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School health is public health: An interview with Richard Meckel

Urban school-based health care is the legacy of a public health crusade that began about 140 years ago, historian Richard Meckel of Brown University writes in his new book. An interview with the author.

School health is public health: An interview with Richard Meckel

The funding crisis in the Philadelphia public schools threatens both the education and the health of city school children. With massive layoffs, including a substantial number of nurses, the public school system now has only one nurse for every 1,500 students.  While many other urban public school systems move towards making schools sites for clinics that can deliver primary care to young people, Philadelphia is turning its back on this opportunity.

Urban school-based health care is the legacy of public health crusade that began about 140 years ago. Historian Richard Meckel of Brown University chronicles its early development in his forthcoming book Classrooms and Clinics: Urban Schools and the Protection and Promotion of Child Health, 1870-1930. (Full disclosure: I coedit the book series in which this volume appears). I interviewed him about how health-care providers became an integral part of urban public education and the benefits they provided to children and communities. School nurses were needed in the past and serve a vital role today.

Janet Golden: How did health care become a part of urban education?

Richard Meckel: It was the product of a school hygiene movement that evolved in four overlapping and cumulative stages. It commenced in the 1870s, when urban public health and medical experts began questioning the health impact of the new mass compulsory education and identified certain “school diseases,” which they connected to schools and schooling.

A second stage began in the 1880s, with rising concern that schools could be incubators of epidemic disease. This led to new policies of surveillance, exclusion and compulsory immunization, and brought nurses and physicians into schools.

In the next stage, beginning around 1900, attention turned to identifying and correcting physical defects as a means of improving academic performance and educational efficiency. States passed legislation requiring urban schools to provide regular medical exams and publicly and privately funded dental, ENT, and eye clinics for schoolchildren were established in many cities. Always too few, and opposed as socialistic and a violation of religious freedom, parental rights, and the sanctity of private practice, the clinics experiment was less effective than it could have been. Thus, by the 1920s, school hygienists began emphasizing prevention through health education over the detection and correction of defect.

Janet Golden: What happened in the years after 1930?

Richard Meckel: Organized health services in urban schools began to contract during the Great Depression and the issue of school health gradually faded from public consciousness. However, there were some government programs that aided general child health programs, most importantly Title V of the Social Security Act of 1935. With the start of World War II and data showing the poor health of draftees, attention returned to health needs of the nation’s youth. Advocates managed to enact the 1946 National School Lunch Act but failed to get legislation to underwrite health care for all children. Children from families who could afford care or who had health insurance received services from private practitioners; children whose families had neither insurance nor funds were channeled into a system of welfare medicine not engaged with schools.

Janet Golden: What is the situation today?

Richard Meckel: In the late 20th century we came full circle as child health advocates rediscovered urban public schools as promising sites for primary care and gave birth to the school-based health center (SBHC) movement. In 1981 SBHCs were made eligible for Maternal and Child Health Block Grant funding and the movement took off. There were fewer than a dozen centers in 1981; today there are an estimated 1,900 to 2,000, mostly in urban school districts but also in poor rural ones. The Affordable Care Act provided $200 million in funding for SBHCs from 2010 to 2013. However, as many urban public school systems and many cities face financial crises it is impossible to predict how much more they can grow.

Janet Golden, a Rutgers University history professor, specializes in the histories of medicine, childhood and women.

Janet Golden, a Rutgers University history professor, specializes in the histories of medicine, childhood and women.
Read more at http://www.philly.com/philly/blogs/public_health/Civil-Rights-movements-often-overlooked-impact-on-health-care.html#dtglMg9xlPFFF9Aa.99 Janet Golden, a Rutgers University history professor, specializes in the histories of medicine, childhood and women.
Read more at http://www.philly.com/philly/blogs/public_health/Civil-Rights-movements-often-overlooked-impact-on-health-care.html#dtglMg9xlPFFF9Aa.99 Janet Golden, a Rutgers University history professor, specializes in the histories of medicine, childhood and women.
Read more at http://www.philly.com/philly/blogs/public_health/Civil-Rights-movements-often-overlooked-impact-on-health-care.html#dtglMg9xlPFFF9Aa.99

Read more about The Public's Health.

Janet Golden, PhD Professor of history, Rutgers University-Camden
About this blog

What is public health — and why does it matter?

Through prevention, education, and intervention, public health practitioners - epidemiologists, health policy experts, municipal workers, environmental health scientists - work to keep us healthy.

It’s not always easy. Michael Yudell, Jonathan Purtle, and other contributors tell you why.

Michael Yudell, PhD, MPH Associate Professor, Drexel University School of Public Health
Jonathan Purtle, DrPH, MPH Research Director, Drexel Center for Nonviolence and Social Justice
Janet Golden, PhD Professor of history, Rutgers University-Camden
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