Laura M. Gottlieb, MD, MPH
This year, over one third of US high school students will drop out of school, putting them at risk of a lifetime of social, economic, and health disadvantage. Disproportionately high numbers of these students are racial and ethnic minorities. When we seek answers to the health disparities that puzzle health services researchers, our school systems should not be overlooked. The World Health Organization agrees: ‘‘Schools could do more than any other single institution to improve the well-being and competence of children and youth.” Yet as public health practitioners and researchers, we have not systematically addressed school context or comprehensively examined the school-level behaviors that may improve children’s outcomes across the life course.
Many educators identify school discipline as a significant contributor to both school drop-out and school drop-out disparities. Despite two decades of policies marked by “zero tolerance” for student misbehavior, there is little evidence for their effectiveness at improving school climate or educational attainment. New discipline policies have begun to spread sporadically into school systems, but again, very limited research supports investment in these strategies. In collaboration with Human Impact Partners in Oakland, I am working on a Health Impact Assessment of school discipline policies. The project has been funded by The California Endowment, and uses nationally representative data to examine the education and subsequent health effects of alternative discipline policies—like Positive Behavioral Supports and Restorative Justice—in Los Angeles Unified, Salinas and Oakland Unified School Districts. Other states have already expressed an interest in this work. Our aim is to expand the school discipline work to regions across the nation that might consider school context as one way to tackle education and health disparities.
The school-based Health Impact Assessment is illustrative of my broader interests in promoting “healthy public policy” in areas not traditionally considered related to health, like agriculture, housing, and transportation. I’ve also worked this year with the California State Task Force on Health in All Policies to help identify effective strategies that encourage cross-sectoral collaboration for health. Much existing research in this area is from international case studies. In a research project with Paula Braveman and Jonathan Fielding, I examine both opportunities and obstacles to bringing inter-sectoral healthy public policy approaches to the United States.
A third project takes me back to my roots as a physician. I am interested in how engaging the medical profession in social determinants of health research and practice may further the aims of this emerging field. As such, I work with Bob Hiatt to explore opportunities for integrating education in the medical and social determinants of health, hoping that it will influence both the clinical and non-clinical roles of future physicians.
And then finally, all my extra time goes into….