National Policy

National Policy

The federal government plays an important role in providing a policy environment that can support student health.

Current Agenda

Our national policy agenda is built on our Change for Good framework: a transformative effort to reimagine and rebuild the education system—including the services it provides beyond the essential task of teaching our children—with health and equity at the center. 

As a country, we do not invest equitably in school facilities and outdoor spaces, or in the number of school health providers—such as school nurses and social workers—needed to meet today’s challenges and address health disparities. The coronavirus pandemic and simultaneous calls for racial justice have exposed the extent, and the impact, of these inequities.

We believe that rebuilding the infrastructure designed to support our children’s educational and health needs—and addressing the role that institutionalized racism plays in forging and perpetuating failed systems—is a national priority.

HSC released a series of federal policy recommendations in 2020 that support the Change for Good framework. We invite you to download “Healthy and Ready to Learn: Recommendations for the Next Administration” for background information and recommendations for both large-scale federal investment and specific actions that can be implemented without congressional approval. (Scroll down for a summary of actions listed by agency.)


Change for Good Framework

An education system focused on prioritizing health and addressing the effects of institutionalized racism must include these four goals: rebuild America’s schools; expand access to school health services; change how schools are funded; restructure how we distribute school food.  

This work requires a significant federal investment from the education, healthcare and public health sectors—an investment that would boost the national economic recovery effort, show that our country understands the value of public schools, and create lasting change in every community. This is our vision.

1. Rebuild America’s Schools

The federal government must recognize the massive inequities that exist in school facilities and prioritize investment, especially in underserved communities, and also include outdoor learning and play spaces designed to improve the health of neighborhoods and the environment.

Why School Buildings Matter

  • The average school building is roughly 44 years old. Students and educators are learning and working in crumbling buildings with asbestos, contaminated water, and mold.
  • A 2020 report issued by the Government Accountability Office (GAO) on the state of school infrastructure—the agency’s first report on the subject since 1996—found that 54 percent of school districts must replace or update major heating, ventilation and air-conditioning (HVAC) systems in more than half their buildings.
  • According to the GAO report, high-poverty schools were more likely to rely on state funding to cover the cost of building repairs compared to wealthier schools, which were more likely to fund projects through local property taxes.
  • An aging and ineffective HVAC system can lead to poor indoor air quality in schools and exacerbate illness. Even before the pandemic, more than 14 million school days were missed every year due to asthma. COVID-19 affects the respiratory system and asthma sufferers are considered high-risk for severe complications from the virus. That means indoor air quality is even more important as schools look to reopen.
  • In a study of the federal role in school facilities, researchers found that between 2004 and 2010, the federal government provided less than .02 percent of school districts’ total capital spending in direct grants for school facilities, mostly awarded through the Federal Emergency Management Agency for schools affected by natural disasters. By contrast, in 2014, the federal government funded a full 38 percent of the nation’s capital investment in wastewater and transportation infrastructure.

2. Reinvigorate School Health Services

The federal government should increase its Medicaid contribution to states to cover school health services—including physical, behavioral and mental health services—that help to ensure children are healthy and ready to learn.

Why School Health Services Matter

  • One in four children in the United States has a chronic physical or mental health issue that affects their ability to succeed in the classroom, double the number just 30 years ago. Left untreated or undermanaged, health issues can adversely affect children’s attendance, their ability to see, hear and pay attention in the classroom, their ability and motivation to learn, and even their chances of graduating from high school.
  • Students in underserved communities, particularly students of color, are at increased risk of chronic health problems such as diabetes and asthma that can hinder learning and have a significant impact on long-term health. Ignoring these health inequities undermines efforts to close the opportunity gap.
  • One in five children between the ages of 13 and 16 experience mental health issues; less than 20 percent of these children receive the help they need. Of those receiving care, nearly 80 percent receive that care in a school setting.
  • Research shows that access to school nurses and other health providers can improve both health and academic outcomes, particularly for students with chronic health issues. Increased access can lead to reductions in chronic absence, improvements in care coordination and reductions in healthcare costs (by reducing the number of emergency room visits).
  • Despite the clear connection between school health services and student success, more than half of public schools do not have a full-time school nurse or school counselor and only 5 percent of students have access to a school-based health center. Significant disparities exist: Students in low-income schools are less likely to have regular access to a school nurse and other health providers compared to their peers in higher-income schools.

