1. Moore, Justin B. PhD, MS, FACSM
  2. Hill, Stanford R. Jr PhD, MEd
  3. Weaver, R. Glenn PhD, MEd

Article Content

Educational attainment is a key social determinant of health. Attaining any education beyond high school is associated with reductions in morbidity and mortality, with degree attainment associated with greater reductions.1 However, the circumstances that one is born into can rob youth of this opportunity far before the college application process begins. Placing students into "college preparatory" or "general education" tracks and courses begins in elementary school, and the determinants of students' placements are often confounded with race and social class.2 Concurrently, poverty, lack of insurance, and familial disruption directly impact the health of youth, which can compound educational disparities by race and income. Their health impacts their learning just as much as learning impacts health. For example, obesity in youth is negatively associated with academic attainment3 and traditional summer breaks are associated with increased weight gain,4 especially in racial and ethnic minority students.5 This health disparity compounds known academic declines experienced by youth over the summer, which may exacerbate disparities.6 Clearly, solutions are being sought to address these inequities, but the research to date has produced more questions than answers.


In the current issue of the Journal of Public Health Management & Practice, 2 articles review the evidence for potential solutions to the academic disparities. The first examined the impact of expanded in-school instructional time to reduce racial/ethnic educational achievement gaps.7 While some of the results were promising, there existed insufficient evidence to determine the effectiveness of expanded in-school instructional time. The second article in the journal examined the effectiveness of year-round school calendars on academic achievement.8 Similar to the results for expanded instructional time, the results of the review of studies examining year-round school calendars were inconclusive. Clearly, these studies highlight that more research is needed in this area and it can be argued that we need to expand the scope of this research to include other health-related outcomes such as health risk behaviors and outcomes (eg, adiposity) that are known to be associated with structured days9 and adult supervision in the after school hours.10


As can be implied from our recommendations for additional research, we feel that the scope of prior research is too narrow. This myopic focus on singular outcomes is not surprising considering the nature of education of academic researchers, structure of academic institutions, and research funders. We still largely encourage scientists in training to focus on a narrow range of behaviors and outcomes. Departments are often structured around behaviors (eg, exercise science, nutrition), populations (eg, maternal and child health, gerontology), or methodologies (eg, epidemiology, health policy). The federal government separates related outcomes into distinct funding mechanisms housed in different agencies with little coordination so that a grant focused on weight gain, science education, and reading proficiency is often a tough sale to a program officer with a focused portfolio.


However, we see reason for optimism. A renewed focus on team science, interdisciplinary training programs, and more broadly focused centers has made transdisciplinary research more attainable. Funders such as the National Institutes of Health and the National Science Foundation are becoming more comfortable with secondary outcomes that may fall out of their primary focus areas. Of utmost importance, scientists are realizing that addressing the broader social determinants of health is necessary if one is to expect behavior change at the individual level. It is from this perspective that we propose addressing disparities in academic achievement, college attainment, and summer weight gain.


It is our opinion that future research should move from a one-size-fits-all approach to a more personalized preventive approach. For example, programs seeking to address academic and health disparities should target the youth most at risk for tracking into lower-level math classes (for example) and/or declines in academic achievement or gains in adiposity over the summer. The solutions should be tailored to their individual needs, rather than focusing on broad class (eg, qualifying for free/reduced lunch). This requires a degree of needs assessment, but it will allow us to provide daily structure (eg, before/after school programs), educational support (eg, tutoring), instrumental support (eg, transportation), and environmental restructuring (eg, healthy summer programs) on an as-needed basis. Coupled with comprehensive implementation monitoring, impact, and outcome evaluation, these programs can provide the evidence that is currently missing on the most effective ways to eliminate disparities in health and education. However, this will require a degree of paradigm shift, interprofessional education and team building, and willingness by funders to support research on topics that they may view as somewhat tangential but that ultimately form the foundational determinants of health.




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8. Finnie RKC, Peng Y, Hahn RA, et al Examining the effectiveness of year-round school calendars on improving educational attainment outcomes within the context of advancement of health equity: a community guide systematic review [published online ahead of print October 15, 2018]. J Public Health Manag Pract. 2018. doi:10.1097/phh.0000000000000860. [Context Link]


9. Brazendale K, Beets MW, Weaver RG, et al Understanding differences between summer vs. school obesogenic behaviors of children: the structured days hypothesis. Int J Behav Nutr Phys Act. 2017;14(1):100. [Context Link]


10. Moore J, Shores K, Watts C, Yin Z. Rural children's afterschool environment and health behaviors. Am J Health Stud. 2012;27(1):49. Accessed August 20, 2019. [Context Link]