Students who miss 10 percent or more of school days in a year are at greater risk of dropout and a host of other negative academic outcomes. During the 2020-2021 school year, in the midst of the COVID-19 pandemic, more than 10 million students were chronically absent, a sharp increase over prior years. Prior to the pandemic, Black and American Indian children (as well as Pacific Islander children) experienced higher rates of chronic absenteeism than their peers. School districts with strong racial and income segregation comprise one quarter of high-absence districts.

Illness is the first and foremost reason for why students miss school, and patterns of disparity in school absence mirror broader racial inequities in health systems (e.g., disparate environmental exposure, disparities in health insurance, disparities in access to pediatricians) and education systems (e.g., disparate use of exclusionary discipline). They also mirror disparities in the health and related challenges that drive chronic absenteeism, including asthma, oral health, behavioral health, food insecurity, acute illness, and poor housing conditions.

Healthy schools connect school environments to broader community efforts to attend to students’ physical health and thereby support efforts to decrease disparities in chronic absenteeism. Education leaders should consider the following strategies to create healthy schools that foster consistent attendance:

• Establish school Medicaid programs and foster Medicaid enrollment.
• Increase access to preventative health services.
• Establish school-based health centers and community schools programs.
• Support healthy nutrition and physical activity.

Students’ experiences of school safety differ widely by race and ethnicity. As of 2019, Black high school students experienced physical fights on school property at greater rates than high school students overall (16% vs. 8%, respectively). More than one third of adolescents who identify as being of two or more races reported being bullied at school—substantially higher than other racial or ethnic groups.

Students of color are more likely to attend schools managed through punitive discipline strategies, rather than those that use supportive approaches. As of 2018, the average public school punished Black students (7.8%) with out-of-school suspensions more than twice as often as White students (3.6%). High schools serving a majority Black student population are more likely to have school-based security or police—and more likely to have more security staff than mental health providers—than high schools that serve majority White populations. Schools with a higher proportion of children of color are more likely to use intensive security and surveillance approaches, including school resource officers, metal detectors, and random sweeps for drugs and weapons. Such measures are linked with increased fear and a reduced sense of school safety, particularly for Black students.

Healthy schools prioritize students’ social, emotional, and behavioral needs and foster stronger interpersonal relationships within the school—actions that are key to addressing inequities in discipline and school culture. To create healthy schools that reduce reliance on punitive and exclusionary discipline, education leaders should consider alternative strategies focused on addressing the root causes of behavior and restoring the overall school climate, including:

• Adopting restorative justice processes designed to address and restore relationships harmed as a result of student misbehavior
• Implementing equity-focused Positive Behavior Interventions and Supports that use a multi-tiered approach to provide interventions to the whole school, targeted groups, and individuals based on need
• Providing teacher interventions designed to help educators build stronger relationships with students

Students of color with disabilities face a range of education inequities and many experience education segregation that limits their access to rigorous academic content. Schools currently identify Black children and American Indian/Alaska Native children with disabilities at disproportionately higher rates than their peers: Black students (ages 5 to 21) are 40 percent more likely than all other racial and ethnic groups to be identified with a disability, while American Indian/Alaska Native students are 60 percent more likely. While these disparities run higher for specific disability categories, including emotional disturbance and intellectual disability, Black and American Indian/Alaska Native infants and toddlers are actually underrepresented in early intervention programs for infants and toddlers. While these racial and ethnic groups are generally more likely to receive special education services, they still experience far higher rates of out-of-school suspension and far lower rates of basic achievement in reading than their White peers and their peers without disabilities across racial and ethnic groups.

Healthy schools have robust capacity to provide school-based health supports and strong community partnerships with early childhood and health providers. Such partnerships allow for identification of developmental delays in early childhood and the ability to provide robust health supports for students with disabilities as part of their individualized education programs. To create healthy schools that prioritize early identification of disabilities, particularly for children of color, education leaders should:

• Prioritize partnerships between community providers, early childhood education, and the K-12 system.
• Establish school-based health systems that include early screening and intervention programs.
• Provide behavioral supports for students to address misbehavior rather than administer punitive discipline.

Clean drinking water, proper heating and cooling, good air quality and ventilation, and adequate lighting are all associated with a number of positive outcomes on student health, thinking, and performance. However, according to the Government Accountability Office, approximately 54 percent of schools need to update or repair multiple building systems. Further, school quality is linked with the percentage of students of color and students experiencing poverty in the school: Lower-quality schools are associated with higher percentages of Black, Hispanic, Asian, Native Hawaiian/Pacific Islander, and American Indian/Alaska Native students; and with higher percentages of students of two or more races and students eligible for reduced-price meals. Such students are also more likely to attend schools without facility improvement plans, with poorly ventilated and temperature-controlled buildings and classrooms, and with inadequate outdoor facilities.

