The relationship between school health programs and public health in the United States dates back to the early 1800s. The work of Chadwick in Europe, and the subsequent work of Shattuck in the United States, focused attention on the importance of child and adolescent health in improving public health. Chadwick noted that one-half of all children born to working class parents in England died before age five. Likewise, Shattuck’s insightful report offered several futuristic recommendations to promote public health in the United States. Many of the recommendations had implications for child and adolescent health, particularly for school-age children. In one important area of public health concern — control of communicable diseases — school health programs played a significant role through health inspections, immunization campaigns, and related activities.
As advances in science and medicine during the late 1800s and early 1900s eliminated or controlled many communicable diseases, attention increasingly was focused on the impact of chronic disease in American society. Participation by the United States in four major wars during this century provided evidence that American youth lacked adequate levels of health. The first such conflict — World War I — provided the first comprehensive assessment of the health status of the American people. Though standards for induction into the United States armed forces were lowered at the beginning of the war, 34% of American males examined for military service still were rejected due to physical and mental health problems. Had these defects been detected previously, many could have been prevented or corrected.
Consequently, public health professionals realized that, while progress had been made in controlling communicable disease, chronic diseases posed a new and growing threat to public health.
Findings from recent research confirm a continuing need to improve child and adolescent health. One such study, the National Adolescent Student Health Survey (NASHS), examined the health knowledge, attitudes, and behavior of American teenagers, and constructed a national health profile for that age group. During fall 1987, a national sample of about 11,000 eighth and 10th grade students was drawn from more than 200 public and private schools in 20 states.
Interestingly, the NASHS results were similar to findings from the national School Health Education Study (SHES) conducted during the early 1960s. While the subject matter addressed by the SHES and NASHS differed in some respects, both studies confirmed a continuing need to promote comprehensive school health programs that increase knowledge, favorably influence attitudes, and promote positive behavior and effective decision-making among American youth.
The problems noted in the NASHS and related studies pose negative implications for the nation not only in terms of child and adolescent health status, but broader negative implications for public health and welfare in areas such as national defense, economic competitiveness, and the long-term social and fiscal impact of chronic diseases on society. An analysis of causes of death in the United States underscore the necessity for dealing with the problem of chronic diseases.