Health problems can plague anyone, but they pose particular risks for children without health insurance.
Shannon Hilton in Gonzales concentrates on her homework.
Experts are learning what teachers have understood for a long time - that success in school is linked to regular attendance, and that attendance improves with access to health care.
"Children should come to school healthy, properly fed, well-rested and ready to learn," says CTA President Wayne Johnson. "However, poverty and lack of access to affordable health care can mean that thousands of students stay at home sick every day."
Teachers can't teach an empty desk.
Healthy children attend school regularly and are not distracted by chronic pain, physical discomfort and anxiety. But this is not the case for all children. Teachers across the country report that 12 percent of their students - up to 18 percent in urban areas - have health problems that impede their academic performance.
According to a 1999 survey by the American Academy of Pediatrics, students who miss more than 10 days of school in a 90-day semester have trouble remaining at their grade level. In California, an estimated 10 percent of students miss more than 18 days of school a year. For students in the early grades this is particularly problematic. Students who are behind in reading in third grade have only a 12 to 20 percent chance of ever catching up, according to the National Institutes of Health.
Thousands of California's students may fail to meet the state's rigorous academic standards due to health-related reasons, warns the Assembly Select Committee on California Children's School Readiness and Health, chaired by Assembly Member Wilma Chan. Its report released last March, "Preparing Our Children to Learn," states that absenteeism rates appear to "have a direct correlation" to students' academic performance, especially in low-performing schools.
But it's not just a problem of absenteeism. Many of the children who show up for school are disadvantaged by easily treatable ailments.
According to one researcher's testimony at a hearing conducted by the committee, individualized vision assessments were made on 400 incoming high school students who were reading below grade level. More than half were found to be suffering from serious vision impairments. The students reacted to their diagnosis with comments like "I knew I wasn't stupid" and "There was something wrong with me that I just couldn't figure out."
Many children struggle with vision problems, yet the state requires testing only for near-sightedness. Other serious eye problems may go undetected, leading to academic difficulties later on.
Likewise, it's estimated that a quarter of California preschoolers have untreated tooth decay and more than half of children ages 6 to 8 suffer from untreated dental disease. Yet dental screening is not required before a child enters school.
Nearly 21 percent of the nation's school children struggle with treatable mental health problems, according to the U.S. Surgeon General. But many don't receive care due to lack of insurance, lack of parent knowledge about mental health issues and the perceived stigma of such problems.
Health problems can face all students, but they pose particular risks for children without health insurance. Preventable and treatable illnesses can turn into chronic and serious problems without timely access to health care.
The 2001 California Academic Performance Index (API) shows that the lowest performing schools have the highest rates of eligibility for public health insurance programs. Last year CTA released a study showing that 80 to 95 percent of students in schools designated as low-performing are economically disadvantaged.
"Since our schools of greatest need are usually those whose students come from the poorest backgrounds, obviously lack of quality care has an impact on student achievement," says CTA Board Member Lynette Henley who teaches second grade at Dan Mini Elementary School in Vallejo. "Students can't learn when they are sick."
Children who are poor and without health insurance are two to three times more likely to miss school due to their illnesses, according to a 1997 report by the National Institute of Medicine. A study by the UCLA School of Health Policy showed that in Los Angeles County, Latino and other children of color are much more likely to be uninsured than Caucasian students.
Despite the existence of two federal and state-funded health insurance programs - the low-cost Healthy Families program and the no-cost Medi-Cal for Families program - about 1 million eligible children in California remain uninsured. Both programs are underutilized, leaving many children without health care needlessly and allowing millions of dollars in federal funding to go untapped.
"It's a matter of awareness," says CTA Director Henley. "Parents want their children to have health care, and in many cases it's just a matter of alerting them to the program's existence and providing them with a referral or contact number."
CTA hopes to increase parent awareness by embarking on the Teachers for Healthy Kids project, a campaign to alert members to the existence of low-cost or no-cost health care for uninsured students.
CTA believes teachers have been the missing link in school outreach efforts and that their involvement will make a significant difference in the effort to raise the awareness of families qualifying for these programs.
"We know teachers and school nurses are a natural and trusted link between students and their families," says CTA President Johnson. "Our research shows that parents consider teachers to be the most credible source of information about issues affecting their children. We want our members to be aware of the programs and to work with their school sites in passing that information along to their students' families."
CTA will be working in partnership with the California Association of Health Plans (CAHP), an organization representing the major health plans in California. A grant proposal has been jointly submitted by CTA and CAHP to the California Endowment, the state's largest health care foundation, seeking funds to support teacher education and outreach to families. Both organizations will work together to develop materials and provide support to teachers willing to convey the message to parents that affordable health insurance is available.
In the first year of the project, Teachers for Healthy Kids will focus on reaching children in targeted areas who are already enrolled in the free and reduced-price school lunch program. Students who are eligible for the lunch program can use the same paperwork to enroll in health insurance, thus simplifying the application process.
Linking eligibility between the two programs, a process known as Express Lane Eligibility, could be key to the success of the outreach project.
Oscar Tellez and Dajuan Knowles in San Bernardino pay attention as their teacher presents a math problem.
Healthy Families and Medi-Cal for Families offer similar benefits and provide complete health, dental and vision coverage to children up to age 19. They are different primarily in the income level of the families they serve.
The Medi-Cal for Families program provides health insurance coverage to children in households with the lowest incomes.
The Healthy Families program targets working families with incomes above the Medi-Cal eligibility level. A family of four with earnings of up to about $44,000 per year could qualify.
Families qualifying for either program can choose from more than 30 participating health plans statewide with a variety of provider options including Blue Cross, Blue Shield, Health Net and Kaiser Permanente.
Parent immigration status, a concern that sometimes keeps undocumented parents from seeking health care for their children, is not a factor. The immigration status of the children can affect eligibility, but some counties offer insurance programs of their own to fill the gap. Application assistance from trained multilingual personnel is available to those who need it.
"We're optimistic that fewer children will go uninsured as our member awareness increases," says Johnson.
"We can't help students learn when they're not in class. But if the reason they're not in class is due to treatable or preventable illness, maybe we can do something about it."
Stories by Frank Wells, Sherry Posnick-Goodwin and Hellan Dowden
Photos by Scott Buschman
