Chronic Absenteeism Directly Affects Lifetime Learning
Chronic absenteeism—or missing 10 percent or more of school days for any reason, excused or unexcused—detracts from learning and is a proven early warning sign of academic risk and school dropout. Nationwide, a staggering number of children are chronically absent, often at a very young age and often without attracting attention or intervention.
While the causes are multi-fold, one stands out as especially significant: student health.
Students with unmanaged chronic health conditions (such as asthma or diabetes) are more likely to miss class because of the symptoms of their illness or because they are receiving medical treatment during the school day. Students can also be chronically absent because of health issues such as fever, flu, dental pain, vision problems or mental health and anxiety issues.
Compounding the problem is the fact that many students do not have access to healthy school environments.
The crisis of health-related chronic absenteeism is especially poignant as it primarily affects young children in ways that can shape academic outcomes for their entire school career. For example, research shows that children who are chronically absent in both kindergarten and first grade (such as a child who suffers frequent asthma attacks) are much less likely to be reading at grade level by the third grade; and students who are not reading at grade level by the third grade, in turn, are four times more likely to drop out of high school.
Policy change to support student health is a critical step to addressing chronic absenteeism and a key opportunity to make a profound positive impact on children’s lifelong learning and health. It also offers a natural opportunity for collaboration among the health, public health and education sectors.
The Challenge We’re Facing
Our nation now has the highest graduation rates in its history and education leaders—from policymakers at the state and federal level to educators on the ground in schools—are working hard to ensure all students receive a quality education. Yet even the most thoughtful efforts to reduce dropout rates and address the achievement gap are threatened by the problem of chronic absenteeism. Chronic absenteeism isn’t just a matter of truancy or skipping school. In fact, many of these absences are excused and tied directly to health factors.
A snapshot of the current environment shows:
- 5 million to 7.5 million students across the U.S. miss nearly a month of school each year.
- Children who are chronically absent in both kindergarten and first grade are much less likely to be reading at grade level by the third grade; and students who are not reading at grade level by the third grade, in turn, are four times more likely to drop out of high school.
- Rates of chronic illness are highest among students from low-income families, communities of color and those with disabilities.
- Asthma is a leading cause of school absenteeism, accounting for one-third of all days of missed instruction. Children with persistent asthma are more than three times as likely to have 10 or more absences than their peers.
- Children between 5 and 17 years miss nearly two million school days per year nationwide due to dental problems. A full twenty percent of children aged 5 to 11 years have at least one untreated decayed tooth.
Chronic Health Conditions
Students with unmanaged chronic health conditions (such as asthma or diabetes) are more likely to miss class because of the symptoms of their illness or because they are receiving medical treatment during the school day.
The examples of asthma and oral health illustrate the scale of this challenge:
- Asthma. Nearly one in 10 children (9.9 percent) age 4-14 are diagnosed with asthma. Asthma is a leading cause of school absenteeism, accounting for one-third of all days of missed instruction. Children with persistent asthma are more than three times as likely to have 10 or more absences than their peers. Asthma can be exacerbated by factors in the school environment, particularly issues such as mold or harsh cleaning chemicals that have an impact on indoor air quality. Yet it doesn’t have to be this way: Research has shown that creating healthy indoor environments and providing adequate levels of school nursing can all but eliminate the disparity in attendance between students with asthma and their peers.
- Oral health. A full 20 percent of children age 5-11 have at least one untreated decayed tooth. Among school-age children, tooth decay is the most common chronic disease, five times more prevalent than asthma. Children age 5-17 miss nearly two million school days in a single year nationwide due to dental health-related problems. Children with poor oral health status are nearly three times more likely than their counterparts to miss school as a result of dental pain. Tooth decay and dental pain are easily treatable if students have access to dental care; the consequences of leaving such pain untreated are significant not only for children’s lifetime health but also for their education. Schools can take on this issue by partnering with public health and health providers to increase access to dental services.
Of course, the problem of health-related chronic absence goes far beyond these two issues. Research indicates that other common health conditions resulting in missed school include diagnosis of Attention Deficit Hyperactivity Disorder (ADHD), influenza, diabetes, obesity, seizure disorders, mental health and anxiety, and vision problems. Other health-related factors such as food insecurity, housing insecurity and violence in the community also play a significant role.
