Schools and the Health of Children: Protecting Our Future


Jennie Jacobs Kronenfeld

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  • Front Matter
  • Back Matter
  • Subject Index
  • Dedication

    Dedicated to the memory of Marcia Lynn Whicker, my friend and colleague with whom I wrote many books, analyzed many colleagues, and shared many special times (both good and bad). You are missed.


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    List of Tables

    • TABLE 3.1 Leading Causes of Death by Selected Age Groups of Children 33
    • TABLE 5.1 Application of Dryfoos's Categories to Selected Arizona Projects 63
    • TABLE 5.2 Categorization of Projects by the Strength of the Initial Role of Each Health Partner as Compared to the School Partner in Beginning the Project 64


    Children occupy unique positions in modern American society. On one hand, we idealize children and childhood, viewing it as the most innocent and carefree time of life, a time free from everyday worries about the necessities of life. However, this is not the reality of childhood for a substantial number of American children. Almost one quarter of US children live in poverty, and children are the age group in American society most likely to live in poverty. Also, children under the age of 18 account for most of the loss of dependents being covered through health insurance plans at the workplace. Thus, the topic of this book, the health of children and school health programs, are an important issue in American society.

    In many ways, schools are an underused resource in the lives of children. At a time when two-parent families generally have both adults working most of the day, and the majority of children will spend part of their childhood in a single-parent home, many schools have not acknowledged this change in the lives at home of most children. Most children in the US from ages 5–18 now spend a major part of their days in schools, but many localities still have a limited view of what schools can provide for children. Obviously, they are to provide education. Federally funded food programs have created a societal agreement that schools should provide an opportunity to buy lunch for all children, and the provision of free lunches and breakfast for many poor children. Increasingly, some elementary schools are providing extended care for younger children, to deal with the issue of “latchkey” children who have no adult at home when the child returns from a typical school day. Many schools, however, do not view their roles as dealing with the “whole” child, including whether they have food to eat at home, school supplies, clothing, an adult to help them in the afternoon, and medical care if they need it. This statement is not meant to castigate schools, or caring individual teachers or principals. In fact, we all know that many schools are filled with caring teachers who give lunch money to a child who forgets it, buy supplies for children who seem to have less than others, and bring in gently used clothing and toys from their own children to distribute to certain children in their classes.

    In my own experience as a parent of school-aged children, first in South Carolina and now in Arizona, I have talked to principals who told me about the extra parts of their job. Often, the principal at the end of the day ended up delivering children home because a parent never showed to pick the child up. Sometimes principals allowed a child to stay and work in the library at school until all staff left because they knew the child was fearful of going home to a cold, empty apartment until closer to the time the parent arrived from work.

    These examples of caring, individual teachers and principals can be found across the nation. They are examples of the best models of caring and concern in American society. As a formal system, however, schools often are only able to deal with limited needs of children. Health care in a school setting has ranged from as little as the placement of bandaids and taking of temperatures to better trained nurses who have tried to advocate for the children in their school and call doctors’ offices to try and help children obtain health care.

    This book is about expanded models for schools in the lives of children, especially focused on the health care needs of children. As part of a local foundation's goal to help provide health care services for more children in Arizona, I became the evaluator of a project of school-based health clinics in the state of Arizona. These were not the first of such clinics in the nation, nor even the very first in Arizona (although there were only a few fledgling examples before the project was begun that is described in detail in Chapter 5 of this book). As I worked with these projects and helped them to develop data systems to collect information, as well as conducted interviews with school nursing and educational personnel, I realized that my previous experience in health prevention projects and projects with child injury had provided important background for this project. My research on issues of access to care and health insurance was also important, because one of the advantages of school based clinics for many children and their families is the immediate availability of help and the ability of school nurses to help serve as advocates for the interest of their children.

    For some parents, the health care system is a complicated place, one difficult to access not only due to lack of money and transportation, but due to language limitations and lack of knowledge of health care. Parents have to learn to use the school system (it is required by law that children attend, generally to age 16, and most parents view schools as very important for the chances of children to have a better life as adults). Although some areas have busing to schools, most children in the nation attend elementary schools near their homes and in places where the staff develop some understanding of the needs to their area. This book presents examples of how school-based clinics have worked in one state with several different types of models. These models are presented after a review of child health and school health programs. As a new program to help provide health insurance to some of the working poor (Child Health Insurance Program - [CHIP]) began in many states in 1999, a book that examines the health of children and roles that schools can play in improving the health of children addressed a topic that is especially timely. The topic is also, in some ways, timeless, because the health of children should also be of special concern in a caring society. Children represent the future of any country, and access to health care provides children with an opportunity for a decent start in life.


    I would like to acknowledge the assistance of several groups and people who helped to make this book possible. Without the grant from the Flinn Foundation, I would not have become so involved in the issue of school-based health services. I wish to thank the Flinn Foundation both for helping to stimulate my interest and for providing the funds for the many site visits that I conducted to each of the projects. Special thanks within the Flinn Foundation goes to Myra Millinger, the program officer with whom I worked most closely. She always helped with thoughtful comments while the grant was underway, and she is most knowledgeable about issues of school health and adolescent health in the state of Arizona.

    I would also like to thank my university, Arizona State University, Larry Penley, dean of my College of Business, and Eugene Schneller, the chairperson of my unit, the School of Health Administration and Policy, during the years I was most involved in writing this book, for helping to facilitate the sabbatical that made the completion of the book possible. For detailed support, I am most appreciative to Matthew Brown, my graduate assistant, who was always willing to try and hunt down more references and statistics, whether in the library or over internet.

    I would also like to thank my family for their patience, as I often stated that I needed to go write and not be bothered with other details. My husband, Michael Kronenfeld, has always been supportive and has read outlines of the proposed book and versions of several of the chapters. My sons, Shaun, Jeffrey, and Aaron, though less patient, generally did respect my need for my materials to be left alone (aided during this project by the addition of computers in their bedrooms).

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    About the Author

    Jennie Jacobs Kronenfeld is a Professor in the School of Health Administration and Policy, College of Business, Arizona State University at Tempe. She holds a doctorate (1976) and a master's (1973) in sociology from Brown University and a BA (1971) in sociology and history at the University of North Carolina, Chapel Hill. Before coming to Arizona, she held faculty positions at the University of Alabama in Birmingham and the University of South Carolina. She has published over 80 articles in public health, medicine, and sociology. She has authored or coauthored 12 books, one in 1981 on the social and economic aspects of coronary artery bypass surgery; one in 1984 on the federal role in health policy; one in 1986 on the impact of technology on sex roles and social change; one in 1990 on social policies and privatization issues in the care of the young, the sick, the imprisoned, and the elderly; one in 1993 on controversial issues in health policy, and several relating to career strategies in academe (tenure, ethical concerns, and the job search). Several recent edited books are part of the research annual series of Research in the Sociology of Health Care, for which she has served as the editor or co-editor since 1993. She has held numerous national offices in various professional sociological and health association. She currently teaches courses on health care policy; social, economic, and political factors in health care; and methodological issues in health care research.

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