History and Background: Student Health

Although in the earliest days of public school, attending school itself was considered a way to improve students’ health, the true era of school health started around 1850. At that point, the Sanitary Commission of Massachusetts released a report indicating that school should be used to prevent the spread of disease and promote public health.

Navigating such periods as the smallpox and tuberculosis pandemics, schools began to develop more robust health centers, and in the early Twentieth Century, schools began to teach students about the effects of tobacco, narcotics and alcohol, while also increasing focus on physical education. By 1911, 102 cities had school nurses on staff in public schools, and that number continued to grow.

School Nurses

School nurses are often the gateway to health care for students. They help manage and identify students’ chronic health conditions and connect families with health services and health insurance plans such as Medicaid or state plans. One in four children have a chronic health condition, according to the CDC, and school health comes into greater focus with the outbreak of COVID-19. Nurses are needed in buildings to assess students’ symptoms and determine who should be sent home or tested for coronavirus — and yet 25% of schools don’t have a nurse.

• The American Academy of Pediatrics and CDC recommend one school nurse per every 750 students in a normal school setting. But many schools, especially those in poor urban areas, far exceed that recommended ratio. Many districts say they can’t afford to hire enough nurses to meet the recommendations. (Nurses are primarily funded through local education dollars.)
• During the COVID-19 outbreak, the National Association of School Nurses (NASN) is asking Congress to fund an additional 10,000 school nurses. Even with that increase, NASN said there would still be a national shortage of 20,000 school nurses.
• NASN and the American Association of Pediatrics advocate that all schools should have full-time nurses. Schools with a smaller nurse-to-student ratio often see lower absenteeism and higher graduation rates, and school nurses are vital in helping students with chronic health conditions manage their illnesses, according to the CDC.

College Health Issues

On many college campuses, the student health center has become the main place that students access both mental and overall health care.

Students on college campuses report mental health issues including anxiety, depression and stress as top problems. The numbers appear to be on the increase as a result of the coronavirus pandemic, according to at least one study undertaken from May to July 2020. Some of those stresses may be caused by housing and food insecurity, which continue to be major issues for college students. While binge drinking is reported to be down among teens, it is still a major concern on campuses.

• Fifty-six percent of students reported feeling hopeless in the past 12 months, 45% reported feeling depressed and nearly 66% reported feeling overwhelming anxiety in the spring 2019 American College Health Association’s National College Health Assessment. Nearly a quarter of students using campus counseling centers in the 2018-19 school year were taking prescribed psychiatric medications, according to a survey from the Association for University and College Counseling Center Directors.
• Anxiety and depression were the most common concerns among 207,818 students being treated at 163 college and university counseling centers in 2019, The Center for Collegiate Mental Health at Penn State University reported. The average reported rates of those conditions increased over the previous eight years. The center also said nearly 40 percent of students being treated reported some suicidal ideation within the past two weeks.
• Binge drinking is most common among the age groups 18-24 and 25-34, with about 25% of individuals in each age category, according to the CDC. That compares to about 17% of high school students. Binge drinking can lead to serious problems, including alcohol poisoning, car accidents, sexual assault and suicide. Nearly 55% of college students ages 18-22 reported drinking alcohol in the previous month, according to 2018 data, with more than one in three saying they engaged in binge drinking.
• While national statistics on food and housing insecurity don’t exist, surveys and reports by advocacy groups attempt to quantify the problem. Thirty-nine percent of students reported food insecurity in the previous 30 days and 46% reported housing insecurity in the past year, with 17% reporting they were homeless in the previous year, according to the #RealCollege 2020 survey, which included students from 171 four-year institutions and 56 two-year colleges. Thirty percent of college students are food insecure, and 75% percent of students who are food insecure receive financial aid, according to the College & University Food Bank Alliance.

Future Coverage Will Be Imperative

As with the overall educational landscape, the COVID-19 pandemic, which began to affect the U.S. in early 2020, will continue to impact health services throughout the entire educational system. Not only were students affected by the virus itself, the impact of having sick family members and the lack of education, but those students who relied on school-based health services as their primary sources of health care will need to catch up once they are back in school.