Access to Healthy School Environments
Compounding the problem is the fact that many students do not have access to healthy school environments.
For example, less than 50 percent of the nation’s students have access to a full-time school nurse or school counselor, and less than 5 percent of the nation’s students have access to health services through a school-based health center. In addition, one in five schools in the United States reports unsatisfactory indoor air quality, a known trigger of asthma attacks. Low-income children are less likely to have access to a healthy school environment. Students in low-income schools are less likely to have recess and high-quality physical education than students in higher income schools. In addition, students in low-income schools are more likely to have no school nurse or have higher ratios of students to nurses than higher-income schools.
Despite the scale of this problem, we must remember that health-related chronic absenteeism is not an inevitable fact of childhood. Keep reading for more on what we’re doing and what you can do.
Reducing Absenteeism by Supporting Healthy Schools
A key piece of addressing health-related chronic absenteeism is ensuring that children are able to attend school in healthy school environments. A healthy school environment includes regular access to school health services (including physical, mental, dental, vision and behavioral services), healthy school food, physical activity, good indoor air in a clean and well-maintained building, access to water and a supportive school climate and culture.
HSC works at the national, state and local levels to ensure that both the health and education sectors understand the connection between chronic absenteeism and student health and have the tools and information necessary to understand and address the health-related causes of chronic absenteeism. HSC also works to ensure policies and programs are in place that support state and local efforts to address chronic absenteeism and bring attention to the important connection between chronic absenteeism and achievement. HSC is currently undertaking several efforts to address chronic absenteeism.
Every Student, Every Day Initiative
In October 2015, the U.S. Department of Education (ED) launched the Every Student, Every Day initiative, which is working to galvanize multi-sector support to catalyze federal, state and local efforts to address chronic absenteeism. The National Collaborative on Education and Health, which HSC co-convenes with Trust for America’s Health, played a key role in informing the development and launch of this initiative. HSC is working with ED and key partners, such as Attendance Works, to support the implementation of the Every Student, Every Day initiative and ensure that health is prioritized within this federal effort.
A key focus of this initiative will also be bringing states and school districts together to develop plans for addressing chronic absenteeism. HSC will play a key role in helping these states and school districts think about the health-related causes of chronic absenteeism and access the tools and resources necessary to support student health and wellness and, in turn, reduce chronic absenteeism.
Implementation of the Every Student Succeeds Act
In December 2015, President Obama signed into law the bipartisan Every Student Succeeds Act of 2015 (ESSA). This is a reauthorization of the Elementary and Secondary Education Act which was last reauthorized in 2001 as the No Child Left Behind Act. The new Every Student Succeeds Act includes several provisions that address chronic absenteeism. For example, ESSA adds chronic absenteeism as a required indicator to school report cards for Title 1 schools (schools with high numbers or high percentages of low-income students). In addition, ESSA allows professional development funding to be used to provide training to school personnel on how to address chronic absenteeism.
HSC is working to ensure these key provisions of ESSA are implemented and that the appropriate guidance and resources are provided to states and school districts to support implementation.
National Collaborative on Education and Health
HSC, in partnership with Trust for America’s Health, co-convenes the National Collaborative on Education and Health which is working to transform the conditions of health in schools across the country. Chronic absenteeism is a key focus of the Collaborative. Through the Collaborative HSC is working to develop guidance for both the health and education sectors that can be used to support efforts to address chronic absenteeism. For example, the Collaborative is working to develop guidance that schools can use to better understand the major student health issues impacting their student population. The Collaborative is also working to support the inclusion of chronic absenteeism data in health and public health data systems, such as Community Health Needs Assessments.
States are uniquely positioned to catalyze efforts to address chronic absenteeism and can play a critical role in analyzing the data to determine who missing too much school and why. ESSA presents news opportunities to address chronic absenteeism. We developed the Addressing Chronic Absenteeism through ESSA Implementation supplement that highlights various approaches that stakeholders might use to leverage ESSA to support efforts to address chronic absenteeism.
Mapping the Early Attendance Gap: Charting a Course for Student Success, a report released by Attendance Works and Healthy Schools Campaign, was informed by the efforts of the National Collaborative on Education and Health. The report emphasizes the key role states can play in changing patterns of chronic absenteeism. The report highlights the connection between health and attendance and the power of states to tackle absenteeism by tapping key champions, leveraging data and learning from leaders who have improved attendance despite challenging conditions. For an example of a state plan to address chronic absenteeism, see Oregon’s state plan.
