EXHIBIT 79 [Reprint from School Life, November 1945] HEALTH NEEDS OF SCHOOL-AGE CHILDREN AND RECOMMENDATIONS FOR IMPLEMENTATION The following statement of the health needs of school-age children and suggested ways for meeting them was prepared by a subcommittee appointed at a meeting of representatives of Federal governmental agencies whose programs affect the health of the school-age child. The meeting, called early this year by Frank S. Stafford, Health and Physical Education Service, United States Office of Education, was attended by representatives of the United States Public Health Service; Committee on Physical Fitness; Children's Bureau, United States Department of Labor; War Food Distribution and Extension Division of the United States Department of Agriculture; Recreation Division of the Office of Community War Services; American Red Cross; United States Office of Education; Office of the Coordinator of InterAmerican Affairs; American Association for Health, Physical Education, and Recreation- National Education Association; School Health Section of the American Public Health Association; and the National Organization for Public Health Nursing. The purpose of the meeting was to exchange information, study needs, and make recommendations for future action. It was felt that there was special need for cooperative planning of the activities of the Federal Government in school health, including the existing programs, the planning of any extension of these programs, the formulation of over-all policies, and the establishment of regulations governing the administration of any funds that might be available. A subcommittee was appointed to study and make a report on child health and fitness needs and to suggest methods of implementing programs which would meet those needs. Members of this subcommittee, which prepared the following statement, are Katherine Bain, Children's Bureau; Mayhew Derryberry, United States Public Health Service; George W. Wheatley, school health section, American Public Health Association; Ben W. Miller, American Association for Health, Physical Education, and Recreation; and Mr. Stafford, United States Office of Education. The terms "health," "school health," or "school health program," used in this report include those programs designated at various times and places as health and physical education, health education, physical fitness, fitness program, school health program, school health services, healthful school living, hygiene, hygiene and sanitation, and health instruction. (It is the intent of this report to give appropriate reference to the health needs of school-age children both in and out of school, but it seems advisable to omit discussion in the report of how the health needs of children who have left school should be met.) Educators and health workers have for years considered the health of school children an area of prime importance to society. The draft findings of World War I and more recently the Selective Service findings of World War II have again focused the attention of the Nation on the health and fitness needs of schoolage children. Those children 5 to 17 years of age composed 21.7 percent of the total population in 1942. The schools, because of compulsory-attendance laws, have contact with more of the children and youth for longer periods of time than any other public agency. No other agency except the home has such an opportunity to give them significant instruction and to develop child health. Less personal, less emotional, and in general more scientific than the home, the schools recognize social as well as individual values in conserving the health of children. It is here that children are first grouped together for long periods under supervision and that health changes may be first observed. The schools are the universal agency whose unique function is education. They possess the leadership, facilities, and equipment for securing effective health outcomes during the most critical and formative period of learning. Yet America with such a strategic and universal agency as the schools has tended to over 1 Acknowledgment is gratefully made to S. S. Lifson, Health Educator, U. S. Public Health Service, District No. 1, New York, N. Y., for compiling the basic content incorporated in part I of this report. simplify or neglect the health objectives in education. Health and physical fitness cannot be conferred by talk or sporadic and feeble efforts. Long term and constant efforts are essential. Economic factors, lack of availability of personnel and service, and lack of the kind of education that precipitates appropriate action reflect the inadequacies of past efforts. The Selective Service findings reveal that many adults 18 to 36 years of age have physical and mental defects which prevent them from serving in the armed services of our country. The situation which concerns the Nation is that of the approximately 22,000,000 men of military age, 40 percent, or between eight and nine million, of them are unfit for military service. Of the over 4,000,000 rejected for military service, approximately 700,000 had remediable defects which were not remedied. It is reasoned that if those defects were detected early and treatment received, these men would not have been rejected. The table below is an illustration of the extent that these health and education