The Relationship Between School Attendance and Health
Chronic absenteeism is a critical national problem that puts more than 6.5 million schoolchildren at risk for falling behind academically, dropping out of school and serious long-term health, employment and financial consequences. There is a growing movement among schools, states and the federal government to address the underlying causes of chronic absenteeism. This policy brief takes a close look at the reasons behind chronic absenteeism, its adverse impact on health and life outcomes, and potential solutions.
What is Chronic Absenteeism?
Chronic absenteeism is widely defined as missing 10 percent or more of school days for any reason, including excused and unexcused absences. This can translate into missing 15 or more days per year or three days per month. Chronic absenteeism begins in early grades: more than 10 percent of kindergartners and first graders are chronically absent. The problem is often overlooked because some schools pay more attention to average daily attendance (the percentage of students who show up each day to school) and unexcused absences.
Health Affects Attendance
Children are chronically absent from school for a wide variety of issues directly related to their physical, mental and social health.
- Physical Health. Asthma is one of the most common causes of school absences, together with significant health concerns such as poor dental health, vision impairment, diabetes and obesity. Research suggests that U.S. schoolchildren with this treatable and remediable condition miss a combined 14 million days of school each year. The same research suggests that dental pain—often due to untreated decay—accounts for almost two million missed days of school annually.
- Mental Health. Fear, depression, social anxiety and other mental health issues can make it difficult for children to feel comfortable going to school. When children are exposed to significant stress, violence or trauma in their homes or communities, it can also trigger mental health issues that cause them to be chronically absent from school.
- Safety Issues. Students who fear or experience violence or bullying are at risk for being chronically absent from school. This is especially true among racial and ethnic minority students. A 2015 report suggests that nearly 35 percent of black students and more than 28 percent of Hispanic students were involved in a physical fight the previous year, compared with about 20 percent of white students. The same report indicates 20 percent of high school students said they had been bullied in the past year.
- Social Factors. Food insecurity or hunger, unstable housing arrangements, unreliable transportation, job loss within the family and lack of health insurance also contribute to chronic absenteeism. In spite of substantial progress in the area of health insurance coverage for children, more than 15 percent of all U.S. children under age 17 remain uninsured, and thus have more limited ability to access health care and treatment.
Absenteeism: A Major Factor in Long-Term Health and Employment?
The effects of chronic absenteeism can last a lifetime and negatively impact education, health, financial stability and employment.
Chronic absenteeism affects graduation rates. Research suggests that students who are chronically absent are significantly less likely to finish high school. According to a recent report, a student who is “chronically absent for any year between eighth and twelfth grade is over seven times more likely to drop out.”
People who are better educated are more likely to live longer, healthier lives. On average, a college graduate is likely to live about nine years longer than someone who has not completed high school. The opposite is also true—adults with fewer years of education are more likely to die prematurely, engage in unhealthy behaviors such as smoking and have higher rates of diabetes and obesity. Infant mortality rates are higher among children born to women who never graduated high school compared with women who have earned a college degree.
Better educated people are more likely to have sound employment—jobs with healthier working conditions, better health insurance and higher wages. College graduates earn nearly twice as much as high school graduates over a lifetime, while people with fewer years of education are more likely to have lower paying jobs that offer fewer benefits.
Chronic absenteeism is disproportionately high among children from low-income families, children of color and children who are homeless or reside in public housing. Children with disabilities also are disproportionately affected, as are those enmeshed in the juvenile justice system. Students from low-income families are four times more likely to be chronically absent than middle-class students. Another example shows that among elementary school students, American Indian, Alaska Native, Native Hawaiian and Pacific Islander children are twice as likely to be chronically absent as white children.
The Importance of Schools
Schools are a source of critical support for students who are more likely to experience adversities or be at high risk for health issues that would cause them to miss school in the first place. For example, many schools provide nutritious meals and drinks, including breakfast, lunch and snacks that are available for free or at a reduced price for low-income families. School-based health centers—where available and when adequately staffed—can offer access to critical services, including primary, dental, and mental health care and help treat conditions that keep children from attending school, such as asthma, diabetes, depression and anxiety.
Students have opportunities to engage with positive role models at school, and schools can help foster a stable environment for children from families that are struggling with housing challenges, job loss and trauma.
School nurses are important members of the education team and often are the first to investigate chronic absenteeism. School nurses can identify health issues and social risk factors at an early stage and connect children and families with resources to help address them. They also play a critical role in managing connections between schools and care providers or other agencies, as well as collecting and monitoring school health data, which may help inform efforts for preventing chronic absenteeism.
Yet the potential to address the root causes of chronic absenteeism is far from realized. Some schools offer a variety of programs that focus on improving student health or cultivating a more positive social climate, including coordinated school health programs, health clinics, mental health services and substance abuse and violence prevention programs. A growing number of schools are also implementing social and emotional learning programs to foster caring relationships between teachers and students, create a greater sense of school safety and help students develop responsibility, social competence, cooperation and other critical life skills. Safe Routes to School initiatives like the walking school bus can help children get to school when families lack reliable transportation or have irregular schedules. Walking school buses also help protect students from bullying, crime and traffic. Evidence demonstrates the benefits of such school-based programs, but programs often are disjointed or lack funding necessary to ensure sustainability.