In Illinois, HSC worked with advocates and legislators to pass a bill that establishes an Illinois Attendance Commission. The Commission has been charged with “identifying strategies, mechanisms, and approaches to help parents, educators, principals, superintendents and the State Board of Education address and prevent chronic absenteeism.” HSC currently serves on the Commission, which was launched in late 2015. The Commission represents an important vehicle for advancing efforts to address chronic absenteeism in Illinois.
HSC’s efforts to create healthier school environments in Chicago directly support the connection between healthy students and good attendance. In Chicago, HSC works to ensure that educators understand how student health and wellness impact attendance. Many of the policies and programs HSC supports in Chicago have a proven impact on student attendance, including universal, in-classroom breakfast and increased access to school health services.
What You Can Do
Taking action to address health-related chronic absenteeism can have a powerful impact on students’ academic success and well-being for a lifetime. There is much we can do as a society to address this issue and relieve the lifelong burden it places on young children. Cross-sector collaboration—particularly connecting the education community with the public health community and the medical community—can play a powerful role in mustering the resources to make lasting change.
Chronic Absenteeism and ESSA
ESSA presents an important opportunity to create public accountability around chronic absenteeism and ensure state ESSA plans support a comprehensive approach to address chronic absenteeism. This document highlights various approaches that stakeholders might use to leverage ESSA to support efforts to address chronic absenteeism. Other resources on Chronic Absenteeism, including Addressing the Health-Related Causes of Chronic Absenteeism: A Toolkit for Action can be found in the resources tab.
Toolkit for Action
Healthy Schools Campaign is pleased to release Addressing the Health-Related Causes of Chronic Absenteeism: A Toolkit for Action. This document focuses on preparing educators—particularly school district decision-makers—with knowledge and practical guidance for creating meaningful change to address health-related chronic absenteeism.
Access the toolkit below.
Addressing the Health-Related Causes of Chronic Absenteeism: A Toolkit for Action
This document provides a summary of the issues and a preview of the full toolkit, with links to each section for more detail. It’s useful as a starting point or to print and share with others.
Background: Chronic Absenteeism + Student Health
This section focuses on the foundation of knowledge for understanding and acting to address health-related chronic absenteeism, including:
- What Is Chronic Absenteeism?
- What Causes Chronic Absenteeism?
- What Is the Impact of Chronic Absenteeism?
- What Health Conditions Contribute to Chronic Absenteeism?
- Who Is Most Affected by Health-Related Chronic Absenteeism?
- What Is the Impact of the School Environment?
Taking Action: Understanding Student Health Needs
This section focuses on identifying key issues in your community and tailoring your strategy to address the factors that are having the biggest impact on student attendance. This includes:
- Identifying Health Issues in Your Community
- Key Data Sources
- Case Study: Unique Partnership to Ensure Students Have Access to School Health Services
Taking Action: Addressing the Health-Related Reasons Students Are Absent
This section focuses on case studies, best practices and proven school-based interventions to address the health conditions shown to have an especially significant impact on chronic absenteeism:
- Oral Health
- Behavioral Health
- Food Insecurity
- Acute Illness
Taking Action: Building Effective Partnerships to Support Student Health
This section focuses on connecting with partners in the health and public health sectors that are well-positioned to support schools in addressing the health-related causes of chronic absenteeism. This includes:
- Who Are Key Partners in the Health and Public Health Sectors?
- Why Is the Health Sector Motivated to Address Chronic Absenteeism?
- What Are Key Opportunities for Collaboration?
- Case Study: Cross-Sector Collaboration to Address Chronic Absenteeism
Taking Action: Building Capacity
This section focuses on building the capacity of the school and key partners to effectively address chronic absenteeism. This includes:
- Key Partners and Resources
- Ensuring Sustainability
- Supportive Policy
Special thanks to members of the National Collaborative on Education and Health Working Group on Chronic Absenteeism for their work that created the foundation for this toolkit, to Trust for America’s Health for their partnership in convening the National Collaborative on Education and Health and to Attendance Works for their thoughtful review and for their leadership and vision on the issue of chronic absenteeism.
We invite you to learn more and lend your voice to the dialogue about this issue. For questions or to discuss this issue, please contact Alex Mays, National Program Director.