defects are preventable and correctable. The expense and loss of time is tremendous. Dental work: Fillings- Defect corrections by Army1 Bridges and dentures.. Dentures repaired Teeth replaced. Venereals inducted and treated_ Hernia operations (1943) – Illiterates inducted and corrected June 1, 1943, to May 31, 1944- 1 Wartime Health and Education-Hearings before a subcommittee of the Committee on Education and Labor, U. S. Senate, 78th Cong., 2d sess., pursuant to S. Res. 74, pt. 5. Washington, D. C., U. S. Government Printing Office, July 10, 11, and 12, 1944, p. 1667. Educational attainment is based on biological endowment and proper growth and development. Infections and physical impairments decrease the opportunity which a child has for optimum physical and educational attainment. Children attend school for 5 hours a day for approximately 175 days a years for 12 years. This is society's way of assuring that each succeeding generation will rise above the accomplishments of the preceding generation. The full benefits of the provisions of society can be realized only when children enjoy optimum health. For that reason, programs designed to assure healthy children have been inaugurated in the schools. They are concerned with health services, health guidance, health instruction, physical education, and recreation. The preinduction or preemployment medical examinations of young draftees and of young workers and the close medical supervision received by members of the armed forces and to an increasing degree by workers reveal many neglected physical and mental inadequacies which could and should have been prevented or corrected in childhood. Similar findings in draft examinations in World War I led to a great wave of legislation intended to prevent this from again occurring by providing for medical inspection and physical education of school children. Studies of these efforts in the last 20 years have revealed again and again their inadequacy to prevent the conditions now being revealed. This reports recommends measures to strengthen and supplement school health programs in order that children may have maximum opportunity to achieve their optimum growth and development and may know how to live healthfully. HEALTH NEEDS OF SCHOOL-AGE CHILDREN What are the health and fitness needs of school-age children which must be considered? These needs may be defined as follows: 1. A safe, sanitary, healthful school environment This means: Control of such environmental factors as heat, air, light, sunshine, buildings, grounds, noise, color, form, construction, water supply, sewage disposal, and play space so that they contribute to, rather than deter from, healthful school experiences. An environment in which boys and girls are freed as far as possible from the conditions which produce unnecessary fear, anxieties, conflicts, and emotional stresses. 2. Protection from infections and conditions which interfere with proper growth and development This means: Adequate examination and inspection of pupils, teachers, and custodial personnel to detect communicable diseases as well as deviations which impair health. An opportunity to receive necessary immunization and testing procedures. 3. An opportunity to realize their potentialities of growth and development This means: Adequate medical and dental care on the basis of individual needs as shown by examinations. Adequate nutrition to assure well-nourished children. Participation in a program of physical activity designed to develop organic power, strength, skill, agility, poise, and endurance, as well as ability to participate with others in games and sports which promote alertness, cooperation, respect for individuals and gorups, initiative, and a feeling of personal worth. Participation in a recreational program designed to create interest in activities which develop talents making for wholesome living, and broadening the child's horizon of the world in which he lives. A balance and rhythm in the child daily life which is in keeping with his physical, mental, and emotional needs. 4. To learn how to live healthfully This means: An opportunity to learn and to make wise decisions, form health habits and attitudes based on scientific knowledge of health and disease. An opportunity to make choices and assume increasing responsibility for one's own personal health. An opportunity to acquire information and attitudes appropriate to the grade level about physical and emotional development, maturity, and patterns of social conduct which will contribute to the health of the individual and other citizens to insure wholesome family and community living. 