Tag: health education

How School-Based Health Centers Can Help Save Our Kids

Thanks to my elementary school nurse, I finished school on time. That’s right: In the 5th grade, I strained during a school vision test to read the little letters I saw projected on a screen 10 feet away. Asking in bewilderment if I wanted to try again, the screener asked, “How have you even been seeing the chalkboard?” Off to the nurse I went to get my prescription recorded for her records, and glasses were ordered that day.

In the context of today’s school health services, my experience seems paradisal. That’s because today, public school health services are conspicuously absent. As a youngster, I never gave much thought to how the presence of that nurse or vision screener and her assessment impacted my uninterrupted performance in school. Given that we know academic success and wellbeing are inextricably linked, the low number of school-based health centers and staff is particularly troubling. Increasing the number of centers with fully staffed health professionals—nurses and school psychologists in particular—can greatly improve child health as well as academic performance.

The Affordable Care Act appropriated $200 million for the explicit purpose of building and expanding school health centers, a number that still seems low considering that only 45 percent of public schools have a full-time nurse, and 30 percent can only count on a nurse part time. A quarter of public schools have no nurse at all. A mere 12 states have met the Department of Health and Human Service’s desired ratio of one nurse for every 750 students.

The cost of a school nurse—the average salary hovers around $43,000 a year—and of equipping a center with supplies varies from state to state, and even county to county. If the ACA money were used solely on nurses, it would only allow 4,651 nurses to enter the field. After covering the staffing of public schools in New York City, Los Angeles, and Chicago we would be left with funding for a little over 1,000 full salaries—without even beginning to consider the cost of dedicating and maintaining a physical space in a school and procuring supplies.

Historically, school-based health centers have done everything from dispensing Band-Aids and cleaning cuts to providing immunizations, dispensing medications, and coming to the aid of children suffering from seizures. These centers have also offered preventive care and treatment for children who may not otherwise have access to health insurance. They can have a significant impact on what is known as the “achievement gap,” the major race and socioeconomic disparities in academic success that begin to emerge as early as elementary school, by working to address the health issues that have the greatest impact on a child’s performance in school.

An emerging body of research points to the ways in which these disparities could be drastically reduced, and preventive care restored, with the return of robust care being offered in house at our public schools.

The Journal of School Health devoted an entire issue to research by Charles Basch, Ph.D., of Teachers College, Columbia University, that highlights health issues with historically high socioeconomic, racial, and urban health disparities, how they contribute to poorer academic outcomes for minority youth, and how school-based health care can mitigate them. Children of color currently make up 85 percent of New York City’s public school system, one of the most racially segregated in the nation, and Basch’s research outlines seven health problems that can be easily addressed by a school nurse within these segregated environments and help reduce the disparities.

The least contentious health issues addressed are asthma, vision and nutrition. The prevalence of asthma among black children in the United States is 12.8 percent versus 8.8 percent for white children, and the annual estimate of asthma attacks among black children is 8.4 percent compared to 5.8 percent among white youth. Poorly controlled asthma can impact cognition and plays a significant role in absenteeism; the overuse of emergency departments and underuse of effective medications among minority youth are a good measure of how the affliction is having greater negative consequences for children of color.

As someone who needed glasses fairly young, it’s unsurprising that more than a fifth of youth have vision problems. A national sample of nearly 50,000 children showed those from low-income families were less likely to have vision diagnoses than high-income children. Once diagnosed, black children have less intensive and sparser care than whites. And everyone knows that breakfast is the most important meal of the day, but one study showed that among 9-year-old girls over a three-day period, 77 percent of white children had breakfast every day while only 57 percent of black children did. Of children qualifying for reduced or free lunch in their public schools, less than half participated in schools’ free breakfast programs for which they were eligible. Nutrition influences brain activity, which results in significant impacts on children’s learning and cognition.

There are uncomplicated solutions to these problems. Asthma screenings are quick, and medicines are immediately effective. Dealing with symptoms and management of asthma at school can decrease both absences and severe attacks. Vision screening is widespread in schools, but the coordination of follow-up care by a school health professional is essential for children in need of eye-care interventions and is the biggest culprit behind current disparities. Participation in universal school-breakfast programs has shown reductions in absences, and allowing children to eat breakfast in their classrooms as opposed to the cafeteria has resulted in increases in the programs. School-based health centers can oversee the distribution of healthy meals for children in need of these programs, with the added perk of highlighting which students may benefit from other school-health services.

Attention deficit and attention deficit hyperactivity disorders (ADD and ADHD) have received much attention in recent years. ADD/HD affects sensory perception, absenteeism, cognition, and even organizational and planning skills. Urban youth of color are more likely to be affected by and less likely to receive a correct diagnosis and effective medication. Screenings by school psychologists and learning specialists can aid in the diagnosis of ADD and ADHD and the accessing of medications, as well as help students with effective behavioral modifications. School nurses are in a position to manage the medications by dispensing them to students at school if necessary, and ensuring that the timing and dosage are accurate.