We encourage you to:
- Check out our Resource Center
- Sign up to receive our newsletters
- Connect with us on Facebook and follow us on Twitter @healthyschools
Make a Donation
As a nonprofit organization, we rely on support from people like you so we can continue to make schools healthier places where all children can learn and thrive. Your gift—large or small—will make a meaningful difference.
Chronic Absenteeism Resources
Access related resources below, or go to our main Resource Center to access resources across all of our program and policy areas.
Addressing Chronic Absenteeism through ESSA Implementation
ESSA presents an important opportunity to create public accountability around chronic absenteeism and ensure state ESSA plans support a comprehensive approach to address chronic absenteeism. This document highlights various approaches that stakeholders might use to leverage ESSA to support efforts to address chronic absenteeism.
Addressing the Health-Related Causes of Chronic Absenteeism
Taking action to address health-related chronic absenteeism can have a powerful impact on students’ academic success and well-being for a lifetime. This document focuses on preparing educators—particularly school district decision-makers —with knowledge and practical guidance for creating meaningful change to address health-related chronic absenteeism.
Oregon: Chronic Absenteeism Statewide Plan
Oregon's statewide plan to address chronic absenteeism takes a strategic multi-sector approach that can provide useful examples for other states. As explained in the plan: "Chronic absenteeism is a complex issue that requires a thoughtful and complex response. Schools and students cannot fix this problem alone. Cross-sector partnerships with local and state health agencies, community based organizations, community and business members, with families must be leveraged to provide essential wrap around support to address the root causes of chronic absenteeism for all students. Creating these partnerships and welcoming school environments can impact absenteeism rates, as well as high school graduation, school discipline, and academic performance. Best and promising practices are most successful when they are systematically applied with knowledge of the local context."
School Attendance, Chronic Health Conditions and Leveraging Data for Improvement: Recommendations for State Education and Health Departments to Address Student Absenteeism
This publication highlights how state education and health departments can help lead the way in reducing absenteeism through a comprehensive approach that is inclusive of addressing chronic health conditions. It describes connections between school attendance and chronic health conditions, discusses challenges and opportunities for data collection and use, and promotes the integration of school health services, specifically nursing, into efforts to improve school attendance. The document provides recommendations for action and features successes within various states and communities.
Healthy and Ready to Learn: Recommendations to the Next Administration
We can create a better future for our children and our nation by improving health in schools. The next President of the United States has the opportunity to support states, school districts and communities in creating the conditions of student health and wellness and giving all children a chance for a healthy, brighter tomorrow. This document outlines Healthy Schools Campaign’s recommendations to the next President for improving health and education for our nation's students.
Letter of Support for Chronic Absenteeism
October 5, 2015 Dear Secretary Duncan, We the undersigned organizations are writing to express our support of the U.S. Department of Education’s national effort to address chronic absenteeism. We commend you for your leadership in increasing awareness of chronic absenteeism as a national problem and we are committed to working with you to support efforts to eliminate chronic absenteeism in our nation’s schools.
Leading Health Conditions Impacting Student Attendance: Chart
This chart was prepared by the National Collaborative on Education and Health, an initiative co-convened by Healthy Schools Campaign and Trust for America’s Health that is working to transform the health and education sectors to support the conditions of health in schools across the country. The chart addresses chronic absenteeism by providing an overview of prevalent health conditions that affect student attendance.
Present, Engaged, and Accounted For: The Critical Importance of Addressing Chronic Absence in the Early Grades
Hedy N. Chang | Mariajosé Romero September 2008 This report seeks to raise awareness of the critical importance of chronic early absence, synthesize available data on the scope of the challenge, and share emerging insights about how schools and communities can use chronic early absence to identify and address challenges affecting the social, educational and physical well-being of children and their families before problems become intractable.
Absences Add Up: How School Attendance Influences Student Success
By Alan Ginsburg, Phyllis Jordan and Hedy Chang August 2014 This analysis of national testing data shows that students with higher absenteeism rates have lower scores on national standardized tests. It reinforce a growing body of research confirming the connection between school attendance and student achievement and reveals the critical importance of intervening as soon as absences begin to add up, whether early in a child’s school career or at the beginning of the school year. The good news is poor attendance can be turned around when policies and practices encourage schools and communities to partner with students and their families to monitor their data and implement promising and proven practices.