physical and mental health, as well as the academic performance.
Summary
Many studies on the issue have demonstrated the role of schools in promoting student health. According to the CDC (2018), children spend more time in school than in other places apart from home; thus, schools should consider their implications for student health. Schools have many roles to play in promoting student health, starting with health education. Through health education, students learn about healthy and unhealthy habits. Students are educated about certain foods that are not healthy, and habits such as smoking are harmful to the health.
Health education is a small aspect of the role of the school in promoting student health. Schools have to do more through changes in policies, activities, and the environment to promote health. With the increasing cases of obesity and chronic conditions among young school children, schools have to change their approaches to student nutrition and physical activity. Student nutrition and physical activities can prevent many illnesses such as asthma, type 2 diabetes, high blood pressure, arthritis among other conditions (Bonnell et al., 2014) . Obesity also has adverse psychological problems such as anxiety and depression. Poor student health is also associated with low self-esteem and lower quality of life, and they all have adverse effects on academic achievement.
Many studies have explored the different school intervention programs created to improve student health. Most intervention programs focus on student nutrition, physical activities, and school environment as the three factors are crucial for student health. For example, the study by Fairclough et al. (2013) concluded that the CHANGE intervention program had positive effects on student weight circumference and BMI. The CHANGE intervention program took place for 20 weeks, and it had positive changes in the health of the participants. The CHANGE initiative focused on physical activity where students engaged in more physical activity as per the World Health Organization recommendations.
School-based intervention programs have a higher chance of success in comparison to community intervention programs. A school is the best setting for introducing changes to diet and engagement in physical activities because schools have the infrastructure for physical activities, staff, facilities, and policies to facilitate healthy changes. Schools already have meal programs in place, and physical education in place, and they can make small adjustments to the program to promote healthy living. Additionally, schools bring together many students, and it is possible to address the childhood obesity problem and other pressing conditions through school intervention plans. Notably, school-based plans have higher chances of success when families are involved. When family/community is involved in health programs, they complement the efforts of the schools by encouraging healthy habits among students after school.
Call to Action
Student health has direct effects on many aspects of student lives, including academic performance. According to Olson (2016), schools can do a better job of providing healthy food, healthy environment and educating students on healthy choices, but they fail to do so for various reasons. Olson (2016) notes that one of the reasons is lack of parental involvement. Most parents feel that schools could improve student nutrition, but they do not make demands because it will require them to be involved more in school activities. Parents, schools, and the community should engage on how to improve the student nutrition. Parents should not be afraid to go to schools with suggestions on how to make school meals healthier. They should also be ready to play an active role in promoting healthy eating in school and the community.
Schools, health agencies, education boards, parents, community and other vested stakeholders should come together to promote student health. Evidence shows that small changes in dietary habits, physical activities engagement and school environment can lead to positive health outcomes (Langford et al., 2015). Consequently, students and schools will experience improved academic performance, education behavior, cognitive skills, and attitudes. Students spend most of their time in school, making school an ideal setting for teaching and implementing a healthy model. Schools should evaluate the health needs of the students to identify the best way to proceed in the creation and implementation of a health model. Creating a healthy school requires the participation of educational and public health agencies, school districts, parents, communities, and students (Langford et al, 2015) . Schools can rely on already established models such as CDC Healthy School model or use the models to develop specific models that address the unique health needs of the institutions.
Steps for Improving the Situation
Schools have the potential to improve acquisition of lifelong healthy eating and engagement in physical activities among students. School efforts to promote student health should be in a coordinated school health framework made up of well planned, sequential and school-affiliated strategies designed to improve the health of students. A coordinated school health framework brings together families and other vested stakeholders to collaborate to improve the health of students successfully.
The first step in the creation of a health program is identifying the health needs of the students. Schools have student files entailing their health information, the problems they face including environmental factors that contribute to the health problems. The health needs will clarify the health problems and enable the school to develop goals for the health program. The socio-economic environment can determine the student health needs. For example, students from wealthy neighborhoods/schools will have different needs from students from low-income neighborhoods. The culture also plays a role in the student/family eating habits.
After identifying the health needs, the next step is identification of the fundamental characteristics of the school health program. The school has to specify if the program will focus on physical education and activity only, or if the program will involve nutritional services or both. Implementing a dietary and physical activity program can be challenging as it requires more resources, personnel and more changes into already established processes. Other notable characteristics include whether the program will be applicable to the entire school, a classroom or a small group of students. A school can start with a pilot program involving one grade or a small group of students to test the viability of the program and to identify what it takes to implement the program.
Next, the school must identify individuals that will be responsible for coordinating and delivering the school health program. There should be a committee responsible for implementing the program to enhance coordination and to hold everyone responsible. There should be collaboration among staff members, parents, outside agencies and even with students if the school intends to achieve the goals of the health program. Coordination of activities improves the implementation of policies, effective utilization of resources and it minimizes duplication of program initiatives. A school health coordinator will be in charge of the program. The coordinator will be responsible for communication and enhance teamwork among staff, student, parents and other stakeholders. The coordinator will also coordinate the evaluation of policies and practices
The implementation of health policies is the most challenging part of the program. Getting students to adopt healthy dietary exercises and physical activities is a problem in the beginning. The school should plan and monitor the implementation and seek student support for the program. The program coordinator and committee members should use different ways to motivate students to adopt the new changes. The school can use health education to inform students about the changes and why they are necessary. The school should also monitor the implementation of the program to ensure that the program is going according to plan. Monitoring the program will also enable the school to evaluate whether the program has positive health effects or not. Depending on the results, the school can make changes to the program or keep implementing the program as it is. A health program should not be implemented on a short-term basis; the school should aim to make proper nutrition and physical fitness a part of the school culture.
Lastly, a school health program requires funds; hence, schools must solicit funds from the education and health agencies or nonprofit to implement the program. There are many sources of funds for student health programs including the CDC Whole School Whole Community Whole Child (WSCC) model. World Health Organization’s Healthy School program also supports such initiatives with technical knowledge and funds to guide the implementation process. There are many local nonprofit that support health initiatives and would be willing to support the program. After seeking the funds, the health coordinator plans for the funds by prioritizing activities. The coordinator works with the health committee to ensure proper utilization of the funds.
Conclusion
Student health is an important issue affecting the education system. When students are unhealthy, their education is adversely affected. Student health/ wellness is a simple issue that affects many aspects of student life. Schools should take an active role in improving student health through wellness programs aimed at addressing hunger, poor eating habits, and physical inactivity among other health needs. School intervention programs have a high chance of success in comparison to community intervention because schools have infrastructure, personnel, resources, and policies to encourage adoption of healthy habits. School programs should involve parents and other stakeholders to maximize the positive effects of the program. School health programs should be well planned and coordinated if the school wants to achieve the goals of the program. Poorly implemented programs do not produce permanent changes. Additionally, schools must realize that student health programs go beyond healthy meals and physical activities. Schools should create a healthy environment for indoor air quality, safety measures, and overall student wellness. Schools should help students by providing necessary health services such as wellness checks by working in partnership with health providers and nonprofit. By taking a proactive role in student health, schools protect children from dangerous health issues while overall student quality of life and academic performance.
References
About CDC Healthy Schools. (2018). In Centers for Disease Control and Prevention website.
Retrieved from: https://www.cdc.gov/healthyschools/about.htm
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