Most contentious of the issues tackled by Basch in his call to arms is teen pregnancy. Among 15- to 17-year old girls, the pregnancy rate among blacks is more than three times higher than whites, and the rate among Hispanic teens is more than four times as high. Teen mothers on average have two fewer years of schooling. They are 10-12 percent less likely to finish high school, and have 14-29 percent lower odds of attending college. The implementation of evidence-based, comprehensive sex education is the best way to reduce the teen pregnancy disparity. This requires the overhaul of the popular abstinence-only education programs, which have been shown to leave students ill-equipped to make the healthiest decisions. Given the fraught political environment, comprehensive sex education is not widespread, and school nurses can be an essential resource for students beginning to engage in sexual activity. From dispensing condoms to connecting students to community resources for treatment who may disclose concerns about both pregnancy and sexually transmitted infections, and being the person on campus who can answer questions privately about reproductive health, nurses can address issues that are not part of classroom learning.

There are signs of hope, as Basch was asked by Secretary of Education Arne Duncan to outline national health strategies in schools, but the now well-known public funding cuts to both healthcare and education continue to threaten the health status and educational attainment of youth in America’s public schools.

The disparities can be shocking. But these specific health issues are fairly straightforward, do not require specialists, and can be tackled easily within a school environment by nurses, resulting in the improvement of both kids’ public health and academic achievement—as long as they are given the finances and support to do so. As a front line of defense against immediate health emergencies and the prevention and maintenance of chronic diseases that develop in elementary school years, ensuring the presence of fully staffed, funded, and stable school-based health centers is essential—most especially for our children already victim to a shameful lack of resources.

 

Originally published at The 2×2 Project

The Conundrum of Caving to the Food Industry in the Battle Against Obesity

I just wanted to bring your attention to an excellent piece by Kelly Brownell of the Rudd Center for Food Policy and Obesity at Yale, in which she addresses the perilous slippery slope of appeasing the food industry and how that specifically impacts our fight against obesity.

He points out that all the research of calories in versus calories out, increasing exercise, cutting sodium, sugar, and fat, the problems with cutting physical activity from the daily routine of children, the abundant prevalence of fast food, and the cost of healthy, organic alternatives has been well and good – but that we are purposely avoiding and not addressing one of the biggest challenges in combating the increasing waistlines in America. The total avoidance of tackling head-on the way food is marketed, made, sold, and how quickly even healthcare organizations in need of a little extra cash may take a sponsorship or donation from a group directly contributing to many of the health issues that organization is tackling.

I know we live in a capitalist society. I know that the element most prized in this economic system is a competitive market and that supporters think private enterprise should be able to do whatever it likes in terms marketing and aggressive behavior towards consumers and that the individual is supposed to be able to make an independent choice. I also think that’s ridiculous. To assume that someone’s behavior is not influenced by the massive inundation of public messages, no matter how smart they are, disproves years of communication and sociological research. I always find it amusing when major corporations or businesses decry critics who say that advertising is harmful and misleading, when in fact most corporations and businesses are counting exactly on that – that the constant (and often subliminal, or in the least, very sly) messages they’re strategically slinging at us all the time are working their magic and ensuring that people will take the bait. As a critic of many advertising practices, a supporter of progressive paternalism (known to those on the opposite side of the aisle as a nanny state), and someone who has worked with people trying to change a range if disordered eating behaviors and poor nutrition habits, I found her piece particularly compelling and in agreement with her claim that the food industry has had plenty of time to prove itself trustworthy.

I think this line really sums it up: “When the history of the world’s attempt to address obesity is written, the greatest failure may be collaboration with and appeasement of the food industry. I expect history will look back with dismay on the celebration of baby steps industry takes (such as public–private partnerships with health organizations, “healthy eating” campaigns, and corporate social responsibility initiatives) while it fights viciously against meaningful change (such as limits on marketing, taxes on products such as sugared beverages, and regulation of nutritional labeling).”

Check it out.

Why Doctors Think mHealth Will Cut Down on Doctor’s Visits

This is a great infographic, courtesy of Mashable, that details the vareity of ways mobile health improves patient outcomes and an individual’s ability to manage their preventitive behavior on their own. It’s a pretty robust outline:

Looking for More Attention? Drop Some lbs.

At least that’s what Skinny Water is promising in their latest advertisement, which I spotted yesterday. The ad shows a woman facing a throng of cameramen snapping her picture, elegant earrings dropping to the top of the headline which says: “Skinny Always Gets the Attention.” Take a look:

Thinspiration, thanks to Skinny Water

A close-up, to see all the text:

Close-up, for good measure.

Below the headline and photo of the various flavors, it also says “Zero calories, Zeor sugar, Zero Carbs, Zero Guilt.” With all that’s not in this water, you might wonder what it does offer. The website tells me that depending on the flavor of water, they’ve added vitamins B3, B5, B6, B12, C, A, and E. They’ve also thrown in magnesium, folic acid, calcium and/or potassium.

