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Funding our Future: Investing in School-Based Health


Despite the link between health and learning, school districts typically do not have the resources or incentives to address the health conditions that influence academic performance. Although most educators understand that health is a condition of learning, they are often reluctant to reallocate limited education dollars from the classroom to invest in student health, which may have the unintended consequences for academic outcomes. Recognizing the reciprocal relationship between health and education, this dissertation explores strategies for and outcomes of funding for school-based health initiatives in an effort to identify practical opportunities to reduce health and education disparities among current and future generations of US children.

Using cases from around the country, Paper 1 reviews successful strategies that education stakeholders have used to fund school health initiatives that address “educationally-relevant” health disparities. These cases share three common facilitators: 1) a local champion, 2) alignment with district priorities, and 3) nontraditional funding mechanisms, including: “braiding” education dollars; local tax revenue; Medicaid; and cross-sector partnerships.

Paper 2 investigates whether California school districts are investing in Physical Education (PE), which has been cut disproportionately in schools serving predominately low-income students, and what characteristics are associated with those districts that do invest in PE. California, which in 2013 overhauled its school finance formula and now provides additional funding to districts serving more “disadvantaged” students, offers a unique opportunity to examine how school districts serving low-income students prioritize funding for health given more funding and flexibility for how it is spent. Controlling for other district-level characteristics, the paper concludes that districts with high percentages of disadvantaged students had greater odds of investing in PE compared to districts with lower percentages of disadvantaged students.

Paper 3 examines whether PE investments are associated with changes in students’ cardiovascular fitness levels. Controlling for other district-level characteristics, this paper finds that PE investments are associated with modest increases in student fitness levels among districts with fewer than 6,350 students (75th percentile of mean statewide enrollment), while among districts with 6,350 students or more, PE investments are associated with modest decreases in fitness levels. Consistent with prior research, this study also documents persistent and troublesome disparities in fitness levels between students in low- and high-income districts. Finally, the study finds great variability in the cardiovascular fitness data over time, particularly among small districts, which raises important questions regarding the value of the FITNESSGRAM aerobic capacity test to reliably monitor student health outcomes.

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