School Dropout Crisis: A Public Health Intervention Approach

In 2000, the overall high school dropout rate in the United States was 10.9 percent. Most recently, in 2016, this dropout rate was 6.1 percent. Crisis averted, right? 

Not quite. Even though the statistics are headed towards an overall dropout rate of below 5 percent, the fact remains that there are still young people dropping out of school. Along with limited job prospects and encountering social stigmas, high school dropouts also face negative health outcomes. Dropping out of school has been found to be associated with increased risk for various major chronic diseases such as diabetes and high blood pressure.[1] The prospect of being affected by these and other diseases is also heightened by social obstacles like drug use, hunger, and poverty.  
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The situation is especially polarizing when it is clear that U.S. unemployment rates tend to be lower as education level increases. In January of 2017, this was evident as there was a 7.7% unemployment rate among people with less than a high school diploma–2.9% percentage points higher than the national average. Research on the association between education attainment and income level further shows that a higher level of education tends to result in positive outcomes like reduced mortality and better eating habits.[2,3] These are benefits that most high school dropouts are not experiencing. So, what can be done to remedy this situation?  

The American Public Health Association (APHA) declared earlier this year that it “advocates reframing school dropout as a public health issue because disparities in education predict disparities in health outcomes”. Designating school dropout as a public health issue can be a big step in ultimately mitigating its pervasiveness within the United States. We have seen, just this year, how public health officials have denounced e-cigarettes, in particular JUUL, as an “epidemic” among teens. This has resulted in stern litigation and intervention against the e-cigarette companies and retailers. Giving precedence to school dropout from a public health lens can introduce the issue to school officials and education leaders, as well as parents students, in order to enact change.
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Furthermore, the APHA has urged for an expansion of school-based health centers (SBHCs) to combat some of the main health components linked to dropout. SBHCs are hubs for health located inside of schools that usually work alongside a community health organization to provide students with primary medical care, dental/oral care, health education, and other health services. These SBHCs can play a crucial role in “facilitating partnerships among administrators, school staff, parents and key community stakeholders” with a goal of establishing a “comprehensive approach to improving the overall well-being of each student”. Some of the key services that can be provided include mental health counseling, fighting food insecurity through means of screening and referrals, and sexual and reproductive health services. As some of these services can be very expensive and inaccessible to some students at home, it is important to have the aid available through the school.

Prevalence of food insecurity in the United States (2015-2017). Courtesy of: USDACurrently, SBHCs are located across 49 states in the U.S. and in 2014 the School-Based Health Alliance made it one of their 2018 goals to “grow the field by 30% more SBHCs”. Hopefully the census data will show that the number of SBHCs did grow because they are a valuable resource to students and can be a crucial step to combat the dropout rate by improving student health. 

There are many factors as to why students drop out of school. These include drugs, violence, food insecurity, safety, transportation, etc. When we consider that the social determinants of health abound similar themes, it becomes evident that approaching the high school/student dropout crisis from a public health perspective not only makes sense, but is imperative.

References

1. Vaughn, M. G., Salas-Wright, C. P., & Maynard, B. R. (2014). Dropping out of school and chronic disease in the United States. Journal of Public Health, 22(3), 265-270. doi:10.1007/s10389-014-0615-x
2. Crimmins, E. M., & Saito, Y. (2001). Trends in healthy life expectancy in the United States, 1970—1990: Gender, racial, and educational differences. Social Science & Medicine, 52(11), 1629-1641. doi:10.1016/s0277-9536(00)00273-2
3. Molla, M. T., Madans, J. H., & Wagener, D. K. (2004). Differentials in Adult Mortality and Activity Limitation by Years of Education in the United States at the End of the 1990s. Population and Development Review, 30(4), 625-646. doi:10.1111/j.1728-4457.2004.00035.x