3. Rethink School Funding

The federal government must take a more active role in minimizing inequities in education funding and in supporting states in achieving this task by rethinking school finance formulas.

Why School Funding Matters

  • There can be no equity when, as studies have found, school districts in wealthier areas and those that serve mainly White student populations receive thousands more per student (from state and local funding) than districts in low-income areas and those that serve mostly students of color.
  • We need to think beyond simply “equal” funding: Students in poverty and from historically underinvested communities need more funding than those in wealthier communities.
  • Core services that have a significant positive influence on instructional quality and student outcomes are systematically unavailable to students in low-income schools relative to students in higher-income schools. 
  • Research shows that increased spending on education leads to better student outcomes. When states invest in their public schools and create more equitable school finance systems, student achievement levels rise. The positive effects are even greater among students from low-income households. 
  • There has been real progress in states that have provided significant, additional resources for low-income students. Weighted student funding— which differentiates school budgeting based on the demographics that each school serves—can fund quality programs that have the greatest impact on the student population.

4. Reimagine School Food

Access to healthy school meals plays a critical role in supporting both student health and achievement—which is why federally funded school meals should be made available at no cost to all students.

Why School Food Matters

  • According to the U.S. Department of Agriculture, 16.7 million children under age 18 live in households where they are unable to consistently access enough nutritious food necessary for a healthy life. 
  • Hunger impairs concentration and cognitive ability, thus interfering with students’ ability to learn, and results in physical symptoms such as headaches and stomachaches that cause children to miss class time
  • At the same time, increases in childhood obesity have been well-documented. Obesity puts children and adolescents at risk for developing diseases and health conditions that hinder their quality of life and can follow them into adulthood. 
  • Schools play a critical role in addressing this dual challenge by providing regular access to healthy school breakfasts and lunches through the federal school meal program, with more than 30 million children participating in the USDA National School Lunch Program and 12 million participating in the USDA School Breakfast Program.

FEDERAL RECOMMENDATIONS

The following recommendations outline how federal agencies can develop and/or support policies and offer guidance to advance the critical connection between health and learning.

U.S. Department of Education (ED)

  • Create a “COVID-19 Educational Equity Gap Challenge Grant” for states.
  • Increase ED’s capacity to support health and wellness.
  • Provide technical assistance to advance efforts to create healthy school environments.
  • Develop a robust set of guidance for states and school districts on how to support student health and wellness through state education policy and practice.
  • Issue standards and guidance on how schools can promote school safety while creating a sense of belonging and school connectedness for all students.
  • Restore protections for transgender students in public schools.
  • Collaborate with the U.S. Environmental Protection Agency to support school districts in improving school facilities.
  • Incorporate health and wellness into the Blue Ribbon Schools Program.

U.S. Department of Health and Human Services (HHS)
– Centers for Medicare and Medicaid Services (CMS)

  • Support state plan amendments to expand school Medicaid programs.
  • Promote partnerships between community providers—such as children’s hospitals and federally qualified health centers—and schools to expand access to school health services.
  • Issue joint guidance with the U.S. Department of Education (ED) on strategies for expanding access to school health services.
  • Ensure Medicaid remains an entitlement program.

– Centers of Disease Control and Prevention (CDC)

  • Issue recommendations to states for addressing how to support school districts and schools during pandemics.
  • Restore the Prevention and Public Health Prevention Fund.
  • Integrate green schoolyard elements into the Whole School, Whole Community, Whole Child (WSCC) model.

U.S. Department of Agriculture (USDA)

  • Restore and uphold the nutrition standards included in the Healthy, Hunger-Free Kids Act.
  • Maximize the impact of the Supplemental Nutrition Assistance Program (SNAP).
  • Fund programs that connect schools with local, sustainable food systems.
  • Provide funding and guidance to invest in professional development and training for school food service workers.

Recommendations of Other Key Federal Agencies

  • U.S. Environmental Protection Agency (EPA)
    • Fund the EPA’s work to support healthy school environments.
    • Fund efforts to develop and maintain green infrastructure.
    • Collaborate with the Department of Education to address building health and safety issues.
  • Occupational Safety and Health Administration (OSHA)
    • Develop standards for protecting student health and require schools to meet them.
  • U.S. Department of Homeland Security (DHS)
    • Repeal the federal public charge rule.

For more information on these federal proposals, please download “Healthy and Ready to Learn: Recommendations for the Next Administration.”