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School-Based Health Centers to Advance Health Equity: A Community Guide Systematic Review
John A Knopf1, Ramona K C Finnie1, Yinan Peng1
1Community Guide Branch, Division of Public Health Information Dissemination, CDC, Atlanta, Georgia.
Insights
School-based health centers (SBHCs) improve educational and health outcomes for disadvantaged children. These centers are key to advancing health equity by overcoming barriers to care.
Area of Science:
- Public Health
- Health Services Research
- Health Equity
Background:
- Disadvantaged children face significant barriers to healthcare access, leading to poorer health and educational outcomes.
- Racial and ethnic minority and low-income children are disproportionately affected by chronic stress, hunger, and sensory impairments.
- These health disparities present obstacles to educational achievement and predict adult morbidity and mortality.
Purpose of the Study:
- To systematically review the evidence on the effectiveness of school-based health centers (SBHCs).
- To assess the impact of SBHCs on educational and health-related outcomes in disadvantaged student populations.
- To determine the role of SBHCs in advancing health equity.
Main Methods:
- A systematic literature search was conducted for studies published up to July 2014.
- Community Guide systematic review methods were employed to identify, abstract, and summarize evidence.
- Analyses were performed between 2014 and 2015.
Main Results:
- The review included 46 studies, primarily evaluating onsite clinics for urban, low-income, minority high school students.
- SBHCs were associated with improved educational outcomes (GPA, promotion, reduced dropout rates) and health outcomes (vaccinations, reduced asthma morbidity, decreased ER visits).
- Increased services and availability at SBHCs correlated with greater reductions in emergency department overuse.
Conclusions:
- School-based health centers demonstrate effectiveness in improving both educational and health-related outcomes for disadvantaged students.
- SBHCs play a crucial role in overcoming educational obstacles and increasing access to necessary medical services.
- By addressing these needs, SBHCs are a vital tool for advancing health equity.
Context:
Children from low-income and racial or ethnic minority populations in the U.S. are less likely to have a conventional source of medical care and more likely to develop chronic health problems than are more-affluent and non-Hispanic white children. They are more often chronically stressed, tired, and hungry, and more likely to have impaired vision and hearing-obstacles to lifetime educational achievement and predictors of adult morbidity and premature mortality. If school-based health centers (SBHCs) can overcome educational obstacles and increase receipt of needed medical services in disadvantaged populations, they can advance health equity.
Evidence Acquisition:
A systematic literature search was conducted for papers published through July 2014. Using Community Guide systematic review methods, reviewers identified, abstracted, and summarized available evidence of the effectiveness of SBHCs on educational and health-related outcomes. Analyses were conducted in 2014-2015.
Evidence Synthesis:
Most of the 46 studies included in the review evaluated onsite clinics serving urban, low-income, and racial or ethnic minority high school students. The presence and use of SBHCs were associated with improved educational (i.e., grade point average, grade promotion, suspension, and non-completion rates) and health-related outcomes (i.e., vaccination and other preventive services, asthma morbidity, emergency department use and hospital admissions, contraceptive use among females, prenatal care, birth weight, illegal substance use, and alcohol consumption). More services and more hours of availability were associated with greater reductions in emergency department overuse.
Conclusions:
Because SBHCs improve educational and health-related outcomes in disadvantaged students, they can be effective in advancing health equity.
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