Healthy Bodies, Healthy Minds
By CHRISTINE KIERNAN

On a typical school day, the medical assistant at a Manhattan high school health clinic said her cases are often anything but ordinary.

“Yesterday we saved the life of a boy,” said Vicky Jiminez, medical assistant at the Julia Richman Educational Complex on East 67th Street. The youth suffered an asthma attack in class and she was able to quickly hook him to a ventilator she keeps in the clinic. Earlier that morning she had handed out emergency contraception, organized an AIDS prevention workshop, and took care of a child with a bad stomach ache.

The clinic, run by Mt. Sinai Medical Center, was one of the first school-based health centers in the city when it opened in 1985. Today it is one of some 1,700 school-based health centers across the country.

Located in elementary, middle and high schools in 45 states, these clinics offer students a wide range of services, from regular checkups and immunizations, to contraception and mental health counseling. Some operate out of makeshift converted storage rooms. Others, more spacious and better equipped, resemble a teen-friendly doctor’s office. All serve students free of charge, regardless of their insurance status or ability to pay.

Still, unfortunately, there are too few clinics serving too few children. Only 2 percent of the nation’s 55 million school children have clinics in their schools. In New York City, there are only 118 clinics for 1,400 public schools.

The reason school-based health centers do not come anywhere near demand comes down to one thing: lack of stable financing.

School-based clinics get their funds from a hodgepodge of sources: state and local government, hospitals, community health centers, other donations, and insurance reimbursements. Many exist on a grant-to-grant basis. Some are barely self-sustaining. In New York State, centers must reapply for state money every five years. Even though the number of centers in the past decade has almost doubled, state funds have stayed stagnant.

A new federal bill introduced in February by Senators Gordon Smith and Christopher Dodd just might change things. If passed, the bill would create the first-ever federally funded program for school-based health centers, authorizing $50 million in desperately sought after funds for the federal year 2008.

In the United States, 39 percent of children—more than 28 million—live in low-income families, according to the National Center for Children in Poverty, and more than 8.4 million have no form of health insurance. Poor children are more prone to suffer from poor health conditions like childhood obesity, diabetes and asthma, which can hinder academic performance and increase school drop-out rates.

Health centers that offer free care and treatment in schools are an excellent way to reach these students, saving not only their lives in some instances, but also saving costs to public health care in the long run. Their convenience means parents don’t have to leave work to bring their children to a doctor. Students can receive regular checkups and treatment for chronic conditions like asthma at school, preventing the high cost of ending up in the emergency room with untreated illnesses. Clinics offer health information and advice that can help children learn to manage their illnesses and reduce risk factors for chronic disease. And students’ insurance status and ability to pay does not restrict the care they get.

The centers are also instrumental in reaching another group of high-risk students—adolescents, who are notoriously lax about seeking out health care, at a time when they may need it most. It’s at this age that mental health problems like depression, anxiety and eating disorders surface. Experimentations with sex, drugs and alcohol can go awry. Each year approximately 3 million teens contract an STD and 860,000 become pregnant. Around 80 percent of teens who become pregnant drop out of school.

Studies have shown that when school-based programs include reproductive health services, such as educational outreach, one-on-one counseling, and the provision of contraceptives, rates of pregnancy decline. At the Mt. Sinai clinic at Julia Richman Educational Complex, teens can pick up morning-after pills and condoms, get a prescription for oral contraceptives, or receive the anti-cervical cancer vaccine for free. The guarantee of confidentiality ensures that more teens will be encouraged to seek out reproductive and mental health care when they need it.

School-based health clinics also are of benefit to the school themselves. Educators say that having clinics increases attendance rates and provides an added “quality of life” bonus. Simply put, kids learn better when they feel good. Studies have shown that good health is a predictor of greater educational achievement and that improved school completion rates, in turn, can help reduce inequities in health.

In February, TheNew York Times reported that education is the one social factor across the globe that researchers agree is consistently linked to longer lives; what makes the biggest difference is keeping young people in school. A federally financed program for school-based health centers is an important step towards keeping kids healthy, keeping them in school, and keeping their options open for the future.