Despite trying to market itself as healthy, Skinny Water is instead perpetrating the cultural message that the best – nay, only – way to ensure that you get attention is by being skinny. This of course positions them well to try to push their product on those women who have been pulled into this lie. This ad tells us that the best way to skinny is not through healthy food choices and exercise and an understanding of what “skinny” means for our particular body type and shape, but essentially through fasting – which is what zero calorie drinks are the equivalent of.

In fact, Skinny Water is doing precisely the opposite of what a health-conscious company and product should be doing. Promoting the idea that those who are skinny deserve attention more than those who are not creates communities that support harmful diet-related behaviors and disordered eating for the goal of a wispy appearance . Not to mention reinforcing the ever-present undercurrent of disapproval of those who are overweight – or even normal weight! – and do not bow to the hierarchy of beauty that says those who are thin are the best. It’s just one more item in the laundry list of products that tell women their size and appearance are what is most important and will attract loyal friends and fans.

In defiance of that, let’s use our brains to remind ourselves why Skinny Water is wrong. While the website details the added vitamins and dietary minerals of each drink, it’s far better to get your needed supplements through a healthy diet rich in cruciferous  and dark and leafy vegetables, fruits, whole grain and lean proteins. Washed down, in fact, by regular old water that keeps you hydrated and helps your body process and absorb nutrients. Skinny Water is telling its buyers that by adding these vitamins and minerals to their product, one can cut out food entirely and survive on a calorie-free but vitamin-rich manipulated water diet. Don’t be fooled! (I know you aren’t. Hopefully, you’re equally horrified.) For example, the“Power,” “Sport” and “Fit” drinks are all fortified with calcium, magnesium, and potassium – to help activate metabolic enzymes, keep your blood regulated, and support strong bones and teeth. Do you know what else can do that?  Bananas, yogurt, kale, almonds and cashews, and quinoa. Frankly, there seems to be little difference between the “Power,” “Sport” and “Fit” drinks despite the claim that they each support different “goals” of the drinker – which lends support to the conclusion that these are madly marketed products that don’t substitute a healthy, well-rounded diet and instead are capitalizing on the now-entrenched notion that women care more about being skinny than anything else.

Summer’s Eve has Bad Marketing. And the Product is Terrible for You.

In light of all the on-point criticism of the ridiculous feminine hygiene ads and how they portray a woman’s relationship with her reproductive organs, I think we should point out a couple things.

First, douching is actually not good for you – it disrupts the balance of good versus not so good bacteria, which maintains a certain acidity level and in turn is key to a healthy vagina. Douching can destroy this careful equilibrium, causing an over-growth of the bad bacteria. This can lead to yeast infections and bacterial vaginosis; both of which are uncomfortable and cause symptoms that are more disruptive than the non-existent issues one thought they were getting rid of in the first place. More dangerously, douching can actually force unhealthy bacteria up into the uterus and ovaries, which if untreated can lead to Pelvic Inflammatory Disease (PID). This, more disturbingly, can cause infertility issues. While this may be rare, why risk the possibility by doing something that is unnecessary at best, but very damaging at worst?

The Summer’s Eve website has an “education” section, which does point out that some regular discharge is normal and offers some good snippets about the importance of wearing 100% cotton underwear. However, in their advice about yeast infections, they include “don’t sit around in a wet bathing suit,” “eat berries and yogurt often,” “don’t wear tight-fitting, non-breathable clothes,” and “eat less sugar,” concluding the list with “use pH-balanced washes formulated for the vaginal area.” Up to that last point, the list was fairly on target. In fact, the list I’ve gotten from my gyno every year has read very much the same with the exception of that last line. In fact, their advice has always been along the lines of: “do not use washes formulated for the vaginal area, even if they say they are pH-balanced, because your body balances that pH like a pro on its own.”

Summer’s Eve says their products have been dermatologist and gynecologist tested – I would be interested in what that test entailed, but also would be remiss to not point out that “tested” does not in any way necessarily equate with “approved.” I can test drive a Mercedes and it tells you nothing about what I think of it (I’d like one). Look, the American College of Obstetricians and Gynecologists as a body of physicians do not recommend douching. I am more inclined to trust them than a Summer’s Eve label.

Interestingly, the site does admit that the vagina is like a “self-cleaning oven.” This begs the question – why do I need this?

Women and their reproductive organs have thrived for thousands of years. Those reproductive organs have done a remarkably efficient job of cleaning themselves all those years without the “help” of douching projects. It doesn’t take a genius to deduce that these people are trying to tell women that their vagina is supposed to smell like a Laura Ashley store. It’s not. It should look and smell the way it has for centuries. Vaginas have spawned babies for generations without the help of branding and perfume, and it seems the marketing efforts could be better spent educating men and women that the vagina isn’t supposed to be the fertile ground of daisy chain making and delicate blossoms.

Your vagina is the foundation of your holistic health as a woman. Summer’s Eve is a masking product, not a health product.

Bottom line – if something seems off down there, swabbing it to make it smell like a bouquet is not the right course of action. Seeing your gynecologist is.