A strong base of evidence suggests that investing in education is also an investment in health. Reducing chronic absenteeism improves the odds that this investment will bear fruit.
Across the country, there is a growing movement to address the underlying health, social and economic causes of chronic absenteeism, including a new national initiative led by the White House and U.S. federal agencies. While some schools and communities have been able to reduce absenteeism by monitoring attendance data and collaborating to help students and families overcome barriers to missing school, eliminating chronic absenteeism will require policy and systems changes at the federal, state and local level.
Some recommendations include:
- The new federal education law—the Every Student Succeeds Act—requires state education agencies to include chronic absenteeism as an indicator in their state report cards. Federal agencies can help support states with model implementation strategies. They can also support absenteeism tracking that can be used to foster positive school environments that promote attendance and overall school well-being.
- The U.S. Department of Education should continue to collect, analyze and publish data—such as those provided through the Civil Rights Data Collection—to better understand contributing factors and identify systemic solutions. In particular, these data should be used to surface equity considerations, such as disparities related to student discipline, restraint and seclusion, retention and bullying and harassment.
- State education agencies are required to submit updated plans to the U.S. Department of Education in order to receive Title I funds. States can support school districts by submitting detailed plans describing how chronic absenteeism will be addressed, including training teachers to identify students most at risk for chronic absenteeism.
- States can provide guidance that helps schools and their districts use the Whole School, Whole Community, Whole Child framework to identify and share core health strategies to help prevent and alleviate the effects of chronic absenteeism. Building a common understanding of the ways in which education and health go hand in hand is essential to improved outcomes for students.
- State and local education agencies should measure and monitor absenteeism, including measures of chronic absenteeism. Other measures that impact attendance should be tracked on state, district and school report cards. Reports should be by district, school, grade and subgroups. Subgroups may include race and ethnicity, economically disadvantaged students, students with disabilities and English language learners. Agencies should use the resulting data to help direct resources to the places with the highest rates of absenteeism.
- All state departments of education should join the growing numbers of states that are implementing early warning systems. These systems have shown promise in ensuring that schools, teachers and parents have ongoing real-time absenteeism data. Such data enables earlier identification and prioritizes for intervention of students who are on a path toward missing a month or more of the school year.
- State and local education agencies can support efforts by school districts to partner with a broad range of third-party providers and agencies, such as housing and transportation agencies. These can provide additional support services to students who are chronically absent and their families.
- States and communities can ensure that all students have access to a school nurse.
Physical and mental health, safety issues & social factors all cause chronic absenteeism from school.
National to Local Efforts on Chronic Absenteeism
Chronic absenteeism is a serious national problem that has been largely overlooked, but there is a growing movement to address the underlying health, social and economic causes.
In support of cross-agency efforts to tackle chronic absenteeism, including the My Brother’s Keeper Initiative, the Obama Administration launched Every Student, Every Day in fall 2015. It is the first national initiative aimed at eliminating chronic absenteeism. Led by the White House and the U.S. Departments of Education, Health and Human Services, Justice, and Housing and Urban Development, the campaign aims to reduce chronic absenteeism by at least 10 percent each year.
To date, efforts include developing a toolkit, convening national meetings and launching a mentoring program and a major Ad Council campaign. These are aimed at helping schools, elected officials, law enforcement, health care professionals and families better understand how to identify and support students who are—or are at risk of becoming—chronically absent. In June 2016, the U.S. Department of Education’s Office for Civil Rights released a story map about the impact of chronic absenteeism and its latest annual survey of all U.S. public schools, which for the first time included data on chronic absenteeism.
Efforts by some schools and communities show promise in increasing regular school attendance. In Vancouver, Washington, leaders of Vancouver Public Schools assembled a powerful team to help residents overcome a housing crisis that was causing a dramatic increase in chronic absenteeism, especially among students from low- and middle-income families. Together with the local housing authority, health department, workforce development council and other community organizations, the district created a network of resource centers. These connect families to food, clothing, school supplies, health care, child care, out-of-school time programs and other services. The team also offers housing vouchers to eligible families. To date, the team has helped 20 households (27 students) secure stable housing.
Another example comes from a 2015 RWJF Culture of Health Prize Winner: Bronx, New York. South Bronx Rising—a community-based coalition focused on reducing chronic school absenteeism—is spearheading innovative efforts to reduce high asthma rates among children living in the South Bronx borough. The group analyzes asthma “hotspots”—neighborhoods where asthma rates are particularly high—and provides health outreach and informational services in those at-risk neighborhoods. Other successful approaches, such as those in Baltimore and 2014 RWJF Culture of Health Prize Winner Spokane, Washington focus on supporting healthy schools and the whole child approach to address absenteeism.
Eliminating chronic absenteeism will require policy & systems changes at the federal, state & local level.