The School as a Platform for Addressing Health in Middle Childhood and Adolescence

Health and nutrition programs targeted at school-age children are among the most ubiquitous of all public health programs worldwide. Since the inclusion of school health and nutrition (SHN) in the launch of the call for Education for All (EFA) in , it has been difficult to find a country that is not attempting at some level to provide SHN services (Sarr and others 2017). It is estimated that more than 368 million schoolchildren are provided with school meals every day (World Food Programme 2016), and according to the World Health Organization (WHO) statistics (WHO 2015), 416 million school-age children were dewormed in 2015, which equals 63.2 percent of the target population of children in endemic areas; see chapter 29 in this volume (Ahuja and others 2017). These largely public efforts are variable in quality, and coverage is greatest in the richer countries, but the scale indicates public recognition of the willingness to invest in middle childhood and adolescence. Health status affects cognitive ability, educational attainment, quality of life, and the ability to contribute to society. Some of the most common health conditions of childhood have consequences for education. SHN interventions can support vulnerable children throughout key stages of their development in middle childhood and adolescence. A set of priority school-based interventions, selected on the basis of cost-effectiveness, benefit-cost analysis, and rate of return, is described in chapter 25 in this volume (Fernandes and Aurino 2017). Schools are a cost-effective platform for providing simple, safe, and effective health interventions to school-age children and adolescents (Horton and others 2017). Many of the health conditions that are most prevalent among poor students have important effects on education—causing absenteeism, leading to grade repetition or dropout, and adversely affecting student achievement—and yet are easily preventable or treatable. With gains in enrollment achieved by the Millennium Development Goals, SHN interventions are important cross-sectoral collaborations between Ministries of Health and Education to promote health, cognition, and physical growth across the life course. The education system is particularly well situated to promoting health among children and adolescents in poor communities without effective health systems who otherwise might not receive health interventions. There are typically more schools than health facilities in all income settings, and rural and poor areas are significantly more likely to have schools than health centers. The economies of scale, coupled with the efficiencies of using existing infrastructure and the potential to administer additional interventions through the same delivery mechanism, make SHN interventions particularly cost-effective. As a result, schools can reach an unprecedented number of children and adolescents and play a key role in national development efforts by improving both child health and education. Because schools are at the heart of all communities, we have an opportunity to use the school as a sustainable, scalable option for simple health service delivery. This chapter explores the developmental rationale for improving the health of school-age children and the economic rationale for administering health interventions to school-age children (typically from ages 5 to 14 years) through existing educational systems as compared with the health system. Definitions of age groupings and age-specific terminology used in this volume can be found in chapter 1 (Bundy, de Silva, and others 2017).