School districts rely heavily on local funding (e.g., property taxes) to assist with facility repairs and building improvement projects—a funding strategy with deeply intertwined with historic segregation and racism. This approach presents barriers for schools in high-poverty communities that lack adequate funding. Because approximately three quarters of all Hispanic and Black youth in the United States attend schools in low-income communities, it also maintains a racial inequity within education systems.

Healthy schools maintain safe and clean environments free of environmental health hazards. To create such schools for all students, education leaders should:

• Seek state and federal financing options that can sustainably and equitably support school infrastructure and maintenance.
• Renovate existing infrastructure and ensure students have the equipment and space needed for physical activity and nutritious meals.

Students benefit from having a diverse, well-prepared teacher workforce—more specifically, they are more likely to thrive when they learn from and interact with teachers who reflect the diversity of the world around them. Having teachers of color promotes a range of benefits for all students, but particularly for students of color. Researchers have found a positive effect on reading and math scores when Black students receive instruction from Black teachers. Black teachers are also less likely to employ disciplinary action upon Black students and more likely to serve as mentors to Black students, thereby promoting safe and supportive learning environments. However, the vast majority of teachers in the United States are White. Further, research suggests that teachers of color depart the profession at higher rates than their White counterparts for a variety  of reasons, including feelings that they don’t belong at their school, workplace experiences of racism, and a lack of support from their school.

Healthy schools prioritize the needs of teachers, including teachers of color, to maintain a robust and diverse workforce. To create a healthy school that attracts and retains educators of color, education leaders should:

• Emphasize employee wellness by providing supports and trainings and by reducing demands on their time and attention.
• Create safe, supportive environments that prioritize employee safety in addition to student safety.
• Support educator health needs through connections to community providers and other wellness programs.

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A cautionary note about worsening health and education inequities

This brief has presented suggestions that clearly illustrate how healthy schools can support community efforts to alleviate racial inequities within education systems. However, attempts to create healthy schools without an explicit focus on equity could exacerbate, rather than ameliorate, racial inequity. Below, we provide two recommendations to education leaders to avoid potential pitfalls in their work to build healthier, more equitable schools.

Avoid relying on race-neutral strategies to correct health and education inequities. Multiple examples illustrate how health resources are unfairly distributed. For example, while students of color are often at greater risk of mental health challenges than their White peers, they have less access to mental health supports. With respect to school-based mental health staff, student-to-staff ratios are larger in schools serving mostly students of color than in other schools. Adding supports to schools that already have such resources will not address educational inequities. Racial inequities arise, or endure, due to a number of factors: policies with disparate impacts by race, implicit racial biases, physical segregation at community and school levels, and historical gaps in available resources. Given these underlying causes, increases in the resources available may worsen inequity in the absence of explicit attention to why present resource allocations are inequitable.

Avoid pathologizing and stigmatizing students. Educators and education leaders should be wary of broad attempts to frame typical (disruptive or challenging) student behaviors and experiences as health problems. While research indicates that Black and Hispanic students have greater exposure to adverse childhood experiences, not all children who experience adversity experience trauma. While schools can and should work to provide safer, more supportive environments for children with trauma, schools risk stigmatizing and harming students by screening for childhood adversity.

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Conclusion

Creating healthy schools that specifically support students’ and educators’ health and well-being is a critical step in addressing educational inequities. Reforms to bolster school capacity to provide health services may help reduce disparities in chronic absenteeism, while shifts in school climate and culture may alleviate disparities in school violence and discipline. Students need access to clean, well-maintained learning spaces and a diverse educator workforce, so education leaders must rethink education financing and broaden their conceptions of education wellness.

The National Healthy Schools Collaborative’s 10-Year Roadmap provides education leaders at the federal, state, district, and school levels with concrete strategies to make every school a healthy school. Although many states, districts, and schools have already begun embracing healthy schools, there remain several critical steps to establishing the policy, funding, and other infrastructure needed to further their adoption.

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This report was commissioned by Kaiser Permanente Thriving Schools. The authors thank Kaiser Permanente for their generous support. The views and opinions expressed in this publication are those of the authors. They do not necessarily reflect the opinions or positions of Kaiser Permanente.

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Footnote

[1] Throughout, much of the available data and research on these areas of education inequities do not directly address the experiences of Indigenous students.