5. Teachers who are equipped by training, temperament, and health not only to give specific instruction but also to help children to mature emotionally This means: Teachers not only prepared to teach but those who are also emotionally stable and adjusted, because the development of healthful personalities is dependent upon the relationships and attitudes which are built up between teacher and children. UNMET NEEDS Federal, State, and local communities need to consider the following: 1. Safe, sanitary, healthful school environment No specific data are at hand to give an over-all national picture of the adequacy and condition of school buildings now in use. It has, however, been estimated that it will require a plant construction program costing approximately $3,000,000,000 to compensate for postponed construction and to recondition, renovate, and repair existing educational plants. This $3,000,000,00 estimate is only to catch up with the wartime lag in school plant construction and maintenance. It is further estimated that an additional $4,000,000,000 will be required to provide adequate educational buildings, equipment, and grounds which will fully meet the environmental and educational needs of all children and youth.2 In its publication, Education for All American Youth, the Educational Policies Commission advocates a school plant which can serve the entire community for all ages.3 The American Association of School Administrators in its publication, Paths to Better Schools, advocates the same principle. That communities and States have a tremendous task ahead, if adequate school facilities are to be provided, may be seen from the 1941-42 report of the United States Office of Education. Of the 226,660 buildings reported in use, 107,692, or 48.4 percent, were one-room buildings. "The proportion that one-room schools constituted 2 Hamon, Ray L., senior specialist in school plants, U. S. Office of Education, Washington, D. C. (unpublished statement). National Education Association of the United States, Educational Policies Commission, Education for All American Youth, Washington, D. C., the Association, 1944, pp. 366–367. Twenty-third Yearbook, American Association of School Administration, Paths 4 to Better Schools, Washington, D. C., the Association, 1945, pp. 255-258. of the total in 1941-42 ranged from 6.3 percent in New Jersey to 87.3 percent in South Dakota. In 18 States more than half of all buildings in use were still one-teacher schools." 5 This does not mean that one-teacher schools contribute to ill health but it is indicative of the need for buildings that can serve all of the needs of the whole community. 2. Preventive health program A health program in the school that is truly preventive must be such that conditions which impair the present or future health and fitness of the child will be recognized and prevented, corrected, or otherwise alleviated. With respect to health service every school-age child needs: (a) Immunization against smallpox, diphtheria, and in some instances pertusis tetanus, and typhoid. (b) Protection against exposure to such diseases as tuberculosis through examination of teachers and other personnel with whom children come in contact in school. (c) Dental care-examination and treatment of any dental abnormality. (d) Screening procedures for vision, hearing, and other defects and conditions. (e) Medical care examination and treatment of any physical and mental abnormality. (f) Health supervision—while the child is in school, day-to-day observation by teachers for signs of good health or illness and protection from injury. (g) Mental health service. (h) Nutrition-to assure well-nourished children. To achieve these goals the amounts of funds being expended are very inadequate. In the 1941-42 report of the United States Office of Education, 43 States report expenditures for school health services. Per pupil expenditure for health services, for all children 5-17 years of age as reported amounted to 78 cents per year. This ranged from .018 cents in one State to $3.07 in another. Ten States reported per pupil expenditures of more than $1. Nineteen States reported expenditures of less than 50 cents per pupil. Expenditures for education per pupil in average daily attendance ranged from $31.23 in Mississippi to $169 in New York, with the national average at $94.03. Expenditures for health services by State departments of education amounted to eight-tenths of 1 percent of the annual average educational expenditure per pupil. The figures covering expenditures for health service as reported by State departments of education do not give the complete picture. Departments of public health, both city and county, have for years provided some health services to school children. In a report by Mountin and Flook dated 1941' it is reported that in 5 States, health departments have full responsibility for school health services; 1 State, the education department has full responsibility for school health services; 41 States, health and education departments jointly share responsibility; 3 States, in addition to education and health, some other State agency is interested in school health services. Federal funds available to States for maternal and child health through appropriations under title V, part 1 of the Social Security Act, are used to promote and carry out school health services in many counties. In addition, States and localities contribute to the support of school health services. Funds available to the State health departments through Federal grants-in-aid for general public health purposes also contribute to school health service through the support of county health units. The amount expended by public health agencies for school health services is not known, yet the evidence previously presented is indicative of how far short of our health goals we are for school children. The most satisfactory progress has been in regard to protecting the child from those communicable diseases for which there are specific preventive measures. Increasing numbers of children are entering school already protected against these diseases and more schools are prepared to administer necessary protection to those who need it. Here legislative and health edu C. S. Office of Education, Biennial Survey of Education, 1938-40, vol. II, ch. III, Washington, D. C., U. S. Government Printing Office, 1940, p. 33. U. S. Office of Education, Biennial Survey of Education, 1938-40 and 1941-42, Statistics of State School Systems, vol. II, ch. III, Washington, D. C., U. S. Government Printing in and Flook, Distribution of Health Services in the Structure of State Governblic Health Service Bulletin No. 184, third edition, 1943. Office. 