Joseph Cramer, M.D.: Schools: Houses of learning and homes for healing
Editor's note: Second in a two-part series on education and healthcare. Click here for the first part.
The thoughts for the article last week germinated from a round table of educators and one lone pediatrician. The need for more services in both education and health care means these two systems are fighting each other for the same state dollars. The question posed is how can we combine public education and public health reform to reduce the perennial battles for limited resources. The issue is how can these two critical aspects of our lives come together to create a new vision for this state.
One must ask what are the advantages or the downsides and what would be the payoff. As stated before in the first article, school boundaries define neighborhoods. The lines surrounding an elementary school are the smallest geographic area to which we relate.
Walking to school for classes about smart food purchase and preparation would be as easy as walking to school for classes in reading, writing and arithmetic. An example would be a child and parent could exercise sufficiently to dramatically reduce the chances of diabetes. Walking only 15 minutes twice a day every school day could reduce diabetes. So on a PTA night, send out a parent and child team in every direction and mark where it takes the team to walk 15 minutes.
The use of facilities all year and day and night increases the utilization of hard assets of brick and mortar. Creating a medical home is important in health care reform. This is the idea that the clinic is the place for care and management of chronic conditions that need regular follow up. Why not make schools the site for the medical home?
They are near the houses of the patients; could it not bring together others with the same condition who are neighbors and friends? Could it not foster the formation of neighborhood watches not looking out for crime, but neighborhood watches looking out for the well-being of the older and frailer or the young and vulnerable?
The epidemiology of diseases or health problems could be measured within the growing concentric circles of the elementary school, then the junior high and the high school to capture larger areas and bigger numbers of subjects.
By using school boundaries, it could be possible to track “hot spots” and link them to an epicenter near a school. A “hot spot” has come to mean an area where there are higher than expected medical costs. These spots could be identified, as well as why the aberrant expenditures occur. The school clinic could be recruited to address the special needs of those patients.
Anything we can do to save the unnecessary expenditure of dollars for preventable conditions we should do. We need to think how systems overlap. It is at these joint areas of common interest, resources or duplication that we can address for better services at better costs.
Education and health care intersect at multiple points. They share the same students/patients. They share the same neighborhoods. They could use the same buildings, parking lots and utilities. They share the goals of enriching lives. They share the same legislature and laws. They include the whole family, not just the patients/students. They confront the same challenges of sickness and sick behavior.
They are both fountains of learning; one teaches the world around us; the other instructs on the world within us. Plus what started these two articles is that the same great big pot of dollars pays for them. Sometimes that pot is not as great and not as big as we would like.
When anyone wants to talk about health care reform and challenges with all the doctors and nurses, hospitals and insurance plans, there should be at least one teacher in the room. Knowing how much we share and how much we care for the same people may open up a new way of thinking only seen by an outsider.
Schools are houses of learning. They can be homes for healing.
Joseph Cramer, M.D., is a fellow of the American Academy of Pediatrics, a practicing pediatrician for 30 years, and an adjunct professor of pediatrics at the University of Utah. Email: firstname.lastname@example.org
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