1942. cation activities have been largely instrumental in bringing about utilization of these protective measures. Rural areas and States without vaccination laws have made the poorest progress in the application of modern knowledge in the control of communicable diseases of childhood. This is one aspect of the school health program which will assume much less importance in time, as the community health services are able to reach all children during infancy and bring them to school already protected against certain diseases. As one of the controls for communicable disease, teachers and custodial personnel should be X-rayed for tuberculosis prior to employment and at regular intervals thereafter. High-school students also should be X-rayed. The most universal need among children is in regard to dental care. Surveys have revealed how widespread is dental caries among the school-age population, how rapidly untreated caries progresses, and how costly and extensive is the repair work required to rehabilitate the neglected teeth of the adult. In some localities substantial sums of public funds are spent to examine children's mouths to find caries and little or no money is spent for corrective work. Dental examinations at present are of little use as a screening measure, since most children need care. After a complete dental-care program for children is inaugurated and continuing care is provided, the annual or semiannual examination will need to be part of the program. Three organs intimately concerned with the education of the child are those involved in seeing, hearing, and speaking. The adequacy of the sense organs and the environmental conditions that make for satisfactory functioning are, therefore, of special importance to school authorities. Prevention, case-finding, and treatment facilities for these conditions are inadequate. In urban centers, vision testing and correction is a more widespread practice than detection and treatment of hard-of-hearing and defective-speech cases. In rural areas, as a rule, there are no satisfactory arrangements to care for poor sight, hearing, or speech cases among school children. All three of these conditions require specialized medical service for diagnosis and treatment. On the other hand, case finding can be done by tests conducted by nonmedical personnel. These tests are particularly important when the child enters school, but should be repeated at intervals. The main purpose for the inauguration of medical examinations or "medical inspections" in the school was to detect physical defects. Forty or more years ago when medical inspection in the schools began, it was introduced as a casefinding procedure. At that time it was the best way to discover children in need of medical attention. 8 In a recent report by the Society of State Directors, 41 States submitted answers to questionnaires stating that they all recommended physical examinations for students: "12 States, however, require such examination by law. Of these 12 States, 5 require the examination annually, 1 requires it every 4 years, and 6 require it every 3 years. "Three of the twelve States report that students may be exempt from the examination for religious or constitutional grounds, and nine report that they may not." Modern public-health methods have led to the development of more satisfactory "screening" procedures than medical inspection to find cases of ill health. Examples are the Wassermann test, the tuberculin test, the paper or microfilm X-ray, the audiometer, the Snellen test, and others. All of these look for special conditions among population groups where the condition is known to be prevalent. Appropriate tests, such as the audiometer and the Snellen test, when properly used with school children, make it possible to examine children frequently and efficiently. Physicians and nurses well qualified in public health and education are needed to organize, supervise, and interpret such modern case-findings programs in the school and to secure additional diagnostic service and treatment for the defects discovered. In addition to such specific defect-finding tests to be done at frequent and regular intervals during the child's school life, provision must be made for thorough medical examinations of school children because the screening tests mentioned above are not a substitute for medical appraisal of the whole child. But such an evaluation takes time and requires a skilled medical and nursing service. There must be opportunity for the physician and nurse to learn the history of the child, to look for physical and emotional abnormalities and devel 8 Society of State Directors of Health and Physical Education, Proceedings of the Nineteenth Annual Meeting. News Bulletin No. 35, 1944. |